Kamsi
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4. A 21-year-old African American college student has had increasing fatigue over the past 3 weeks. Since an episode of cystitis treated with trimethoprim-sulfamethoxazole 3 weeks ago, he has been unable to keep up with his physical education classes. For 6 months, he has been following a vegetarian diet that has been supervised by student health services. Examination shows no abnormalities. His hemoglobin level is 10 g/dL, mean corpuscular volume is 85 μm3, and reticulocyte count is 15%. Which of the following is the most likely cause of anemia in this patient?
A ) Anemia secondary to infection
B ) Antibiotic therapy
C ) Gastrointestinal blood loss
D ) Sickle cell disease
E ) Vegetarian diet
A previously healthy 44-year-old woman, gravida 4, para 4, comes to the physician because of a 9-month history of progressive loss of small amounts of urine while running; she now has to wear an absorbent pad. Examination shows a second-degree cystourethrocele.
For each patient with urinary incontinence, select the most likely cause.
A ) Detrusor instability
B ) Interstitial cystitis
C ) Overflow incontinence
D ) Stress incontinence
E ) Urethra diverticulum
F ) Urinary fistula
26. A 27-year-old woman comes to the physician because of a 2-year history of intermittent diarrhea and severe cramping abdominal pain. The stools are watery, occasionally foul-smelling, and nonbloody. She is currently pain-free and has not had diarrhea for 2 days. She also has intermittent constipation. She has not had fever or weight loss. She returned from a trip to Mexico 3 months ago. She had an appendectomy at the age of 12 years and a cesarean delivery 4 years ago. Examination shows no abnormalities. Which of the following is the most likely diagnosis?
A
) Bacterial gastroenteritis
B
) Crohn's disease
C
) Intermittent small-bowel obstruction
D
) Irritable bowel syndrome
E
) Laxative abuse
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| manjari
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my guess is..B..D ...E
B..already on a veg diet..then took broad spectrum ABs..normal flora destroyed n led to B12 def....
D..cystourethrocoele...nd dribbling while running..stress incont..
last one i gssd by ruling out other choices...but really confused..!!
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| dr.wad
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B antibiotic tx
D stress incontinence ( i guess fistula will cause cont dribbling )
D_ irritable bowel
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| dermatology
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i wud say D for alll the questions .
Sickel cell anemia normoblastic normocytic anemia
stress incontinence in old female with cystourthrocele
IBD for last one as alternate diarrhoea constipation ..... examination normal ....
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| dermatology
Forum Elite
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sorry normo chromic not normoblastic ........
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| SOS
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I marked it as B,D,D
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| peraspera
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#1.D. It could be Sickle cell.
Becouse reticulocyte count 15% ( so high) can be in the Sickle cell d or G6PD deficiency. We can caunt correction for anemia : the reticulocyte % is multiplied by the ratio of the patients Hb or Ht to the expected Hb/ Ht for the age and gender of the patient. 15(10/15)=10%.
Both diseases are Normocytic, normochronic . G6PD, there is history of sulfa drugs, male, African- American, but no jaundice..
#2 D.
#3 D.
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| Justice
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B
D
D
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| Dr.D
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I. B It is because of antibiotics/ Hct high/ sulpha drug intake
2. D Stress incontinence
3. D IBD
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| Dr.D
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Kamsi can you please tell us the answers
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| manjari
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i agree with peraspera..it is sickle cell dis. ........ but can u pls give an explanation for the third ques....
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| tamerbashir
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D
D
D
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| arlete
Intern in 2009!!!!!
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B
D
D
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| maki
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I think it is DDD. sickle cell anemia, normocytic normochromic anemia which is ppted by sulfa drug intake. If G6PD def was in the choice it will be the answer too. But in sickle cell anemia we also give folic acid supplement to prevent hemolyisis. sulfa drugs decrease folic acid and ppt hemolysis.
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| Ivonne
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I think the same DDD. Not sure about the first one...
What do you think about the first question guys, it can be G6P deficiency precipitated by sulfa clearly seen by the timing but SCD is more common and could be precipitated by infection or medication.
Edited by Ivonne on 01/25/08 - 07:58 PM
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| drshvetasm
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B D D
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| Korotkoff
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BDD
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| lucky_doc
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BDD  otherwise they won't mention hx of sulfa exposure!
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| Ivonne
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OK BDD
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| bax
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d d d
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| Vietnamese
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Sickle patient often get pain crisis, very little related to anemia crisis, if any, Parvo 19 virus is the culprit.
B
D
D
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| bax
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alright Vietnamese
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