Board Review 8/7

Which one of the following disorders is caused by an underlying mechanism of osteochondrosis rather than apophysitis?

• Legg-Calvé-Perthes disease

• Osgood-Schlatter disease

• Sever’s disease

• Sinding-Larsen-Johansson syndrome

In an adult who has a critical illness but no history of cardiac disease, the threshold for transfusion of red blood cells should be a hemoglobin level of ?

• 6 g/dL

• 7 g/dL

• 8 g/dL

• 9 g/dL

• 10 g/dL

A 64-year-old male with a previous history of hypertension and atrial fibrillation presents with an acute onset of ataxia, headache, mild confusion, and restlessness. His only current medications are lisinopril (Prinivil, Zestril) and warfarin (Coumadin). On examination his blood pressure is 160/100 mm Hg, pulse rate 86 beats/min, respirations 12/min, and temperature 36.7°C (98.1°F). A CBC, serum electrolyte levels, and cardiac enzyme levels are normal. His INR is 1.1. Noncontrast CT shows a cerebellar hemorrhage with a hematoma volume of 50 mL.

Which one of the following should be performed urgently?

• Neurosurgical consultation for posterior cerebellar hematoma decompression

• A reduction in blood pressure to 140/90 mm Hg

• Administration of vitamin K, 10 mg intravenously

• Administration of mannitol (Osmitrol), 0.5–1.0 mg/kg intravenously

• Induction of hypothermia to achieve a body temperature of 34.4°C (94.0°F)

A 67-year-old female hospitalized with pneumonia develops the rapid onset of dyspnea, pleuritic chest pain, tachypnea, and hypoxemia not responding to oxygen and requiring intubation. A physical examination is notable for rales throughout both lung fields with no peripheral edema noted. A chest radiograph shows bilateral pulmonary infiltrates. Her BNP level is 90 ng/L.

Which one of the following is the most likely reason for her worsening clinical situation?

• Heart failure

• Hypersensitivity pneumonitis

• Acute respiratory distress syndrome

• Pulmonary embolus

• Pneumothorax

You prescribe enalapril (Vasotec) for a 68-year-old male with heart failure. At a follow-up visit 6 weeks later the patient’s serum creatinine level is 2.5 mg/dL (N 0.6–1.5) and his serum potassium level is 5.7 mEq/L (N 3.4–4.8). His baseline values were normal.

Which one of the following is a side effect of ACE inhibitors that is the most likely cause of these changes in renal function?

• Toxicity to the proximal renal tubules

• Impaired autoregulation of glomerular blood flow

• Microangiopathic arteriolar thrombosis

• Rhabdomyolysis

• Interstitial nephritis

A 46-year-old African-American female sees you because of a history of excessive uterine bleeding and irregularity in her menstrual cycle. She has three children and had a tubal ligation after her last delivery. A pelvic examination does not reveal any pathology to explain her symptoms. Further laboratory evaluation indicates that she is mildly anemic. You perform an endometrial biopsy in the office that confirms your suspicion of endometrial hyperplasia without atypia.

Which one of the following is the treatment of choice for this patient?

• Elective hysterectomy

• Hysteroscopic endometrial laser ablation

• High-dose oral estrogen supplementation

• Antifibrinolytic therapy

• Progestational drugs

The diagnosis of Osgood-Schlatter disease (osteochondritis of the tibial tubercle apophysis) is best made on the basis of findings from:

• the history and examination

• evaluation by an orthopedic specialist

• radiographs

• ultrasonography

• MRI

A 40-year-old female presents with several pruritic, thickened, scaly areas on her lower back, knees, and elbows. She says that when she tries to remove the scales they often bleed.

Which one of the following would be the most appropriate pharmacologic therapy for this patient?

• Clobetasol propionate 0.05% lotion (Clobex)

• Selenium sulfide 2.5% lotion

• Permethrin cream (Nix)

• Terbinafine cream 1%

• Loratadine (Claritin), 10 mg daily

A 55-year-old female comes to your clinic for follow-up of her poorly controlled hypertension. Her medical history also includes type 2 diabetes and worsening obstructive sleep apnea (OSA). Her BMI is 52 kg/m2. Her heart rate is 62 beats/min and regular. Her blood pressure in the clinic today is 160/96 mm Hg, and she reports similar average readings at home. She is asymptomatic and says she has been following lifestyle modifications including a low-salt diet. She also reports that she has been adherent with her current antihypertensive regimen, which includes the following:

Amlodipine (Norvasc), 10 mg daily
Carvedilol (Coreg), 25 mg twice daily
Chlorthalidone, 25 mg daily
Losartan (Cozaar), 100 mg daily

Which one of the following antihypertensive medication changes would benefit both her blood pressure and her OSA?

• Switching chlorthalidone to hydrochlorothiazide, 25 mg daily

• Switching carvedilol to an equivalent dosage of metoprolol tartrate (Lopressor)

• Switching losartan to an equivalent dosage of an ACE inhibitor

• Increasing the current dosage of losartan to 100 mg twice daily

• Adding a low dosage of spironolactone (Aldactone) to her current regimen

A 17-year-old cross country runner sees you to discuss the results of pulmonary function tests to evaluate his episodic shortness of breath and chest tightness. He had previously been diagnosed with exercise-induced asthma and prescribed albuterol (Proventil, Ventolin), which provided minimal relief. You tell him that the pulmonary function tests revealed normal expiratory findings including normal FEV1 and FVC and a flattened inspiratory flow loop.

The test most likely to confirm a diagnosis for this patient’s shortness of breath is

• a sleep study

• chest radiography

• chest CT

• esophagogastroduodenoscopy

• nasolaryngoscopy