By E. Potros. Louisburg College.
A 32-year-old woman presents to you after a recent hospital admission for flash pulmonary edema buy cheap levitra super active 20mg on line. She was diagnosed with hypertension several months ago discount 40 mg levitra super active free shipping. Her blood pressure remains poorly controlled despite compliance with a regimen of hydrochlorothiazide, amlodipine, and metoprolol. Her physical examination is remarkable for a blood pressure of 204/106 mm Hg in the left arm and bilateral abdominal bruits. You consider the diagnosis of renal artery steno- sis (RAS) secondary to fibromuscular dysplasia (FMD). Which of the following statements regarding RAS and FMD is true? Renal ultrasonography should be the first step in the evaluation of RAS because a finding of symmetrical kidneys precludes the need for further testing B. Angioplasty with stenting has become the most common method of managing FMD associated with hypertension and renal insufficien- cy; this procedure completely cures more then 50% of patients with hypertension and improves renal function in over one third C. The segmental nature of medial fibroplasia, the most common sub- type of FMD, results in the classic so-called beads-on-a-string appear- ance in the proximal third of the main renal artery D. Surgical repair of aneurysms is required if their diameter is greater than 1. It affects the distal two thirds of the main renal artery and its branches. In patients with a compatible clinical picture, evaluation for RAS starts with renal ultrasonography to measure kidney size. Even if the ultrasound scan shows that the kidneys are equal in size, further diagnostic testing is required. The choice of procedures is determined by the level of renal function: patients with a serum creati- nine level below 2 mg/dl should undergo renography; those with a serum creatinine above 2 mg/dl should undergo magnetic resonance angiography (MRA). The gold stan- dard for the diagnosis of RAS remains a renal arteriogram.
Therefore cheap levitra super active 20mg free shipping, the aim of therapy should be to make the pain more tolerable without adding intolerable side effects of medication buy levitra super active 20mg amex. Of the many drugs that can be tried for neuropathic pain, tricyclics (espe- cially amitriptyline) and carbamazepine are still most frequently used, although gabapentin is increasingly used as a first-line agent. A 32-year-old woman presents to the emergency department with a complaint of weakness. Yesterday, she noticed some prickling paresthesias in her feet. Today, when she awoke, she noticed weakness in both legs; this weakness has rapidly worsened. You admit her to the hospital with a presumptive diag- nosis of Guillain-Barré syndrome (GBS). Which of the following statements regarding GBS is true? Another name for GBS is chronic inflammatory demyelinating polyneuropathy B. The fundamental pathologic event in GBS is the stripping of myelin from axons by macrophages, which occurs in a patchy fashion throughout the peripheral nervous system 4 BOARD REVIEW C. Several studies have proved that there is a link between a preceding Shigella dysentery infection and GBS D. A cardinal feature of GBS is the asymmetrical pattern of involvement Key Concept/Objective: To understand the pathophysiology and clinical presentation of GBS GBS, or acute inflammatory demyelinating polyradiculoneuropathy, is the most common cause of acute generalized paralysis in the Western world. Chronic inflammatory demyeli- nating polyradiculoneuropathy is an immune-mediated neuropathy whose onset is insidi- ous, with symptoms and signs developing over weeks to months. Most often, the first symptom of GBS is prickling paresthesia, begin- ning in the feet and spreading proximally hour by hour. Some patients have only motor symptoms without sensory symptoms. Classically, symptoms begin symmetrically in the distal limbs and proceed proximally (so- called ascending paralysis).