(MCQS 286-288 ):A 56 yr old diabetic complains of pain and stiffness in both her shoulders

Correct Answer: D
Dysfunctional uterine bleeding is the term used to describe abnormal bleeding caused by hormonal abnormalities in the absence of pregnancy, tumor, infection, or coagulopathy. Dysfunctional uterine bleeding is often associated with anovulation and continuous ovarian estrogen production. Continuous ovarian estrogen production associated with anovulation occurs and is diagnosed most commonly in adolescent and perimenopausal women. In adolescents, the hypothalamus begins to secrete GnRH once a critical body mass (weight) is achieved. The GnRH secretion stimulates LH and FSH secretion, which causes an increase in ovarian estrogen production, but ovulation may not occur. Continuous estrogen exposure results in endometrial growth. The absence of ovulation and progesterone exposure prevents the proper maturation of the endometrium and may result in abnormal uterine bleeding. In adolescents who are not pregnant, abnormal uterine bleeding is almost always the result of a hormonal abnormality (anovulation) or coagulopathy.

Correct Answer: I
For individuals with active TB isoniazid and rifampin are the recommended initial treatment regimen. In addition, ethambutol should be used unless primary isoniazid resistance is unlikely. International TB organizations also routinely recommend pyrazinamide; Pyridoxine should be added to the regimen to protect against isoniazid neurotoxicity. Isoniazid readily crosses the placenta, but it appears to be well tolerated. The risk of hepatotoxicity to the mother from this drug may be increased during pregnancy. The safety of rifampin in pregnancy is not well established. Limb reduction has been reported, but the incidence is not statistically different from the expected background rate. Rifampin induces hepatic enzymes that may increase the risk of hypoprothrombinemia and bleeding during the perinatal period. Ethambutol has shown no teratogenicity in humans, although cleft palate and other congenital defects have been reported in experimental animals. The ability of pyrazinamide to cause fetal harm is not known. Streptomycin should not be used during pregnancy. It has been reported to cause eighth cranial nerve damage and deafness in children born to mothers receiving this drug during pregnancy

Correct Answer: J
The primary symptoms of polymyalgia rheumatica are moderate to severe stiffness and muscle pain near the neck, shoulders, or hips. The stiffness is more severe upon waking or after a period of inactivity, and typically lasts longer than 30 minutes. People with this condition also may have flu-like symptoms, including fever, weakness, and weight loss. <br>The most typical laboratory finding in people with polymyalgia rheumatica is an elevated erythrocyte sedimentation rate


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