Kamsi
Forum Guru
Topics: 103
Posts: 347
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9) A 17-year-old boy presents with chronic low back pain for the past 8 months. He was the most promising member of the high school swim team but was forced to quit because of his back pain. The pain begins frequently at night, radiates down the thighs, and is accompanied by pronounced stiffness of the lumbar spine. He denies any gastrointestinal or genital infections. His temperature is 37.0 C (98.6 F). Examination reveals moderate limitation of back motion and tenderness of the lower spine. A diastolic murmur along the left sternal border is heard on chest examination. Laboratory investigation shows an elevated erythrocyte sedimentation rate (ESR) and negative rheumatoid factor. X-ray films of the vertebral column and pelvic region show flattening of the lumbar curve and subchondral bone erosion involving the sacroiliac joints. Which of the following is the most likely diagnosis?
A. Ankylosing spondylitis
B. Degenerative join disease
C. Reiter syndrome
D. Seronegative rheumatoid arthritis
E. Still disease
12) A 29-year-old man presents to the clinic complaining of generalized fatigue. The patient is new to the clinic and reports that, over the past few weeks, he has been feeling much more tired than usual. He also reports that this happens to him just about every year, and that other physicians have told him that he is "overworked." His review of symptoms is notable for frequent sneezing, post-nasal drip, eye watering, and a itch of his posterior pharynx. These symptoms tend to be worse in the spring and summer and have been bothering him since mid-April, about 1 month ago. His past medical history is remarkable only for mild asthma induced by being outdoors. He takes no regular medications but does take diphenhydramine on occasion. He denies tobacco, ethanol, or illicit substance use. Which of the following is the most appropriate diagnostic test at this time?
A. Blood radioallergosorbent test
B. None, the diagnosis is based solely on the history and physical examination
C. Intradermal testing
D. Serum protein electrophoresis
E. Skin-prick testing
13) A 58-year-old man with known hepatitis C and cirrhosis complains of worsening fatigue and confusion over the past 5 days. He has been admitted three times in the past 4 months for variceal bleeding and has had ascites that has been refractory to high-dose oral diuretic use. He also reports that over the past 48 hours he has had a declining urinary output. On physical examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Laboratory results reveal a white blood cell count of 4600/mm3, a hemoglobin of 9.4 g/dL, and a hematocrit of 29%. His electrolytes reveal a BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary sodium is less than 10 mEq/L. Which of the following is the most appropriate treatment for his elevated BUN and creatinine?
A. Large volume paracentesis
B. Hemodialysis
C. Mesocaval shunt
D. Kidney transplantation
E. Liver transplantation
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| kpmle2
Forum Guru
Topics: 95
Posts: 512
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9) A. Ankylosing spondylitis
12) B. None, the diagnosis is based solely on the history and physical examination
13) B. Hemodialysis
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| hanialkhadher
Forum Elite
Topics: 18
Posts: 262
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A. Ankylosing spondylitis
B. None, the diagnosis is based solely on the history and physical examination
E. Liver transplantation
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| neuroblastoma
Forum Guru
Topics: 110
Posts: 1,097
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A- akylosing spodylitis-- stiff back pain in young men+ sacroilitis jt
B None, the diagnosis is based solely on the history and physical examination
E Liver transplantation --chirhosis +hepC worsening--> indication for liver transplantation
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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A
B
E
Correct guys
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| RitaM
Forum Newbie
Topics: 1
Posts: 61
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A,
B
c but the reasoning is different the reason the Bun and Cr are high which is an indication of Hepato renal syndrome and the treatment in this case is transplant possibly secondary to Hep c
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