A 14-year-old boy presents with symptoms of fatigue and oliguria with
cola-colored urine, following streptococcal pharyngitis two weeks ago.
Physical examination reveals elevated blood pressure and swelling in
the hands and feet. Urinalysis shows proteinuria and hematuria with
red blood cell casts. What is the most likely diagnosis?
,Acute glomerulonephritis
Acute pyelonephritis
Acute tubular necrosis
Initial onset of diabetes mellitus - ANSWERS-Acute glomerulonephritis
Acute glomerulonephritis can occur 1-3 weeks after a streptococcal
infection. The reaction that occurs as a result of streptococcal infection
is the result of an abnormal immunologic response, resulting in damage
to the glomeruli. Symptoms include hematuria, cola-colored urine,
oliguria, hypertension, and edema of the face and extremities.
Urinalysis reveals red blood cells, mild proteinuria, and red blood cell
casts. Pediatric patients usually have depressed C3 complement levels.
In adults, elevation of creatinine levels is more common. Management
of postinfectious glomerulonephritis is supportive, with water and salt
restriction. Calcium channel blockers or ACE inhibitors may be used in
cases of severe hypertension. More than 90% of children achieve full
recovery; complete remission in adults is 26-56%, depending on age
and other comorbidities.
A 23-year-old woman presents to the clinic with a history of
debilitating, unilateral headaches that only occur shortly before her
period and take her several days to recover. Which one of the following
triptans has been found to be effective in preventing these kinds of
headaches?
Almotriptan
,Frovatriptan
Rizatriptan
Sumatriptan - ANSWERS-Frovatriptan
Frovatriptan and naratriptan are two long-acting triptans that have
been found to be effective in preventing menstrual migraine if taken
around-the-clock starting two days before menses and continuing for a
total of five to six days. Menstrual migraines are migraine headaches
that occur exclusively near the time of menses. Triptans are drugs
specific to migraine treatment and bind to serotonergic receptors. They
are considered first-line treatment for moderate to severe migraines or
for mild-to-moderate migraine headaches that have failed other
analgesics. Triptans have vasoconstrictive properties so their use is
contraindicated in those with ischemic heart disease, stroke,
uncontrolled hypertension, or basilar migraine
A 55-year-old woman with restless legs syndrome presents with
worsening leg symptoms described as crawling and fidgeting over the
past 4 weeks. Her symptoms have been interfering with her quality of
sleep. When asked about medications, she reports only taking
pramipexole 0.5 mg (normal dose range: 0.125-0.5 mg) in the evenings.
Which of the following is the most appropriate next step in
management?
Discontinue pramipexole and start gabapentin
Offer reassurance and recommend a melatonin supplement at bedtime
, Order a CBC
Refer to neurology - ANSWERS-Order a CBC
Restless legs syndrome is a condition characterized by sensory
disturbances and an irresistible urge to move the legs during periods of
rest. Patients will often report disturbed sleep patterns and daytime
sleepiness. Certain conditions can predispose individuals to developing
the syndrome, such as family history of restless legs syndrome,
Parkinson disease, pregnancy, iron deficiency anemia, or diabetic
peripheral neuropathy
A 42-year-old woman presents to the office with double vision and eye
pain. She reports these symptoms started 4 days ago, and she
experienced a similar episode around 3 months ago. She reports pain
and blurring of vision in her left eye. She has no significant past medical
history and takes no medications. On physical examination, her vital
signs are normal. A focused neurologic examination reveals that the
patient cannot fully adduct her left eye while at the same time you
notice nystagmus on abduction of the right eye. There is dysmetria with
finger-nose testing in the right arm. What would be the first test to
order on this patient based on the suspected diagnosis?
Cerebrospinal fluid analysis for oligoclonal bands
Computed tomography of the brain with and without contrast
Magnetic resonance imaging of the brain with and without contrast
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