MCQ 9-11 : A 28 year old with severe left lower quadrant abdominal pain with an eight week history of amenorrhea

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Question: 09
A 38 year old woman being treated for hypertension and diabetes has the sudden onset of swelling and tenderness of the wrists and knees. On examination she is febrile and flushed. A friction rub can be heard at the left lower sternal border.
Which of the following drugs is most likely the cause of these findings ?
a) Metformin
b) Hydralazine
c) Minoxidil
d) Nitroprusside
e) Propranolol

Question: 10
Pulmonary abnormalities are a known side effect of several cytotoxic drugs. Which of the following cytotoxic drugs is most likely to lead to pleural effusions ?
a) methotrexate
b) 5-fluorouracil
c) taxoids
d) cyclopentenyl cytosine
e) trastuzumab
Question: 11
A 28 year old with severe left lower quadrant abdominal pain with an eight week history of amenorrhea. Her serum elevated human chorionic gonadotropin level is elevated. The most likely diagnosis is
a) dermoid cyst
b) ectopic pregnancy
c) endometrioma
d) follicular cyst
e) corpus luteum cyst

 Correct Answer: B

Explanation:
Drug-induced lupus refers to a form of lupus caused by medication. It causes some symptoms similar to those of SLE (arthritis, rash, fever, and chest pain, but not kidney disease) that go away when the drug is stopped. Common medications that may cause drug-induced lupus include hydralazine (Apresoline), procainamide (Procan, Pronestyl), methyldopa (Aldomet), quinidine (Quinaglute), isoniazid (INH), and some anti-seizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol).
This complication is more common in femlaes. It is also more common in 'slow acetylators' since the metabolism of hydralazine is reduced in these patients.

Correct Answer: A

Explanation:
There are at least 40 drugs which may produce adverse pulmonary effects. The more common ones are bleomycin, busulfan, mitomycin, BCNU, arabinoside, IL2 and methotrexate. The clinical features are dyspnoea, cough, pulmonary infiltrates, basal inspiratory crackles, and, rarely, pleural friction rub, pleural effusions, pulmonary fibrosis and eosinophilia.


Correct Answer: B

Explanation:
Most pregnancy tests are based on the fact that the placenta secretes human chorionic gonadotropin (hCG), a hormone that has a luteinizing action on ovarian follicles and probably has other functions that are not completely known. Serum hCG levels of about 25 milli-international units (mIU)/ ml (IU/L) are reached about 8-10 days after conception Abdominal pain with amenorrhea is the most common presenting complaint in an ectopic pregnancy, and clinicians should have a high index of suspicion for ectopic pregnancy in every woman of reproductive age who presents with these symptoms. Vaginal bleeding is present in only 40% to 50% of patients and may often be mistaken for a normal menstrual period. Patients may also experience the common pregnancy-associated symptoms of nausea and vomiting, breast tenderness, and fatigue


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