Question 31

37 year old white male is brought to the ER with acute onset breathlessness. He is a known case of HIV on Triple therapy. Last month his CD4 count was 180 when he visited his physician. He appears to be thin and weak. His BP is 90/40 mm Hg, pulse is 92/min, and he has no fever. He lives with his same sex partner for last 3 years. The partner is also HIV positive and on treatment. He is a chronic smoker and occasionally consumes alcohol and marijuana. No other significant history is obtained. On chest auscultation, there are few scattered rhonchi and rest of the examination is unremarkable. He appears to be cyanotic and the arterial blood gas shows decreased Saturation with a normal PaO2. What is the most likely cause of his decreased saturation?

a) Drug induced

b) Tuberculosis

c) Pneumocystic Carini

d) CO Poisoning

e) Anemia

f) Smoking induced

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Question 30

45 year Caucasian male is brought to the ER with acute onset breathlessness. He gives history of having burning micturation and fever since 7 days. He was seen by the community clinic and was prescribed Antibiotics and Tylenol a week ago for his symptoms. But his symptoms did not subside and fever persisted. Since yesterday he was having heavy breathing and he was brought to the hospital today due to severe breathlessness and high grade fever. On examination, he is febrile, T = 102 F, BP is 90/30 mm Hg, P = 122/min. The O2 Sat is 85%, He was given nasal oxygen and rapid IV infusion in the ER. the portable CXR suggests ground glass appearance, and his chest shows diffuse rhonchi. He has a past history of smoking 2-3 cigarettes per day for last 15 years, and occasionally consumes beer on weekends. His father and mother are healthy. He works as a manager in textile industry. After initial resuscitation, his BP was found to be 100/40 mm Hg, but his O2 saturation is just 87%. The ABG was taken and results are awaited. CBC shows Hb 14.2, and TLC of 18600. This is an example of:

a) Diffusion defect

b) Ventilation defect

c) Perfusion defect

d) Restrictive Lung disease

e) Obstructive Lung Disease

f) Occupational Hazard

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Question 29

The mother of the boy (mentioned under question 28) inquires about the child's prognosis. She is worried if he can grow up and have children. What is the physicians response to the mother's concerns.

A) Patients with this disease are fertile and can reproduce

B) Patients with this disease are infertile

C) Patients with this disease has huge testes and spermatogenesis would be abnormal

D) Patients with this disease have problems with gender identity

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Question 28

A 5 year old boy is brought to the office for evaluation. He is joyful in the office, but the mother gives history that his social, speech and motor development is inappropriate. In fact, he lost his speech at the age of 2 years. He has constant dribbling and often remains constipated. The mother says he had feeding problems during infancy and used to cry like meowing. He has strabismus and epicanthic folds. On auscultation, he has a pansystolic murmur. His IQ was tested and was found to be around 55. What is the most likely chromosomal alteration in this patient.

A) Nondisjunction

B) Mosaicism

C) Translocation

D) Deletion

Answer posted under comments for question 29.

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Question 27

14 year old boy is brought to the Office with swelling of the right knee. The joint is extremely tender, and the boy walks with a limp. He has no fever or any history of trauma to the knee. Both his parents are healthy and fine. He gives history of his paternal uncle who had some eye surgery in childhood, but he passed away in his adolescent years. The X ray of the right knee shows spiculated pattern and bone lifting periosteum. Which of the following regulatory gene is responsible for the boy's knee lesion?

A) BRCA 1

B) MYC

C) RB

D) TP 53

E) RAS

Answer will be posted in the comments section.

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