MCQS 208-210 :A 65 year old diabetic on treatment with insulin injections for 15 yrs is now being investigated for recurrent hypoglycemia

A 65 year old diabetic on treatment with insulin injections for 15 yrs is now being investigated for recurrent hypoglycemia. She is fully compliant with her treatment. A likely cause is
a) keto acidosis
b) Nonketotic Hyperosmolarity
c) autonomic neuropathy
d) Hypoglycaemia unawareness
e) peripheral neuropathy
f) infection
g) Amytrophy
h) Focal nerve palsy
i) retinopathy
j) nephropathy

A young man with a history of acne develops diffuse severe chronic pustules resistant to local treatment
a) oral metronidazole
b) Minocycline
c) Chloroquine + Primaquine
d) First-generation cephalosporin
e) Broad-spectrum antibiotic treatment
f) Malathion
g) topical benzoyl peroxide
h) Albendazole
i) chloroquine alone
j) topical clotrimazole

A 20 year old girl conplains of bilateral knee pain that worsens after sitting for prolonged time . The pain worsens with using stairs or getting out of a chair and there is a grinding sensation when the knee is extended . On examination the knee appears mildly swollen, and with the knee extended, pressing the kneecap against the femur elicits pain. Radiographs of the knees appear normal. A likely diagnosis is :
a) chondromalacia patella
b) gout
c) pseudogout
d) inflammatory osteoarthritis
e) reiters
f) enteropathic arthritis
g) septic arthritis
h) rheumatoid arthritis
i) anterior cruciate ligament tears
j) bilateral medial meniscal tears
Question :208 
Correct Answer: D
There is a critical and potentially life-threatening complication associated with recurrent hypoglycemia: Hypoglycemia Unawareness and Reduced Counterregulatory Responses. While the mechanisms for this syndrome of hypoglycemia-associated autonomic failure are still under investigation, the dangers of the self-defeating response are apparent. If hypoglycemia leads to further and more severe hypoglycemia, a vicious cycle is set forth and the patient becomes more vulnerable to CNS damage. Prolonged hypoglycemia may cause permanent neurological deficit or death. Unrecognized infection causing hypoglycemia in diabetic patients may result in recurrent hypoglycemic spells or progression of the infection This patient should be switched to continuous subcutaneous insulin infusion, this may result in better control of her glycemia. Alternatively her dosage should be reviewed.
Correct Answer: B
Pustular acne appears just how it sounds. The presence of small pustules or tiny red pimples characterizes this form of acne. Minocycline is a tetracycline derivative that has been used effectively for decades as a treatment for acne. It is especially useful for pustular type acne. While the absorption of minocycline is decreased with food, it is not as significant as the decrease seen with tetracycline. The usual starting dose is 50 to 100 mg twice a day. Major side effects of minocycline include dizziness, nausea, vomiting, skin pigmentation changes, and tooth discoloration. The skin and tooth changes are seen more often in people who have taken minocycline for a long time
Correct Answer: A
chondromalacia patella is manifested by : 1. Pain at the anterior aspect of the knee, during walking and running 2. Anterior knee pain with squatting, walking up or down stairs 3. Recurrent effusion 4. Crepitus during flexion and extension 5. Very rare to have symptoms at rest On examination the clinician may find Crepitus as the patella is moved in the femoral grove 1. Easy lateral subluxation of the patella 2. Pain and recurrence of symptoms with passive movement of and simultaneous pressure to patella within the femoral grove


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