JT, a 65-year-old individual, visits their doctor with fatigue, weakness, and shortness of breath. They appear pale with an enlarged, smooth tongue. JT has a history of chronic gastritis but no dietary restrictions or vitamin supplements. Answer the following questions based on the given information.
- What is the most likely diagnosis for JT’s condition?
- A) Iron-deficiency anemia
- B) Anemia of chronic disease
- C) Vitamin B12 deficiency anemia
- D) Folate deficiency anemia
- E) Thalassemia
Answer
Answer: C) Vitamin B12 deficiency anemia
- Which of the following symptoms is specifically associated with Vitamin B12 deficiency?
- A) Fatigue and weakness
- B) Shortness of breath
- C) Enlarged, smooth tongue
- D) Numbness and tingling in extremities
- E) Pale skin
Answer
Answer: D) Numbness and tingling in extremities
- Given JT’s diagnosis, which dietary or supplementation advice would be most appropriate?
- A) Increase intake of iron-rich foods
- B) Increase intake of folate-rich foods
- C) Increase intake of vitamin C-rich foods
- D) Supplement with vitamin B12
- E) Avoid gluten-containing foods
Answer
Answer: D) Supplement with vitamin B12
JT, a 65-year-old individual, visits their doctor with numbness and tingling in their hands and feet. They appear pale with an enlarged, smooth tongue. Answer the following questions based on the given information.
- The presence of which antibody is suggestive of pernicious anemia in JT’s case?
- A) Anti-nuclear antibody
- B) Anti-double-stranded DNA antibody
- C) Anti-intrinsic factor antibody
- D) Anti-smooth muscle antibody
- E) Anti-mitochondrial antibody
Answer
Answer: C) Anti-intrinsic factor antibody
- Which of the following factors in JT’s history is most likely contributing to their condition?
- A) Their age
- B) Their diet
- C) Chronic gastritis
- D) Lack of physical activity
- E) Not taking vitamin supplements
Answer
Answer: C) Chronic gastritis
- Given JT’s symptoms and lab results, what would be the most appropriate next step in their treatment?
- A) Start iron supplements
- B) Administer vitamin B12 injections
- C) Recommend increased physical activity
- D) Prescribe a gluten-free diet
- E) Increase folate intake
Answer
Answer: B) Administer vitamin B12 injections
A 65-year-old man with a history of hypertension and chronic obstructive pulmonary disease (COPD) is prescribed propranolol. After a few days, he complains of shortness of breath and wheezing. Which side effect of propranolol is most likely responsible for these symptoms?
- A. Bradycardia
- B. Bronchoconstriction
- C. Hypotension
- D. Fatigue
- E. Cold Extremities
Answer
Answer: B. Bronchoconstriction
Explanation: Propranolol is a non-selective beta blocker that can cause bronchoconstriction by blocking beta-2 receptors in the lungs, leading to shortness of breath and wheezing, particularly in patients with respiratory conditions like COPD.
A 45-year-old woman with a history of hypertension and type 2 diabetes is started on metoprolol. She later experiences episodes of dizziness and fainting. What is the most likely side effect of metoprolol causing these symptoms?
- A. Depression
- B. Cold Extremities
- C. Hypotension
- D. Sleep Disturbances
- E. Hyperlipidemia
Answer
Answer: C. Hypotension
Explanation: Metoprolol, a beta-1 selective blocker, can cause hypotension by reducing cardiac output and causing vasodilation, leading to dizziness and fainting.
A 55-year-old man taking atenolol for hypertension reports persistent tiredness and weakness. Which side effect of beta blockers is he most likely experiencing?
- A. Fatigue
- B. Gastrointestinal Issues
- C. Sleep Disturbances
- D. Masking of Hypoglycemia Symptoms
- E. Sexual Dysfunction
Answer
Answer: A. Fatigue
Explanation: Beta blockers like atenolol can cause fatigue by reducing heart rate and blood pressure, which can decrease overall energy levels.
A 60-year-old woman with a history of depression is prescribed bisoprolol for heart failure. She later reports increased sadness and loss of interest in daily activities. Which side effect of bisoprolol is most likely responsible for these symptoms?
- A. Cold Extremities
- B. Depression
- C. Bronchoconstriction
- D. Sexual Dysfunction
- E. Hyperlipidemia
Answer
Answer: B. Depression
Explanation: Beta blockers, including bisoprolol, can potentially cause or exacerbate depression due to their effects on the central nervous system.
A 50-year-old diabetic patient on propranolol for migraine prophylaxis notices that he is unable to recognize the usual symptoms of low blood sugar. Which side effect of propranolol is he experiencing?
- A. Gastrointestinal Issues
- B. Hypotension
- C. Masking of Hypoglycemia Symptoms
- D. Fatigue
- E. Sleep Disturbances
Answer
Answer: C. Masking of Hypoglycemia Symptoms
Explanation: Propranolol can mask the adrenergic symptoms of hypoglycemia, such as tachycardia, making it difficult for diabetic patients to recognize low blood sugar episodes.
A 70-year-old patient on timolol eye drops for glaucoma complains of cold hands and feet. Which side effect of timolol is responsible for these symptoms?
- A. Sleep Disturbances
- B. Bronchoconstriction
- C. Cold Extremities
- D. Depression
- E. Sexual Dysfunction
Answer
Answer: C. Cold Extremities
Explanation: Beta-blockers like timolol can cause reduced blood flow to peripheral tissues, leading to cold hands and feet.
Case: Mrs. Johnson, a 65-year-old woman, has been prescribed amlodipine for hypertension. She reports experiencing swelling in her ankles and feet since starting the medication.
Question: What is the most likely cause of Mrs. Johnson’s symptoms?
- Amlodipine-induced peripheral edema
- Heart failure exacerbation
- Deep vein thrombosis
- Kidney failure
- Allergic reaction to amlodipine
Answer
Answer: Amlodipine-induced peripheral edema
Follow-up Question: Which of the following is an appropriate management strategy for Mrs. Johnson’s peripheral edema?
- Discontinue amlodipine and switch to a different antihypertensive medication
- Increase the dose of amlodipine
- Add a diuretic to her treatment regimen
- Advise her to elevate her legs and reduce salt intake
- Continue amlodipine and monitor for worsening symptoms
Answer
Answer: Add a diuretic to her treatment regimen
Follow-up Question: Which medication class is less likely to cause peripheral edema and can be considered as an alternative to amlodipine?
- Beta-blockers
- ACE inhibitors
- Thiazide diuretics
- Loop diuretics
- Calcium channel blockers
Answer
Answer: ACE inhibitors
Case: Mr. Smith, a 45-year-old man with a history of type 2 diabetes and chronic kidney disease, was mistakenly prescribed metformin despite his contraindications.
Question: What is the primary concern with prescribing metformin to a patient with chronic kidney disease?
- Increased risk of hypoglycemia
- Development of lactic acidosis
- Severe gastrointestinal side effects
- Drug-induced liver injury
- Hyperkalemia
Answer
Answer: Development of lactic acidosis
Follow-up Question: Which of the following actions should be taken immediately for Mr. Smith?
- Continue metformin and monitor kidney function
- Discontinue metformin and switch to insulin therapy
- Lower the dose of metformin
- Add another oral antidiabetic medication
- Refer to a nephrologist for further management
Answer
Answer: Discontinue metformin and switch to insulin therapy
Follow-up Question: Which of the following antidiabetic medications is safer for patients with chronic kidney disease?
- Sulfonylureas
- Thiazolidinediones
- DPP-4 inhibitors
- GLP-1 receptor agonists
- SGLT2 inhibitors
Answer
Answer: DPP-4 inhibitors
Case: Ms. Brown, a 55-year-old woman, is taking warfarin for atrial fibrillation and has recently been started on trimethoprim-sulfamethoxazole for a urinary tract infection.
Question: What is the primary concern with the concomitant use of warfarin and trimethoprim-sulfamethoxazole?
- Decreased efficacy of warfarin
- Increased risk of bleeding
- Increased risk of clot formation
- Severe gastrointestinal side effects
- Allergic reaction
Answer
Answer: Increased risk of bleeding
Follow-up Question: What should be monitored closely in Ms. Brown while she is taking both medications?
- Renal function
- Blood pressure
- INR levels
- Liver enzymes
- Blood glucose levels
Answer
Answer: INR levels
Follow-up Question: Which of the following actions should be considered to manage the interaction between warfarin and trimethoprim-sulfamethoxazole?
- Discontinue warfarin and switch to a different anticoagulant
- Increase the dose of warfarin
- Decrease the dose of warfarin and monitor INR frequently
- Discontinue trimethoprim-sulfamethoxazole and choose an alternative antibiotic
- Continue both medications without any dose adjustments
Answer
Answer: Decrease the dose of warfarin and monitor INR frequently
Case: Mr. Lee, a 60-year-old man with a history of asthma, has been prescribed propranolol for anxiety management.
Question: What is the primary concern with prescribing propranolol to a patient with asthma?
- Increased risk of bronchospasm
- Development of heart failure
- Severe hypotension
- Exacerbation of anxiety symptoms
- Drug-induced liver injury
Answer
Answer: Increased risk of bronchospasm
Follow-up Question: Which of the following medications would be a safer alternative for anxiety management in a patient with asthma?
- Atenolol
- Clonazepam
- Buspirone
- Fluoxetine
- Lorazepam
Answer
Answer: Buspirone
Follow-up Question: What should be monitored in Mr. Lee if propranolol is continued despite his asthma?
- Blood pressure
- Blood glucose levels
- Respiratory function
- Liver enzymes
- Heart rate
Answer
Answer: Respiratory function