Which of the following tests would be considered t

Question 1 of 5

Which of the following tests would be considered the gold standard for the diagnosis of pulmonary embolism?

A. Arterial blood gas (ABG) B. Pulmonary angiogram C. D-dimer test D. Pulmonary arteriogram

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 2 of 5

Which of the following most correctly describes the actions of insulin?

A. Insulin stimulates cellular potassium uptake, inhibits adipocyte lipolysis and inhibits protein breakdown in peripheral tissues B. Insulin stimulates hepatic gluconeogenesis, glucose uptake in peripheral tissues and adipocyte lipolysis C. Insulin stimulates hepatic glycogen synthesis, glucose uptake in peripheral tissues and adipocyte lipolysis D. Insulin stimulates hepatic glycogen synthesis, glucose uptake in peripheral tissues and stimulates adipocyte lipolysis

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 3 of 5

An 80-year-old woman with background history of Type 2 Diabetes, hypertension and mild renal impairment is admitted with symptoms of haemoptysis and pleuritic chest pain. She is suspected to have a pulmonary embolism and a CT pulmonary angiogram is booked. She normally takes Metformin 500 mg TDS. What advice would you give her regarding metformin?

A. Patients on metformin should not undergo I.V contrast examinations irrespective of the renal function and should be considered for alternate investigations B. Suspend metformin for 48 hours before and for 48 hours after the test and start at a lower dose if renal function has returned to the baseline C. Suspend metformin for 48 hours prior to the test and restart immediately after if the renal function is returned to baseline D. Suspend metformin immediately after the test for 48 hours and restart if renal function has returned to baseline

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 4 of 5

A patient has a history of chronic iron deficiency anemia requiring a recent blood transfusion. She has undergone an extensive GI work-up including upper endoscopy, colonoscopy, capsule enteroscopy, and abdominal CT scan. Her only medications are ferrous sulfate, baby aspirin, COX II inhibitor, and HCTZ. Which statement is true?

A. A dedicated small bowel series has a high likelihood of being positive B. 81 mg of aspirin per day decreases the benefit of using a COX II inhibitor C. The patient should have a provocative arteriogram with heparin infusion to identify the source of blood loss D. Hormonal therapy has been shown to be effective in decreasing blood loss due to arteriovenous malformations

Correct Answer: B

Rationale: Dedicated small bowel series is typically of low yield in the diagnostic evaluation of chronic iron deficiency anemia. Provocative arteriograms have been performed in patients with gastrointestinal hemorrhage of obscure origin, but only a small series of cases have been reported, and it remains to be determined if this therapy can truly be done safely with a significant diagnostic yield. Hormonal therapy has been given to patients with arteriovenous malformations, but a randomized controlled trial published in 2001 showed no benefit using ethinyl estradiol and norethisterone in reducing recurrent bleeding in patients with angiodysplasia. It is important to recognize that even a baby aspirin a day can decrease the benefit in mucosal protection gained from using a COX II selective inhibitor.

Question 5 of 5

Which statement is true regarding Barrett's esophagus?

A. Treatment with PPI to control GERD symptoms causes Barrett's epithelium to regress B. Barrett's esophagus with high-grade dysplasia should be treated by more frequent endoscopic surveillance and esophagectomy considered once malignancy is identified C. Most patients with Barrett's esophagus will eventually develop esophageal cancer D. Endoscopic surveillance should be conducted in patients with Barrett's esophagus with intestinal metaplasia, but the frequency is debated

Correct Answer: D

Rationale: Treatment with PPIs should be directed at control of GERD symptoms and not with the expectation that Barrett's epithelium will regress, as this has yet to be proven. The presence of high-grade dysplasia is an indication for esophagectomy or endoscopic ablation by photodynamic therapy because there is high likelihood that adenocarcinoma is present by the time high-grade dysplasia is identified. Although patients with Barrett's esophagus with intestinal metaplasia are at higher risk of developing adenocarcinoma compared to the general population, the reality is that the vast majority of patients will never develop adenocarcinoma. Endoscopic surveillance at periodic intervals is generally recommended in those patients with Barrett's esophagus and intestinal metaplasia.

Which of the following tests would be considered the gold standard for the diagnosis of pulmonary embolism?

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