Question 26

62 year old Caucasian alcoholic male is brought to the ER in a semi-concious state. He remains drowsy and is unable to answer to questions. On examination, he is drowsy, responds to shaking, and then goes back to drowsiness. His Serum ketone levels are high, and his blood sugar level on glucometer shows 36 mg%. He has swelling on his great toes bilaterally. Serum AST is greater than ALT. Serum Bilirubin is 9.2 mg%. What is the biochemical cause of his swelling of toes?

A) Lactic Acid & Beta Hydroxy butyric Acid

B) Raised GGT

C) Hypertriglyceridemia

D) Mitochondrial Toxins

E) Increased NAD

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Question 21

25 year old nurse complaints of dizziness and sweating in the ER. A few days ago she had similar complaints and was adviced to go home from work after stabilizing. She joined work yesterday after leave. This is her third episode of similar complaints. She usually have such complaints whenever she is stressed due to patient overload, and feels better with rest and some juice. Today, her BP is 124/88 mm Hg, pulse is 102/min. She is sweating profusely. The doctor requests for blood chemistry, glucose level, and C- peptide level. The electrolytes levels are as follows, Na 134, K 3.4, Cl 98, Ca 9.2, Mg 2.4, BUN 20, Creat 0.9. Her Glucose level is 54 mg %, and C peptide levels are high. The doctor orders her 5 % Dextrose 100 cc, and she is stabilized subsequently. What is the most likely diagnosis?

A) Factitious disorder
B) Insulinoma
C) Glucagonoma
D) Manchausen Syndrome
E) Hypochondriasis

Answer will be posted soon under comments section.

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Question 19

What vitamin deficiency is linked to the patient's symptoms in question 17?

A) Thiamine
B) Riboflavin
C) Niacin
D) Biotin
E) Cobalamine
F) Folic Acid

Answer will be posted under comments section soon

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Question 6

(Source: www.futurehealth.rochester.edu)

An 80 year of Caucasian male is brought to the physician due to skin bruises and is accompanied with his son and daughter in law. The man says he stays alone since his wife died 3 years ago. He has no other significant medical illness. He denies smoking, drinks wine sometimes, and never have used any recreational drugs. He denies any guilt feelings, or any abnormal perceptions. He says he used to walk daily for 5 miles earlier but have lost interest since last 3 years, and rather prefers to stay at home alone. He has lost about 4 lbs. in last 3 years, and has decreased appetite. when asked about his diet he says "since his wife has passed away, there is no one to cook. So he most often eats toast with tea". He occassionally has bleeding while brushing his teeth. His skin examination looks as in the picture above. He denies any falls or abuse, and says "I am perfectly fine, my kids are just anxious". His memory appears to be intact. What is the most likely diagnosis?

A) Elderly Abuse

B) Elderly Neglect

C) Alzheimers

D) Nutritional deficit

E) Hypothyroidism

F) Depression

G) Coagulopathies

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