QUESTION: 137

A 74-year-old woman is referred to osteoporosis clinic for advice on management of osteoporosis. She has a history of hiatus hernia, hypertension, hypercholesterolemia, chronic kidney disease stage 4 and COPD. She has recently been found to have osteoporosis after a Colles' fracture. She is taking calcitriol, and other medication for her comorbidities.
Based on the information above, which would be the most appropriate agent for treatment of her osteoporosis?

Denosumab
Intravenous zoledronate
Strontium ranelate
Calcium and Vitamin D supplements

Answer(s): A

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QUESTION: 138

A 55-year-old man has epigastric discomfort. He is seropositive for Helicobacter pylori. Upper endoscopy reveals no gastritis and no ulcer disease. Biopsy of the stomach shows Helicobacter.
What should you do?

Breath testing
PPI alone as symptomatic therapy
Repeat endoscopy after 6 weeks of PPIs D-PPI, amoxocillin, and clarithromycin

Answer(s): B

Explanation:

You do not need to treat Helicobacter pylori unless there is gastritis or ulcer disease. This patient has epigastric pain and Helicobacter but no ulcer or gastritis.
This is non-ulcer dyspepsia. Treat it symptomatically with a PPI. Enormous numbers of people are colonized with H. pylori; you do not need to eradicate it from the world without evidence of disease. H. pylori is not the cause of non-ulcer dyspepsia.

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QUESTION: 139

A patient develops recurrent episodes of gonorrhea. What should he be tested for?

Terminal complement deficiency
Presence of a spleen
HIV
Steroid use

Answer(s): A

Explanation:

Terminal complement deficiency predisposes a patient to recurrent episodes of Neisseria infection. This includes any form, including genital and CNS infection.

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QUESTION: 140

A third-year medical student is examining a patient who has acute onset of abdominal pain. The patient is a 65-year-old smoker with HTN and DM who has had dull abdominal pain gradually building for the last 12 hours. It is not related to food nor relieved by taking famotidine. On physical examination, auscultation reveals a bruit. Palpation shows a pulsatile mass. While lightly palpating the epigastrium, the patient suddenly becomes hypotensive and passes out.
What is the most likely diagnosis?

Hemorrhagic gastritis
Narcolepsy
Ruptured abdominal aortic aneurysm
Ruptured peptic ulcer

Answer(s): C

Explanation:

A bruit and pulsatile abdominal mass are hallmark signs of an abdominal aortic aneurysm (AAA). The fact that the medical student was palpating the area and the patient passed out was a coincidence; however, syncope in the setting of the AAA is rupture until proven otherwise. Ruptured peptic ulcer would have more severe and sharp abdominal pain. Hemorrhagic gastritis could cause syncope, but the bleeding would cause emesis, and the patient is supine, so orthostasis is not of concern. Narcolepsy would not have hypotension. This patient's abdominal pain was from the AAA beginning to rupture and was dull and gradual in onset.

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QUESTION: 137

QUESTION: 138

Explanation:

QUESTION: 139

Explanation:

QUESTION: 140

Explanation: