Which one of the following is a risk factor for acute pancreatitis?
Correct Answer E:
Pancreatitis is most closely associated with gallstones and excessive alcohol use. Gastroesophageal reflux disease, pyelonephritis, drug abuse (other than alcohol), and angiotensin receptor blocker use are not risk factors for the development of pancreatitis.
Which of the following drugs will NOT promote urine retention?
Correct Answer C: Urinary retention is a common side effect that occurs with drugs that have anticholinergic properties. Drugs with such side effect profiles include sympathomimetic, anticholinergics, TCAs, smooth muscle depressants.
During the physical exam of a patient’s foot, you notice an inability to dorsiflex.
What nerve root(s) is most likely affected?
Foot drop can be associated with a variety of conditions such as dorsiflexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes.
Often drop foot is caused by injury to the common peroneal nerve (also called common fibular nerve, peroneal nerve, external popliteal nerve, lateral popliteal nerve), which is derived from the dorsal branches of the fourth and fifth lumbar and the first and second sacral nerves.
The common peroneal nerve branches from the sciatic nerve. It includes the deep and superficial peroneal branches. These nerves provide sensation to the anterior and lateral parts of the legs and to the top of the feet.
Symptoms of common peroneal nerve injury (foot drop) may include:
A 25-year-old woman with family history of kidney disease is found to be hypertensive and is started on a beta blocker.
What is your next step in the work-up of her condition?
Correct Answer B:
This woman, being so young, most likely has high blood pressure from a secondary cause of renal artery stenosis.
Renovascular hypertension is blood pressure elevation due to partial or complete occlusion of one or more renal arteries or their branches. It is usually asymptomatic unless long-standing. A bruit can be heard over one or both renal arteries in < 50% of patients.
Diagnosis is by physical examination and renal imaging with duplex ultrasonography, radionuclide imaging, or magnetic resonance angiography. Angiography is done before definitive treatment with surgery or angioplasty.
On her annual physical exam, a young white patient asks you to help her quit smoking. On her physical exam, she is found to have right flank continuous bruit. She is known for refractory hypertension and you suspect a secondary cause for her hypertension.
Which of the following is most likely?
Correct Answer C:
Renovascular hypertension (RVH) is the most common form of curable high blood pressure and is estimated to affect 1% of all hypertensive individuals. It occurs when significant unilateral or bilateral renal artery stenosis causes renal ischemia.
RVH develops as a result of significant stenosis (generally >60%) of one main renal artery and occasionally arises from lesions of a distal branch. Two thirds of renal artery stenoses result from atherosclerosis, whereas the various forms of fibromuscular dysplasia (FMD) are responsible for approximately one third. Atherosclerotic lesions are typically proximal and found more frequently in older men with evidence of extensive vascular involvement. Bilateral disease, azotemia, and recurrent pulmonary edema are also more frequent in this group. Conversely, patients with FMD tend to be young white women with no family history of essential hypertension; lesions usually involve the middle and distal segments of the renal artery. Smoking increases the risk of renovascular hypertension in both groups.
Physical examination may show abdominal or flank continuous bruit and/or advanced retinopathy (grades III, IV by KWB classification).
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