Property:AnswerBExp
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'''Correct'''-Early morning hyperglycemia without nocturnal hypoglycemia in diabetes mellitus patients who are on insulin is called as Dawn phenomenon. This is due to the increased body production of certain hormones (growth hormones, cortisol, catecholamines, glucagon and epinephrine) between 4 a.m. and 8 a.m., which suppress the activity of insulin and trigger the glucose release from liver. In non-diabetic people, the body responds to the excess glucose that accumulates as a result of this process by producing insulin. The insulin then moves the excess glucose into the cells. However, people with diabetes either fail to produce insulin or cannot properly use the insulin that is available. As a result, glucose continues to rise to abnormally high levels (hyperglycemia). The first step will be to monitor nocturnal blood glucose on several consecutive days, to rule out hypoglycemia that occurs due to Somogyi effect. After confirming, the next step in managing Dawn phenomenon will depend on the case. When the patient is not responding to adjusted dosage of evening medication (increased evening NPH insulin dose), the next best step will be to switching over to a longer acting insulin (glargine) during the evening. +
'''Correct'''-Acute exposures to sound pressure levels above 180 dB result in traumatic rupture of the tympanic membrane and conductive hearing loss. The rupture should repair spontaneously unless infection occurs. If the loss persists for more than 3 months, surgical repair is possible. +
'''Incorrect'''-The use of barium is contraindicated since spillage of barium mixed with feces into the peritoneal cavity would increase the likelihood of subsequent intraabdominal abscess. +
'''Incorrect'''-Impaired myocardial contractility and hypotension usually occurs at a pH of 7.1 or lower. +
'''Incorrect'''-A drug susceptibility testing is only a reliable lab test done before initiating treatment for the multi drug resistant strain. It is not useful in diagnosing the cause of hypotension in this patient. +
Type 2 ADH receptors are located at the basolateral aspect of the collecting tubules, particularly in the cortical and outer medullary collecting ducts. Once type 2 ADH receptors are activated, they stimulate downstream mediators via adenylate cyclase/cAMP that leads to aquaporin translocation to the luminal side. +
Glucocorticoids inhibit leukocyte adhesion that results in increased circulating neutrophils and neutrophilia on blood examination. +
Thyroid hormones stimulate the expression of a larger number of β1 receptors in the heart. +
Activated macrophages fuse and become multinucleated giant cells that constitute a granuloma to phagocytose and contain the infection +
''RB'' gene mutations are implicated in the tumorigenesis of osteosarcoma and retinoblastoma. +
The activation of polyol pathway, which is mediated by the intracellular aldose reductase enzyme, and the consequent accumulation of intracellular sorbitol are responsible for the swelling of lens fibrils. This osmotic-induced damage is associated with the development of cataracts among diabetic patients. +
Positive antibodies against the Fc portion of IgG refers to a positive rheumatoid factor (RF). RF is a sensitive but non-specific biomarker that is present in approximately 80% of patients. It is also present in several other autoimmune and connective tissue diseases. +
Respect for autonomy is a principle of medical ethics. Before initiation with chemotherapy for this patient, the physician is required to educate the patient about her condition and obtain an informed consent. A physician's respect for a patient's autonomy, or self-rule, requires that the physician communicates with the patient, discusses all concerns, and answers questions in an evidence-based manner. Adult patients (> 18 years according to US law) who are deemed able to make their own decisions have the right to refuse to be treated, regardless of how significant or trivial the treatment may be for their health. +
Diffuse capillary and glomerular basement membrane thickening are findings observed in membranous nephropathy (MN). MN is a slowly progressive kidney disease prevalent among Caucasians between 30 and 50 years of age. +
Displacement is an immature defense mechanism characterized by the redirection of thoughts, feelings, and impulses onto a neutral person or an object. For example, a husband having a bad day at work may arrive home and act aggressively at home with his wife and children. +
A lysosomal degranulation defect with failure of phagolysosome formation is the main mechanism of disease in Chediac-Higashi syndrome. +
Alpha toxin of ''C. perfringens'' forms phospholipase that degrades tissue and cell membranes. It results in gas gangrene due to myonecrosis. On blood agar, ''C. perfringens'' demonstrates a double zone of hemolysis. +