Internal-Medicine

304 14: Comprehensive Review
At times, a diverticulectomy is also required.
(Kasper, p. 1745)
97. (C) The film shows hypochromic, microcytic
red cells, suggesting iron deficiency. Although
thalassemia can mimic iron deficiency, the
normal hemoglobin 1 year earlier makes this
unlikely. Anemia of chronic disease is unlikely
because there are no signs of such a chronic
disease. Thus, blood loss from the GI tract is the
most likely cause. (Kasper, pp. 589–590)
98. (A) The macrocytic cells and hypersegmented
neutrophil are characteristic of megaloblastic
anemia. Vitamin B 12
and folate deficiency are
the most common cause. Lack of intrinsic factor
because of gastrectomy will eventually result in
B 12
deficiency. (Kasper, p. 604)
99. (D) Coronary angiography is a relatively safe
procedure in the right individual. There are
complications associated with this procedure that
must be reviewed with the patient while
obtaining informed consent. The risk of stroke
and myocardial infarction is 1 in 1000 with
coronary angiography. Other complications are
arrhythmias, allergic reaction to the dye, and
renal dysfunction. (Kasper, pp. 1327–1328)
100. (C) The major bleeding complication rate with
long-term warfarin anticoagulation is approximately
1–3% per year when the target international
normalized ratio (INR) is 2–3. (Kasper,
pp. 689–690)
101. (B) Beta-adrenergic receptors become less sensitive
with advancing age. Higher rates of isoproterenol
infusion are required in the elderly
to achieve an increased resting heart rate.
Clinically, higher doses of propranolol have
been shown to be required in the elderly to
achieve similar degrees of beta-blockade as in
the young. (Grimley Evans, pp. 132–133)
102. (A) The response to benzodiazepines is more
pronounced in the elderly, even when corrected
for pharmacokinetics. Prior impairment is a
factor in this response. (Grimley Evans, pp.
132–133)
103. (A) Despite similar pharmacokinetics, the dose
of warfarin to provide effective anticoagulation
is lower in the elderly. (Grimley Evans, p. 132)
104. (E) The elderly have more body fat and less
body water. A water-soluble drug such as
lithium will have a considerably smaller
volume of distribution. Thus, dosages should
be decreased in the elderly to prevent toxicity.
(Grimley Evans, p. 130)
105. (A) Failure to correct for the elderly patient’s
increased sensitivity to narcotics can result in
significant toxicity. (Grimley Evans, p. 132)
106. (A) Tricyclic antidepressants and SSRIs are both
effective treatments for depression, but their
side effect profiles are different. Tricyclics can
promote weight gain while weight loss is more
common with SSRIs. (Grimley Evans, pp.
993–994)
107. (C) Diuretics promote urinary losses of magnesium,
zinc, and potassium. Zinc deficiency is
also seen in liver cirrhosis, Type II diabetes,
and lung cancer. (Grimley Evans, p. 163)
108. (D) INH can result in pyridoxine (vitamin B 6
)
deficiency, particularly in malnourished individuals.
It is recommended that patients who
are elderly, or have DM, poor nutrition, alcoholism,
seizure diathesis, or uremia, take pyridoxine
while on INH. (Grimley Evans, p. 538)
109. (G) Corticosteroids impair calcium absorption.
They are useful in managing hypercalcemia,
but bisphosphonates are the usual drug of
choice. (Grimley Evans, p. 183)
110. (E) Both phenytoin and phenobarbital can
cause altered vitamin D metabolism and can
even result in osteomalacia. Calcium absorption
from the gut is also blocked directly.
(Grimley Evans, p. 628)
111. (B) Sleep becomes more shallow with the loss
of deep stages of sleep, resulting in more frequent
arousals. Specific sleep disturbances such
as sleep apnea and periodic leg movements