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  #1  
Old 05-15-2015
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Default nbme ques... can somebody explain what not B?

36. One day after missing her dialysis treatment, a 27-year-old woman comes to the physician because of generalized weakness. Her blood pressure is 95172 mm Hg, and pulse is 45/min and regular. Examination shows a well-functioning arteriovenous fistula in the left upper extremity. Muscle strength is 315 in all extremities. An ECG shows third-degree atrioventricular block. Laboratory studies are ordered. Which of the following is the most appropriate next step in management?
O A) Kayexalate-sorbitol enema
O B) Intravenous administration of calcium gluconate
O C) Oral administration of sodium polystyrene sulfonate (Kayexalate)
O D) Immediate placement of a pacemaker
O E) No treatment pending laboratory results

D
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  #2  
Old 05-15-2015
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Third degree AV block is an indication for pacemaker placement.
you will not correct the AV block by giving calcium
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Old 05-16-2015
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thankyou...
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  #4  
Old 05-16-2015
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2. A 15-year-old girl is brought to the physician 3 months after she had a blood pressure of 150/95 mm Hg at a routine examination prior to participation in school sports. She is asymptomatic and has no history
of serious illness. Twelve months ago, she was diagnosed with a urinary tract infection and treated with oral trimethoprim-sulfamethoxazole. She currently takes no medications. Subsequent blood pressure measurements on three separate occasions since the last visit have been: 155/94 mm Hg, 145/90 mm Hg, and 150/92 mm Hg. She is at the 50th percentile for height and 95th percentile for weight. Her blood pressure today is 150/90 mm Hg confirmed by a second measurement, pulse is 80/min, and respirations are 12/min. Examination shows no other abnormalities. Her hematocrit is 40%. Urinalysis is within normal limits. Cardiac and renal ultrasonography shows no abnormalities. Which of the following is the most appropriate next step in management?
A ) Exercise and weight reduction program
B ) Measurement of urine catecholamine levels
C ) Measurement of urine corticosteroid levels
D ) Captopril therapy
E ) Hydrochlorothiazide therapy
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Old 05-16-2015
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A : best initial management of hypertension is exercise and weight reduction (she's at the 95th percentile for weight).
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Old 05-25-2015
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yes i did the same bt there was key mistake probably.. wanted to confirm. thanxx..
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Old 05-26-2015
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Default Answer for the 15 year girl with HTN

I would like to ask why can the answer not be urine for corticosteroids. The clinical picture does mimic Cushing's Disease and they have asked for next step. Also as per uworld, increased blood pressure in younger patients suspect secondary causes of hypertension
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Old 05-26-2015
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Quote:
Originally Posted by drdminorc View Post
I would like to ask why can the answer not be urine for corticosteroids. The clinical picture does mimic Cushing's Disease and they have asked for next step. Also as per uworld, increased blood pressure in younger patients suspect secondary causes of hypertension
I'm afraid I have to agree -- I would chose 'CC' as the correct answer. Here's why:

Whenever I answer CK questions, my first question to myself is always this:

What is my diagnosis?

In this case, we're looking at hypertension, primary vs secondary. Do I have enough information to make a diagnosis one way or the other? No, I don't believe I do.

This patient has severe hypertension (Stage II) as she is past the 99th percentile for her age and height. If I diagnose her with essential hypertension, she needs both lifestyle modification AND medication for hypertension this severe.

I do have some suspicious history of secondary causes. The relatively recent finding of hypertension, the severe obesity, and the history of a UTI in a presumably sexually inactive girl all suggest a possible secondary cause. Furthermore, the level of HTN is far beyond what we would expect for someone of her height and weight. In real life, I would not be comfortable sending this patient home with a Rx for weight loss; I would want to eliminate ALL possible causes of secondary HTN.

My thoughts on why all the other answers are wrong:

a) BP too high, must rule out secondary causes
b) her normal pulse and lack of headache/sweating + normal renal U/s makes a pheochromocytoma or neuroblastoma highly unlikely
c) I believe this is the correct answer.
d) Even if we felt this was essential htn, this would not be our first drug
e) Would need this PLUS diet/exercise according to guidelines; would still want to rule out Cushings before deciding this is primary HTN after all.
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The above post was thanked by:
drjds (05-10-2016)
  #9  
Old 05-27-2015
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Yes,reading the case again,I guess the diagnosis of Cushing explains all more than obesity does.It is a good idea to exclude Cushing first. I stand corrected.
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