MCQS 205 –207 :A patient with known AIDS develops a new onset focal seizure

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Question:205
a breast lump that appears during the menstrual cycle, grows rapidly and shows spontaneous regression with completion of the menses is most suggestive of
a) Paget's disease
b) fibroadenoma
c) simple cyst
d) carcinoma in-situ
e) galactocele
f) subareolar duct ectasia
g) fat necrosis
h) inflammatory carcinoma
i) Breast abscess
j) phylloides tumor

Question:206
A 54 year old man presents with a symmetrical distal arthopathy. On examination he has finger clubbing and a symmetrical arthropathy. Radiography demonstrates visible periosteal newbone formation over the diaphyses of his metacarpals and phalanges. These features are a recognised complication of
a) juvenile rheumatoid arthritis
b) scleroderma
c) epidermolysis bullosa
d) bronchial carcinoma
e) infectious mononucleosis
f) ulcerative colitis
g) epididymitis
h) renal carcinoma
i) syringomyelia
j) cat-scratch disease

Question:207
A patient with known AIDS develops a new onset focal seizure . The investigation of choice at this stage would be
a) skull x-ray
b) non-contrast CT scan brain
c) contrast CT scan brain
d) contrast enhanced MRI of the optic nerves
e) four vessel cerebral angiogram
f) single vessel cerebral angiogram
g) MR cerebral Angiography
h) mri with emphasis on the frontal lobe
i) mri of the pituitary gland
j) mri with emphasis on the temporal lobe
Question:205
Correct Answer: C
Explanation:
Cysts are unquestionably influenced by ovarian hormones, a fact that explains their sudden appearance during the menstrual cycle, their rapid growth, and their spontaneous regression with completion of the menses. Most women with new cyst formation present after the age of 35 and rarely before the age of 25 years. The incidence of cyst development steadily increases until the age of menopause and sharply declines after menopause. New cyst formation detected clinically in older women commonly is explained by the use of exogenous hormone replacement.
 
Question:206
Correct Answer: D
Explanation:
hypertrophic pulmonary arthropathy is often diagnosed radiologically, when a patient presents with a symmetrical distal arthopathy. It is characterised by finger clubbing and a vaguely symmetrical arthropathy, with visible periosteal newbone formation over the diaphyses, but usually not extending to the bone end. There may be hyperaemia. The condition is thought to be a form of autonomic neuropathy, although the exact mechanism is not fully understood. The more pronouced that a uniform periosteal reaction appears then the greater likelihood of the patient's having survived long enough to generate it. In adults, intrathoracic sepsis and carcinoma of the bronchus are the most frequent underlying conditions. Congenital heart disease has an association with HPOA. This and bowel disorders such as Crohn's disease, are more probable in the young as causes of peripheral periosteal reactions.
 
Question:207
Correct Answer: C
Explanation:
Toxoplasma encephalitis used to be a rare infection of the central nervous system in the immunocompromised, however, it recently became the most common cause of cerebral mass lesions in patients with acquired immunodeficiency syndrome. In addition, CNS Toxoplasmosis is emerging as the most prevalent AIDS-related opportunistic infection. The most common general manifestations are headaches, fever, and behavioral disturbances. Focal signs including hemiparesis, ataxia, cranial nerve palsies, sensory deficits, aphasia and hemianopsia. Hemideficiency and focal seizures reflect the frequent hemispheric localization of lesions on CT scans. Most cases of Toxoplasma encephalitis (TE) represent reactivation of a latent infection. In patients with AIDS, it is thought that the impaired production of lymphokines and gamma interferon and the lack of specific antibody response and opsonisation of T-gondii are responsible for reactivation of the infection. Typically, immunosuppression is far advanced when TE occurs. The early diagnosis of CNS toxoplasmosis requires a high index of suspicion. Computed tomography is extremely useful for investigating suspected TE. Lesions, single or multiple, are usually seen in the cerebral hemispheres, often with surrounding edema and mass effect. Contrast studies reveal either ring or nodular enhancement in most cases. Magnetic resonance imaging may detect lesions not demonstrated by CT and therefore may be recommended if clinical suspicion is high and CT is negative


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