MCQS 214 –216:A 12 year old complains of recurrent hemarturia following a recent upper respiratory tract infections.

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Question:214
An infant has diarrhea for 3 days with weight loss from 10 kg to 9 kg. On examination he is noted to have dry mucous membranes, poor skin turgor, markedly decreased urine output, and tachycardia. His BP is normal and compression-release of the nail beds shows satisfactory refilling. Appropriate treatment would include
a) plasmapheresis and plasma infusion
b) half strength Normal Saline
c) lactated Ringer's injection
d) Packed cells
e) Whole blood
f) platelets
g) fresh frozen plasma
h) double strength Normal Saline
i) 5% dextrose in 0.5N saline solution
j) intravenous heparin
Question:215
A 38 year old male complains of a painless red sore on the penis after returning from a long stay in Asia. The lesion disappears after a few weeks without any specific treatment. . Around two months later he develops a rash on the body with small red scaly bumps; this is be followed by 'flu-like' symptoms including fever and aching muscles. A likely diagnosis is:
a) Gonorrhea
b) Chlamydia
c) scabies
d) Hemophilus Ducreyi
e) a DNA Virus of the hepadnaviridae family
f) human papilloma virus
g) Trichomonas
h) Syphilis
i) Human Immuno-deficiency Virus
j) Herpes
Question:216
A 12 year old complains of recurrent hemarturia following a recent upper respiratory tract infections. On investigation his renal function is relatively normal and he has a proteinuria of 0.5 g/24 hr. The serum levels of C3 are normal. A renal biopsy demonstrates glomerulonephritis with evidence of deposition of IgA in the glomeruli. The most 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:214
 
Correct Answer: C
Explanation:
Clinical findings support the estimate of 10% fluid deficit--dry mucous membranes, poor skin turgor, markedly decreased urine output, and tachycardia--but BP is normal and peripheral perfusion is adequate, as shown by compression-release of the nail beds. table of fluid replacement technique Isotonic solutions such as normal saline and Ringer's lactate are usually the correct fluids for the initial treatment of dehydration that requires intravenous fluids . The fluid is administered in boluses of 15 to 30 mL per kg every 20 minutes until hypovolemia is corrected and some urine flow is established. At that time, continued maintenance and further deficit replacement can be continued at a slower rate. Adjustments can then be made in tonicity of the fluid, and appropriate potassium may be added to the infusion as needed. In children who are hypovolemic with signs of more than 5 percent dehydration with mental status changes, the initial fluid resuscitation should be aggressive, using boluses of isotonic fluid. Intravenous access should be initiated quickly while the child is being assessed. In children with normal cardiac and renal function, it is most important to give adequate amounts of fluid. Overhydrating is preferred to underhydrating. Any excess fluid will be eliminated eventually in the urine. If it is difficult to start an intravenous line, fluids can be given orally by a drip method or, if the situation is life-threatening, by an interosseous route until intravenous access is obtained.
 
Question:215
 
Correct Answer: H
Explanation:
Syphilis is a sexually transmitted disease which is caused by a bacteria (Treponema pallidum). Babies can be born with syphilis as they can catch the disease from their mothers in the womb. Syphilis is no longer commonplace in the developed world but it is still widespread in Asia and Africa,. Many of the cases of syphilis seen in the UK are contracted in these countries. How is syphilis contracted? Syphilis is spread through close sexual contact What are the signs of syphilis? The first stage of syphilis is contagious and occurs 3-6 days after contact. Lesions show where the skin has been in contact with the bacteria. The lesions appear as painless red sores (chancre) and are often seen on the penis or the labia or inside the vagina itself. Lesions can also be found in the rectum after anal sex or in the mouth after oral sex. The lesions will usually disappear after a few weeks. The second stage is contagious and occurs around 6 weeks or more after the chancre appears. A rash may appear on the body with small red scaly bumps; this may be followed by 'flu-like symptoms such as fever and aching muscles. The symptoms disappear but may return at any time. Without treatment, the latent phase will ultimately give way to tertiary syphilis which is characterized by body-wide organ damage. The infected individual exhibits cardiac complications, neurological damage, dementia, dermatological problems, and orthopedic abnormalities.
 
Question:216
 
Correct Answer: B
Explanation:
Patients with this disorder have glomerulonephritis with IgA as the predominant immunoglobulin in mesangial deposits, in the absence of any systemic disease such as systemic lupus erythematosus or Henoch-Schonlein purpura. On light microscopy, the kidney has focal and segmental mesangial proliferation and increased matrix. Some show generalized mesangial proliferation, occasionally associated with crescent formation and scarring. IgA is the predominant immunoglobulin deposited in the mesangium, but lesser amounts of IgG, IgM, C3, and properdin are common. Electron microscopic studies confirm these findings. IgA nephropathy is more common in males than in females (2:1). Patients either present with an episode of gross hematuria or are found to have microscopic hematuria on routine examination. While the gross hematuria lasts, renal function usually remains relatively normal and proteinuria minimal (<1 g/24 hr). Normal serum levels of C3 in IgA nephropathy help to distinguish this disorder from poststreptococcal glomerulonephritis.


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