TommyK 1681 - 1731

[Cadusma]

1681
happy 4th! and the new format erased all the mails, so if I did not respond, then please email again.
Anyhow, some friends told me that some of the questions were tricky regarding HIV. The concepts were:
1) Why is HIV so hard to eradicate? (Concept was in molecular biology).
2) Which HIV section is responsible for the inability for vaccination (choices were env, gag, pol, ... up to about 5-6 choices I heard!)
3) Another was HOW QUICKLY does the virus titer elevate? The case concept was a health care worker injected with a needle stick only 7 days prior! (I think too soon for CD4 levels to show marked decrease which was of course what they wanted you to pick). They wished to know how to measure possible infection within such a short period of time, if any...
Big concept...HIV research...


1682
This was a classic one... but a bit hard...
Questions were centered on simply "pointing" to a certain structure in the brainstem. Seems easy, but there are SO MANY structures!!! Many of the students got the same cross sections, but some had to point to the pituitary gland, some to the hypothalamus. CT scans can get a bit tough, so the best way I recommended, and still recommend, is to get an atlas, then COVER UP ALL THE NAMES, and pretend that ALL the structures are a single "concept"/questions, and see if you can point them all out (nucleus basalis of Meynert was a VERY CRUCIAL ONE because it is Ach-related and is implicated in Alzheimer's dx.). Remember that!


1683
Here is a good one, and thanks for prayers, it is about a sick family member.
A 4 year old girl is listless and not arousable, so her mother takes the child to the emergency room. The examining physician notes a temperature of 38.8 C and nuchal rigidity. Child had no immunization shots. A lumbar puncture yields slightly cloudy CSF with a protein of 70 mg/dL and glucose 20 mg/dL (serum glucose 80mg/dL). A culture of CSF is most likely to yield ...? (Pick from: H flu., Cryptococcus...pigeons! as Dr. Goljan would say), Asper****us, Mycobacterium, CMV)...(Guess first please) (Group B strep not one of the choices).

a) Due to no immunizations, H. flu is an older, tricky correct choice. This concept reminds me of the association between C. jejuni and Guillain-Bare syndrome...a board favorite...do you recall how Guillain-Bare presents???...after a viral infection, ascending paralysis..etc...


1684
A newer juicy juice but HARD concept is...
A case regarding a young man (20s) with sudden onset of severe anxiety not related to phobias. He is sweating, panic attacks, racing heart...no history of drug abuse at all or prior history. He is woken up at night. Labs all normal. TSH normal!! The class argued forever on the possible treatment...(Buspirone, Benzodiazepine, or Beta Blockers).
Not certain of this one because all seem possible. I have to see the exact wording, but this is a toughie...

Hmmm...
I'm thinking Buspirone b/c of the lower likeliness of addiction...in a situation like this, shouldn't we choose a drug with fewer side effects and decreased likelihood of addiction?


1685
One of my friends asked if she should quit after her 5th failure and I had to
ask her what are the exact scores and how long does she have to study???
That is a crucial issue. If you have multiple failures, you should not give up unless:
1) Family matters most. If someone is close to you and needs you, you have a good reason before God and to yourself to back away from medicine.
2) Your "psyche" matters much. If you are "going insane" or "losing your mind" as I have heard some do, then STOP! I have heard of many suicides...that is not going to serve yourself or God! If you are near a breaking point, you should pray and ask God for a new direction, or take a vacation.
3) Consider your score improvement. Are they slowly INCREASING OR DECREASING? Also, Kaplan Q-Bank is very useful in that you can keep a written journal on your progress. This IS VERY VERY IMPORTANT! If you are scoring say, 115, 134, 151, 165, 178, ... then you will likely pass soon!!! But if your scores keep going down or plateau OR if there are financial issues in addition to family matters that is stopping you from passing, you must ask God for a new direction. Many I knew hit that wall and then did something related like Physician's Assistant, Nurse, etc. There is NO shame, you are responsible to God and yourself.
4) Time issues are critical...if you are stopped from studying due to lack of money or there is an issue where you cannot study for more than 3-4 hours a day, you must regroup and try to see if you will have time in the near future.
5) HOW are you studying? Some have ALL the resources, but are only reading to memorize, not understand. Simply flash-memorizing worked 99% of the time in the past, but the sheer magnitude of the material necessitates understanding, which lasts much longer than quick flash-memory. For e.g., are you drawing out the biochem. pathways from your mind or only reading them? If you only read them over, you WILL forget because there is TOO MUCH material.


1686
There was a specific concept on the mech. of action of strychnine. Say I present a case of toxic dose to a human who was using it as either a drug or a rat-poison. What is the mech of action? What neurotransmitter is blocked?

a) Serve as antagonists of the neurotransmitter glycine at the postsynaptic spinal cord motor neuron. So the "off" button is deactivated, leading to overexcited nerves.


1687
KNOW that impulse conduction in axons can be blocked by PRESSURE, and a cut of the nerve cord distal to the lesion exhibits Wallerian degeneration.


1688
Here is a fruity concept, strict anatomie
There is a picture I am presenting in your mind of the duodenum...I am asking about the blood supply that feeds from the abdominal aorta. Name the two arteries...KEY concept.

a) Off the abdominal aorta, the celiac trunk gives off the common hepatic artery, then the gastroduodenal artery.


1689
A forty yr old male comes in with all the features of ACROMEGALY. You know, bigger jaw, nose, shoe size... Tell me the best test to pinpoint the diagnosis....(random GH, prolactin, or IGF-1)

a) IGF-1, remember that random GH is too inconsistent.


1690
Here we go...immuno...
Picture this concept, a picture of a developing CD8 T-cell is shown with IL-2 directly activating it. BUT...know that Boards want you to understand which subset T cell (Th0, Th1, Th2, Th3) is IL-12...again IL-12...acting on which turns it into the CD8 cytotoxic cell.

a) People got it confused...MHC Class I and Th1 and CD1. KNOW it is Th1. Th2 is made as IL-4 acts on the naive T cell. Recall that it is IL-4 that pushes the naive T-cell to become Th2 which via IL-4 and IL-5 assists in antibodies to be formed.


1691
A bit hard, but HY
Elderly female pt. Has loss of vision in left eye, generalized fatigue, left sided headaches, arthritis, mild weight loss. She has...(Optic neuritis, Temporal arteritis, neoplasm adjacent to optic chiasm, closed angle glaucoma) Pick one...

a) Temporal arteritis! do not be fooled by the eye symptom and get too mislead to picking the other choices. Temporal arteritis is common and has the arthritis mixed with the vision and headaches. Administer corticosteroids to prevent blindness.


1692
delicious!
Where does Fe2+ feed into the cycle of hemoglobin synthesis (specific location AND with what compound...please guess first before looking at the answer below)...

a) Fe2+ feeds in with PROTOPORPHYRIN in the MITOCHONDRIA to make heme as an end product. KNOW that lead paint chips will block this step as well as other steps.


1693
Missing


1694
Basically, there was a series of Boards questions which tested the concept of whether a schizophrenic patient can either refuse or accept treatment which is life saving. So, tell me, can he refuse?

a) I believe that he cannot have a say because he is not legally competent according to U.S. law. Does anyone think otherwise regarding this HY concept?


1695
I cannot believe that they got this specific...
Hard question, but guess first. Which is the best inhibition for gluconeogenesis (pick from AMP, ADP, ATP, cAMP, NADPH)...?

a) ADP


1696
Yummy case...
Female, 50 years old, woman noticed tinnitus in her left ear which progressed over 5 weeks to hearing loss. On PE she is found to have a marked decrease in hearing-- left, with Rinne test indicating air conduction better than bone conduction. All other CNs normal. A brain MRI scan showed a solitary, discrete, 3 cm mass located in left cerebellopontine angle. What is this? Could it be a malignant neoplasm from HIV?

a) People confused this with multiple sclerosis or non Hodgkins lymphoma. The correct answer is SCHWANNOMA, which may be cut out with a good prognosis!

[Cadusma]

1697
Not Available


1698
Hey, KNOW that activated platelets release negative phospholipids to form a surface to bind clotting factors. Boards are focusing on "third" tier thinking now like knowing platlets release PHOSPHOLIPIDS, and not just the obvious stuff like NO (nitrous oxide) that vasodilate... OK? KNOW the "third tier" stuff. Questions such as "Which factor is in the extrinsic pathway?" (factor 7) are no longer being asked with frequency... By the way, I heard that the MCAT is getting really really hard too...


1699
Before looking below, what is the EXACT mech of action of plasminogen/plasmin? BE PERFECT... Plasminogen is a third component of blood, and can be activated to yield another trypsin-like protease (remember the word PROTEASE) called plasmin. Plasmin specifically attacks the helical regions of fibrin clots, allowing the clot to redissolve (remember the word HELICAL REGIONS)


1700
If you have a PM, try to send it again. If I do not respond, then that means I never got it at all! My mailbox got overloaded about 7 times, but I could not access the mailbox. Sorry. Listen, what nerve innervates the adductor muscles in the thigh (visualize a DIAGRAM OF THE LEG POINTING TO THE ADDUCTOR LONGUS)? Guess before looking at the answer below!

a) One of the large muscles innervated by the nerve forms the medial boundary of the femoral triangle. Answer is the Obturator nerve, L2, 3, 4. (You better know that! It is key in Orthopedic surgery)


1701
Turner's Syndrome. You KNOW it is XO genotype. But is the mechanism of action imprinting? (While at it, know all about Turner's) If so, what is the mechanism of the imprinting? Always asked, but it is exactly how the Boards are asking questions now.

a) Yes, it IS imprinting. The optimal method for gene imprinting is DNA methylation. Remember the word methylation!!!!


1702
There is a case of a 44 year old patient with inoperable gastric adenocarcinoma and exuberant lesions of the skin, hyperpigmentation of the axilla. What is the disease that is PARA ENDOCRINE?

a) acanthosis nigricans. Please look at a picture of it....


1703
(popular Histo question) KNOW that dynein arms have CILIA. And ATP activity. Be ready to see a picture since cilia, flagella, and centrioles are all made up of MICROTUBULES. You WILL encounter microtubules on your test.


1704
So common that you will see this... Pt. Presents with pain in hands and feet and you are told the disease is Fabry’s Disease, a lipid storage disease with increased risk of strokes and other organ damage. What is the missing enzyme? Also what is the drugs of choice? Guess first please.

A) Deficiency of alpha-galactosidase A is the problem. Antiplatelet agents are used for secondary stroke prevention. Anticoagulation with warfarin is prescribed when a cardioembolic stroke is suspected. Painful neuropathies can be treated with a variety of medications, including carbamazepine or phenytoin. This is an X-linked lysosomal disorder that leads to excessive deposition of neutral glycosphingolipids in the vascular endothelium of several organs in the body. Progressive endothelial accumulation of glycosphingolipids accounts for the associated clinical abnormalities of skin, eye, kidney, heart, brain, and peripheral nervous system.


1705
Patient 35 year old male (note the young age!) presents with low back pain (LBP) that progresses with a series of exacerbations and remissions. Patient complains of morning stiffness that is relieved with exercise. Fever and weight loss may occur during periods of active disease. The LBP is dull and poorly localized to the gluteal and SI areas. He was diagnosed with ulcerative colitis last year. You likely KNOW the HLA marker, but what bacteria is now thought to trigger this disease? Also, tell us all you know about this disease that has up to a 1% prevalence in the world and so it bound to be on your test….

a) Klebsiella pneumoniae is now studied as a possible “trigger” for Ankylosing spondylitis (AS), a chronic, multisystem inflammatory disorder of the sacroiliac (SI) joints and the axial skeleton. AS is characterized as a seronegative spondyloarthropathy. The disorder often is found in association with other seronegative spondyloarthropathies including reactive arthritis, psoriasis, juvenile chronic arthritis, ulcerative colitis, and Crohn disease. The etiology is not understood completely; however, a strong genetic predisposition exists. A direct relationship between AS and the major histocompatability human leukocyte antigen (HLA)-B27 has been determined. You know this already I hope. A genetic predisposition exists among persons with the HLA-B27 major histocompatability antigen. Patients often have a family history of either AS or another seronegative spondyloarthropathy.


1706
A MALE patient of yours presents with hemolytic anemia, high reticulocytes. And dark urine in the morning. Smear shows sickling. What is the disease and treatment? KNOW that sickle cell anemia and other hemolytic disorders can be associated with leg ulcers caused by decreased red cell deformity and endothelial changes. This is also G6PD deficiency!! KNOW that the platelet count is normal in most hemolytic anemias. KNOW that you can administer packed RBC slowly to avoid cardiac stress and you should avoid oxidant meds like penicillin and other agents that can cause immune hemolysis and oxidant medication such as sulfa drugs. This is so common on Boards.


1707
Straightforward question: What AA makes melatonin?

a) tryptophan


1708
Again, please guess before looking at the HY answer... Another straightforward: Of the water soluble vitamins, which one is stored in the liver?

a) Vitamin B12


1709
Basically, you are asked the cremasteric reflex. What are the spinal cord segments and the nerve involved?

a) Genitofemoral nerve, L1 and L2


1710
Hard Question, but a good one. Say you are given a case on Krabbe disease. It is rapidly progressive and presents early in infancy with irritability, seizures, and hypertonia. Question is, What is the mechanism of the disease? How is it diagnosed? Think first the category of the disease.

a) This is a lipid storage disorder, they are a family of diverse diseases related by their molecular pathology. In each disorder, a deficiency of a lysosomal hydrolase is inherited, which leads to lysosomal accumulation of the enzyme's specific sphingolipid substrate. Lipid substrates share a common structure, including a ceramide backbone (2-N-acyl-sphingosine), in which various sphingolipids are derived by substitution of hexoses, phosphorylcholine, or one or more sialic acid residues on terminal hydroxyl groups of the ceramide molecule. Pathways of glycosphingolipid metabolism in both nervous tissue and visceral organs are elucidated, and for each catabolic step, a genetically determined metabolic derangement is identified. Diagnosis is via brain imaging studies frequently obtained during evaluation of infants and children with developmental delay or retrogression. However, they are not essential to diagnosis, which is dependent upon demonstration of specific enzymatic deficiency in peripheral blood leukocytes or cultured fibroblasts. You can also do a chest radiograph and they include anterior beaking of vertebrae, enlargement of sella-turcica and thickening of calvarium.


1711
Gaucher’s Disease (esp. type 2) is often deadly with little tx.possible. But, what is often newly used to treat Gaucher disease?

a) New enzyme production products are HOT on Boards. KNOW recombinant b-glucocerebrosidase product (imiglucerase) can be used (because this enzyme is DEFICIENT!). KNOW splenic rupture is common in untreated Gaucher’s.


1712
Biggie Scoop of Vanilla Ice Cream Question KNOW THIS: The filtered plasma after the glomerulus is slightly hypotonic repeat: hypotonic! to blood, as it contains no protein (usually). Also KNOW where in the nephron it is MOST hypotonic and hypertonic!!! (Hint: there will be arrows and a,b,c,d,e everywhere)


1713
KNOW this conversion: In blood: But in the urine, these changes occur via the kidney tubules
Bicarbonate turns to CO2 and H20
NH3 NH4+ (ion)
HPO4- H2PO4-
It is on Boards. Do you understand the mechanisms? Don’t just memorize, but understand the above concept along with the enzymes needed. It IS very high yield.


1714
Guaranteed to be seen KNOW the very basics on banding patterns on gel electrophoresis and how it is used in the laboratory in clinical tests. EVERYONE got at least one of these. I promise you will too.


1715
Remember not to get AML and CML confused since the ages of onset interlap. Many lost points on these. KNOW that Boards often show Auer Rods in AML (note the 2 A’s in the name), and CML is the one with the clue on the t(9,22) and philadelphia chromosome. ALL and CLL are more obvious from the age of the patient clue. Note also any signs of acute onset!


1716
A 17 year old patient has a knife wound at T4 level on left side with pleuritic chest pain, dyspnea, tachypnea, cyanosis, and decreased breath sounds on the involved side. What is the disease and what will you do? (Hint: Inhalation of some toxic substances, most notably crack cocaine, can also lead to this condition). Boards love this, be ready to see a radiograph.

a) This is a pneumothorax. If the radiograph showed the affected lung moved over to the other side, it is a TENSION pneumothorax. In general, treat a small, simple pneumothorax conservatively unless the patient is symptomatic; use oxygen to increase reabsorption of intrapleural air (remember George Clooney helped Mark Wahlberg in Three Kings?), observe the patient, and repeat chest radiographs. However, a small, simple pneumothorax in a trauma patient is best treated with a chest tube since it may rapidly convert into a tension pneumothorax, especially if positive pressure ventilation is applied. Large or symptomatic pneumothoraces require chest tube placement and surgical intervention. A tension pneumothorax requires immediate decompression with needle thoracostomy.


1717
Do you know in which phase of the cell cycle (you will be shown a circle with the phases labeled) the enzymes for glycolysis are made?

Hint: Think of what phase of the cell cycle most proteins are made...

So in response to question 1717, proteins are made in G2 of the cell cycle. So is that where the enzymes of glycolosis are made?

Take a look here ... http://www.cellsalive.com/cell_cycle.htm

Interphase: Interphase generally lasts at least 12 to 24 hours in mammalian tissue. During this period, the cell is constantly synthesizing RNA, producing protein and growing in size. By studying molecular events in cells, scientists have determined that interphase can be divided into 4 steps: Gap 0 (G0), Gap 1 (G1), S (synthesis) phase, Gap 2 (G2).

Gap 0 (G0): There are times when a cell will leave the cycle and quit dividing. This may be a temporary resting period or more permanent. An example of the latter is a cell that has reached an end stage of development and will no longer divide (e.g. neuron).
Gap 1 (G1): Cells increase in size in Gap 1, produce RNA and synthesize protein. An important cell cycle control mechanism activated during this period (G1 Checkpoint) ensures that everything is ready for DNA synthesis. (Click on the Checkpoints animation, above.)
S Phase: To produce two similar daughter cells, the complete DNA instructions in the cell must be duplicated. DNA replication occurs during this S (synthesis) phase.
Gap 2 (G2): During the gap between DNA synthesis and mitosis, the cell will continue to grow and produce new proteins. At the end of this gap is another control checkpoint (G2 Checkpoint) to determine if the cell can now proceed to enter M (mitosis) and divide.

Mitosis or M Phase: Cell growth and protein production stop at this stage in the cell cycle. All of the cell's energy is focused on the complex and orderly division into two similar daughter cells. Mitosis is much shorter than interphase, lasting perhaps only one to two hours. As in both G1 and G2, there is a Checkpoint in the middle of mitosis (Metaphase Checkpoint) that ensures the cell is ready to complete cell division. Actual stages of mitosis can be viewed at Animal Cell Mitosis.


1718
On Boards: Your patient has hypertension but also asthma. Do you give Reserpine or Propanolol if those are the only choices?

a) Reserpine. Propanolol is VERY bad here. Think why…(recall binding receptors)


1719
Pt. Male, older, presents with urinary retention and urinary frequency and incomplete emptying and straining during voiding. Biopsy shows NO cancerous cells. What is the disease and what substance does it secrete? What drugs can you use? Since physical diagnosis questions are in vogue, what is the first thing you should do? Also, what does the secretion of the organ do? All this is on Part 1…

This is benign prostatic hypertrophy. Confirm with a digital rectal exam. I know I know, I do not like doing this either…Also do a prostate specific antigen level test (even though BPH does NOT lead to cancer) Meds include alpha blockers like prazosin, terazosin, phenoxybenzamine (each have slight different MOAs, do you know them?). You may also be asked to choose a 5 alpha reductase inhibitor like finasteride (what product is blocked? DHT!) Transurethral resection of the prostate (TURP) has long been accepted as the criterion standard for relieving BOO secondary to BPH. But they use lasers and all sorts of other procedures for relief! The prostate produces alkaline fluid that comprises approximately 70% of the seminal volume. It is a conduit for semen to pass, and it prevents retrograde ejaculation (ejaculation resulting in semen being forced backwards into the bladder) by closing off the bladder neck during sexual climax. The fluid (semen) helps to neutralize the acidic vaginal environment and provides carbohydrates and nutrients for the sperm. Cool!


1720
90% chance of this being on your test
Does Lasix/furosemide get rid of Calcium in the urine?

a) Clinical uses of the diuretics include alkalization of the urine in myoglobinuria (e.g., crush injuries, cocaine abuse) and in uric acid nephropathy, as well as in aspirin or barbiturate overdose. Acetazolamide is useful in high-altitude sickness. It induces a metabolic acidosis which stimulates the respiratory drive and diminishes altitude-induced hypoxemia. Recall it alkalanizes the urine. The number-one side effect of thiazide diuretics is mild hypercalcemia. KEY POINT is that furosemide/Lasix another type of diuretic induces hypocalcemia. A MAJOR MAJOR clinical point and thus often asked. E.g. You can use Lasix to lower serum Calcium in cancer patients. Also, KNOW Selegiline is a MAO B inhib that blocks the dopamine degradation. It is used in Parkinson’s.


1721
Always be monitoring your progress via Q-Bank, or use these concepts on notecards, etc. etc. You have to know if you are making progress. If not, you HAVE to find an alternate strategy. OK? Get a strict monitoring system (percent correct) today. And make SURE you are getting the TIME to study. If your % percent correct in any test question bank is falling or not rising, you have to reassess your strategy.


1722
A 27 year old Britney Spears look alike develops a UTI from Chlamydia trachomatis. What pharm drug will you chose? Pick between gentamycin, tetracycline, erythromycin.

a) erythromycin


1723
100% board material You 22 year old male pt ingests an overdose of bicarbonate for his heartburn. What is the blood gas going to show?

a) You will see metabolic ALKALOSIS and respiratory ACIDOSIS. Look for those values in the answer choices. Be CAREFUL.


1724
Board Worthy Really, 95% prob. Of being on your test A 18 year old high school student is found with an APTT of 78/32. PT is 13/12 (patient/control). Bleeding Time is given as 10 minutes with a platlet count of 350,000. [This is elevated] What is the disease? What is the inheritance pattern? What lab test is positive? Drug treatment please? What disease that is growing in the U.S. in prevalence is often associated with this disease?

a) This is Von Willebrand’s disease. So common. It is autosomal dominant. Look for epistaxis and MENORRHAGIA. Ristocetin test is positive. Transfuse with CRYOPRECIPITATE. HIV patients often are seen with Von Willebrand’s dx.


1725
Kinda Hard, but try it… An 85 yr old male, weighing 75 kg, emphysema is intubated after developing adult respiratory distress syndrome fr. Escherichia coli. His ventilator is set to a respiratory rate of 20/min, a tidal volume of 750 mL/breath, and a pO2 of 100%. If these settings are continued for 80 hours, the patient is likely to get what complication? (Pulmonary embolus OR Pulmonary fibrosis), and why?

a) High concentrations of oxygen delivered through a ventilator may lead to pulmonary fibrosis. In (ARDS), if the inspired fraction of oxygen cannot be lowered without producing hypoxia, the addition of positive-end expiratory pressure (PEEP) is needed, KNOW this. Although PEEP does increase the risk of hypotension by impairing right-sided heart filling, it is indicated to prevent the development of oxygen toxicity.


1726
KNOW you can get jugular venous distention from a tension pneumothorax.


1727
(Picture shown) A young boy is found to have bilateral metaphyseal fractures of both proximal and distal ends of the tibia. The mother says that her boyfriend takes care of the infant while she is at work. Which of the following is the most likely diagnosis? Pick Osteogenesis imperfecta or Physical abuse (Hint: consider location of the injuries and past history)

a) Physical abuse. Punch that boyfriend in the face. KNOW Metaphyseal fractures are the most typical (although not the most frequent) injuries due to physical abuse


1728
KNOW that Osteopetrosis is a hereditary disease caused by dysfunction in osteoclasts. not osteoblasts.


1729
There once was an 80 yr old man w renal dysfunction, congestive heart failure, myocardial infarction undergoing dialysis. Over the past few weeks, however, he has been feeling increasingly depressed and has begun to act bizarrely, with delusions that the government is poisoning him. Also in the last few weeks, due to increased stomach pain, his medications have been adjusted and now include cimetidine for stomach ulcers, digoxin, and a baby aspirin daily. He also takes docusate sodium as needed for stool softening and ibuprofen. Which pharm drug is causing this craziness of the meds listed?

a) Cimetidine is the only drug listed known to cause psychiatric effects of clinical significance.


1730
(Labs given) A 35-year-old primigravid woman at 30 weeks' gestation comes to YOU with regular contractions every 6 minutes. Her prenatal course was significant for type 1 diabetes, which she has had for 10 years. Over the course of 1 hour, she continues to contract, and her cervix advances from closed and long to a fingertip of dilation with effacement. The patient is started on magnesium sulfate, penicillin, and betamethasone. Which is the most likely side effect from the administration of corticosteroids? Pick Increased maternal insulin requirement OR Neonatal adrenal suppression.

a) Increased maternal insulin requirement. Corticosteroids are known to lead to more difficult glucose control in diabetic women. This is Step 1 material.


1731
A 27yr old woman comes to you because of amenorrhea. She had menarche at age 13 and has had normal menses. However, her last menstrual period was 8 months ago. She also complains of milky nipple discharge. She is particularly concerned because she would like to become pregnant. (hCG) is negative. Thyroid stimulating hormone (TSH) is normal. Prolactin is elevated. What drug do you give? (T4, T3, Bromocriptine, OCPs)

Bromocriptine, Hyperprolactinemia is the cause in approximately 10 to 20% of cases of amenorrhea. It is known that elevated prolactin levels alter the hypothalamic-pituitary-ovarian axis such that ovulation is suppressed and menses do not occur all this is likely coming from a pituitary microadenoma. Bromocriptine is a dopamine agonist that has been shown to decrease prolactin levels and bring about a return of ovulation and menses.