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q14)
Hearing loss accompanying Chronic otitis media is strongly related to delay in language development. Physicians, parents, and educators need to be aware of the implication of this language handicap, as it might affect future performance.
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15.
A 59-year-old white man comes to the office because of generalized itching. He has been your patient since he had colon resection for carcinoma 5 years ago. His current medications include occasional use of an albuterol inhaler for pollen allergies. Medical history is otherwise unremarkable. Physical examination today discloses icterus and dry skin. The right upper quadrant is mildly tender and there is hepatomegaly. Results of laboratory studies are shown:
Serum
Alkaline phosphatase 800 U/L
AST 118 U/L
Bilirubin
Total 7.0 mg/dL
Direct 5.5 mg/dL
Lactate dehydrogenase 82 U/L
Proteins, total 7.0 g/dL
Results of hepatitis serology tests are all negative. CT scan shows multiple liver metastases. Bile ducts are not visibly dilated. Which of the following is the most appropriate next step in the management of his itching?
A) Arrange for radiation therapy of the abdomen
B) Initiate oral cholestyramine therapy
C) Initiate oral codeine therapy
D) Initiate oral methotrexate therapy
E) Place the patient on a low-fat diet
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yayy!! that questions really fooled me
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B.... it will take away bile acids ????
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Yes Kat  B
q15)
B) Initiate oral cholestyramine therapy
Treatment of Pruritus of Obstructive Jaundice with Cholestyramine
Bile acid sequestrants such as cholestyramine were first used to treat hypercholesterolemia, but since the introduction of statins, now have only a minor role for this indication. They are used to treat pruritus of Obstructive Jaundice and other types of cholestasis where the ability to eliminate bile acids is reduced.
pruritus cholestasis - cholestyramine
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16.
A 73-year-old woman returns to the office for follow-up of hypertension. She has tried lowering her blood pressure with lifestyle modification, but blood pressure measurements checked regularly at home during the past 3 months have averaged 150/82 mm Hg. She is otherwise healthy and takes no medications. She has a family history of hypertension in her mother, who had a stroke at age 71 years. The patient's vital signs today are temperature 36.8°C (98.2°F), pulse 74/min, respirations 18/min, and blood pressure 154/84 mm Hg. Physical examination, including funduscopic examination, shows no abnormalities. Results of laboratory studies are shown:
Serum
Creatinine 1.0 mg/dL
Na+ 141 mEq/L
K+ 3.9 mEq/L
ECG is obtained and is normal. Echocardiogram shows an ejection fraction of 0.60 but is otherwise normal. In assessing this patient's need for pharmacotherapy, which of the following factors is most compelling?
A) Diastolic blood pressure measurement
B) Family history of stroke
C) The lack of end-organ damage
D) The patient's age
E) Systolic blood pressure measurement
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On the test I was lost with this question!! I put D which is Wrong!! I'm between A or E!! NO CLUE!!
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Actually, there was a similar qs on form 2, I remembered Systolic BP was more important to treat if high values in order to prevent end stage renal disease.
q16)
Ans: E
E) Systolic blood pressure measurement
nbme cert
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17.
A 32-year-old man comes to the office for an annual health maintenance examination. He says he generally has felt well. Medical history is remarkable only for an episode of renal calculi 4 years ago. The patient works in construction, is married, and has no children. He does not smoke cigarettes or use illicit drugs. He drinks three to four beers daily. Family history is remarkable for diabetes mellitus in his mother and myocardial infarction at age 53 years. His father died of thyroid cancer at age 44 years. A paternal uncle also has a history of renal calculi and had recent neck surgery. The patient is 180 cm (5 ft 11 in) tall and weighs 109 kg (240 lb); BMI is 34 kg/m2. Vital signs are temperature 37.2°C (99.0°F), pulse 96/min, respirations 14/min, and blood pressure 130/80 mm Hg. Physical examination discloses no abnormalities. Results of fasting laboratory studies are shown:
Serum
ALT 28 U/L
AST 26 U/L
Urea nitrogen 9 mg/dL
Creatinine 0.9 mg/dL
Na+ 144 mEq/L
K+ 3.9 mEq/L
Cl− 100 mEq/L
HCO3− 23 mEq/L
Calcium 10.4 mg/dL
Glucose 154 mg/dL
Phosphorus 2.0 mg/dL
TSH 3.6 μU/mL
Which of the following is the most appropriate next test to order?
A) CT scan of the neck
B) Exercise stress test
C) Renal ultrasonography
D) Serum calcitonin concentration
E) Serum parathyroid hormone concentration
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