Property:AnswerDExp
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'''Incorrect''' : Prolonged fasting results in underproduction of both insulin and C-peptide. +
'''Correct''' : MRI of the abdomen is the best option of investigation for adrenal tumors. +
'''Correct''' : Pituitary enlargement and hyperpigmentation following bilateral adrenalectomy is called Nelson’s syndrome +
'''Correct''' : Screening with plasma-free metanephrines (metanephrine and normetanephrine) or 24-hour urine metanephrines and catecholamines for confirming pheochromcytoma. +
'''Incorrect''' : Never give beta blockade first; otherwise, unopposed alpha adrenergic stimulation will lead to refractory hypertension. +
Fluoroquinolones are antibiotics that act by inhibiting topoisomerase activity. However, fluoroquinolones are not the optimal pharmacologic therapy to treat Lyme disease. +
'''Incorrect''' : It has long been advocated that urate-lowering therapy should not be initiated until after an acute gout flare has resolved, and we wait at least two weeks after an acute flare has subsided to initiate urate-lowering medication. +
Expressivity refers to the range of symptoms a patient shows. Heteroplasmy is the presence of a mixture of more than one type of an mitochondrial genome within a cell or individual. Some individuals and even particular tissues within certain individuals will differ in the proportion of mitochondria carrying a mutant allele. Thus, the variable phenotype of MERRF can be caused by differing proportions of mutant mitochondria. +
Mltiple endocrine neoplasia (MEN) syndromes (Types 1, 2A, and 2B) are autosomal dominant diseases. +
Activating mutation of the ''BRAF'' gene, a member of the ''RAF'' gene family, is present among the majority of patients with melanoma. +
Tetracyclines bind to 30S and prevents attachment of aminoacyl-tRNA. Tetracyclines, along with clindamycin and erythromycin, may be administered to treat actinomycosis, but they are reserved for patients with penicillin allergy. However, the patient in this vignette may be prescribed penicillin since she denies known drug allergies. +
Metronidazole forms free radical toxic metabolites that cause DNA injury in the bacterial cell. Metronidazole is the first line antimicrobial therapy to treat bacterial vaginosis. +
Thrombotic thrombocytopenic purpura is a bleeding disorder that may be inherited (deficiency of ADAMTS13) or acquired (auto-antibodies against ADAMTS13). ADAMTS13 is a metalloprotease responsible for cleaving vWF into smaller subunits. Acquired TTP is common in pregnancy and the early post-partum period. In TTP, the circulating multimers of vWF increases platelet adhesion to areas where subendothelial collagen is exposed. TTP is characterized by pentad of manifestations: Microangiopathic hemolysis, thrombocytopenia, fever, neurological symptoms, and renal disease. The lack of other TTP signs and symptoms make the diagnosis of TTP unlikely in this patient. +
'''Correct'''-Perforation of the esophagus requires aggressive intervention in virtually all circumstances. While that intervention can usually consist of efforts to patch the perforation and drain the mediastinum, concomitant obstructive esophageal disease, whether inflammatory stenosis or cancer, mandates removal or bypass of the obstruction if control of the leak and its consequent persisting mediastinal and pleural contamination is to be accomplished. For distal esophageal cancers, many thoracic surgeons would use the classic Ivor-Lewis operation, which consists of mobilizing the stomach in the abdomen and then performing a right thoracotomy with mediastinal drainage, esophagectomy, and esophagogastrostomy. +