08-14-2014, 05:35 PM
1. A 12-year-old with systemic lupus erythematosus (SLE) diagnosed 1 year ago is brought to the office by her parents for a routine follow-up visit. Since the diagnosis was made, the patient has been treated with prednisone, methotrexate, and hydroxychloroquine with good response. She has continued to report occasional mild frontal headaches, fatigue, and arthralgias: however, results of serial laboratory studies obtained during the past 2 months have been within the reference ranges. Her parents state that the child has missed 20 days of school during the past 4 months; the mother says, “We don’t like to send her to school when she’s not feeling well. Besides, with her condition, we’re concerned about sending her to school where she could be exposed to children with contagious illnesses.” The patient says that she misses seeing her friends when she misses so much school. She is 150 cm tall and weight 42 kg. Vital signs are T 37.2C, pulse 80/min, respiration 14/min, and BP 110/72 mm Hg. PE discloses no abnormalities except for mild discomfort on passive motion of her elbows, wrists, and knees. Results of her most recent laboratory studies obtained 2 weeks ago are shown; Blood Hemoglobin 12.5 g/dL, WBC 4500/mm3, ESR 20 mm/h
Serum antinuclear antibody (ANA) titer was 1:1280; her ANA has been stable for three consecutive months. Which of the following is the most likely underlying cause of this patient’s excessive school absences?
A) Depression
B) Exacerbation of SLE symptoms
C) Malingering
D) School phobia
E) Vulnerable child syndrome
2. A 10-year-old boy with HIV infection is brought to the office by his mother because of a low-grade fever, headache, green nasal discharge, and ear pain for the past 2 days. He has had no weight loss and, until today, no change in his activity level. The patient’s HIV infection is well controlled. He takes zidovudine and abacavir that are managed by his infectious disease specialist. Vital signs are T 37.6C, pulse 100/min, respirations 22/min, and BP 105/60 mm Hg. PE discloses a right tympanic membrane that is erythematous and has poor mobility. There is minimal maxillary sinus tenderness. The remainder of the examination shows no abnormalities. X-ray of the sinuses is shown. The patient’s mother asks if this new development is serious. Which of the following is the most appropriate response to the mother?
A)Antibiotics will cure his maxillary sinusitis and otitis media
B) He is most likely seriously ill with central nervous system lymphoma
C) He might have middle ear rhabdomyosarcoma with sinus extension that can be successfully treated
D) He will need to be hospitalized for administration of intravenous antibiotics to treat the sinus osteomyelitis
E) The medications have predisposed him to invasive aspergillus infection that is most difficult to treat
3. A previously healthy 48-year-old woman comes to the office because of difficulty sleeping and recurring nightmares during the past 4 weeks. She says she narrowly ecaped a terrorist attack and she misses her colleagues who were killed during the attack. She states, “ I feel so angry all the time.” She also notes that she has been easily distracted and has had difficulty meeting deadlines at work. She has been avoiding family and friends and has found little pleasure in recreational activities she used to enjoy. She does not take any medication. Vital signs and physical examination are normal. In addition to referring her for psychological counseling, the most appropriate management is to prescribe which of the following?
A) Smitripttyline
B) Lorazepam
C) Sertraline
D) Tranylcypromine
E) No pharmacotherapy is indicated at this time
Please help. Thanks a lot
Serum antinuclear antibody (ANA) titer was 1:1280; her ANA has been stable for three consecutive months. Which of the following is the most likely underlying cause of this patient’s excessive school absences?
A) Depression
B) Exacerbation of SLE symptoms
C) Malingering
D) School phobia
E) Vulnerable child syndrome
2. A 10-year-old boy with HIV infection is brought to the office by his mother because of a low-grade fever, headache, green nasal discharge, and ear pain for the past 2 days. He has had no weight loss and, until today, no change in his activity level. The patient’s HIV infection is well controlled. He takes zidovudine and abacavir that are managed by his infectious disease specialist. Vital signs are T 37.6C, pulse 100/min, respirations 22/min, and BP 105/60 mm Hg. PE discloses a right tympanic membrane that is erythematous and has poor mobility. There is minimal maxillary sinus tenderness. The remainder of the examination shows no abnormalities. X-ray of the sinuses is shown. The patient’s mother asks if this new development is serious. Which of the following is the most appropriate response to the mother?
A)Antibiotics will cure his maxillary sinusitis and otitis media
B) He is most likely seriously ill with central nervous system lymphoma
C) He might have middle ear rhabdomyosarcoma with sinus extension that can be successfully treated
D) He will need to be hospitalized for administration of intravenous antibiotics to treat the sinus osteomyelitis
E) The medications have predisposed him to invasive aspergillus infection that is most difficult to treat
3. A previously healthy 48-year-old woman comes to the office because of difficulty sleeping and recurring nightmares during the past 4 weeks. She says she narrowly ecaped a terrorist attack and she misses her colleagues who were killed during the attack. She states, “ I feel so angry all the time.” She also notes that she has been easily distracted and has had difficulty meeting deadlines at work. She has been avoiding family and friends and has found little pleasure in recreational activities she used to enjoy. She does not take any medication. Vital signs and physical examination are normal. In addition to referring her for psychological counseling, the most appropriate management is to prescribe which of the following?
A) Smitripttyline
B) Lorazepam
C) Sertraline
D) Tranylcypromine
E) No pharmacotherapy is indicated at this time
Please help. Thanks a lot