MCQS 186-188 :A 35-year-old male with abdominal pain and diarrhoea has evidence of hundreds of polyps in the colon and rectum

A 35-year-old male with abdominal pain and diarrhoea has evidence of hundreds of polyps in the colon and rectum. The most likely diagnosis is
a) Muir-Torre syndrome
b) Turcot's syndrome
c) Cowden's disease
d) Adenomatous polyposis
e) Familial adenomatous polyposis [FAP]
f) Familial juvenile polyposis
g) Gardner's syndrome
h) Cronkhite-Canada syndrome
i) Pneumatosis cystoides intestinalis
j) Peutz-Jegher's syndrome

MCV: Decreased Serum ferritin: Increased Total iron binding capacity: Decreased Serum iron: Decreased Marrow iron: Present The most likely diagnosis is
a) Thalassaemia trait
b) Hypoparathyroidism
c) Hereditary sideroblastic anaemia
d) Protein energy malnutrition
e) Chronic renal failure
f) Anaemia of chronic disease
g) Acute blood loss
h) Iron deficiency anaemia
i) Oral contraceptives
j) Megaloblastic anaemia

A young drug abuser develops a fever and cough. A chest radiograph reveals multiple cavitating pulmonary nodules. The likely cause is
a) P. aeruginosa
b) pneumocytis carinii
c) S. Aureus
d) mycobacterium tuberculosis
e) Legionnaires disease
f) pneumococcal pneumonia
g) Nocardia asteroides
h) Haemophilus influenzae
i) Mycoplasma pneumoniae
j) Pseudomonas aeruginosa

Correct Answer: E
FAP is an autosomal dominant condition with the defect localized to the APC gene on chromosome 5q21. There are several thousand polyps in the colon. The polyps appear between the age of 10 and 35 years. The potential malignant change is 100% by the age of 40 years. Hence all relatives ought to be screened annually from the age of 12 years and all patients ought to have prophylactic colectomy by the age of 30. Recently, a protein assay has been developed that can diagnose the genetic defect in 87% of such families and 150mg sulindac twice daily has been shown to reduce the number and size of the adenomatous polyps in the rectum.
Correct Answer: F
In anaemia of chronic disease, serum iron will be decreased, serum ferritin increased and TIBC will be decreased. Marrow iron stores will be normal to high but not absent, as in iron deficiency anaemia [IDA]. In IDA, the serum ferritin will be decreased and the TIBC will be increased. However, the marrow iron stores will be absent.
Correct Answer: C
Cavitary pulmonary nodules are another recognized radiographic finding often associated with bacterial pneumonia in HIV-infected patients. P. aeruginosa and S. aureus are the most frequently found pathogens in cavitary lung lesions. S. aureus infection is frequently associated with septic emboli among intravenous drug abusers. This subset of patients is also prone to develop empyemas


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