Items 341342

341. A 58-year-old Scandinavian male presents with shortness of breath and is found to have anemia. Peripheral blood smear shows macrocytosis and hypersegmented polyps. The patient also has postural hypotension. Skin shows both vitiligo and hyperpigmentation. Romberg sign is positive. Serum sodium is 120 meq/L (normal is 136 to 145 meq/L) and potassium is 5.2 meq/L (normal is 3.5 to 5.0 meq/L). Urinary sodium is increased. Which of the following is correct?

a. The patient's symptoms will be explained on the basis of folate deficiency b. Only 50% of such patients will have parietal cell antibody c. The patient is likely to have low levels of vitamin B12 and high levels of intrinsic factor d. The patient is likely to have low levels of vitamin B12 and decreased secretion of intrinsic factor

342. In addition to anemia, this patient is most likely to have a. Addison's disease of autoimmune etiology b. Pituitary insufficiency c. Hemochromatosis d. Inappropriate ADH secretion

343. A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter. Laboratory studies are as follows:

Platelet count: 40,000/|L (normal 130,000 to 400,000) Peripheral blood smear: fragmented RBCs PT: elevated PTT: elevated

Plasma fibrinogen: 70 mg/dL (normal 200 to 400)

The best course of therapy in this patient is a. Begin heparin b. Treat underlying disease c. Begin plasmapheresis d. Give vitamin K

e. Begin red blood cell transfusion

344. A 30-year-old female with Graves' disease has been started on propylthiouracil. She complains of low-grade fever, chills, and sore throat. The most important initial step in evaluating this patient's fever is a. Serum TSH

b. Serum T3

d. Chest x-ray e. Blood cultures

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