cirus
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1. A 42-year-old woman presents to the hospital with the sudden onset of shortness of breath associated with chest pain. The pain does not radiate and increases on inspiration. On physical examination, blood pressure is 110/80 mm Hg, pulse is 116/min, and respirations are 22/min. She is 125 pounds. An EKG reveals sinus tachycardia at 120 beats per minute, and the chest x-ray is normal. Baseline prothrombin time (PT) is 12 seconds, and the partial thromboplastin time (PTT) is 28 seconds. The patient is bolused with 5,000 units of heparin and then started on a drip of 1,000 units per hour. The V/Q scan gives a high probability for a pulmonary embolus.
Six hours later, the repeat PT is 12.5 seconds, and the PTT is 30 seconds. She is rebolused with 5,000 units of heparin, and the drip is raised to 1,100 units per hour. Six hours later, the PT is 12.4 seconds, and the PTT is 31 seconds.
What is the most likely reason for this scenario?
(A) Lupus anticoagulant
(B) Anticardiolipin antibodies
(C) Factor V mutation
(D) Antithrombin III deficiency
(E) Protein S deficiency
2. A 25-year-old man comes to your office complaining of pain in the right eye, which started three days ago. The pain was associated with blurred vision and hypersensitivity to light on Day 1. The problem increased gradually and was associated with redness of the eye and increased lacrimation. The patient denies a problem of this type in the past. He has been having some bilateral, deep, and dull pain in the gluteal region with mild lower backache and stiffness, which is worse in the morning and improves by the time he starts working in his office 1 to 2 hours later. The patient uses analgesics for the backache. He has been married for the last year, is a computer programmer, and goes to the gym three days a week. On physical examination, the patient is healthy-looking but anxious. He has a hazy cornea in the right eye with precipitates on the corneal endothelium and yellowish spots on the iris with indistinct margins. Funduscopy, after dilation, shows a grossly normal retina and choroid. His left eye is normal. The rests of the physical examination shows some limitation in the range of movement of the lumber spine in all directions and vague tenderness deep in the gluteal region. The ESR is 60 mm/h, and the urinalysis and chemistries are normal. An x-ray shows slightly blurred cortical margins of the subchondral bones in the sacroiliac joints bilaterally. Which of the following would be most appropriate next action?
(A) Culture from the urethra
(B) Serological test for syphilis
(C) HLA-B27 typing
(D) Methylprednisolone
(E) Steroid eye drops
3. A 38-year-old, HIV-positive woman finds out that someone at her workplace has tuberculosis. Her PPD at employee health is negative. Her chest x-ray is now normal, and her PPD last year was negative. What should you do next for her?
(A) Nothing further is required
(B) Repeat the PPD in three months
(C) Start isoniazid and stop in three months if the tuberculosis skin test (PPD) is negative
(D) Start isoniazid for a full nine months
(E) Yearly chest x-rays
4. A 40-year-old man returns to the office because of sinusitis that did not respond to a second course of antibiotics. At this time, he also complains cough, shortness of breath, and malaise. On physical examination, his temperature is 37.7 C, pulse is 88/min, respiratory rate is 18/min, and blood pressure is 110/65 mm Hg. You notice slight left eye proptosis. There is also mild tenderness over the maxillary sinuses. On auscultation of the lungs, there are bilateral basilar crackles. The heart examination is normal. Laboratory values reveal: WBC 10,500/mm3, hematocrit 37%, platelets 440,000/mm3. Urinalysis shows protein 2+, and red cell casts are present.
The chest x-ray shows multiple bilateral infiltrates with cavities and hilar adenopathy. C-ANCA is positive. Which of the following statements is true?
(A) This patient has an increased risk of malignant lymphoma
(B) Chronic nasal carriage of Staphylococcus aureus has been reported to be associated with a higher relapse rate of the disease presenting here
(C) The presenting disease is more common among blacks
(D) If the disease does not involve the kidney, the sensitivity of C-ANCA increases from 70 to 90%
(E) Pulmonary tissue obtained by thoracotomy is less specific than biopsy of the upper airway
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| khorshid
Forum Guru
Topics: 32
Posts: 591
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1.D (antithrombin III)
2.E (steroid eye drop)
3.B
4.B
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| cirus
Forum Guru
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Posts: 740
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3 is wrong, rest is right
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| khorshid
Forum Guru
Topics: 32
Posts: 591
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is it A?(3)
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| cirus
Forum Guru
Topics: 108
Posts: 740
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q 3 expl:
Answer:
(D) Start isoniazid for a full nine months
Explanation:
If a patient has been exposed to tuberculosis (TB), and the tuberculosis skin test (PPD) is negative, you do not have to do a chest x-ray. The PPD should be repeated at three months. Most patients who have been exposed to TB and who are going to develop a positive PPD will do so within three months of the exposure, and the PPD should be repeated at 12 weeks. So, she should have the repeat test. However, it is more important to start treatment with isoniazid. There is no reason to give isoniazid to most patients if the PPD is negative. The only exception to this rule is in small children under two years of age who can have a serious exposure but still have a negative PPD because of immature T cells. The other exception is an HIV-positive patient with profound immunosupression and a very low T-cell count who has a serious exposure, such as someone in their own household. There is no routine indication for yearly chest x-rays in any population. Any person with a newly positive PPD should get a chest x-ray. This person's test, however, was negative.
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| khorshid
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Thanx good qs
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| suv
Forum Elite
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Someone Please explain 1,2 and 4. 
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| Kamsi
Forum Guru
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1 Heparin works through enhancing effect of anti-thrombin on clotting,With limited anti thrombin heparin will not work effectively
2 Ankylosing Spondylitis - hx of back pain and X-ray finding has Uveitis explains the eye findings
4 Wegner Granulomatis Both upper and lower resp findings,+ CANCA
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| suv
Forum Elite
Topics: 43
Posts: 233
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thank u very much
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