Property:AnswerEExp
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The patient may need a chest tube if there's an associated large hemothorax, However that can be done after repair of the aorta. The chest Xray here does not reveal a hemothorax. +
Hemodilution and increased GFR associated with pregnancy leads to low values of BUN and Creatinine. +
'''Incorrect'''-Only after night hypoglycemia documentation for confirmation, evening insulin dosage is reduced to treat Somogyi phenomenon. +
'''Correct'''-Magnesium deficiency is common in malnourished patients and patients with large gastrointestinal fluid losses. The neuromuscular effects resemble those of calcium deficiency namely, paresthesia, hyperreflexia, muscle spasm, and ultimately tetany. But the cardiac effects are more like those of hypercalcemia. Thus an electrocardiogram serves as a rapid means of differentiating between hypocalcemia and hypomagnesemia. Hypomagnesemia also causes potassium wasting by the kidney. Many hospital patients with refractory hypocalcemia will be found to be magnesium deficient. Often this deficiency becomes manifest during the response to parenteral nutrition when normal cellular ionic gradients are restored. +
Incorrect. MAHA is associated with increased reticulocyte count not decreased retic count. +
CMV causes retinitis in HIV infected patients, typically when CD4 is below 50 cells/mm<sup>3</sup>. +
Beta-amyloid deposits correspond to the composition of senile plaques, which are pathological changes characteristic of Alzheimer disease. Manifestations of Alzheimer disease include slowly progressive dementia and late disability. The patient's symptoms are progressing relatively rapidly, which is not consistent with Alzheimer disease. +
'''Incorrect''' : Chemistry studies of the joint fluid, such as the concentrations of glucose, lactate dehydrogenase, or protein have only limited value; a reduction in glucose concentration and elevation of LDH are consistent with a bacterial infection, but are not diagnostic or particularly sensitive. +
'''Incorrect'''-Tightening of glycemic control has not been shown to improve erectile dysfunction. +
'''Incorrect'''-Diabetes insipidus will present with excretion of dilute urine and elevated serum osmolality. +
'''Correct'''-The patient has features suggestive of MEN IIa, which is characterized by medullary thyroid carcinoma, pheochromocytoma as well as parathyroid hyperplasia. It is an autosomal dominant disorder arising from mutation in RET proto-oncogene localized in chromosome 10. Genetic testing can be easily carried out in peripheral blood sample by a sensitive PCR method that will identify the mutations. More than 95% have RET proto-oncogene mutation. +
'''Correct'''-The patient has hypertension associated with hypokalemia that manifests as muscle weakness and abdominal cramps. Along with worsening symptoms of diabetes like polyuria, primary hyperaldosteronism should be suspected in 30 to 50 year age group individuals in the absence of secondary causes like CHF. Excessive aldosterone production increases distal tubular exchange of sodium for potassium, leading to hypertension following increased sodium absorption and hypokalemia following progressive depletion of body potassium. Following increased plasma sodium, plasma renin levels fall low and fail to increase even with appropriate stimulus such as volume depletion. Along with elevated aldosterone levels due to hypersecretion, the diagnosis of primary hyperaldosteronism can be made. Suppressed renin activity alone can even occur in about 25% of hypertensive patients with essential hypertension. But lack of suppression of aldosterone is also necessary to diagnose primary hyperaldosteronism. High aldosterone levels that are not suppressed by salt loading will prove that there is a primary inappropriate secretion of aldosterone. Adrenal adenoma is the commonest cause, followed by bilateral adrenal hyperplasia and unilateral adrenal hyperplasia for primary hyperaldosteronism. +