j*****o
发帖数: 137 | 1 A 76-year-old man has had fatigue and loss of interest in daily activities
over the past 4 months. He sleeps poorly and has had a 4.5-kg (10-lb) weight
loss during this period. He states that he has probably lived long enough.
His blood pressure is 110/78 mm Hg, and pulse is 68/min. Examination shows a
slow return of deep tendon reflexes. Measurement of which of the following
serum levels is the most appropriate next step in management?
A ) Calcium
B ) Creatinine
C ) Glucose
D ) Testosterone
E ) Thyroid-stimulating hormone
A or E?
If its E, but why weight gain? |
j*****o
发帖数: 137 | 2 One more:
34. A healthy 27-year-old woman comes for a routine health maintenance
examination. Her blood pressure is 185/90 mm Hg. Examination shows no other
abnormalities except for hypertensive retinopathy. Serum studies show a
sodium level of 140 mEq/L, potassium
level of 4 mEq/L, and creatinine level of 1.1 mg/dL. A complete blood count,
serum
catecholamine levels, and urinalysis are within normal limits. At two
subsequent visits, her blood pressure is 190/100 mm Hg and 182/96 mm Hg,
respectively. Which of the following is the most appropriate next step in
diagnosis?
A) 24-Hour urine collection for measurement of creatinine clearance
B) 24-Hour urine collection for measurement of 17-hydroxycorticosteroid and
total 17-ketosteroid levels
C) Measurement of serum aldosterone level
D) Magnetic resonance angiography of renal vessels
E) CT scan of the abdomen |
J*********4
发帖数: 1274 | 3 1. Slowed DTR is typical of hypothyroidism. All diseases at its very severe
stage can cause weight loss.
2. A? The most common cause of secondary hypertension is renal parenchymal
diseases. However, not entirely sure about 1.1 creatinine, it is not a
entirely accurate indicator for renal function |
D*********t
发帖数: 140 | 4 C) Measurement of serum aldosterone level |
n***a
发帖数: 1373 | 5 E. TSH, Depression, delayed DTR.
I guess in real life, patients won't necessarily have all the textbook
symptoms.
weight
.
a
following
【在 j*****o 的大作中提到】
: A 76-year-old man has had fatigue and loss of interest in daily activities
: over the past 4 months. He sleeps poorly and has had a 4.5-kg (10-lb) weight
: loss during this period. He states that he has probably lived long enough.
: His blood pressure is 110/78 mm Hg, and pulse is 68/min. Examination shows a
: slow return of deep tendon reflexes. Measurement of which of the following
: serum levels is the most appropriate next step in management?
: A ) Calcium
: B ) Creatinine
: C ) Glucose
: D ) Testosterone
|
t******a
发帖数: 408 | 6 Depression pt must be DDx vs. hypothyroidism.
Thus TSH must be done to r/o [rule out] the endocrine cause.
One does not need ALL symptoms/signs to suspect a clinical diagnosis. This
pt's picture: decreased DTR, relatively slow HR (<60/min is bradycardia) is
consistent w/ hypothyroidism.
Isn't it common for someone who has poor sleep to lose weight?
I am not saying hypothyroidism IS the Dx.
But it IS a Dx that MUST be entertained and r/o, before starting anti-
depression Tx.
Serious conditions, which are easily treatable/reversible if the cause are
correctly identified, are Boards' favorite, like depression secondary to
hypothyroidism.
Correct the hypothyroidism, pt feels happier.
weight
.
a
following
【在 j*****o 的大作中提到】
: A 76-year-old man has had fatigue and loss of interest in daily activities
: over the past 4 months. He sleeps poorly and has had a 4.5-kg (10-lb) weight
: loss during this period. He states that he has probably lived long enough.
: His blood pressure is 110/78 mm Hg, and pulse is 68/min. Examination shows a
: slow return of deep tendon reflexes. Measurement of which of the following
: serum levels is the most appropriate next step in management?
: A ) Calcium
: B ) Creatinine
: C ) Glucose
: D ) Testosterone
|
t******a
发帖数: 408 | 7 1. where do these questions come from? can you please tell us the source? I
am really curious.
2. I will choose D.
pt is a young healthy F, has HTN.
Suspect secondary HTN.
Because (1)"healthy" pt = Board's code word for ASX(asymptomatic) and (2)
urinalysis are within normal limits ---> unlikely to be
glomerulonephritis (nephritic synd.)
Then suspect: RAS --- renal artery stenosis
In Young female: ---> consider fibromuscular dysplasia
Old male: ---> consider atherosclerosis
[This is a very HY point,in both CK and step1 (remember Pathoma?)]
Thus, ultrasound of the renal vessels would be the best initial test.
However, since it's not in the options. I will choose D.
D) Magnetic resonance angiography of renal vessels ---- would confirm the Dx
.
Other options:
C) Measurement of serum aldosterone level ---- for hyper-aldo.
but the K+ is wnl. unlikely to be hyper-aldo.
same reason for B) Cushing synd. One would often expect to see electrolyte
disturbance, hypokalemia, in both B and C [esp. in Board test].
E) CT scan for mass/tumor? like a shot-gun approach, not really helpful for
establishing the Dx.
3. 还请有临床经验的前辈指正，谢谢！
other
count,
【在 j*****o 的大作中提到】
: One more:
: 34. A healthy 27-year-old woman comes for a routine health maintenance
: examination. Her blood pressure is 185/90 mm Hg. Examination shows no other
: abnormalities except for hypertensive retinopathy. Serum studies show a
: sodium level of 140 mEq/L, potassium
: level of 4 mEq/L, and creatinine level of 1.1 mg/dL. A complete blood count,
: serum
: catecholamine levels, and urinalysis are within normal limits. At two
: subsequent visits, her blood pressure is 190/100 mm Hg and 182/96 mm Hg,
: respectively. Which of the following is the most appropriate next step in
|
J*********4
发帖数: 1274 | 8 Agree with your analysis:)
Good job~
I
【在 t******a 的大作中提到】
: 1. where do these questions come from? can you please tell us the source? I
: am really curious.
: 2. I will choose D.
: pt is a young healthy F, has HTN.
: Suspect secondary HTN.
: Because (1)"healthy" pt = Board's code word for ASX(asymptomatic) and (2)
: urinalysis are within normal limits ---> unlikely to be
: glomerulonephritis (nephritic synd.)
: Then suspect: RAS --- renal artery stenosis
: In Young female: ---> consider fibromuscular dysplasia
|
j*****o
发帖数: 137 | 9 These questions are from NBME form 2.
Thanks.
For hyperaldosteronism, the measurement for diagnosis is aldosterone/renin.
Just measure aldo is not enough. |
s*******y
发帖数: 1739 | 10 第二题为啥没有人考虑是E，这个病人也要排除动脉瘤啊，虽然肾脏血管的变异MRI最直
接，但是临床上不都是先CT一下看看肾脏的其它病变吗 |
M***D
发帖数: 249 | 11 This young female pt has significantly elevated pulse pressure, which is
likely due blood vessel malformation. Choice D angiogram will confirm the
diagnosis.
【在 s*******y 的大作中提到】
: 第二题为啥没有人考虑是E，这个病人也要排除动脉瘤啊，虽然肾脏血管的变异MRI最直
: 接，但是临床上不都是先CT一下看看肾脏的其它病变吗
|
M***D
发帖数: 249 | 12 This pt has following major depression symptoms:
1. Decreased energy: fatigue
2. Anhedonia: loss of interest
3. Insomnia: sleeps poorly
4. Wt loss: lost 10 lbs
5. Passive suicidal thought: he has probably lived long enough
6. Lasted over 2 weeks: the pt has above symptoms over 4 months.
TSH test will help to differentiate primary depression from secondary
depression due to medical problems such hypothyroidism.
weight
.
a
following
【在 j*****o 的大作中提到】
: A 76-year-old man has had fatigue and loss of interest in daily activities
: over the past 4 months. He sleeps poorly and has had a 4.5-kg (10-lb) weight
: loss during this period. He states that he has probably lived long enough.
: His blood pressure is 110/78 mm Hg, and pulse is 68/min. Examination shows a
: slow return of deep tendon reflexes. Measurement of which of the following
: serum levels is the most appropriate next step in management?
: A ) Calcium
: B ) Creatinine
: C ) Glucose
: D ) Testosterone
|
h*****h
发帖数: 47 | |
