#11

Question 1

Researcher decide to set alpha at 0.01 instead of 0.05

What would be the result of the change?

Answer 1

Any significant findings will be reported with greater confidence

Question 2

3 yo boy persistent diarrhea

• 4 episodes otitis media, 3 episodes pneumococcal pneumonia
• Giardia is isolated in duodenum
• Low serum of all immunoglobulin

FLow cytometry will show absence of what marker?

Answer 2

CD19

- X-linked agammaglobulinemia

Question 3

65 yo man
- Cohort study reported that compared to heavy smokers , RR of COPD for nonsmokers is 0.10 and for moderate smokers is 0.4

What is the RR of COPD for moderate compared to nonsmokers?

Answer 3

4

Question 4

24 yo woman
- 3 weeks worsening throat pain and difficulty swallowing
- Student from senegal
- Vulvovaginal candidiasis and bacterial folliculitis
- Weight loss 4.5 kg
HIV is negative
- CD4 is 180

How can this be explained?

Answer 4

Infection with HIV-2

Question 5

50 yo wo periodic reddening of skin
- Watery diarrhea
- purple vascular lesion
- Elevated 5-HIAA
TUmor in small intestine

Responsible?

Answer 5

Metastatic carcinoid

- If flushing or diarrhea is present then metastatic if not is localized

Question 6

15 yo learning disabilities
- Cytogenetic shows 47 chromosomes

Most likely present in evaluation?

Answer 6

Tall stature, gynecomatia, azoospermia

• Klinefleter syndrome meiotic nondisjunction

Question 7

24 yo man

• Convinced people on television were monitoring his thoughts
• 1st treated with chlorpromazine then changes to fluphenazine because he didn’t like the way it make him feel

Fluphenazine more likely to cause ?

Answer 7

muscular rigidity

- First generation antipsychotics (dystonia, akathisia, parkinsonism)

Question 8

Newborn, circumoral cyanosis while breastfeed

• Patient has subcostal retractions and grunting
• 2/6 systolic murmur at left lower sternal border

Cause of cyanosis?

Answer 8

Right to left shunt via patent ductus arteriosus

Question 9

10 yo boy
- Disrupts class continuously
sniffing, throat cleaning, grunting sounds
- Recurrent otitis media, atopic dermatitis
- Frequent eye blinking and shoulder shrugging

Diagnosis?

Answer 9

Tourette syndrome - motor and vocal tics

Question 10

48 yo deaf man

• patient can read lips
• He wants a longer acting inhaler

Appropriate step in evaluation?

Answer 10

Use a qualified american sign language interpreter

Question 11

62 yo wo left mastectomy and axillary node dissection for invasive ductal carcinoma

• Burning and aching in her left upper arm
• Sensation diminished in medial upper arm near axilla

Injury to which nerve?

Answer 11

Intercostobrachial

Question 12

54 yo wo postmenopausal

• Increasing vaginal pressure
• BMI 18
• anterior vaginal wall bulges with the valsalva maneuver
• Uterus is small and mobile

Cause of this?

Answer 12

Pudendal nerve injury

Question 13

45 yo ankle swelling

• pulmonary crackles, bilateral pitting edema up to the knees
• Sodium nitroprusside infusion is begun
• Left ventricular pressure/volume relationship best represent effects of therapy?

Answer 13

Pressure decreases and volume moves down to the left

Question 14

39 yo

• LVEDV 125 ml
• LVESV 75

What can we say?

Answer 14

Left ventricular ejection fraction is 40%

50/125 = 40%

Question 15

34 yo wo

• Reduced sensation in her legs
• 6 months ago episode of visual blurring
• History of psoriasis for which she uses glucocorticoid ointment
• Decreased pain and light tough perception in both legs below umbilicus

Pathologic brain lesion most specific ?

Answer 15

Perivenular inflammatory cells

- Suffers from multiple sclerosis, infiltrating macrophages containing myelin debris

Question 16

25 yo wo 2 weeks history of neck pain
- Upper respiratory infection month ago
- Now she feels palpitations and excessive sweating
- Thyroid tender to palpation and diffusely enlarged
Suppressed TSH and elevated free thyroxine levels

ESR is 70

Additional finding?

Answer 16

Low radioactive iodine uptake