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United State Médical Licensing Examination
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| La Pharmacienne |
Publié le 15-02-2009 04:25
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MedeSpacien rédacteur
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Question 04 :
A 2-year-old child is admitted to your hospital team. The child's primary care doctor has been following the child for several days and has noted her to have had high fever, peeling skin, abdominal pain, and a bright red throat. You are concerned because two common pediatric problems that could explain this child's condition have overlapping presenting signs and symptoms.
Which of the following statements comparing these two diseases in your differential is true?
a- Neither has cardiac complications
b- Serologic tests are helpful in diagnosing both
c- Only one of the diseases has mucocutaneous and lymph node involvement
d- Pharyngeal culture aids in the diagnosis of one of the conditions
e- A specific antibiotic therapy is recommended for one of the conditions, but only supportive care is recommended for the other
peeling skin = peau desquamante
differential = diagnostic differentiel
supportive treatment = traitement symptomatique
lymph node = ganglion lymphatique (ADP) |
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| La Pharmacienne |
Publié le 15-02-2009 04:27
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MedeSpacien rédacteur
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The answer is d, Pharyngeal culture aids in the diagnosis of one of the conditions.
The two conditions in consideration are Kawasaki disease and scarlet fever (i.e., "strep" throat). Kawasaki disease is an acute febrile illness of unknown etiology and shares many of its clinical manifestations with scarlet fever. Scarlatiniform rash, desquamation, erythema of the mucous membranes that produces an injected pharynx and strawberry tongue, and cervical lymphadenopathy are prominent findings in both.
The most serious complication of Kawasaki disease and scarlet fever is cardiac involvement. Erythrogenic toxin-producing group A ß-hemolytic streptococcus is the agent responsible for scarlet fever. Isolation of the organism from the nasopharynx and a rise in antistreptolysin titers will confirm the diagnosis. Serologic tests for a variety of infectious agents, both viral and bacterial, have been negative in Kawasaki disease.
Rheumatic heart disease is a serious sequela of streptococcal pharyngitis, which can be prevented by appropriate treatment with penicillin. Coronary artery aneurysm and thrombosis are the most serious complications of Kawasaki disease. The current approach to treatment of Kawasaki disease, which includes specific therapy with aspirin and IV gamma globulin administered within a week of the onset of fever, appears to lower the prevalence of coronary artery dilatation and aneurysm and to shorten the acute phase of the illness.
Rq:
Neither has cardiac complications = Aucune des maladies n'a de complications cardiaques.
Rheumatic heart disease (or Rheumatic Fever) = Rhumatisme Articulaire Aigu |
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| La Pharmacienne |
Publié le 15-02-2009 04:29
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MedeSpacien rédacteur
Messages : 8494
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Question 05 :
An 8-year-old sickle cell patient arrives at the emergency room in respiratory distress. Over the previous several days, the child has become progressively tired and pale. The child's hemoglobin concentration in the emergency room is 3.1 mg/dL.
Which of the following viruses commonly causes such a clinical picture?
a- Roseola
b- Parvovirus B19
c- Coxsackie A16
d- Echovirus 11
e- Cytomegalovirus
sickle cell patient = patient atteint de drepanocytose
respiratory distress = detresse respiratoire
clinical picture = tableau clinique |
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| La Pharmacienne |
Publié le 15-02-2009 04:30
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MedeSpacien rédacteur
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The answer is b, Parvovirus B19.
Fifth disease (erythema infectiosum), long recognized as a benign mild exanthem of school-age children, is now known to be caused by human parvovirus B19. In the compromised patient, the parvovirus can cause serious anemia by infecting red-cell precursors and causing them to lyse. Patients with hemolytic conditions, such as sickle cell anemia, thus develop a transient aplastic crisis. A poorly functioning bone marrow (for a week or more) in a patient with a reduced red-cell life span (about 30 days) can result in profound anemia.
Other problems can result in patients infected with parvovirus B19. In patients with immunodeficiency, the B19 infection can be persistent and lead to life-threatening chronic anemia. Infection in a pregnant woman can result in severe anemia in the infected fetus, with secondary hydrops fetalis and death. Roseola is now thought to be caused most often by the human herpesvirus 6. Coxsackie A16 virus causes hand-foot-and-mouth disease. Echo-11 virus frequently causes viral meningitis, and cytomegalovirus causes a congenital infection. |
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| La Pharmacienne |
Publié le 15-02-2009 04:32
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MedeSpacien rédacteur
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After an initial pregnancy resulted in a spontaneous loss in the first trimester, your patient is concerned about the possibility of this recurring.
Which of the following is an appropriate answer regarding the chance of recurrence?
a- It depends on the genetic makeup of the prior abortus
b- It is no different than it was prior to the miscarriage
c- It is increased to approximately 50%
d- It is increased most likely to greater than 50%
e- It depends on the sex of the prior abortus
spontaneous loss = perte spontanée (dans ce contexte = avortement)
miscarriage = fausse-couche |
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