Internal-Medicine

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272 13: Clinical Pharmacology 52. (D) Benzene is associated with bone marrow depression. Benzene is present to some extent in most gasolines, and poisoning may result from ingestion or vapors. Acute benzene poisoning can cause severe CNS symptoms such as blurred vision, tremors, shallow and rapid respiration, ventricular irregularities, paralysis, and loss of consciousness. (Brunton, pp. 625–626) 53. (F) Ethylene glycol is widely used as antifreeze. It causes CNS depression and renal toxicity characterized by oxalate crystals in the tubules. As in methanol poisoning, ethanol is used as a competitive substance for alcohol dehydrogenase to decrease the rate of formation of toxic metabolites. (Brunton, pp. 599–600) 54. (K) Digitalis and verapamil decrease the refractoriness of the accessory pathways in Wolff- Parkinson-White syndrome (WPW) and the ventricular rate can exceed 300/min. This can be life-threatening and is treated with IV procainamide or cardioversion. (Kasper, pp. 1350–1351) 55. (I) Numerous cardiac and noncardiac medications can cause torsades de pointes. Although it has been described with amiodarone, this is quite rare. The arrhythmia can result in sudden death. Unstable forms of this arrhythmia are treated with cardioversion. (Kasper, p. 1353) 56. (B) MAT usually occurs in the setting of advanced lung disease. Treatment involves withdrawing theophylline and improving lung function. There may be some role for treatment with verapamil. (Kasper, p. 1350) 57. (E) Adenosine is the agent of first choice for the termination of AV nodal or AV reentrant tachycardias that are not terminated by vagal maneuvers such as carotid sinus massage. IV beta-blockers and calcium channel blockers are second choice. Digitalis IV acts too slowly and is not recommended for this type of arrhythmia. (Kasper, pp. 1347–1349) 58. (C, G, L) Melphalan is an alkylating agent of the nitrogen mustard type. Although not curative therapy, it is particularly useful in the management of multiple myeloma, breast cancer, and ovarian cancer. (Brunton, p. 1328) 59. (B, G, J) Methotrexate is classified as an antimetabolite, and is a folic acid analogue. Other tumors where methotrexate has an effect include osteogenic sarcoma, mycosis fungoides, and lung cancer. (Brunton, pp. 1338–1339) 60. (A) Bleomycin, a naturally occurring antibiotic, is useful in Hodgkin’s disease, non-Hodgkin’s lymphoma, and cancers of the testes, head and neck, skin, esophagus, lungs, and genitourinary tract. (Brunton, pp. 1361–1362) 61. (K) Flutamide is an antiandrogen that is useful in prostate cancer. Leuprolide, a gonadotropinreleasing hormone analogue, and various estrogen compounds are the other hormonal-type agents used in prostate cancer therapy. (Brunton, p. 1388) 62. (C, G) Sensory loss is not a side effect of phenothiazines. Parkinson-like symptoms disappear when phenothiazine is withdrawn. Dystonic movements involve the mouth, tongue, and shoulder girdle. As well as having useful antipsychotic effects, phenothiazines are useful as antiemetics and antinausea agents. They can also potentiate the effects of sedatives, analgesics, and general anesthetics. Some phenothiazines are intrinsically sedating, but none of them commonly interfere with sleep. (Brunton, pp. 477–480) 63. (B, F) The increased refractory period accounts for the effect on tachycardia. Similar effects are seen with procainamide. The slowed repolarization can result in a prolonged QT interval. Life-threatening polymorphic ventricular tachycardias (torsades de pointes) can be provoked by quinidine. It is rarely used in modern practice. (Brunton, pp. 928–929) 64. (A, D) In susceptible individuals, the beta2- adrenergic blocking effect of propranolol can cause life-threatening bronchoconstriction. Ephedrine, isoproterenol, and albuterol are betaadrenergic agonists and cause bronchodilatation.
Answers: 52–66 273 Ipratropium bromide results in bronchodilatation by its anticholinergic effect. The other medications listed have no effect on bronchial airways. (Brunton, pp. 195, 719–720) 65. (B, F) Caffeine and other methylxanthines also stimulate acid production. Vagal cholinergic stimulation is a major stimulus for gastric secretion. Alcohol may increase secretion by stimulating gastrin and histamine release. (Brunton, pp. 727–728) 66. (C) Xerostomia (dry mouth) can result from the anticholinergic side effects of taking amitriptyline. The other medications on the list are not usually known to cause a dry mouth. (Brunton, pp. 446–447)
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FOURTH EDITION LANGE Q&A INTERNAL
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iv Contents 9. Muscles and Joints .
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30 1: Cardiology 73. (D) In Wolff-P
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36 2: Skin DIRECTIONS (Questions 6
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42 2: Skin 32. A 32-year-old woman
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44 2: Skin DIRECTIONS (Questions 43
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50 2: Skin 50. (C) Chloroquine is u
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100 5: Hematology 4. A 62-year-old
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114 5: Hematology 19. (E) Steroids
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118 5: Hematology a chronic disease
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120 6: Oncology 3. A 42-year-old ma
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128 6: Oncology Questions 60 throug
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174 8: Kidneys 75. (A) The autosoma
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192 9: Muscles and Joints 8. (B) It
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198 9: Muscles and Joints 76. (D) D
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Page 240 and 241: 230 11: Immunology and Allergy 6. A
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Page 320 and 321: 310 Index Antineutrophil cytoplasmi
Page 322 and 323: 312 Index Dobutamine, 263, 270 Dono
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Page 326 and 327: 316 Index Pleuritis, 194 Pneumococc
Page 328: 318 Index Toxoplasmosis, 148, 226 T
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