Question of the Week # 158

158) A 55 year old man comes to the Emergency Room complaining of left upper quadrant discomfort. His physical examination reveals Splenomegaly. Laboratory investigations were sent but there was a significant delay in sending the specimen to the laboratory after collection. Laboratory investigations reveal a WBC count of 110,000/µl with neutrophilia,  basophilia and eosinophilia and Serum potassium of  3.0/µl. Leucocyte Alkaline Phosphatase level is low. A bone marrow biopsy is obtained and the results are pending. The most likely explanation of the patients hypokalemia :

A) Delay in specimen transport to lab

B) Marked Leucocytosis and Delay in specimen transport

C) Tumor Lysis

D) Splenomegaly

E) Renal loss

Question of the Week # 157

157) A 25 year old woman presents to your office with complaints of muscle cramps and weakness. She smokes 1 pack cigarettes per day and chews tobacco and flavored gum. She also has history of alcoholism and ingests about one pint of vodka every day for the past 2 years. She also uses “Ecstasy”  during weekend parties. She has a history of snoring in the night. On examination,  afebrile,  heart rate is 88/min and blood pressure is 150/98.  Laboratory investigations reveal a Sodium of 144 meq/L, potassium of 3.0meq/L, Chloride 98meq/L , Bicarbonate of 34meq/L and Creatinine of 0.8mg%. Urinary chloride is 45meq/L. Which of the following points in the patient’s history is most helpful in diagnosing her condition?

A) Alcohol use

B) Chewing tobacco and flavored gum

C) Snoring in the night

D) Smoking

E) Use of Ecstasy

Question of the Week # 156

156) A 25 year old woman presents to your office with complaints of muscle cramps and weakness. On examination, she is afebrile,  heart rate is 88/min and blood pressure is 150/98.  Ophthalmoscopic examination shows the following :

Laboratory investigations reveal a Sodium of 144 meq/L, potassium of 3.0meq/L, Chloride 98meq/L , Bicarbonate of 34meq/L and Creatinine of 0.8mg%. Urinary chloride is 45meq/L. The most likely diagnosis that explains this patient’s clinical features :

A) Gitelman’s syndrome

B) Chronic Laxative abuse

C) Diuretic Abuse

D) Primary Hyperaldosteronism

E) Bartter’s syndrome

Question of the Week # 155

155)  A 55 year old man presents to the clinic for progressive right hip pain. He has a history of hearing impairment. He reports pain in the right hip when walking more than 1 block and also, has difficulty putting shoes on his right foot. On examination, the range of motion is significantly limited in the right hip. An X-ray of the right hip reveals significant loss of cartilage, subchondral sclerosis and sub-chondral cysts. X-ray also reveals pagetoid changes in the right iliac wing and right femoral neck. Serum alkaline phosphatase level is 432 IU/L (n = 20 to 140 IU/L). The most appropriate initial step in managing this patient is:

A)           Bisphosphanates

B)            Acetaminophen

C)            Bisphosphanates and Acetaminoiphen

D)           Calcitonin Intranasally

E)           Oral prednisone

Question of the Week # 154

154) A 68 year old man presents to the clinic for progressive right hip pain.  He reports pain in the right hip when walking more than 1 block and also, has difficulty putting shoes on his right foot. On examination, the range of motion is significantly limited in the right hip. An X-ray of the right hip reveals significant loss of cartilage, subchondral sclerosis and sub-chondral cysts. The patient is diagnosed with Right Hip Osteoarthritis and is started on Acetaminophen. Which of the following exercises should not be recommended to this patient at this time:

A) Stair climbing

B) Quadriceps strtengthening

C) Tai-Chi

D) Swimming

E) Bicycling

Question of the Week # 153

153) A 68 year old man presents to the clinic for progressive right hip pain. He has a history of hearing impairment. He reports pain in the right hip when walking more than 1 block and also, has difficulty putting shoes on his right foot. On examination, the range of motion is significantly limited in the right hip. An X-ray of the right hip reveals significant loss of cartilage, subchondral sclerosis and sub-chondral cysts. X-ray also reveals pagetoid changes in the right liac wing and right femoral neck. Serum alkaline phosphatase level is normal. The most appropriate initial step in managing this patient is:

A) Bisphosphanates

B) Acetaminophen, Quadriceps strtengthening and Tai-Chi

C) Bisphosphanates and Acetaminoiphen

D) Calcitonin

E) Oral prednisone

Question of the Week # 152

152) A 34 year old woman with history of recently diagnosed Rheumatoid Arthritis presents to your office for follow up. She reports much improvement in her symptoms after starting Ibuprofen for pain. She was also started on Hydroxychloroquine 3 weeks ago. Which of the following is most appropriate in monitoring her therapy?

A)     Liver function tests every month

B)      Complete Blood Count every 3 months

C)      Serum Creatinine every week

D)     Ophthalmologic evaluation every year

E)      Hydroxychloroquine serum levels every month

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