Q- A 40-year-old man presents with severe hypertension, palpitations, headaches, and diaphoresis. CT scan reveals an adrenal mass.
What is the best preoperative management?
A- Beta-blocker before alpha-blocker
B- Immediate surgery without medications
C- Intravenous nitroglycerin only
D- Phenoxybenzamine before the beta-blocker
D- Phenoxybenzamine before beta-blocker- In pheochromocytoma, alpha blockade must be initiated before beta blockade to prevent a hypertensive crisis. Why alpha first? Blocking beta receptors first removes beta-2 vasodilation, leaving the flood of catecholamines to act on alpha-1 receptors unopposed. This causes severe vasoconstriction and a hypertensive crisis. Phenoxybenzamine is given for about 10–14 days first, then a beta-blocker is added to control tachycardia./bg_collapse]
Q- A 52-year-old woman presents with progressive fatigue and pruritus. Labs show elevated alkaline phosphatase and positive antimitochondrial antibodies.
Which treatment slows the progression of this disease?
A- Azathioprine
B- Prednisone
C- Ursodeoxycholic acid
D- Vitamin E
C- Ursodeoxycholic acid- Primary biliary cholangitis is treated with ursodeoxycholic acid.
Q- A 29-year-old man presents with sudden severe scrotal pain and nausea. Physical examination reveals a high-riding testis with absent cremasteric reflex.
What is the best next step?
A- Oral antibiotics
B- Scrotal ultrasound before intervention
C- Supportive care and discharge
D- Surgical exploration immediately
D- Surgical exploration immediately- Testicular torsion is a surgical emergency. Do not delay surgery for imaging if suspicion is high. Torsion vs. epididymitis: Torsion starts suddenly, the testis rides high with a horizontal lie, the cremasteric reflex is absent, and lifting the scrotum does not relieve pain (negative Prehn sign). Epididymitis comes on gradually, often with fever or dysuria, the cremasteric reflex is present, and lifting the scrotum may ease the pain (positive Prehn sign). Surgery within 6 hours gives the best chance of saving the testis.
