Nokea
A 50-year-old man presents with fatigue, arthralgia, and darkening of the skin. Laboratory tests reveal elevated liver enzymes and high serum ferritin levels. What is the most likely diagnosis?
- A. Wilson's disease
- B. Hemochromatosis
- C. Alpha-1 antitrypsin deficiency
- D. Autoimmune hepatitis
Correct Answer: B
Rationale: The correct answer is B: Hemochromatosis. In this case, the patient's symptoms of fatigue, arthralgia, darkening of the skin, elevated liver enzymes, and high serum ferritin levels point towards iron overload disorder. Hemochromatosis is a genetic condition characterized by excessive absorption and accumulation of iron in various organs, leading to liver damage and skin pigmentation. Wilson's disease (A) presents with copper accumulation, not iron. Alpha-1 antitrypsin deficiency (C) primarily affects the lungs and liver, not causing iron overload. Autoimmune hepatitis (D) does not typically present with elevated ferritin levels.
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A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?
- A. Proton-pump inhibitors and H2-blockers are equally effective in prophylaxis against NSAID-related GI toxicity.
- B. Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity.
- C. Sucralfate is not the drug of choice for prophylaxis in this patient.
- D. H. pylori infection can alter the risk for an NSAID-induced ulcer.
Correct Answer: B
Rationale: Step 1: Misoprostol is a prostaglandin analog that helps protect the gastric mucosa by increasing mucus production. This mechanism of action makes it effective in preventing NSAID-related GI toxicity.
Step 2: H2-blockers (Choice A) and PPIs are not as effective as misoprostol in preventing NSAID-related GI toxicity.
Step 3: Sucralfate (Choice C) is not as effective as misoprostol in preventing NSAID-related GI toxicity due to its different mechanism of action.
Step 4: H. pylori infection (Choice D) can increase the risk of NSAID-induced ulcers but is not directly related to the prophylactic treatment with misoprostol.
Which regimen is most effective for treating H. pylori infection?
- A. Metronidazole, bismuth subsalicylate, amoxicillin for 14 days
- B. Clarithromycin and omeprazole for 14 days
- C. Metronidazole, lansoprazole, and clarithromycin for 14 days
- D. Metronidazole, clarithromycin, and omeprazole for 7 days
Correct Answer: C
Rationale: The correct answer is C - Metronidazole, lansoprazole, and clarithromycin for 14 days. This regimen includes a proton pump inhibitor (lansoprazole) to reduce stomach acid, clarithromycin to kill the bacteria, and metronidazole as an alternative antibiotic. This combination therapy is recommended by guidelines as it targets H. pylori effectively, reducing the risk of resistance.
Choice A is incorrect as bismuth subsalicylate is not included in the recommended regimen. Choice B is incorrect because omeprazole is not the preferred proton pump inhibitor, and using clarithromycin alone can lead to resistance. Choice D is incorrect as the duration of treatment is insufficient for eradication. Overall, choice C is the most effective option based on current guidelines and best practices for treating H. pylori infection.
A 60-year-old woman presents with pruritus, jaundice, and xanthomas. Laboratory tests reveal elevated cholesterol and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Primary biliary cirrhosis
- B. Primary sclerosing cholangitis
- C. Gallstones
- D. Pancreatic cancer
Correct Answer: A
Rationale: The most likely diagnosis is A: Primary biliary cirrhosis.
Rationale:
1. Pruritus, jaundice, and xanthomas are classic symptoms of cholestatic liver disease.
2. Elevated cholesterol and alkaline phosphatase levels are characteristic of primary biliary cirrhosis.
3. Primary biliary cirrhosis is an autoimmune disease affecting small bile ducts, leading to liver damage.
4. Primary sclerosing cholangitis (B) presents with similar symptoms but typically affects larger bile ducts.
5. Gallstones (C) could cause jaundice but would not explain the elevated cholesterol levels.
6. Pancreatic cancer (D) may present with jaundice but is less likely given the specific lab findings.
A 45-year-old man with a history of chronic heartburn presents with progressive difficulty swallowing solids and liquids. He has lost 10 pounds in the past two months. What is the most likely diagnosis?
- A. Esophageal stricture
- B. Esophageal cancer
- C. Achalasia
- D. Peptic ulcer disease
Correct Answer: B
Rationale: The correct answer is B: Esophageal cancer. This patient's symptoms of difficulty swallowing solids and liquids, along with unintentional weight loss, are concerning for a malignancy like esophageal cancer. The progressive nature of dysphagia and significant weight loss are red flags for cancer. Esophageal stricture (A) can cause dysphagia but typically presents with a history of chronic inflammation or injury. Achalasia (C) is characterized by dysfunction of the lower esophageal sphincter, leading to dysphagia, but it is less likely in this case due to the weight loss. Peptic ulcer disease (D) usually presents with epigastric pain and can cause weight loss, but it is less likely to cause progressive dysphagia.
In a patient with a history of chronic iron deficiency anemia requiring a recent blood transfusion and an extensive GI work-up, which statement is true based on their medications?
- A. A dedicated small bowel series has a high likelihood of being positive
- B. 81 mg of aspirin per day decreases the benefit of using a COX II inhibitor
- C. The patient should have a provocative arteriogram with heparin infusion to identify the source of blood loss
- D. Hormonal therapy has been shown to be effective in decreasing blood loss due to arteriovenous malformations
Correct Answer: B
Rationale: The correct answer is B: 81 mg of aspirin per day decreases the benefit of using a COX II inhibitor. Aspirin, a non-selective COX inhibitor, can interfere with the action of selective COX II inhibitors by competing for the same binding site on the COX enzyme. This competition can limit the effectiveness of the COX II inhibitor in reducing inflammation and pain. This is particularly important in patients with a history of chronic iron deficiency anemia who may require NSAIDs for pain management.
Option A is incorrect because a dedicated small bowel series may not necessarily be positive for identifying the source of blood loss in this patient. Option C is incorrect as a provocative arteriogram with heparin infusion is an invasive procedure and not typically indicated as a first-line investigation for blood loss in patients with iron deficiency anemia. Option D is incorrect as hormonal therapy is not typically used to decrease blood loss from arteriovenous malformations.