USMLE Forum Archives - USMLE Step 3 - IM: itching
IM: itching
meduploader - 05-31-09 14:12
A 45-year-old woman presents to your office in January with a complaint of generalized itching which has been present off and on for several months but has recently become more severe and almost constant over the past month. She has been healthy otherwise, takes no medications other than oral contraceptives, and has had no previous surgeries or hospital admissions other than to deliver 3 normal children. She thinks she may have had some itching during her third pregnancy.
No one else in the family has had similar complaints. Her physical exam is normal except for obvious excoriations related to scratching. 1. Possible causes of her itching include all of the following except a. uremiab. primary biliary cirrhosis c. oral contraceptivesd. dry skin related to dry winter climatee. celiac sprue2. Which of the following would be most likely to lead to the diagnosis of the cause of itching in this patient?a. Isolated elevation of alkaline phosphataseb. Elevated blood urea nitrogen(BUN) with a normal creatininec. Isolated elevation of aspartate aminotransferase(AST), normal alanine aminotransferase(ALT)d. Elevation of ALT and AST, normal alkaline phosphatasee. Elevated gamma-glutamyl transpeptidase(GGTP), normal alkaline phosphataseAn antimitochondrial antibody test is positive. The patient undergoes uneventful liver biopsy which shows changes diagnostic of stage 2 PBC.3. Which of the following drugs is least likely to relieve her itching?a. cholestyramineb. rifampinc. narcotic antagonistsd. colchicine4. Which of the following has had the greatest impact on the increased survival of PBC patients?a. Ursodeoxycholic acid 5-7 mg/kg/dayb. Ursodeoxycholic acid 13-15 mg/kg/dayc. Methotrexated. 6-mercaptopurinee. Liver transplantation5. Which is NOT a recommended treatment for osteoporosis associated with PBC?a. Estrogenb. Calcitoninc. Calciumd. Vitamin De. Bisphosphonate
meduploader - 05-31-09 14:12
A 45-year-old woman presents to your office in January with a complaint of generalized itching which has been present off and on for several months but has recently become more severe and almost constant over the past month. She has been healthy otherwise, takes no medications other than oral contraceptives, and has had no previous surgeries or hospital admissions other than to deliver 3 normal children. She thinks she may have had some itching during her third pregnancy.
No one else in the family has had similar complaints. Her physical exam is normal except for obvious excoriations related to scratching. 1. Possible causes of her itching include all of the following except a. uremiab. primary biliary cirrhosis c. oral contraceptivesd. dry skin related to dry winter climatee. celiac sprue2. Which of the following would be most likely to lead to the diagnosis of the cause of itching in this patient?a. Isolated elevation of alkaline phosphataseb. Elevated blood urea nitrogen(BUN) with a normal creatininec. Isolated elevation of aspartate aminotransferase(AST), normal alanine aminotransferase(ALT)d. Elevation of ALT and AST, normal alkaline phosphatasee. Elevated gamma-glutamyl transpeptidase(GGTP), normal alkaline phosphataseAn antimitochondrial antibody test is positive. The patient undergoes uneventful liver biopsy which shows changes diagnostic of stage 2 PBC.3. Which of the following drugs is least likely to relieve her itching?a. cholestyramineb. rifampinc. narcotic antagonistsd. colchicine4. Which of the following has had the greatest impact on the increased survival of PBC patients?a. Ursodeoxycholic acid 5-7 mg/kg/dayb. Ursodeoxycholic acid 13-15 mg/kg/dayc. Methotrexated. 6-mercaptopurinee. Liver transplantation5. Which is NOT a recommended treatment for osteoporosis associated with PBC?a. Estrogenb. Calcitoninc. Calciumd. Vitamin De. Bisphosphonate
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