Property:AnswerDExp
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Succinyl-CoA is a substrate used in heme synthesis. With vitamin B6 deficiency heme synthesis decreases, so does consumption of succinyl-CoA +
This is reserved for severe cases, and also for those who experienced a relapse after a course of metronidazole treatment. The use of vancomycin is limited due its expensive cost, and also the risk of developing vancomycin-resistant enterococci (VRE). +
This is reserved for cases with a high suspicion of C. diff infection despite negative laboratory assay, failure of response to drug treatment or in cases where prompt diagnosis is required. This reveals the presence of a pseudomembrane in the colon. +
Hypothyroidism is a common cause of reversible cognitive impairment in the elderly, and one of the first blood work usually ordered in the evaluation of dementia is TSH. This patient has a history of hypothyroidism, but he is regular on his medication which rules out this choice together with the absence of symptoms and signs suggestive of hypothyroidism. +
Frontotemporal lobar degeneration (FTLD) or Picks disease is a pathologic process involving degeneration of gray matter in the frontal lobe and anterior portion of the temporal lobe of the cerebrum, with sparing of the parietal and occipital lobes. Symptoms include: Parkinsonism with dystonia, dementia, urinary incontinence, neck stiffness, memory loss. This is an irreversible cause of dementia. +
This is the most sensitive and most specific modality for the detection of acute infarct, especially with its ability to detect small cortical and subcortical lesions, which is a major limitation with the use of non-contrast enhanced CT. +
IV acetaminophen may be indicated in treating fever in thrombolysis-ineligible patients. Furthermore, in stroke patients, nothing is given by mouth until speech and swallow evaluation is done in order to reduce the risk of aspiration. +
A follow-up CT/MRI and speech and swallow evaluation are indicated before oral treatment can be initiated. Furthermore, all forms of anticoagulation are contraindicated in the first 24 hours of symptom onset. +
Correct
Stress test is the answer when the case is not acute, and EKG or enzymes don’t establish the diagnosis +
Incorrect
The diagnosis is already set, and repeating CK-MB will not add to your management plan. +
Increased levels of phosphpribosylpyrophosphate (PRPP) leads to the overproduction and accumulation of uric acid leading to hyperuricemia and hyperuricosuria. Increased levels of PRPP are present in Lesch-Nyhan Syndrome. Decreased levels of hypoxanthine guanine phosphoribosyl transferase (HGPRT) causes this accumulation, as PRPP is a substrate used by HGPRT during purine salvage. +
Crystals that are blue when perpendicular to light are characteristic of gout and not pseudogout. +
Serotonin is a competitive antagonist of ondansetron. When a competitive antagonist is present, the potency of the agonist is altered and the curve of the effect of the agonist by increasing dose will be shifted towards the right. +
Since the patient is dehydrated, his spot urine sodium is expected to be low and not more than 20. +