Title: Usmle Step 1 MCQ’s # 50
Subject: Behavioral Science
Q NO 50: A 55-year-old man with a history of alcoholism and hepatitis C undergoes an orthotopic liver transplant. His surgery goes well, and he is taken to the intensive care unit. On postoperative day 4, the patient’s sedation is discontinued, and he is extubated. On postoperative day 5, the patient begins to experience tremor, tachycardia, hypertension, nausea, and malaise. He begins to have visual hallucinations. On examination, his wound is clean, dry, and intact. No unexpected abdominal tenderness is elicited. Which of the following pairs best explains the patient’s symptoms and gives the appropriate treatment?
A. Alcohol withdrawal/administer benzodiazepines
B. Mallory-Weiss syndrome /administer benzodiazepines
C. Mallory-Weiss syndrome/ administer thiamine
D. Wernicke-Korsakoff syndrome/administer benzodiazepines
E. Wernicke-Korsakoff syndrome/administer thiamine
Explanation:
The correct answer is A. Patients with a history of alcoholism should always be watched for symptoms of alcohol withdrawal because the sequelae can be life-threatening. In this case, the patient exhibits many of the classic findings of alcohol withdrawal: tremor, tachycardia, hypertension, malaise, nausea, hallucinations, and delirium tremens. Delirium tremens is a constellation of signs and symptoms including autonomic instability, tachycardia, hypertension, delirium, and death. Treatment for withdrawal can include replacing the alcohol or giving benzodiazepines.
Choice B does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. In Mallow-Weiss syndrome, patients develop longitudinal lacerations at the gastroesophageal junction. Itis caused by excessive vomiting with failure of the LBS to relax, and can lead to fatal hematemesis. Treatment may include preventing the emesis and/or managing hemorrhage. Choice C does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. See above (choice B) for explanation. Choice D does not correctly identify this patient’s condition, nor does it properly address the treatment for Wernicke-Korsakoff syndrome. Wernicke-Korsakoff syndrome is caused by a thiamine deficiency, and results in psychosis, ophthalmoplegia, and ataxia. Untreated it may progress to memory loss, confabulation, and confusion. Treatment is thiamine replacement.
Choice E correctly matches the disease with the treatment, but it tails to correctly identify the symptoms seen in this patient.
Source: http://www.usmleworldwide.com/blog/?p=1312
Subject: Behavioral Science
Q NO 50: A 55-year-old man with a history of alcoholism and hepatitis C undergoes an orthotopic liver transplant. His surgery goes well, and he is taken to the intensive care unit. On postoperative day 4, the patient’s sedation is discontinued, and he is extubated. On postoperative day 5, the patient begins to experience tremor, tachycardia, hypertension, nausea, and malaise. He begins to have visual hallucinations. On examination, his wound is clean, dry, and intact. No unexpected abdominal tenderness is elicited. Which of the following pairs best explains the patient’s symptoms and gives the appropriate treatment?
A. Alcohol withdrawal/administer benzodiazepines
B. Mallory-Weiss syndrome /administer benzodiazepines
C. Mallory-Weiss syndrome/ administer thiamine
D. Wernicke-Korsakoff syndrome/administer benzodiazepines
E. Wernicke-Korsakoff syndrome/administer thiamine
Explanation:
The correct answer is A. Patients with a history of alcoholism should always be watched for symptoms of alcohol withdrawal because the sequelae can be life-threatening. In this case, the patient exhibits many of the classic findings of alcohol withdrawal: tremor, tachycardia, hypertension, malaise, nausea, hallucinations, and delirium tremens. Delirium tremens is a constellation of signs and symptoms including autonomic instability, tachycardia, hypertension, delirium, and death. Treatment for withdrawal can include replacing the alcohol or giving benzodiazepines.
Choice B does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. In Mallow-Weiss syndrome, patients develop longitudinal lacerations at the gastroesophageal junction. Itis caused by excessive vomiting with failure of the LBS to relax, and can lead to fatal hematemesis. Treatment may include preventing the emesis and/or managing hemorrhage. Choice C does not correctly identify this patient’s condition, nor does it properly address the treatment for Mallory-Weiss syndrome. See above (choice B) for explanation. Choice D does not correctly identify this patient’s condition, nor does it properly address the treatment for Wernicke-Korsakoff syndrome. Wernicke-Korsakoff syndrome is caused by a thiamine deficiency, and results in psychosis, ophthalmoplegia, and ataxia. Untreated it may progress to memory loss, confabulation, and confusion. Treatment is thiamine replacement.
Choice E correctly matches the disease with the treatment, but it tails to correctly identify the symptoms seen in this patient.
Source: http://www.usmleworldwide.com/blog/?p=1312
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