Property:AnswerEExp
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Phenoxybenzamine is a noncompetitive inhibitor of norepinephrine. An increase in the concentration of norepinephrine is not able to overcome the effect of phenoxybenzamine. +
A spot urine sodium >20 and a BUN/creatinine ratio <20:1 is usually found in the setting of euvolemic patients. Since the patient is dehydrated, his spot urine sodium is expected to be low and not more than 20. Moreover, the patient is dehydrated; therefore, his BUN/Creatinine ratio should be high reflecting a low fluid volume in his body. BUN/Creatinine <20:1 is incorrect. +
UDP-glucose-pyrophosphorylase catalyzes the conversion of UDP-glucose to glucose-1-phosphate. The enzyme is not directly involved in the synthesis of lactose. +
This enzyme assay finding is observed in patients with lactase deficiency, i.e. lactose intolerance. +
Lactase, or β-D-galactosidase, hydrolyzes lactose into its monosaccharide components: galactose and glucose. +
UDP-glucose-pyrophosphorylase converts UDP glucose to glucose-1-phosphate. This deficiency is yet to be reported among humans, or is likely benign and asymptomatic. +
'''Correct'''-Since the blood glucose has fallen below 200 mg/dL, diabetic ketoacidosis patients on treatment are switched over to half the dosage of regular insulin that they were receiving and the isotonic saline is replaced by hypertonic D5 normal saline to prevent the complication of development of cerebral edema. +
'''Incorrect'''-Oral feeding can be started once the patient becomes stable without nausea and vomiting. It also gives a chance to shift to subcutaneous insulin. Stopping all medications will be inappropriate to this patient. +
'''Incorrect'''-Decision for a comfort care can be done on patients who deny treatment and on those who are high-risk poor candidates for surgery with several comorbidities. +
'''Correct'''-On recurrence of intussusception, the patient is managed with another non-operative reduction. Only after multiple unsuccessful non-operative reductions, operative reduction (laparoscopic or open) is considered. Laparoscopy or laparotomy and segmental resection with end-to-end anastomosis is the treatment of choice in patients with complicated intussusception i.e. intussusception with ischemia or perforation. +
'''Correct'''-Worsening uncomplicated and complicated acute cholecystitis patients who are not surgical candidates with advanced pulmonary and cardiac diseases may benefit from percutaneous gallbladder drainage and placement of a cholecystostomy or T-tube if common bile duct stones are suspected. The alternative is ERCP to attempt endoscopic opening of the common bile duct or cystic duct. +
'''Incorrect'''-Repeat colonoscopy after 15 years is not the correct approach to any of above scenario. +
'''Correct'''-After confirming the dawn phenomenon, if the patient is not responding to adjusted dosage of evening medication (increased evening NPH insulin dose) and switching over to a longer acting insulin (glargine) during the evening, adding metformin will be the next best step in management since metformin inhibits liver glucose production. +
'''Correct'''-After documentation of hypoglycemia during night and confirmation of Somogyi phenomenon, reducing the evening or night insulin dose (short acting or intermediate acting) is the first appropriate step in management. +
'''Correct'''-Arthritis is the most common clinical manifestation of parvo B 19 virus in adults. The arthritis is usually non erosive (but erosive arthritis have been reported) and involves the proximal interphalangeal joints, metacarpophalangeal joints, the knees, the wrists, and the ankles with a stiffness lasting for less then 30 minutes after prolonged rest. Diagnostically, anti-B 19 IgM and IgG are specific for immunocompetent patients while nucleic acid amplification testing (NAAT) for detecting B 19 DNA is specific for immunosuppressed patients. +
'''Incorrect'''-Non resolving pseudocysts after a period of 6 weeks observation, pseudocysts larger than 5 cm and complicated pseudocysts should be drained by either percutaneous catheter or endoscopic gastrostomy or laparoscopic gastrostomy drainage. +
'''Correct'''-Non resolving pseudocysts after a period of 6 weeks observation, pseudocysts larger than 5 cm and complicated pseudocysts should be drained. Laparoscopic gastrostomy and drainage of the cyst is the preferred approach as in this case. +
Incorrect
Mechanical ventilation maximizes myocardial oxygen delivery and ventilation, and should be used when the inotropes fail to improve the case, and oxygen saturation is not improving. Positive end-expiratory pressure is generally recommended to increase alveolar patency and to enhance oxygen delivery and carbon dioxide exchange. +