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  #1  
Old 10-17-2012
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Poison Monday Headaches and Dizziness

A 36-year-old man who works at an explosives factory comes to the clinic for an annual check-up. He is concerned about long-term exposure to industrial chemicals. He reports that although he is in excellent health otherwise, he experiences headaches, dizziness, and palpitations every Monday. Laboratory tests show:

Na+: 137 mEq/L
K+: 3.4 mEq/L
Cl−: 102 mEq/L
HCO3−: 24 mEq/L
Blood urea nitrogen: 12 mg/dL
Creatinine: 1.0 mg/dL
WBC count: 8000/mm3
Platelet count: 310,000/mm3
Hematocrit: 46%
Hemoglobin: 15 g/dL

An ECG shows normal sinus rhythm with no Q wave changes. Which of the following is the most likely serious complication that can occur as a result of his exposure?

A anemia
B atherosclerosis
C cardiac arrest
D CHF
E dementia
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  #2  
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E. Dementia ??
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Old 10-17-2012
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may be D )CHF
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  #4  
Old 10-17-2012
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Default dementia

E. dementia (may be)
As he is anxious about his job.
and have monday fear
Lab reports normal.
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This disease has a special name...I just can't recall it...Its sounds something like "weekend syndrome".

Anyway i think its not the fear of monday...Its just when he goes to work the whole week, he get tolerant to the chemical...On weekends he is away of work. But when he goes back to work again on Monday he experiences dizziness, headache and palpitation.

Someone plz help me recall the name of the dx and also what chemical is it...Thanks
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Old 10-17-2012
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I know that Monday disease-nitroglycerin tolerance

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Quote:
Originally Posted by dr.Irina View Post
I know that Monday disease-nitroglycerin tolerance
Thanks...Thats what I meant.
Couldn't recall at all...Blocking You know
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hmm..may be cause he work at industrial area..so much co2 exposure..made false result for CBC....those symptoms..may be cause he has Anaemia..
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D?
due to powder inhalation -> fibrosis -> CHF
just a guess

is this a wtf questions like the wtf ones on the exam?
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  #10  
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Monday disease is a toxicity that happens to those who are exposed to Nitroglycerin or isosorbide dinitrate industrially, like who work in construction or demolition industries, mix concrete, do plaster, ect.
During the week, Monday to Friday, they are exposed to the vasodilating action, so they build up a tolerance. If they are off on Saturday and Sunday the tolerance is lost. So when they go back to work on Monday the tachycardia, hypotension, flusing and headache return, but a tolerance is built up again by the next day.
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Default my answer :)

C cardiac arrest
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E) dementia
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  #13  
Old 10-18-2012
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Idea!

C cardiac arrest

Monday disease is a toxicity that happens to those who are exposed to Nitroglycerin or isosorbide dinitrate industrially, like who work in construction or demolition industries, mix concrete, do plaster, ect.
During the week, Monday to Friday, they are exposed to the vasodilating action, so they build up a tolerance. If they are off on Saturday and Sunday the tolerance is lost. So when they go back to work on Monday the tachycardia, hypotension, flusing and headache return, but a tolerance is built up again by the next day.
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I meant to choose D-CHF not C sry
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The correct answer is C. This patient's symptoms suggest that he is experiencing nitroglycerine withdrawal. Nitroglycerine is a vasodilator. Chronic industrial exposure leads to tolerance for vasodilatation on work days and a compensatory vasoconstriction on weekends when the exposure is removed, thus resulting in the "Monday disease." The most severe consequence is when the compensatory vasoconstriction is unopposed in critical areas such as the coronary vessels, leading to non-atherosclerotic-related ischemia.

Answer A is incorrect. Anemia can be a result of lead or other heavy metal poisoning, but not nitroglycerine.

Answer B is incorrect. Atherosclerosis is formed by fatty streak deposition, which along with endothelial damage results in plaque formation over time. It is not linked to nitroglycerine exposure.

Answer D is incorrect. Congestive heart failure can be a complication of long-term coronary artery disease or a myocardial infarction, but not of nitroglycerine exposure.

Answer E is incorrect. Dementia can be a result of neurotoxin exposures (eg., mercury). Nitroglycerine exposure does not cause dementia.
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  #16  
Old 10-31-2012
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good question
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nice question,thanks
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Old 11-02-2012
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What about anemia? Couldn't it be because of the probable lead exposure? Or that would be more reasonable in an ammunition factory?
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Quote:
Originally Posted by OVRPS View Post
What about anemia? Couldn't it be because of the probable lead exposure? Or that would be more reasonable in an ammunition factory?
Pal the question already gives a Hb of 15............so there's no anemia.
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Old 11-02-2012
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Quote:
Originally Posted by subbi View Post
Pal the question already gives a Hb of 15............so there's no anemia.
Lol well that settles it
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Cardiovascular-, Pharmacology-, Step-1-Questions, Toxicology-

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