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A 5 year old boy is brought to the emergency department because of a 16 hour history of severe vomiting and increased sleepiness. His mother says that he had flu like illness 5 days ago and she treated with aspirin.Shortly after admission he becomes delerious then comatose. His prothrombin time is prolonged.Serum studies showed increase ammonia and lactate concentration and increased transaminase activity. which of the following is the most likely cause of coma?
a)cerebral edema
b)metabolic alkalosis
c)subarachnoid hemorrhage
d)venous sinus thrombosis
e)viral encephalitis
Note:e) viral encephalitis is wrong.
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Thinking Reye's syndrome. A
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i think so. thanks. another one:
A 43-year-old woman comes to the physician because of progressive difficulty walking during the past 3 months. Neurologic examination shows weakness and decreased muscle bulk of the lower extremities. Patellar and Achilles tendon reflexes are diminished. Sensations of joint position, pain, and temperature in the lower extremities are normal. Which of the following is the most likely cause of the findings in this patient?
A) Acute peripheral neuropathy
B) Degeneration of motoneurons of the lumbar cord
C) Demyelination of the corticospinal pathways
D) Loss of afferent la axons innervating muscle spindles
E) Myotonic muscular dystrophy
NOTE:C is not the answer
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B
Lumber cord motor neuron degeneration will show LMN signs including weakness, wasting and hyporeflexia
Duration is 3 months, so its not ACUTE
Sensory examination is normal, so its not peripheral neuropathy
Demyelination of corticospinal pathways leads to UMN signs, so reflexes should be hyper
Muscle spindle affection will not lead to wasting ( reduced bulk)
MYotonic dystropathy affects hands more , and history should be long.
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3) A 51 year old man with 3 month history of hepatitis b antigen negative polyarteritis nodosa has progressive proximal muscular muscular weakness and myalgia. A biopsy specimen of involved muscle would most likely show which of the following?
a)central vacuolization with glycogen accumulation
b)central vacuolization with lipid accumulation
c)mitochondrial proliferation
d)mucopolysaccharide deposition
e)PAS positive intramyofibrillar vacuoles
f)segmental ischemic necrosis
NOTE:c is wrong
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seems F
PAN produce necrotising vasculitis of small and med vessels.
Rest of the choices points to other etiologies.
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4)An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal
male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes
is most likely to be observed? Is everything low? smoking impairs mucocilliary clearance I know that much..
Mucus Production and Secretion up/down
Alveolar Macrophage Function up/down
Activity of Airway Cilia up/down
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Smoking increases mucous secretion, decreases both ciliary and macrophage function.
thanks
