Sunday, July 19, 2009

Question 16

The patient in the question 14 is diagnosed accordingly and managed successfully after staging the disease. Six months after treatment is begun, he arrives in the ER at midnight with complaints of breatlessness and fever. He gives history of alopecia since last 2 months. He also complains that his fingers often turn blue in cold conditions. On examination he is breathing heavily at the rate of 26/min, and his oxygen stauration is 88%. The pulmonary function test suggest increase in FEV1/FVC. What is the cause of patient's current symptoms?

A) Busulfan
B) Bleomycin
C) Radiation
D) Methotrexate
E) worsening of prior disease
F) Asthmatic attack
G) Sarcoidosis
H) Amiodarone
I) Adriamycin
J) Dacarbazine


Question 15

What organism is most commonly associated with the diagnosis mentioned in Question 14?

A) Coxsackie Virus
B) Human T Cell Virus
C) Cytomegalovirus
D) Ebstein Baar
E) H. Pylori
F) S. Hematobium
G) C. Sinesis
H) Human immunodeficiency Virus
I) Hantavirus
J) Picorna Virus


Question 14

22 year old Hispanic male was brought to the ER with breathlessness and swelling in the neck. On history he says he has these symptoms for some time now. He does not have any history of fever, weight loss, night sweats or hemoptysis. He has never been in contact with anyone suffering from TB and he says he is an electrician by profession. His mother was diagnosed with TB long ago for which she took Anti-TB medicines for an year. His father is a smoker and has DM. He stays along with his girlfriend since last six years, and his parents stay by themselves. He studies part time, and has a healthy baby from his present girlfriend. He has never been ill, and was completely immunized as a child. he does not smokes and drinks beer on weekends. On examination his vitals and systemic examination is unremarkable, except his non tender lymph node swelling in the supraclavicular area. The physician orders him a Complete blood count and X ray Chest. On chest X ray he is found to have hilar swellings. Lymph node biopsy suggest cells having CD15 and CD30. What is the most likely diagnosis?

A) Squamous Cell Ca of Lymph node
B) Squmaous Cell Ca of lung with mets
C) Small Cell Ca of lung with mets
D) Large Cell Ca of lung with mets
E) Nodular Sclerosing B cell malignancy
F) Nodular Sclerosing T Cell malignancy
G) Lymphocyte depleted B Cell malignancy
H) Lymphocyte depleted T Cell malignancy
I) Non hodgkins lymphoma
J) Non smokers lung Ca
K) Hairy Cell Leukemia

Please solve questions 15 & 16 alonwith before reading the answer in the comment section.


Question 13

65 year old farmer was brought to the hospital by his wife at midnight. She says he is having severe headache since last 8 hours after he returned from work. He is sweating a lot and tears are falling from his eyes. He says he is feeling weak and tired and has vomited once. The vomitus just contains what he has eaten in the evening and there was no blood. On examination his skin is cool and wet. His BP is 124/82 mm Hg and Pulse is 64/min. He appears to be confused and answers only a few questions. During the interview, he was repeatedly spitting in the thrash bin in the ER. Systemic examination is non significant, except his pupils are smaller and few twitches can be seen in his limb muscles. He is diagnosed as insecticide toxicity and atropine is administered. What is the mechanism of action of the toxin?

A) Blocks Acetylcholine receptor at the post synaptic membrane
B) Stimulates Acetylcholine receptor at the post synaptic membrane
C) Blocks the enzymes that produce choline & Acetate in the synapse
D) Blocks the reuptake of choline in the presynaptic membrane
E) Block release of Acetylcholine
F) Blocks the Ryanodine receptors
G) Blocks the enzyme that metabolizes Catecholamines after uptake in the presynapse


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