(MCQS 325-327):A 17-year-old develops a tightening sensation in his mid sternum during exercise

Correct Answer: B
The pressurelike sensation after intense exercise, combined with the findings on auscultation, are the tip-offs to aortic stenosis. This patient is at risk for sudden death and needs immediate referral to a cardiologist.

Correct Answer: J
Valproate has emerged as a drug of primary choice for the treatment of acute mania, especially mixed mania and, partially, rapid cycling. Because of its relative safety, it can be administered in high doses as an oral loading therapy, with approximately 60% to 70% of patients showing a favorable response. Sodium Valproate may be used by people who have difficulty tolerating or do not respond to Carbemazipine, and in some cases Lithium. Another name for Sodium Valproate is Epilim. Side effects include those for carbemazipine plus increase in appetite, hair loss (transient) and tremor. Mixed states and rapid cycling are far more closely related than commonly thought. Both are more common in women, are associated with thyroid abnormalities, respond better to valproate than to lithium, and may be exacerbated by antidepressant therapy

Correct Answer: H
Cushing's disease typically causes fat cell enlargement causing medullary hypertension and intraosseous venous occlusion which may result in femoral head avascular necrosis


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