MCQS 183-185 :A 26 year old man complained of a dull ache in her left loin followed a few days later by increased frequency both by day and by night

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Question:183
A 26 year old man complained of a dull ache in her left loin followed a few days later by increased frequency both by day and by night. He also noted hematuria. Urinalysis revealed a sterile pyuria and albuminuria. The urine was acidic. On examination the physician could palpate a thickened left lower ureter and a nodule in the prostate. A likely diagnosis is
a) polycystic disease of the kidneys
b) Berger's nephritis
c) systemic lupus erythematosus
d) renal vein thrombosis
e) Goodpasture's syndrome
f) renal tuberculosis
g) Alport's syndrome
h) renal calculus
i) chronic interstitial nephritis
j) Henoch Schonlein syndrome


Question:184
A lecturer is giving a talk about a ribonucleic acid virus that causes hepatitis. He is describing how this virus requires coinfection with a deoxyribonucleic acid virus to support its replication. This virus has been confined primarily to populations with frequent percutaneous exposures, such as drug addicts and hemophiliacs. Which virus or viral agent is he talking about ?
a) recombinant hepatitis B vaccine
b) hepatitis C virus
c) Hepatitis B surface antigen
d) hepatitis C vaccine
e) hepatitis D
f) hepatitis B immune globulin (HBIG)
g) hepatitis B virus DNA
h) hepatitis B e antigen
i) hepatitis A
j) atopic dermatitis

Question:185
An association with primary lymphedema and chronic obstructive pulmonary disease is a feature of
a) yellow nail syndrome
b) leukonychia
c) onychomycosis
d) lichen planus
e) pellagra
f) thallium toxicity
g) contact dermatitis
h) zinc deficiency
i) hypoalbuminemia
j) psoriasis
Question:183
Correct Answer: F
Explanation:
Patients with renal colic usually present with severe and sudden ureteral colic. In this case the pain was precipitated by the calculus being dislodged by the long and bumpy journey. In renal colic the pain is mediated through the autonomic nervous system. Since this is visceral pain, it is difficult to pinpoint the exact site of origin. The celiac ganglion innervates part of the gastrointestinal tract, as well as the kidney and the proximal half or two-thirds of the ureter; therefore, abdominal discomfort, nausea, and vomiting often accompany ureteral colic. Pain in which the patient can find no comfortable position is more likely to be renal or ureteral colic, whereas pain in which the patient wants to lie still is more likely to be related to peritoneal inflammation (eg, appendicitis, diverticulosis, salpingitis). Acute ureteral colic produces an agonizing, gripping pain that radiates intermittently from the loin to the groin, testicle, or labium, with a constant, less intense background colic. Stones can also cause intermittent or constant aching in the lumbar region.
 
Question:184
 
Correct Answer: E
Explanation:
hepatitis D is a ribonucleic acid (RNA) virus that requires coinfection with hepatitis B (a deoxyribonucleic acid [DNA] virus) to support its replication. Infection with this agent occurs either simultaneously with acute hepatitis B infection or is superimposed on chronic hepatitis B. Like hepatitis B, hepatitis D is transmitted by percutaneous inoculation and intimate contact. In nonendemic areas, such as the United States and western Europe, hepatitis D has been confined primarily to populations with frequent percutaneous exposures, such as drug addicts and hemophiliacs. In endemic areas, such as the Mediterranean countries, hepatitis D is transmitted primarily through intimate contact. Hepatitis D (delta hepatitis) is being recognized with increasing frequency. Its incubation period is similar to that for hepatitis B, and, when both hepatitis B and hepatitis D infections are acquired simultaneously, a single clinically apparent episode of hepatitis may ensue. There is a slight increase in the risk of fulminant hepatitis when the two infections occur simultaneously, but, in general, the outcome of simultaneous acute hepatitis B and D is no different from the outcome of hepatitis B alone. In contrast, among patients with chronic hepatitis B infection, superimposed hepatitis D may lead to severe, fulminant hepatitis, convert a mild or asymptomatic chronic hepatitis B infection into a severe form of chronic hepatitis ( chronic active hepatitis ), or accelerate the course of chronic active hepatitis. A diagnosis of delta hepatitis is made by demonstrating the appearance of antibody to hepatitis D (anti-HDV)
 
Question:185
Correct Answer: A
Explanation:
. This rare disease can be confused with onychomycosis. It accompanies primary lymphedema and chronic obstructive pulmonary disease. Clinically, the nails lack cuticles, have yellow pigmentation, and exhibit growth retardation


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