id q - navz

[ArchivalUser]

anyone else like to try before i post the answers!!!

[ArchivalUser]

D
A
D
D
B
A

[ArchivalUser]

Ans 1) Correct Answer = D

Although this patient has asymptomatic HIV infection, his CD4 cell count is less than 200/µL (0.2 × 109/L). He is therefore at risk for AIDS-related complications, and antiretroviral therapy is indicated now. The patient also has chronic hepatitis B, as evidenced by the positive hepatitis B surface antigen and core antibody. In addition, his mildly elevated serum aminotransferase levels suggest active hepatitis. Both regimens listed are either preferred or alternative regimens for initial therapy in an antiretroviral treatment“naïve patient. However, lamivudine, efavirenz, and tenofovir are preferred because lamivudine and tenofovir also have activity against chronic hepatitis B.
As noted above, therapy should not be delayed because of the patient's risk of AIDS-related complications. The regimen containing zidovudine, didanosine, and nelfinavir is not effective for treating hepatitis B.



Ans2) Correct Answer = A


The patient has a subacute illness that could be either pneumonia or pulmonary hypersensitivity. The overwhelming likelihood is that her illness is related to hot tub exposure and that an aerosol of Mycobacterium avium complex (MAC) is causing hypersensitivity pneumonitis. MAC is present in the water supply in most areas of the United States, which explains why people who use hot tubs (and, less frequently, showers) sometimes develop this form of hypersensitivity pneumonitis. What is not understood is why more people do not develop this infection.
Although the patient's pulmonary function tests are somewhat abnormal, she does not have tuberculosis because of the normal chest radiograph. Nocardia species can cause pneumonia. However, the most common Nocardia lung syndrome is nodular and tends to occur in patients with defects in cell-mediated immunity. Infection with Rhodococcus species is a rare cause of pneumonia in patients with reduced cell-mediated immunity and does not induce bronchitis. Although contamination of the sputum sample is possible, the clinical presentation is quite consistent with MAC hypersensitivity pneumonitis.



Ans 3) Correct Answer = D


Vancomycin should be started per rectum. In a patient with marked paralytic ileus, oral medications are unlikely to be transported to the colon in sufficient quantity to be therapeutic. In addition, metronidazole, which has extensive enterohepatic circulation, is equally unlikely to reach the colon.
Clindamycin is inappropriate because Clostridium difficile is uniformly resistant to this antibiotic. Clindamycin is also likely to cause colitis. Ciprofloxacin, either orally or rectally, has little or no effect on C. difficile, and some studies report that ciprofloxacin is one of the most common antibiotics associated with nosocomial outbreaks of C. difficile colitis.



Ans 4) Correct Answer = D


This patient most likely has cytomegalovirus infection involving the gastrointestinal tract. Administration of ganciclovir or valganciclovir has greatly reduced, but not eliminated, the occurrence of cytomegalovirus infections in transplant recipients. In addition, this patient's ganciclovir was discontinued after he developed neutropenia postoperatively. Gastrointestinal cytomegalovirus infection is a potentially fatal complication because an ulcer may perforate and cause peritonitis, or the patient may bleed to death because of sudden and massive hemorrhage.
He does not have respiratory findings consistent with development of Pneumocystis jiroveci (formerly Pneumocystis carinii) infection. Although herpes simplex virus does cause ulcerated lesions in the mouth and esophagus, it rarely, if ever, causes gastric or duodenal ulcers in transplant recipients. Epstein“Barr virus also does not cause gastrointestinal ulcers, and polyomavirus BK does not cause cutaneous or mucosal lesions.



Ans 5) Correct Answer = B


This patient most likely has meningitis caused by Listeria monocytogenes and is at increased risk because of her renal transplant and immunosuppressive therapy. She may have acquired the infection through the gastrointestinal tract, which has been recognized as a portal of transmission in outbreaks of Listeria infection. The negative cerebrospinal fluid Gram stain indicates that, in addition to Listeria, empiric therapy should be directed against Streptococcus pneumoniae and Neisseria meningitidis. The latter two pathogens should be treated with vancomycin combined with ceftriaxone. The therapy of choice for Listeria meningitis is ampicillin or penicillin G combined with an aminoglycoside. However, because of the patient's severe allergy to penicillin, trimethoprim“sulfamethoxazole is the recommended alternative antimicrobial agent.
Ceftriaxone alone provides insufficient therapy. Levofloxacin has not been studied for the treatment of meningitis. Azithromycin has in vitro activity against L. monocytogenes but is associated with unacceptably high failure rates in patients with Listeria meningitis.



Ans 6) Correct Answer = A


This pregnant patient most likely has latent syphilis of unknown duration because of her asymptomatic status, normal physical examination, positive rapid plasma reagin test, and reactive treponemal antibody assay for syphilis. Treatment is essential during pregnancy because of the potential danger of congenital syphilis in the fetus, and penicillin is the agent of choice for all forms of syphilis.
Based on her description, the patient was probably treated with amoxicillin for presumed streptococcal pharyngitis. Although she describes her allergy as œhives, the reaction developed when she had an illness that, in retrospect, may have been acute infectious mononucleosis. Over 90% of patients treated with ampicillin or amoxicillin during an episode of acute infectious mononucleosis develop a rash. However, the rash is typically maculopapular rather than urticarial. Since it is impossible to know whether the patient had urticarial hives or a maculopapular rash, the safest approach is a skin test using a commercially available penicillin skin test reagent. A negative test virtually eliminates the likelihood of a severe anaphylactic reaction to penicillin, and penicillin therapy can be started.
If the skin test reaction is positive, she should undergo desensitization and then begin penicillin. Experience using ceftriaxone for treatment of syphilis is limited. In addition, cross-reactivity of ceftriaxone with penicillin could conceivably occur if the patient actually had true urticaria. Although doxycycline is effective for treatment of syphilis, it is contraindicated in pregnant patients.

[ArchivalUser]

nice one shuun

[ArchivalUser]

1. C
2. C
3. D
4.B
5.A
6.C

[ArchivalUser]

thanx navz for nice qs.

I think u typed it wrong.It should be 1 E.

[ArchivalUser]

but 1 doesnt have the option E