Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
10.
A 9-month-old boy is brought to the office for treatment of failure to thrive. His medical history includes a birth weight of 3620 g (8 lb), recurrent episodes of vomiting and dehydration, poor weight gain, and feeding problems. Findings on physical examination today include a weight of 4530 g (10 lb), a thready pulse, low blood pressure, muscle wasting, and hyperpigmentation around the genitalia, nipples, and axilla. Which of the following is the most likely cause of this patient's failure to thrive?
A) Hypofunction of the adrenal cortex
B) Hypofunction of the adrenal medulla
C) Hypopituitarism
D) Hypothyroidism
E) Poor parent-infant interaction
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
Answer by NBME Feedback:
A) Hypofunction of the adrenal cortex
--------------------------------------
Congenital Adrenal Hyperplasia
It’s a syndrome Assoc/ w adrenal androgen or estrogen production due to congenital enzymatic defects for cortisol synthesis, mostly from AR mutations. It’s the m.c. adrenal disorder of infancy and childhood. Family history and short stature are common.
21-hydroxylase deficiency:
No. 1 common type (95%, early onset), Assoc/ w decreased cortisol and aldosterone, increased 17-OH progesterone, DHEA and ACTH, causing congenital masculine signs (ambiguous female genitalia— Image 79 or male macrogenitosomia ), low Na, high K, dehydration, and hypotension.
Gong MD, Yale (2013-02-05). Yale-G's Refined Clinical Review for USMLE Step 2 & 3 (New Edition) (Kindle Locations 3164-3169). www.usmle-yaleg.com.
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
11.
A 6-year-old Syrian American boy is brought to the office because his mother has found bloodstains on his pillow each of the previous three mornings. She has also noted crusted blood around the left nostril. Further questioning of the mother reveals that the symptoms appeared after the resolution of an illness characterized by low-grade fever and clear rhinorrhea. Physical examination is normal except for a 3×4-mm eschar on the nasal septum. The most appropriate treatment at this time is to apply which of the following?
A) Alum to the left naris
B) Beclomethasone to the nares twice a day
C) Petrolatum to the nares twice a day
D) Phenylephrine to the nares twice a day
E) Silver nitrate to the area around the eschar
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
12.
A 35-year-old African American man comes to the office because of weakness and numbness in his right arm and leg for the past week. He complains of blurred vision in the right eye and periods of seeing double. He also has poor bladder control. His deep tendon reflexes are hyperactive on the right side and Babinski sign is present. Funduscopic examination shows pallor of the right optic disk. Which of the following is the most likely diagnosis?
A) Amyotrophic lateral sclerosis
B)Conversion disorder
C) Guillain-Barré syndrome
D) Multiple sclerosis
E) Stroke
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
A 40-year-old Latina American woman who has been your patient for 10 years comes to the office for a periodic health evaluation. She says, "Doctor, I just can't seem to sleep at night. I work all day and I'm tired, but I just can't sleep. And the heat. I want to put on the air conditioning when everyone else is complaining how cold it is." She says her menstrual periods have become irregular. Vital signs are shown:
Today 1 Year ago
Pulse 110/min 80/min
Respirations 14/min 14/min
Blood pressure 130/86 mm Hg 110/70 mm Hg
Weight 54 kg (120 lb) 59 kg (130 lb)
She is 165 cm (5 ft 5 in) tall; BMI is 20 kg/m2. Her appearance is unchanged from last year. Physical examination, including pelvic examination, is normal. The laboratory study most likely to be abnormal in this patient is the serum concentration of which of the following?
A) ACTH
B) Estradiol
C) Follicle-stimulating hormone
D) Luteinizing hormone
E) Thyroid-stimulating hormon
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
Posts: 3,675,937
Threads: 734,344
Joined: Sep 2021
Reputation:
5
11)
C) Petrolatum to the nares twice a day
It was not D in my exam.
I found this about it
http://i42.photobucket.com/albums/e338/G...a2b7bb.png
|
