jessie1976318
Forum Junior
Topics: 24
Posts: 42
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my answers are different with the standard ones.
A 12-year-old African American male presents for follow-up for otitis media, for which he was prescribed trimethoprim-sulfamethoxazole. He appears pale and weak. History reveals that certain Mediterranean foods have elicited a similar problem in the past. Family history reveals a maternal uncle with similar health concerns. Which of the following statements is most correct?
A. Current assessment of an erythrocyte would reveal normal glucose-6-phosphate dehydrogenase activity.
B. Genetic analysis would reveal one of two possible genetic defects.
C. Most glutathione cannot be oxidized at present.
D. NADPH is globally reduced throughout the entire body.
E. NADPH levels remain normal during the acute episode.
Your 72-year-old patient presented to your office with severe back pain, upper leg pain, hearing loss, and high some signs of cardiac failure. You took an X ray of the pelvis and noticed that bone architecture in the femur and spine was abnormal. You described the architecture as ‘mosaic.’ Which lab abnormalities would you expect to see in this patient?
A. Increased alkaline phosphatase levels
B. Decreased calcium levels
C. Decreased phosphorus levels
D. Decreased alkaline phosphatase levels
E. Normal alkaline phosphatase levels
Your team has just admitted a 36-year-old female who complains of feeling really down for the last two weeks and has no interest in her usual activities. She has been waking at 3 a.m. every day. Her appetite is poor and she feels like she is moving in slow motion. She admits that she has thought about killing herself because life isn't worth living anymore. Which of the following medications would you prescribe?
A. Alprazolam (Xanax)
B. Amitriptyline (Elavil)
C. Chlorpromazine (Thorazine)
D. Fluoxetine (Prozac)
E. Temazepam (Restoril
An eight-week-old infant is brought to clinic by his Old World Mennonite parents. They have noticed sweet-smelling urine in this child, and they also have a three-year-old daughter who has failed to meet developmental milestones. Upon evaluation of the infant's urine, which metabolite would you expect to be elevated?
A. Histidine
B. Homocystine
C. Homogentisate
D. Phenylalanine
E. Valine
A 17-year-old Honduran male presents to your office with a complaint of increasing spells of losing attention and falling during exercise. He has also noted feeling some shortness of breath lately. The patient states that he has always suffered such spells, but previously they happened rarely. On further questioning, you find out that a brother, father, paternal aunt, and grandmother all had similar spells. The patient has another brother who is unaffected. The brother who had these spells died when he was 14. One of his father's siblings who did not have these spells died suddenly at age 18 during a soccer game. On physical examination, you would expect to hear which of the following cardiac murmurs?
A. A continuous murmur
B. A crescendo–decrescendo systolic ejection murmur beginning immediately after S1
C. A crescendo–decrescendo systolic ejection murmur beginning well after S1
D. A high-pitched diastolic murmur beginning immediately after S2
E. A high-pitched systolic murmur beginning well after S2, often accompanied with an initial snap
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| Idiopathic
Forum Guru
Topics: 19
Posts: 641
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1) A
2) D(?)
3) B
4) E
5) C
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| dxtxpx
Forum Guru
Topics: 259
Posts: 1,233
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1) A
2) A
3) D
4) E
5) C
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| uscan
Forum Senior
Topics: 19
Posts: 88
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I agree with your answers except:
-For the 1st question, I tought the patient is G6PD deficient, so why giving the answer A? I choose B
-And for Q3: both B and D are antidepressants, why did you choose D?[/list]
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| jessie1976318
Forum Junior
Topics: 24
Posts: 42
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1, A: I also think the patient is G6PD, I don't know why?
2 A (which disease?)
3,D (I think fluxitine can lose the weight, which will make the patient worse. ?)
4,E(which disease?)
5,
after these questions are solved, I will post more.
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| Idiopathic
Forum Guru
Topics: 19
Posts: 641
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For question 1, it is G6PD deficiency, but the cells that are still viable will have normal enzyme activity, or they would have been lysed. This is why an enzyme assay in a G6PD-deficient Px currently going through a hemolytic attack will be normal, since all of the RBC's that are available to assay will have normal levels of enzyme. This is somewhat of a trick question, but Goljan stresses this point quite a bit.
For question 3, I picked amitryptiline, because I know that it is used as an anti-depressant, sleep aid, and appetite stimulator. Is it contraindicated in suicidal patients?
For question 4, the disease is maple-syrup-urine disease, due to failure to reabsorb branched-chain amino acids (valine, leucine, isoleucine) in the kidney. The urine will smell very sweet, and there will most likely be failure to thrive.
For question 5, the disease is IHSS/HOCUM, and the murmur involves the sucking of the mitral valve against the thickened IV septum. Increased preload will make the murmur come later than decreased preload, but it always comes after S1 and is finished before S2. Since it is an ejection murmur, it will be crescendo-decrescendo.
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| uscan
Forum Senior
Topics: 19
Posts: 88
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Thanks idiopathic for your reply for Q1; Do you mean that in a patient with G6PD deficiency not all RBCs are deficient in the EZ?? I tought in those patients, all Cs are deficient in G6PD!
Jessie, you gave the answer to Q3 as D which is fluoxetine and then you explain that it will make the patient feel worse???
Can anybody explain how to choose an antidepressant for a patient (Tricyclic/SSRi)??
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| jessie1976318
Forum Junior
Topics: 24
Posts: 42
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for q3 the answer is D. but my attemp is B. i think fluxitine can result in the losing of the weight, which makes patient worse, since he lack of apetite.
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| dxtxpx
Forum Guru
Topics: 259
Posts: 1,233
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for Q2, pt seems to have Pagets disease as u mentioned mosiac pattern and they have high alk phosphate levels.
For major depression pt, drug of first choice is SSRI: fluoxetine (its a very common step2 question so thats y i know)
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| Quinn
Forum Elite
Topics: 63
Posts: 308
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Good point about G 6-PD.....never thought of it that way, but know that it is the older RBC's in which the G 6-PD levels are lower that are more at risk for hemolysis than the newer RBC's.....that is why the hemolysis is self-limiting.
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The universe will yield to the will of the determined person.
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| jessie1976318
Forum Junior
Topics: 24
Posts: 42
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thanx
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