Property:AnswerEExp
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'''Incorrect''' : Thyroid ultrasound would be useful if there is thyroid enlargement is present in order to monitor any change in size and look for dominant nodule(>1cm). Patient examination is normal and hence won’t be appropriate next step. +
'''Incorrect''' : Inferior petrosal sampling is required to differentiate ectopic ACTH from pituitary ACTH Cushing’s syndrome. +
'''Correct''' : Hypokalemia and hypocalcemia will not correct without magnesium correction. +
'''Incorrect''' : Patient has elevated ionized and total calcium. Hence lab error is unlikely in this patient. +
'''Incorrect''' : Treatment is started after biochemical confirmation is made, because the drugs may interfere with interpretation of results. +
'''Correct''' : Systolic blood pressure of >90 mmHg is incorrect as systolic blood pressure >100 mg Hg is a pre-requisite. +
Tetracyclines are antibiotics that act by inhibiting aminoacyl tRNA entry into ribosome. Tetracyclines are the optimal pharmacologic therapy to treat Lyme disease in adult patients. +
'''Incorrect''' : Imaging studies are not routinely employed in the evaluation for possible CTS. +
'''Incorrect''' : Surgical treatment of CTS appears to be more effective than splinting. It is usually indicated when conservative measures fail. +
MERRF is not an X-linked disease. Variable expressivity due to X-inactivation in females is true of fragile X syndrome. +
Myoclonic epilepsy with ragged red fibers is a disease with a mitochondrial pattern of inheritance. +
Macrolides bind to 23S of the 50S ribosomal subunit and block translocation. Erythromycin, along with clindamycin and tetracyclines, may be administered to treat actinomycosis, but they are reserved for patients with penicillin allergy. However, the patient in this vignette may be prescribed penicillin since she denies known drug allergies. +
While Protein C is decreased by vitamin K deficiency, the main feature of vitamin K deficiency is a decrease in coabulability. Isolated protein C deficiency causes hypercoagulability. +
von Willebrand disease is an autosomal dominant bleeding disorder caused by dysfunctional platelet adhesion. Patients with von Willebrand disease may present similarly to the patient in the vignette. Typically, patients with VWD have a prolonged bleeding time, normal/prolonged aPTT, and normal PTT and platelet count. +
'''Correct'''-Besides primary, secondary and tertiary hypothyroidism, rarely generalized resistance to thyroid hormones may cause hypothyroidism. Generalized resistance to thyroid hormones results from a receptor defect in the peripheral tissues. They usually present at an early age with growth and mental retardation, however patients with milder defects can present later in life. Elevated circulating thyroid hormone levels with normal or elevated TSH levels are characteristic. They present with hypothyroidism despite having elevated thyroid hormone levels. +
'''Correct'''-The most frequent cause of iron overload is a common genetic disorder (C282Y mutation of HFE gene) known as (idiopathic) hemochromatosis. Secondary iron storage problems can occur in a variety of anemias. The most practical screening test is the determination of serum iron, transferrin saturation, and plasma ferritin. Serum iron will be elevated and so will the plasma ferritin level. But increased ferritin value is less sensitive than increased transferrin saturation value, since they require greater degree of iron overload to increase the iron stores. So transferrin saturation >45% along with increased serum iron will be the most sensitive screening test. +