MCQS 377-379 :A 38 year old farmer is seen with severe headache and fever

Correct Answer: G

'The extraintestinal manifestations of Gardner's syndrome include bony and soft tissue abnormalities. Bone abnormalities include osteomas of the mandible, skull, and long bones, exostoses, and various dental abnormalities (including mandibular cysts, impacted teeth, and supernumerary teeth). When carefully sought, mandibular osteomas can be seen in up to 90% of patients with FAP even without other stigmata of Gardner's syndrome. Orthopantomography of the mandible is a simple and noninvasive means to screen for young carriers of the FAP gene; however, it is crucial to distinguish nonspecific sclerotic lesions in the mandible from true osteomas. Mandibular osteomas in FAP tend to be multiple, whereas nonspecific sclerotic bony lesions are usually single and located close to a diseased tooth. In case of this patient the radiograph of the jaw demonstrated two impacted teeth and at least two mandibular osteomas. The osteomas characteristic of Gardner's syndrome may be distinguished from ordinary sclerotic lesions of the jaw when they are multiple and not contiguous with the root of the tooth.


Correct Answer: C

Coxiella burnetii, the etiologic agent of Q fever, is a highly pleomorphic coccobacillus with a gram-negative cell wall There are three presentations of Q fever : atypical pneumonia, rapidly progressive pneumonia, and pneumonia as an incidental finding in a patient with a febrile illness. This last presentation is probably the most common form of Q fever pneumonia. In Q fever due to .Coxiella burnetii the physical examination of the chest is often unremarkable. The most common physical finding is inspiratory crackles. Patients with rapidly progressive pneumonia usually have the physical signs of pulmonary consolidation. About 5% of patients have splenomegaly. Fever and severe headache suggest central nervous system infection, and lumbar puncture is often performed.The rapidly progressive form of Q fever pneumonia mimics legionnaires' disease and the pneumonic form of tularemia, and indeed, all the causes of rapidly progressive pneumonia enter the differential diagnosis


Correct Answer: D

Whilst most patients with diabetes are aware of the symptoms of a hypoglycaemic reaction, there are some in whom the first sign may be a seizure or unconsciousness. It would appear that in these patients there is little adrenaline secreted in response to the falling blood glucose and the body's ability to raise the blood glucose level is impaired. Hypoglycaemia unawareness occurs more frequently in those attempting very tight control of their diabetes especially if on an insulin pump (frequent episodes of hypoglycaemia leads to a blunting of the counter-regulatory hormonal responses due to low blood glucose). Patients who have this problem are at particular risk of developing severe hypoglycaemic reactions and their doctors must take this into account in setting somewhat higher target levels of blood glucose control. Increased blood glucose monitoring is helpful in reducing the number of hypoglycaemic episodes in these patients, especially when unaccustomed or special activities are undertaken. Hypoglycaemia unawareness may be brought on by frequent, undiagnosed, hypoglycaemic events which leads to autonomic failure. Scrupulous prevention of these hypoglycaemic events may restore the hypoglycaemic awareness. Further, it is important to be aware that undiagnosed hypoglycaemic events often occur during the night


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