Which one of the following complications occurs most frequently after Roux-en-Y gastric bypass surgery for obesity?
Correct Answer D: Iron and vitamin B12 deficiencies develop in more than 30% of patients after Roux-en-Y gastric bypass. The incidence of pulmonary embolus is 1%-2%. The incidence of dumping syndrome is very low.
Which one of the following medications for diabetes should be stopped 2-3 days prior to elective angiographic studies?
Correct Answer C: Metformin is associated with lactic acidosis in rare patients with normal renal function. Increased concentrations of the drug can occur in patients with renal impairment, causing lactic acidosis to occur. This can occur even with a temporary reduction in renal function, such as with angiography. Therefore, the drug should be stopped 2-3 days prior to such procedures and restarted only after renal function returns to normal.
Which one of the following has been associated with tendon rupture?
Correct Answer D: Although quinolones are well tolerated and relatively safe, certain adverse effects are common with all agents in this antibiotic class. Tendon rupture is a potential side effect of quinolone therapy.
A 28-year-old male presents to the hospital complaining of intermittent right flank pain radiating to the groin. He rates the pain as 10 on a scale of 10. He denies fever and chills, but has nausea and vomiting unrelieved by a promethazine (Phenergan) suppository in the emergency department. An abdominal examination is remarkable for tenderness of the right lower quadrant and right flank on deep palpation. He has no guarding or rebound tenderness. A urinalysis reveals 15-20 RBCs/hpf but is otherwise unremarkable. An abdominal KUB radiograph shows a right ureteral calculus in the mid-ureter, measuring 4 mm.
Which one of the following would be most appropriate?
Correct Answer C: This is a case of ureteral calculi (Ureterolithiasis). The classic presentation for a patient with acute renal colic is the sudden onset of severe pain originating in the flank and radiating inferiorly and anteriorly. The pain is usually, but not always, associated with microscopic hematuria, nausea, and vomiting. Dramatic costovertebral angle tenderness is common; this pain can move to the upper or lower abdominal quadrant as a ureteral stone migrates distally. However, the rest of the examination findings are often unremarkable.
This patient has nausea and vomiting and will require hospitalization for hydration and pain management. If the patient has no vomiting or it resolves with medication, then outpatient treatment with oral hydration and pain medication is appropriate. If neither obstruction nor infection is present, analgesics and other medical measures to facilitate passage of the stone can be initiated with the expectation that the stone will likely pass from the upper urinary tract if its diameter is smaller than 5-6 mm (larger stones are more likely to require surgical measures). However, close follow-up is recommended to document spontaneous passage of the stone. It is appropriate to wait up to 2 weeks for the stone to pass. If the stone does not pass in 2 weeks, urologic referral is recommended.
A 64-year-old female is scheduled for hysterectomy for uterine cancer. She currently takes aspirin, 325 mg daily, because of a previous transient ischemic attack.
Which one of the following would be the most appropriate management to prevent perioperative bleeding?
Correct Answer A: Aspirin affects platelet function; this can be measured by bleeding time and platelet function tests. Research indicates that there is no demonstrable hemostatic effect 5 days after cessation of aspirin therapy, and there is no difference in duration of effect with different doses of aspirin. Vitamin K has no effect on platelets.
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