docdoc9
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1.) A 50-year-old man with a 20-year history of type
2 diabetes mellitus has had sensory neuropathy for 2 weeks.
Pulses are decreased at the ankle. There is no peripheral edema. His serum
glucose levels have been between 150 mg/dL and 200 mg/dL over the past 6
months. Which of the following is the most effective measure to prevent
serious foot infections?
A) Use of support hose
B) Use of well-fitted shoes
C) Prophylactic antibiotics
D) Daily aspirin and dipyridamole
E) Decrease in serum glucose level
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| docdoc9
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7.) A 16-year-old girl comes to the physician for her first prenatal
visit at 12 weeks' gestation. She has not had any immunizations since
the age of 5 years. She has received the following immunizations at the
recommended ages:
5 Diphtheria-tetanus-pertussis
3 Hepatitis B
1 Measles-mumps-rubella
4 Oral poliovirus
Examination shows no abnormalities. Which of the following is the most
appropriate immunization to administer at this visit?
A) Diphtheria-tetanus-pertussis
B) Diphtheria (child)-tetanus toxoid
C) Diphtheria (adult)-tetanus toxoid
D) Haemophilus influenzae type b
E) Hepatitis B
F) Inactivated poliovirus
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| docdoc9
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9. )An asymptomatic 57-year-old man with a 3-year history of type 2
diabetes mellitus comes for a routine follow-up visit. Examination shows no
abnormalities. Serum studies show:
Aspartate aminotransferase (AST, GOT) 76 U/L
Alanine aminotransferase (ALT, GPT) 86 U/L
Iron 260 µg/dL Total iron-binding capacity 300 µg/dL (N=250–450)
Ferritin 1200 ng/mL Antinuclear antibody negative
Serologic testing for hepatitis is negative. Which of the following is
the most appropriate next step in management?
A) Corticosteroid therapy
B) Interferon therapy
C) Penicillamine therapy
D) Chronic phlebotomy
E) No therapy indicated
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| nightflight1945
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1- B) Use of well-fitted shoes
7- C) Diphtheria (adult)-tetanus toxoid
D) Chronic phlebotomy
the best next step in this case is liver biopsy to confirm the diagnosis of hemochromatosis , however because it is not in answers I'll go for repeated phlebotomies.
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| docdoc9
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Thanks night flight
for the last q patient is asympotomatic, even then chronic phlebotomies are indicated?
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| nightflight1945
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yes , even asymptomatic family members of a patient with hemoch , should be screened by transferrin saturation and ferritin , if high------>liver biopsy or recently genetic testing for HFE gene mutation----------->if pos even in asymptomatic phlebotomy becasue other than CHF other symptoms doesnot regress by phlebotomy.
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| docdoc9
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Thanks nightflight,
This is from emedicine:
The goal of therapy in patients with iron overload disorders is to remove the iron before it can produce irreversible parenchymal damage.
Because a normal life span can be expected if iron reduction is initiated before the development of cirrhosis, clinical suspicion and early diagnosis are essential.
- Once diagnosed, hemochromatosis is treated by phlebotomy to rid the body of excess iron and to maintain normal iron stores.
- Iron supplements should be avoided.
- Patients should limit alcohol consumption and should not eat raw oysters.
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| docdoc9
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http://www.emedicine.com/med/topic975.htm
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| nightflight1945
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| minhuaw_99
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1. Why not E) Decrease in serum glucose level ?
His serum glucose levels have been between 150 mg/dL and 200 mg/dL over the past 6
months.
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| Last1
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Well, strict serum glucose level isn't recommended in diabetic pts and the levels mentioned above are very acceptable ..
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| sait
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for Q 9, i wonder if we have to know the normal values of given things in serum:. . 
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