Ischemic Heart Disease - Complications and Management MCQs

The first thing to note is the question is about planned management. This patient has been picked up early and has had a tumor resected. His CEA would be normal and would not be expected to be elevated until the disease was quite established on the TNM scale. However, this patient'' prognosis would be excellent but he is by definition someone with increased risk. Therefore, he should continue to be reviewed with colonoscopy annually for at least two years. Reference: Harrison's Principles of Internal Medicine, 21 st Ed, Ch:81 Pg: 640

First generation drug eluting stents include Sirolimus and Paclitaxel which have higher risk of restenosis and late stent thrombosis. Second generation stents including Biolimus, Zotarolimus and Everolimus have lower chances of these complications. Reference: Harrison Principles of Internal Medicine 21 st edition Page 2067

The patient in the question has a TIA(Transient Ischemic Attack). The next best step is to find out the source of the thrombus and treat it to prevent the recurrence and stroke. CT angiography of vessels in the head and neck to find the source of the clot.

The presence of low back ache with morning stiffness in indicative of an inflammatory low back ache. The features of inflammatory back ache includes: Age of onset Morning stiffness of > 30 minutes Improvement with exercise No improvement with rest Pain during the second half of night which improves up on awakening Alternating buttock pain Axial spondyloarthritis are a common cause of inflammatory back ache in young patients and among the given options the test used in diagnosing an axial spondyloarthritis is Sacroiliac tenderness. Others include stretching of the Sacroiliac joint- FABER (Flexion abduction and external rotation) test or the Patrick test. Tenderness in the posterior spinous process of the vertebrae. Reference: Harrison's Principles of Internal Medicine 21 st ed, Ch: 362, Pg: 2793

The chief interleukins that drive PsA are IL17 and IL 23. The biologics that are used in treatment of PsA act by antagonizing these cytokines. They include: Anti IL 17: secukinumab and ixekizumab Anti IL-23/IL-12p40 : ustekinumab, a monoclonal antibody to the shared subunit. Anti IL-23 (p19 subunit)-guselkumab, risankizumab, and tildrakizumab Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch: 362, Pg: 2800

Pain and stiffness in the lower back or buttocks, especially in the morning is typical of sacroiliitis. It is typically helped by NSAIDS or steroids . X rays will help to confirm the diagnosis. It is associated with various inflammatory diseases e.g. ankylosing spondylitis, psoriatic arthritis, arthritis associated with IBD, Reactive arthritis etc Reference: Harrison's Principles of Internal Medicine 21 st ed, Ch: 362, Pg: 2790

The cornerstone in the management of RA are DMARDS. Conventional DMARDS are the first choice, Methotrexate is the DMARD of choice for RA. It can be started either as a monotherapy or with other conventional DMARDS like HCQ, Sulfasalazine. Leflunomide is another DMARD that can be used which is equally efficacious as Methotrexate. The recent approach is early intensive therapy with combination of DMARDs to minimize disability. Reference: Harrison's Principles of Internal Medicine, 21st ed, Ch: 358, Pg: 2761-2764

The patient presents with an acute hypercalcemic crisis which can result in the development of systolic arrest of the heart. Therefore, it is imperative to decrease serum calcium of the patient with administration of normal saline and eventually furosemide drip.Normal saline will cause hydration and once the rehydration is complete then initiate furosemide drip. This will result in urinary loss of calcium.Eventually, bisphosphonates and intranasal calcitonin are administered.In the case of AKI, hemodialysis is needed. Reference: Harrison 20 th chap. pg.314