A 35-year-old woman comes to the physician because of pain of her left leg for 2 days. Physical exam shows deep vein thrombosis in left lower extremity. Laboratory studies show a platelet count of 200,000/mm3, prothrombin time of 12 seconds (INR=1), and partial thromboplastin time of 37 seconds. Treatment with heparin is started. Five days later, physical examination shows no active bleeding. Her platelet count now is 120,000/mm3. Which of the following best explains the decreased platelets in this patient?
a. antithrombin III deficiency
b. Cold agglutinin disease
c. disseminated intravascular coagulation
d. drug-related antibodies
e. kasabach-merritt syndrome
f. migratory thrombophlebitis
g. splenomegaly
h. vitamin k deficiency
d) drug related antibodies -> they refer to heparin induced trombocytopenia. treatment is stop heparin and use another drug to anticoagulate
A 24-year-old man is brought to the physician because of a 3-day history of progressive numbness of both feet that now has ascending to the level of his thighs. In the last 24 hours, he has developed numbness and tingling of his hands. Physical examination shows an ataxic gait. Deep tendon reflexes diminished in upper extremities and absent at knees/ankles. Sensation to vibration and joint position absent in fingertips and feet bilaterally. Mild weakness of distal upper extremities and moderate weakness of lower extremities. Process involving which of the following structures is the most likely explanation for these sensory findings?
a. Dorsal spinocerebellar tract
b. Fasciculus cuneatus
c. Fasciculus gracilis
d. myelinated primary afferents
e. unmyelianted primary afferents
f. ventral spinocerebellar tract
Doesn't look like Guillain-Barre? Young healthy guy, ascending paralysis...
A 2-month-old boy is brought to the physician for a well-child examination. The mother has no concerns about his growth or breast -feeding habits and says he has begun to smile. He is at the 25th percentile for length and 30th percentile for weight. Cardiac examination shows a blowing holosystolic murmur heard best over the lower left sternal border. Which of the following is the most likely cause of the cardiac findings in this patient?
a. coarctation of the aorta
b. functional murmur
c. patent ductus arteriosus
d. patent foramen ovale
e. ventricular septal defect
I got this right but I dont remember.. functional murmur? It really looks like Still's murmur, healthy kid, systolic, LLEB. He could also have a small VSD and no symptoms. For sure not a, c or d.
A 58-year-old man comes to the physician to obtain a prescription for benzodiazepine because he is experiencing an intolerable situation at work (etcetc.) Two weeks later, the patient's wife calls and says, "My husband just got fired...he has a long history of alcoholism?" Which of the following is the most appropriate initial action by the physician?
a. Contact the patient to discuss the situation
b. Contact the risk management department of the medical practice's insurance company regarding a potential claim
c. Discharge patient from medical practice for inappropriate use of medication
d. Inform patient's wife that information cannot be accepted because of HIPAA
e. Refer patient to a substance abuse program
E. refer to substance abuse program, I believe
A 4-year-old boy is brought to the physician by his parents because of fatigue and irritability over the past 2 months. The family visited relatives in rural Louisiana 5 months ago where the patient ran around barefoot. The child is active and appears normal. The conjunctivae are pale. Lab studies include normal leukocyte count with 15% eosinophils. Stool preparation discloses parasite egg shown. Which of the following is the most likely cause of fatigue and irritability in this patient?
a. Activation of IgE
b. CNS infestation
c. Circulating immune complexes
d. Microcytic anemia
e. Myocarditis
d) microcytic anemia. he probably got necator americanus or ancylostoma duodenale, both suck blood from intestinal walls
Thanks in advance!
