Sujet de la discussion : MedeSpace.Net :: United State Médical Licensing Examination

Publié par Administrateur le 27-10-2008 02:07
#1

i18.servimg.com/u/f18/11/66/67/80/header10.gif



USMLE est United State Médical Licensing Examination est l'examen d'accès à la spécialité aux USA.

Il comporte trois étapes :

1ère étape :
Les sciences initiales

Anatomie, science comportementale, biochimie, pharmacologie, physio, physiopath, génétique, nutrition, biologie moléculaire et cellulaire, immunologie....

La liste des cours à préparer dans la biochimie et la biologie moléculaire:

Code
Biochemistry and molecular biology
• gene expression: DNA structure, replication, and exchange
– DNA structure: single- and double-stranded DNA, stabilizing forces, supercoiling
– analysis of DNA: sequencing, restriction analysis, PCR amplification, hybridization
– DNA replication, mutation, repair, degradation, and inactivation
– gene structure and organization; chromosomes; centromere, telomere
– recombination, insertion sequences, transposons
– mechanisms of genetic exchange, including transformation, transduction, conjugation, crossover,
recombination, linkage
– plasmids and bacteriophages
• gene expression: transcription, including defects
– transcription of DNA into RNA, enzymatic reactions, RNA, RNA degradation
– regulation: cis-regulatory elements, transcription factors, enhancers, promoters, silencers, repressants,
splicing
• gene expression: translation, including defects
– the genetic code
– structure and function of tRNA
– structure and function of ribosomes
– protein synthesis
– regulation of translation
– post-translational modifications, including phosphorylation, addition of CHO units
– protein degradation
• structure and function of proteins
– principles of protein structure and folding
– enzymes: kinetics, reaction mechanisms
– structural and regulatory proteins: ligand binding, self-assembly
– regulatory properties
• energy metabolism, including metabolic sequences and regulation
– generation of energy from carbohydrates, fatty acids, and essential amino acids; glycolysis, pentose
phosphate pathway, tricarboxylic acid cycle, ketogenesis, electron transport and oxidative phosphorylation,
glycogenolysis
– storage of energy: gluconeogenesis, glycogenesis, fatty acid and triglyceride synthesis
– thermodynamics: free energy, chemical equilibria and group transfer potential, energetics of ATP and
other high-energy compounds
• metabolic pathways of small molecules and associated diseases
– biosynthesis and degradation of amino acids (eg, homocystinuria, maple syrup urine disease)
– biosynthesis and degradation of purine and pyrimidine nucleotides
– biosynthesis and degradation of lipids (eg, dyslipidemias, carnitine deficiency, adrenogenital
syndromes)
– biosynthesis and degradation of porphyrins
– galactosemia and other small sugar disorders
– biosynthesis and degradation of alcohols and other small molecules
• biosynthesis and degradation of other macromolecules and associated abnormalities, complex
carbohydrates (eg, lysosomal storage disease), glycoproteins, and proteoglycans (eg, type II glycogen storage
disease)




Toute la liste des cours : http://download.u...8step1.pdf

Il s'agit de questions à choix multiples, intégré dans un programme informatique..

Et pour passer l'examen lorsqu'on est des étrangers on doit s'enregistrer sur ce site: http://www.ecfmg....

Pour le préparer voici un logiciel qui va vous aider :

En effet on peut se préparer à cet examen à l'aide d'un logiciel disponible sur cette http://download.u...ep1mcq.zip

Exemple de question:

Code
A 32-year-old woman with type 1 diabetes
mellitus has had progressive renal failure over the
past 2 years. She has not yet started dialysis.
Examination shows no abnormalities. Her
hemoglobin concentration is 9 g/dL, hematocrit is
28%, and mean corpuscular volume is 94 μm3. A
blood smear shows normochromic, normocytic
cells. Which of the following is the most likely
cause?
(A) Acute blood loss
(B) Chronic lymphocytic leukemia
(C) Erythrocyte enzyme deficiency
(D) Erythropoietin deficiency
(E) Immunohemolysis
(F) Microangiopathic hemolysis
(G) Polycythemia vera
(H) Sickle cell disease
(I) Sideroblastic anemia
(J) β-Thalassemia trait
(Answer: D)



Publié par La Pharmacienne le 27-10-2008 02:25
#2

Un très bon topic, les USMLE aident trop ceux qqui veulent suivre leurs études dans les pays anglophones.. merci pour le topic boss ;)

Publié par Administrateur le 27-10-2008 13:55
#3

2ème étape :
Faite de 02 parties:

Partie1: Clinical Knowledge (CK)
Des QCM sur les connaissances cliniques, voici le programme :

Code
Step 2 CK Content Outline
TABLE OF CONTENTS
1. General Principles
Infancy and Childhood
Adolescence
Senescence
Medical Ethics and Jurisprudence
Applied Biostatistics and Clinical Epidemiology
Systems-Based Practice and Patient Safety

2. Infectious and Parasitic Diseases
3. Neoplasms
4. Immunologic Disorders
5. Diseases of the Blood and Blood-forming Organs
6. Mental Disorders
7. Diseases of the Nervous System and Special Senses
8. Cardiovascular Disorders11
9. Diseases of the Respiratory System
10. Nutritional and Digestive Disorders.
11. Gynecologic Disorders
12. Renal, Urinary, and Male Reproductive Systems
13. Disorders of Pregnancy, Childbirth, and the Puerperium.
14. Disorders of the Skin and Subcutaneous Tissues.
15. Diseases of the Musculoskeletal System and Connective Tissue
16. Endocrine and Metabolic Disorders
17. Congenital Anomalies
18. Conditions Originating in the Perinatal Period
19. Symptoms, Signs, and Ill-defined Conditions
20. Injury and Poisoning




Voici le lien de tous les cours:
http://download.u...8step2.pdf



La 2ème partie :
Step 2 Clinical Skills (CS)

http://download.u...manual.pdf


C'est en Face du patient, voici cette vidéo :

http://download.u...video1.zip


Pour bien se préparer au Step2 CK

Multiple Choice Tutorial and Practice Test Items :
http://download.u...ep2mcq.zip

Une autre vidéo :
http://download.u...video1.zip

Bonne chance.

Etre résidant renforce vos chances.. Donc bon courage

Edité par Administrateur le 27-10-2008 13:56

Publié par La Pharmacienne le 06-12-2008 21:37
#4

Bonsoir bis boss,

Et la troisième partie ? :|
Si non, boss est ce que je peux poster sur ce topic des Quiz de USMLE corrigés ?
mes respects :)

Publié par Administrateur le 06-12-2008 21:45
#5

Bonsoir :

Apparemment il y a que toi Aphrodite qui s'intéresse de ce sujet :


3ème étape :

Puisque une fois avoir réussis les 02 premiers tests, on devient officiellement ou presque médecin américain.

C'est toujours en QCM, mais un peu compliqué (un cas clinique complet de A à T), pour le comprendre veuillez télécharger ces préparatifs:

Multiple Choice Tutorial and Practice Test Items :
http://download.u...ep3mcq.zip

Primum Computer-Based Case Simulations (CCS) - Tutorial and Practice Cases
http://download.u...ep3ccs.zip

Feedback for Step 3 CCS Practice Cases
http://www.usmle....edback.htm

Bien à vous

Publié par Administrateur le 06-12-2008 21:46
#6

Bonsoir :

Oui, bien sur Aphrodite. Tu peux

Bien à vous.

Publié par La Pharmacienne le 06-12-2008 22:08
#7

Bonsoir boss,

Oki, vais les poster, ma source sera : Harrison's Online Self-Assessment
and Board Review


Bien à vous [copy right boss] :D

Publié par La Pharmacienne le 08-12-2008 00:10
#8

Bonsoir a tous..

Comme promis boss.. :|

1. A 23-year-old female nursing student is brought to the emergency room by her parents after being found unconscious at home. She is noted to have a fingerstick glucose of 29 mg/dL. After administration of intravenous D50, she rapidly regains consciousness. Her parents state that this is the fourth time in a month that this has occurred. She is not taking any medications. The medical history is unremarkable except for a history of depression and a mother with diabetes mellitus. Examination is unremarkable. During an observed period in the hospital, the patient is noted to have a symptomatic glucose level of 31 mg/dL. Plasma insulin levels are elevated, and C-peptide levels are low. Which of the following is the most likely cause of her hypoglycemia?


Choose the one best response to this question.


A. Glipizide overdose
B. Surreptitious insulin use
C. Insulinoma
D. Glucagonoma
E. Diabetic ketoacidosis


Diabetic ketoacidosis = acidocétose diabetique
Insulinoma = Insulinome
Glucagonoma = Glucagonome
Hypoglycemia = Hypoglycémie
unconscious = inconsciente
fingerstick glucose = glycémie capillaire
D50 = Sérum Glucosé 5% (Dextrose 50).
Medical history = ATCD médicaux
Diabetes mellitus = Diabète sucré



Answer:

The answer is B.
>>> Factitious hypoglycemia from self-administration of insulin or ingestion of a sulfonylurea shares clinical and laboratory features with insulinoma. The absence of an elevated C peptide distinguishes exogenous insulin use from insulinoma. An undetectable sulfonylurea level works against a diagnosis of sulfonylurea toxicity. Factitious hypoglycemia is more common in health care workers, patients with diabetes and their relatives, and patients with psychiatric histories

Publié par La Pharmacienne le 08-12-2008 01:21
#9

Choose the one best response to this question :
2. A physician is deciding whether to use a new test to screen for disease X in his practice. The prevalence of disease X is 5%. The sensitivity of the test is 85%, and the specificity is 75%. In a population of 1000, how many patients will be erroneously told they have diagnosis X on the basis of the results of this test?

A. 713
B. 505
C. 237
D. 42
E. 8


Diagnosis = Diagnostic
how many patients will be erroneously told they have diagnosis X = Quel est le nombre des faux positifs (traduction du sens et non pas des mots)

Answer:

Ps: It should be noted that the medical terms used in this case are the following :
TP = True Positive and FP = False Positive
TN = True Negative and FN = False Negative

The answer is C.
>>> In evaluating the usefulness of a test, it is imperative to understand the clinical implications of the sensitivity and specificity of that test. By obtaining information about the prevalence of the disease in the population—the specificity and sensitivity—one can generate a two-by-two table, as shown below. This table is used to generate the total number of patients in each group of the population.

img47.imageshack.us/img47/621/tab01os2.jpg

The sensitivity of the test is TP/(TP + FN). The specificity is TN/(TN + FP). In this case the table is filled in as follows:

img128.imageshack.us/img128/1783/tab02so4.jpg

Notez bien: A physician c'est un médecin, un physicien en anglais c'est "a physicist"

Publié par osiris le 08-12-2008 08:35
#10

merci petite aphrodite

Publié par La Pharmacienne le 09-12-2008 02:08
#11

Good morning

This time we will provide you with two MCQs (Multiple Choice Questions) at a time! You have to choose the single best response to these questions :

Question 01: Why is this infant's cough getting worse?

A previously well 1-year-old infant has had a runny nose and has been sneezing and coughing for 2 days. Two other members of the family had similar symptoms. Four hours ago, his cough became much worse. On physical examination, he is in moderate respiratory distress with nasal flaring, hyperexpansion of the chest, and easily audible wheezing without rales. Which of the following is the most likely diagnosis?

a- Bronchiolitis
b- Viral croup
c- Asthma
d- Epiglottitis
e- Diphtheria

runny nose = rhinorrhea = un nez qui coule
sneezing = eternuement
coughing = toux
respiratory distress = destresse respiratoire
nasal flaring = elargissement des narines
chest = thorax


Question 02 : What's wrong with this baby?
You are asked to evaluate an infant born vaginally three hours previously to a mother whose only pregnancy complication was poorly controlled gestational diabetes. The nursing staff noticed that the infant was breathing abnormally. On examination, you find that the infant is cyanotic, has irregular, labored breathing, and has decreased breath sounds on the right side. You also note decreased tone in the right arm. You provide oxygen and order a stat portable chest radiograph, which is normal. Which of the following tests is most likely to confirm your diagnosis?

a- Nasal wash for viral culture
b- Fiberoptic bronchoscopy
c- Chest CT
d- Chest ultrasound
e- Induced sputum culture

born vaginally = né par voie basse
pregnancy = grossesse
gestational diabetes = diabète gestationnel
breathing = respiration
cyanotic = cyanosé
breath sounds = bruits respiratoires (murmur vesiculaire)
tone = tonus
Chest radiograph = radiographie thoracique
Chest CT = Chest Computed Tomography = TDM thoracique
Chest Ultrasound = echographie thoracique
sputum culture = culture des crachats


Answers:
Answer 01
The answer is a, Bronchiolitis.
Of the choices given, bronchiolitis is the most likely, although asthma, pertussis, and bronchopneumonia can present similarly. The family history of upper respiratory infections, the previous upper respiratory illness in the patient, and signs of intrathoracic airway obstruction make the diagnosis of bronchiolitis more likely. Viral croup, epiglottitis, and diphtheria are not reasonable choices because there are no signs of extrathoracic airway obstruction.

The most likely cause of the illness is infection by respiratory syncytial virus, which causes outbreaks of bronchiolitis of varying severity, usually in the winter and spring. Other viruses, such as parainfluenza and the adenoviruses, have also been implicated in producing bronchiolitis. Treatment is generally supportive in this usually self-limited condition.

Supportive treatment = TRT symptomatique.


Answer 02 :

The answer is d, Chest ultrasound.
Infants born to mothers with gestational diabetes are at risk for being large for their gestational age and thus at increased risk for peripheral nerve injuries such as Erb-Duchenne and phrenic nerve paralysis. An ultrasound or fluoroscopy of the chest would reveal asymmetric diaphragmatic motion in a seesaw manner. With a negative chest radiograph, a chest CT would not be helpful at this point. Bronchoscopy would help delineate airway abnormalities and foreign bodies, but would not identify phrenic nerve paralysis

Peace :)

Publié par La Pharmacienne le 10-12-2008 16:50
#12

Bonsoir:

Choose the one best response to this question:

4. A 73-year-old female develops substernal chest pain, severe nausea, and vomiting while mowing the lawn. In the emergency department she has cool extremities, right arm and left arm blood pressure of 85/70 mmHg, heart rate of 65/min, clear lungs, and no murmurs. She has no urine output. A Swan-Ganz catheter is placed and reveals cardiac index of 1.1 L/min per m2, PA pressure of 20/14 mmHg, PCW pressure of 6 mmHg, and RA pressure of 24 mmHg. The patient most likely has:

A. gram-negative sepsis
B. occlusion of the left main coronary artery
C. occlusion of the right coronary artery
D. perforated duodenal ulcer
E. ruptured aortic aneurysm


PA pressure = Pulmonary Artery pressure
PCWP = Pulmonary Capillary Wedge Pressure = c'est la PCP ou la PAPO
RA pressure = Right Atrial pressure = pression de Oreillette Droite
Blood pressure = pression artérielle
Heart rate = pouls ( parfois ils parlent de "pulse" )
infarction = infarctus
Right ventricular failure = insuffisance ventriculaire droite


Answer:
The answer is C.
This patient has a right ventricular infarction. The combination of findings consistent with bradycardia, cardiogenic shock, low normal left ventricular and PA pressures, and markedly elevated right atrial pressure is consistent with acute right ventricular (RV) failure. An acute pulmonary embolus may also cause acute RV failure, but the PA pressure is usually elevated. RV infarction is usually due to occlusion of the right coronary artery; the bradycardia is due to sinus or AV node ischemia. Right-sided precordial ECG will show ST-segment elevation. Occlusion of the left main artery will cause cardiogenic shock, but the PCW pressure will be elevated. Perforated duodenal ulcer and ruptured aortic aneurysm will cause hypovolemic shock with low RA and PCW pressures. Gram-negative sepsis will generally have an normal or increased cardiac index with normal filling pressures and low blood pressure

Publié par La Pharmacienne le 10-12-2008 17:22
#13

This time we've got 3 short and relatively easy questions :

As usual: Choose the best response for these questions :

Question 01 :
What's Making this Girl's Mouth Droop?
Two weeks after a viral syndrome, a 9-year-old girl presents to your clinic with a complaint of several days of weakness of her mouth. In addition to the drooping of the left side of her mouth, you note that she is unable to completely shut her left eye. Her smile is asymmetric, but her examination is otherwise normal. Which of the following is the most likely diagnosis?


a- Guillain-Barré syndrome
b- Botulism
c- Cerebral vascular accident
d- Brainstem tumor
e- Bell palsy

Cerebral vascular accident = AVC
Brainstem = Tronc cerebral
Bell palsy = Faites une petite recherche :|


Question 02 :
An infant can move his head from side to side while following a moving object, can lift his head from a prone position 45° off the examining table, smiles when encouraged, and makes cooing sounds. He cannot maintain a seated position. Which of the following is the most likely age of the infant?

a- 1 month
b- 3 months
c- 6 months
d- 9 months
e- 12 months

Prone position = décubitus ventral


Question 03 :

A child is brought to your clinic for a routine examination. She can dress with help, can ride a tricycle, knows her own age, and can speak in short sentences. She had difficulty in copying a square. Which of the following is the most likely age of this child?

a- 1 year
b- 2 years
c- 3 years
d- 4 years
e- 5 years

Ps: je repasserai pour poster les réponses.

Publié par La Pharmacienne le 10-12-2008 21:19
#14

Answer to Question 01 :
The answer is e, Bell palsy.[1-3]

Bell palsy is an acute, unilateral facial nerve palsy that begins about 2 weeks after a viral infection. The exact pathophysiology is unknown, but it is thought to be immune or allergic. On the affected side, the upper and lower face are typically paretic, the mouth droops, and the patient cannot close the eye. Treatment consists of maintaining moisture to the affected eye (especially at night) to prevent keratitis. Complete, spontaneous resolution occurs in about 85% of cases, 10% of cases have mild residual disease, and about 5% of cases do not resolve. Occasionally infants will have a facial nerve palsy at birth; this is usually related to compression from forceps and spontaneously resolves over several weeks. As this is a compression neuropathy, it should not be called congenital Bell palsy.


Answer to Question 02 :
The answer is b, 3 months.[4-6]

By 8 weeks of age, infants who are developing normally should be able to smile and coo when smiled at or talked to. By 3 months of age, infants should be able to follow a moving toy not only from side to side but also in the vertical plane. When placed on his or her abdomen, a normal 3-month-old infant can raise his or her face 45° to 90° from the horizontal. Not until 6 to 8 months of age should an infant be able to maintain a seated position.


Answer to Question 03 :

The answer is c, 3 years.[4,5,7]

By 3 years of age, children become quite skilled in many areas. Most can say many words and speak in sentences. They can help dress and undress themselves, with the exception of shoelaces and sometimes buttons. They can ride a tricycle and can alternate feet when climbing stairs, although they still place both feet on each step when going down stairs. They can identify at least one color by name, know their age and gender, but have not progressed beyond copying a circle and a crude cross. Only at 4 to 5 years of age can a child copy a square.



References
1.Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Co.; 2003:2081-2082.
2.McMillan JA, DeAngelis CD, Feigin RD, Warshaw JB, eds. Oski's Pediatrics. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1999:1963-1964.
3.Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, eds. Rudolph's Pediatrics. 21st ed. New York: McGraw-Hill; 2003:2366.
4.Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Co.; 2003:31-36.
5.McMillan JA, DeAngelis CD, Feigin RD, Warshaw JB, eds. Oski's Pediatrics. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1999:756-761.
6.Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, eds. Rudolph's Pediatrics. 21st ed. New York: McGraw-Hill; 2003:14.
7.Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, eds. Rudolph's Pediatrics. 21st ed. New York: McGraw-Hill; 2003:440.

Publié par La Pharmacienne le 10-12-2008 21:41
#15

Bonsoir,

Why is this patient fainting?
Choose the one best response to this question.

A 78-year-old male presents to the clinic complaining that every time he shaves with a straight razor, he passes out. His symptoms have been occurring for the last 2 months. Occasionally, when he puts on a tight collar, he passes out as well. The loss of consciousness is brief, he has no associated prodrome, and he feels well afterward. His past medical history is notable for hypertension and hypercholesterolemia. His only medication is hydrochlorothiazide. On physical exam his vital signs are normal, and his cardiac exam is normal with the exception of a fourth heart sound. Which of the following is the most appropriate next diagnostic test?

A. Stress echocardiography
B. Adenosine thallium scan
C. Computed tomogram of the neck
D. Carotid sinus massage
E. Tilt table test

Fourth heart sound = B4 (4ème bruit)


Answer:
The answer is D.

>>> The patient presents with carotid hypersensitivity syndrome in which pressure on the carotid sinus baroreceptors results in activation of the sympathetic nervous system with subsequent bradycardia caused by sinus arrest or atrioventricular block, vasodilation, or both. Generally, men older than 50 are at risk for this condition, and it classically presents with syncope in the setting of shaving, wearing a tight collar, or turning the head to one side. Diagnosis is suggested by carotid sinus massage with prolonged (more than 3 s) asystole.

Publié par La Pharmacienne le 10-12-2008 22:03
#16

Choose the one best response to this question, the answer is easy but the details are quite interesting..

All the following are features of lipoprotein lipase deficiency except:

A. low levels of plasma chylomicrons
B. acute pancreatitis
C. hepatosplenomegaly
D. xanthomas
E. autosomal recessive inheritance


The answer is A.

Lipoprotein lipase (LPL) and its cofactor apo CII are required for the hydrolysis of triglycerides in chylomicrons and very low density lipoproteins (VLDLs). A genetic deficiency of either protein impairs lipolysis and results in an elevation in plasma chylomicrons. VLDL is also elevated. The triglyceride-rich proteins persist for days in the circulation, causing fasting levels higher than 1000 mg/dL. The inheritance pattern is autosomal recessive. Heterozygotes have normal or mildly elevated plasma triglyceride levels. Clinically, these patients may have repeated episodes of pancreatitis secondary to hypertriglyceridemia. Eruptive xanthomas may appear on the back, the buttocks, and the extensor surfaces of the arms and legs.

Hepatosplenomegaly may result from the uptake of circulating chylomicrons by the reticuloendothelial cells. The diagnosis is made by assaying triglyceride lipolytic activity in plasma. Dietary fat restriction is the treatment of choice.

Publié par La Pharmacienne le 10-12-2008 23:18
#17


Choose the one best response to this question.


A 28-year-old female complains of chronic diarrhea. After a lengthy history and a negative physical examination, you suspect surreptitious laxative abuse. Which of the following tests would be most consistent with this hypothesis?


A. Elevated stool osmotic gap
B. Fecal leukocytes on stool examination
C. Excess stool fat
D. Charcot-Leyden crystals on stool examination
E. Inflammatory cells on small bowel biopsy

Stool = les selles
Bowel = intestins


The answer is A.
>>> Chronic diarrhea (lasting more than 4 weeks) may be due to a host of causes, including medications [especially habitual use of laxatives, which may be stimulant (senna, castor oil) or osmotic (e.g., Mg-containing) in nature], enterocolic fistulas, hormones (from certain endocrine tumors, such as carcinoid, VIPoma, and medullary carcinoma of the thyroid), carbohydrate malabsorption (e.g., lactase deficiency, which leads to a low stool pH), fat malabsorption, pancreatic exocrine insufficiency, mucosal malabsorption (e.g., celiac sprue, seen on small-bowel biopsy), or IBD. Diarrhea can result from invasion of the small bowel with lymphoma cells or eosinophils in which the Charcot-Leyden crystals from extruded eosinophils may be seen. If inflammation or infection is the cause, fecal leukocytes will usually be found. Laxative use is consistent with an osmotic gap: 2([Na] + [K]) <290 mosmol/kg. However, certain anionic laxatives containing sulfates or phosphates produce diarrhea without an osmotic gap, since sodium secretion occurs in response. In these cases direct measurement of the laxative in the stool is required to confirm the suspicion of laxative abuse.

IBD = Inflammatory Bowel Disease = MICI (Maladie Inflammatoire Chronique de l'Intestin)

Publié par La Pharmacienne le 11-12-2008 00:45
#18

This one is really hard... ;)

Choose the one best response to this question.

All the following therapies have been shown to reduce the risk of hip fractures in postmenopausal women with osteoporosis except :


A. alendronate
B. estrogen
C. parathyroid hormone
D. raloxifene
E. risedronate
F. vitamin D plus calcium


The answer
is D.

>>> The selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene act in a fashion similar to that of estrogen in decreasing bone turnover and bone loss in postmenopausal women. These agents have been shown to decrease the risk of invasive breast cancer. Raloxifene, which is approved for the prevention of osteoporosis, reduces the risk of vertebral fractures by 30 to 50%. There are no data confirming a similar effect on nonvertebral fractures. Optimal calcium intake reduces bone loss and suppresses bone turnover. Vitamin D plus calcium supplements have been shown to reduce the risk of hip fractures by 20 to 30%. The bisphosphonates alendronate and risedronate are structurally related to pyrophosphate and are incorporated into bone matrix. They reduce the number of osteoclasts and impair the function of those already present. Both have been shown to reduce the risk of vertebral and hip fractures by 40 to 50%. One trial found that risedronate reduced hip fractures in osteoporotic women in their seventies but not in older women without osteoporosis. Risedronate may be administered weekly. The newer bisphosphonates zoledronate and ibandronate may be dosed yearly or monthly. A daily injection of exogenous parathyroid hormone analogue superimposed on estrogen therapy produced increases in bone mass and decreased vertebral and nonvertebral fractures by 45 to 65%. There are no published studies of combinations of parathyroid hormone and SERMs or bisphosphonates.

Publié par La Pharmacienne le 11-12-2008 00:52
#19

Choose the one best response to this question.

A 55-year-old white male with a history of diabetes presents to your office with complaints of generalized weakness, weight loss, nonspecific diffuse abdominal pain, and erectile dysfunction. The examination is significant for hepatomegaly without tenderness, testicular atrophy, and gynecomastia. Skin examination shows a diffuse slate-gray hue slightly more pronounced on the face and neck. Joint examination shows mild swelling of the second and third metacarpophalangeal joints on the right hand. What is the recommended test for diagnosis?

A. Serum ferritin
B. Serum iron studies, including transferrin saturation
C. Urinary iron quantification in 24-h collection
D. Genetic screen for HFE gene mutation (C282Y and H63D)
E. Liver biopsy

weight loss = perte de poids
hepatomegaly without tenderness = HPM non douloureuse
hue = coloration
Joint examination = l'examen des articulations
swelling = tumefaction
liver biopsy = biopsie du foie


The answer is D.

>>> Hemochromatosis is a common disorder of iron storage in which inappropriate increases in intestinal iron absorption result in excessive deposition in multiple organs but predominantly in the liver.

There are two forms: (1) hereditary hemochromatosis, in which the majority of cases are associated with mutations of the HFE gene, and (2) secondary iron overload, which usually is associated with iron-loading anemias such as thalassemia and sideroblastic anemia.

Serum ferritin testing and plasma iron studies can be very suggestive of the diagnosis, with the ferritin often >500 g/L and transferrin saturation of 50 to 100%. However, these tests are not conclusive, and further testing is still required for the diagnosis.

Although liver biopsy and evaluation for iron deposition or a hepatic iron index > 2 is the definitive diagnosis, genetic testing is widely available today, and because of the high prevalence of HFE gene mutations associated with hereditary hemochromatosis, it is recommended for diagnostic evaluation. If the genetic testing is inconclusive, the invasive liver biopsy evaluation may be indicated

Publié par La Pharmacienne le 11-12-2008 01:02
#20

Is This Baby At Risk For Heart Disease?

The parents of a 2-month-old boy are concerned about his risk of coronary artery disease because of the recent death of his 40-year-old maternal uncle from a myocardial infarction. Which of the following is the most appropriate management in this situation?

a- Screen the parents for total cholesterol
b- Counsel the parents regarding appropriate dietary practices for a 2-month-old infant and test him for total cholesterol at 6 months of age
c- Reduce the infant's dietary fat to less than 30% of his calories by giving him skim milk
d- Initiate lipid-lowering agents
e- Recommend yearly ECGs for the patient

Myocardial infarction (MI) = IDM
Lipid-lowering agents = médicaments hypolipémiants


The answer is a, Screen the parents for total cholesterol.[1-2]
>>> Identification of those with a genetic predisposition to hypercholesterolemia and of the factors that increase the risk of the condition is recommended so that dietary and other measures to reduce serum lipids can be introduced if indicated. Children with a first- or second-degree relative with early onset of coronary heart disease should be evaluated early in life but after 2 years of age. Other known risk factors include obesity, diabetes, hypertension, and smoking. No change in current infant dietary practice is recommended for children under 2 years of age. The high total fat content of the infant diet is considered to be biologically sound, given the need for lipid for a developing nervous system and the infant's limited capacity for an intake of high volume during this period of rapid growth. It is generally agreed that a dietary fat intake of 40% of calories is excessive over the age of 2 years. There is, however, concern about the potential loss of minerals such as iron, zinc, and calcium when dietary fat is reduced below 30% of calories in children 2 to 18 years of age. Principal sources of fat in the American diet are meat and milk, which are also sources of minerals such as iron and calcium. Simple modifications in the current U.S. diet of children of these ages (trimming excess fat from meat and drinking 1% fat milk) would effect a reduction of fat intake by 5% of calories without the risk of lowering mineral intake. It would be helpful in this situation to determine whether the uncle had hypercholesterolemia. Yearly ECGs and lipid-lowering agents are not indicated in this situation.


References
[1] Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Co.; 2003: 449.
[2] Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, eds. Rudolph's Pediatrics. 21st ed. New York: McGraw-Hill; 2003:696-698.

Publié par La Pharmacienne le 11-12-2008 14:48
#21

Bonjour tout le monde,

Two questions for this one


How Should a Postmenopausal Woman Be Examined?


Question 1
You are following up on the results of routine testing of a 68-year-old G4P3 for her well-woman examination. Her physical examination was normal for a postmenopausal woman. Her Pap smear revealed parabasal cells, her mammogram was normal, lipid profile was normal, and the urinalysis shows hematuria. Which of the following is the most appropriate next step in the management of this patient?

a- Colposcopy
b- Endometrial biopsy
c- Renal sonogram
d- Urine culture
e- No further treatment/evaluation is necessary if the patient is asymptomatic

Pap smear = Frottis Cervico-Vaginal (Pap = Papanicolaou, smear = frottis)


Question 2
A 74-year-old woman presents to your office for well-woman exam. Her last Pap smear and mammogram were 3 years ago. She has hypertension, high cholesterol, and osteoarthritis. She stopped smoking 15 years ago, and denies alcohol use. What is the leading cause of death in women of this patient's age?

a- Alzheimer's disease
b- Breast cancer
c- Cerebrovascular disease
d- Heart disease
e- Lung cance
f- Trauma

osteoarthritis = arthrose (et non pas arthrite car arthrite = arthritis)
Breast = sein
Lung= poumon


Answer 01 :
The answer is d, Urine culture [1,2]
>>> A urinalysis that is positive for blood should be followed up with a urine culture to detect an asymptomatic urinary tract infection before further workup is done or referral to a urologist is made. Parabasal cells on a Pap smear indicate lack of estrogen and are a normal finding in postmenopausal women.

Answer 02 :
The answer is d, heart disease.[1,2]
>>> In order of decreasing incidence, the leading causes of death in women over 65 years old are the following: diseases of the heart, cancer, cerebrovascular diseases, chronic obstructive pulmonary diseases, pneumonia and influenza, diabetes mellitus, accidents, and Alzheimer's disease.

References
1- Stenchever MA, Droegemueller W, Herbst AL, Mishell DR, ed. Comprehensive Gynecology. 4th ed. St. Louis: Mosby; 2002: 138-154.
2- American College of Obstetricians and Gynecologists. Primary and preventive care: periodic assessments. Committee opinion 292. November 2003

Publié par La Pharmacienne le 11-12-2008 15:03
#22

These questions are full of information...

Question 01 :
Is Fruit Juice Causing This Infant's Health Problems?
A 6-month-old infant has been exclusively fed a commercially available infant formula. Upon introduction of fruit juices, however, the child develops jaundice, hepatomegaly, vomiting, lethargy, irritability, and seizures. Tests for urine-reducing substances are positive. Which of the following is likely to explain this child's condition?

a- Tyrosinosis
b- Galactosemia
c- Fructosemia
d- a1-antitrypsin
e- Glucose-6-phosphatase deficiency

jaundice = ictère
seizures = crises convulsives/epileptiques


Answer to Question 01 :
The answer is c, Fructosemia.[1-2]
>>> The patient in the question likely has fructosemia, manifest only when fructose in fruit juice is provided in the diet. Galactosemia, fructosemia, tyrosinosis, and glucose-6-phosphatase deficiency represent diseases in which a congenital deficiency of enzyme causes an interruption of a normal metabolic pathway and an accumulation of metabolic precursors that damage vital organs. Galactosemia (found in milk) and fructosemia (found in fruit juices) produce urinary-reducing substances. The mode of inheritance of galactosemia, fructosemia, and most forms of glucose-6-phosphatase deficiency is autosomal recessive. In galactosemia and fructosemia, errors in carbohydrate metabolism cause the accumulation of toxic metabolites when specific dietary sugars are introduced (lactose in galactosemia; fructose and sucrose in fructosemia). Exclusion of the offending carbohydrate from the diet will prevent liver damage. In tyrosinemia type I, or tyrosinosis, the accumulation of tyrosine and its metabolites is associated with severe involvement of liver, kidney, and central nervous system (CNS). Manifestations of acute liver failure can appear in infancy. A chronic form of the disorder presents as progressive cirrhosis and leads to liver failure or hepatoma. Dietary management does not prevent liver disease. Glucose-6-phosphatase deficiency often presents at 3 to 4 months of age with failure to thrive, hypoglycemia, hepatomegaly, and acidosis. Alpha-1-antitrypsin deficiency causes liver disease through accumulation of an abnormal protein, caused by a single amino acid substitution on chromosome 14. It has a variable presentation, but the following are common in infancy: cholestasis; bleeding into the CNS, GI tract, or at the umbilical stump; and elevation of transaminase concentrations. In childhood, a picture of chronic hepatitis with cirrhosis and portal hypertension is seen.

Edité par La Pharmacienne le 13-02-2009 18:49

Publié par La Pharmacienne le 13-02-2009 18:50
#23

Question 02 :
A 12-year-old healthy Jewish girl is found on routine blood count to have a mild anemia, leukopenia, and thrombocytopenia. Physical examination reveals an enlarged spleen. An x-ray of the femur is described as "appearing to be an Erlenmeyer flask." Bone marrow examination shows abnormal cells. The diagnosis can be confirmed by measurement of activity of which of the following?

a- Sphingomyelinase activity
b- Hexosamidase A
c- Sulfatase A
d- Glucocerebrosidase
e- Ceramide trihexosidase

Jewish = juive
enlarged spleen = splenomegalie
x-ray = radiographie standard
Erlenmeyer flask = flacon d'Erlenmeyer
Bone marrow = Moelle osseuse

Answer to Question 02 :
The answer is d, Glucocerebrosidase.[3-4]
>>> Gaucher disease is characterized by a glucocerebrosidase deficiency, which causes an abnormal accumulation of glucocerebroside in the reticuloendothelial system. Bone marrow aspirate shows the typical Gaucher cells engorged with glucocerebroside. Replacement of marrow with these cells leads to anemia, leukopenia, and thrombocytopenia. The liver and spleen can also be involved. Serum acid phosphatase is elevated. X-ray demonstrates an Erlenmeyer-flask appearance of the long bones. The diagnosis of Gaucher disease is confirmed by the absence of glucocerebrosidase activity in leukocytes, in cultured skin fibroblasts, and in liver cells. Prenatal diagnosis by enzyme analysis is now possible. In the most common form of Gaucher disease, adult type I, there is no involvement of the central nervous system. Therefore, MRI of the brain is not indicated.

Sphingomyelinase deficiency causes type A Niemann-Pick disease; hexosaminidase A deficiency causes Sandhoff disease; sulfatase A deficiency causes juvenile metachromatic leukodystrophy; and serum trihexosidase causes Fabry disease


References
1- Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Co.; 2003: 402-404, 469-471, 475-477, 1323.
2- Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, eds. Rudolph's Pediatrics. 21st ed. New York: McGraw-Hill; 2003: 612, 1487-1488, 1490-1491, 1542-1543, 1996-1997.
3- Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Co.; 2003: 463-464.
4- Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, eds. Rudolph's Pediatrics. 21st ed. New York: McGraw-Hill; 2003: 2326-2328.

Publié par La Pharmacienne le 13-02-2009 18:53
#24

Hi,

Question 01 :


A 17-year-old boy is brought to the emergency department by his parents with the complaint of coughing up blood. He is stabilized, and his hemoglobin and hematocrit levels are determined to be in the safe range. During his hospitalization, he is noted to have persistently elevated blood pressures, and his urinalysis is remarkable for hematuria and proteinuria.


You are suspicious the patient has which of the following?

a- Hemolytic-uremic syndrome
b- Goodpasture syndrome
c- Nephrotic syndrome
d- Poststreptococcal glomerulonephritis
e- Renal vein thrombosis


Coughing up blood = hemoptysis = hémoptysie.

Publié par La Pharmacienne le 13-02-2009 18:56
#25

Answer to Question 01 :

---> The answer is b, Goodpasture syndrome.

The patient in the question has a classic description of Goodpasture syndrome, a rare disease in children. The pulmonary hemorrhage can be life-threatening and the renal function progressive. Diagnosis is suggested by kidney biopsy and finding antibodies to the glomerular basement membrane.

Publié par ilhamo le 13-02-2009 22:15
#26

jaimerais bien participer:( cest trés interessant comme qcm.
je suis nule en anglais:(:(

Publié par La Pharmacienne le 15-02-2009 02:59
#27

Bonjour,

Question 02 :

A 7-year-old child is noted to have 3+ protein on urinalysis. A 24-h collection of urine reveals a protein excretion of 3.7 g/24 h. A thorough history might reveal ingestion of which of the following medications?

a- Tetracycline
b- Streptomycin
c- Trimethadione
d- Diazepam
e- Chlorambucil

Publié par La Pharmacienne le 15-02-2009 03:01
#28

Answer to Question 02 :

The answer is c, Trimethadione.

The patient described appears to have nephrotic syndrome (protein excretion of greater than 3.5 g/24 h). Drug-related nephrotic syndrome has been described in connection with the use of trimethadione, penicillamine, captopril, probenicid, ethosuximide, methimazole, lithium, procainamide, chlorpropamide, phenytoin, paramethadione, tolbutamide, some of the nonsteroidal anti-inflammatory drugs (NSAIDs), and certain heavy metals (e.g., gold, mercury-containing medications).

NSAIDs = AINS

Publié par La Pharmacienne le 15-02-2009 03:02
#29

Question 03 :

A 1-year-old child presents with failure to thrive, frequent large voids of dilute urine, excessive thirst, and three episodes of dehydration not associated with vomiting or diarrhea. Over the years, other family members reportedly have had similar histories.


Which of the following is the most likely diagnosis?

a- Water intoxication
b- Diabetes mellitus
c- Diabetes insipidus
d- Child abuse
e- Nephrotic syndrome

large voids of dilute urine = polyuria = polyurie.

Publié par La Pharmacienne le 15-02-2009 03:04
#30

Answer to Question 03 :

The answer is c, Diabetes insipidus.

Nephrogenic diabetes insipidus is a hereditary congenital disorder in which the urine is hypotonic and produced in large volumes because the kidneys fail to respond to antidiuretic hormone. Most North American patients thus involved are descendants of Ulster Scots who came to Nova Scotia in 1761 on the ship Hopewell. Males are primarily affected, through an X-linked recessive inheritance causing inactivating mutation of the vasopressin V2 receptor; autosomal dominant and recessive forms are also known. The disorder is felt to result from primary unresponsiveness of the distal tubule and collecting duct to vasopressin.

Although the condition is present at birth, the diagnosis is often not made until several months later, when excessive thirst, frequent voiding of large volumes of dilute urine, dehydration, and failure to thrive become obvious. Maintenance of adequate fluid intake and diet and use of saluretic drugs are the bases of therapy for this incurable disease.

Water intoxication would not present with episodes of dehydration; diabetes mellitus rarely presents with a protracted course in such a young child (it is usually a more acute illness and often with vomiting). Child abuse would be unlikely, especially with a family history as noted. Nephrotic syndrome would be expected to present with other signs such as edema and proteinuria.

A vous.

Publié par La Pharmacienne le 15-02-2009 03:06
#31

A 53-year-old postmenopausal woman, gravida 3, para 3, presents for evaluation of troublesome urinary leakage 6 weeks in duration.


Which of the following is the most appropriate first step in this patient's evaluation?

a- Urinalysis and culture
b- Urethral pressure profiles
c- Intravenous pyelogram
d- Cystourethrogram
e- Urethrocystoscopy

urinary leakage = urinary incontinence = incontinence urinaire

Publié par La Pharmacienne le 15-02-2009 03:07
#32

The answer is a, Urinalysis and culture.

When patients present with urinary incontinence, a urinalysis and culture should be performed. In patients diagnosed with a urinary tract infection, treatment should be initiated and then the patient should be reevaluated. It is not uncommon for symptoms of urinary leakage to resolve after appropriate therapy. After obtaining the history and physical examination and evaluating a urinalysis (including urine culture), initial evaluation of the incontinent patient includes a cystometrogram, check for residual urine volume, stress test, and urinary diary.

A cystometrogram is a test that determines urethral and bladder pressures as a function of bladder volume; also noted are the volumes and pressures when the patient first has the sensation of need to void, when maximal bladder capacity is reached, and so on. Residual urine volume is determined by bladder catheterization after the patient has voided; when urine remains after voiding, infection and incontinence may result.

Publié par La Pharmacienne le 15-02-2009 03:09
#33

A postmenopausal woman is undergoing evaluation for fecal incontinence. She has no other diagnosed medical problems. She lives by herself and is self-sufficient, oriented, and an excellent historian. Physical examination is completely normal.


Which of the following is the most likely cause of this patient's condition?


a- Rectal prolapse
b- Diabetes
c- Obstetric trauma
d- Senility
e- Excessive caffeine intake

Publié par La Pharmacienne le 15-02-2009 03:10
#34

The answer is c, Obstetric trauma.

The most common cause of fecal incontinence is obstetric trauma with inadequate repair. The rectal sphincter can be completely lacerated, but as long as the patient retains a functional puborectalis sling, a high degree of continence will be maintained. Generally the patient is continent of formed stool but not of flatus. Other causes of fecal incontinence include senility, central nervous system (CNS) disease, rectal prolapse, diabetes, chronic diarrhea, and inflammatory bowel disease.

While rectal prolapse, CNS disease, and senility are thus potential causes of this condition, they can be excluded by the history of the patient in the question. Approximately 20% of all diabetics complain of fecal incontinence. Therapy for fecal incontinence includes bulk-forming and antispasmodic agents, especially in those patients presenting with diarrhea.

All caffeinated beverages should be stopped. Biofeedback and electrical stimulation of the rectal sphincter are other possible conservative treatments. Surgical repair of a defect is indicated when conservative measures fail, when the defect is large, or when symptoms warrant a more aggressive treatment approach.

Publié par La Pharmacienne le 15-02-2009 03:15
#35

Question 01 :

Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal hemoglobin, hematocrit, and white blood count and differential. The platelet count is 15,000/µL.

Which of the following is the most likely diagnosis?

a- von Willebrand disease
b- Acute leukemia
c- Idiopathic (immune) thrombocytopenic purpura
d- Aplastic anemia
e- Thrombotic thrombocytopenic purpura

Bruising = Ecchymoses
Lymph node enlargement = ADP
Platelet = Plaquette

Publié par La Pharmacienne le 15-02-2009 03:16
#36

The answer is c, Idiopathic (immune) thrombocytopenic purpura.

In children, idiopathic or immune thrombocytopenic purpura (ITP) is the most common form of thrombocytopenic purpura. In most cases, a preceding viral infection can be noted. No diagnostic test identifies this disease; exclusion of the other diseases listed in the question is necessary.

In this disease, the platelet count is frequently less than 20,000/µL, but other laboratory tests yield essentially normal results, including the bone marrow aspiration (if done). For ITP, platelets are sequestered and destroyed at the spleen by the reticuloendothelial system (RES) that binds self-immunoglobulins attached to the platelet.

Treatment for ITP consists of observation and/or gamma globulin and steroids. Splenectomy is reserved for the most severe and chronic forms. Exogenous IV gamma globulin can work to saturate the RES binding sites for platelet-bound self-immunoglobulin. Thus, there is less platelet uptake and destruction by the spleen.

Aplastic anemia is unlikely if the other cell lines are normal. Von Willebrand disease might be expected to present with bleeding and not just bruising. It is unlikely that acute leukemia would present with thrombocytopenia only. Thrombotic thrombocytopenic purpura is rare in children.


Edit:
bone marrow aspiration = Ponction-aspiration de la moelle osseuse
steroids = corticoides

Edité par La Pharmacienne le 15-02-2009 03:19

Publié par La Pharmacienne le 15-02-2009 03:18
#37

Question 02 :

An 11-month-old African American boy has a hematocrit of 24% on a screening laboratory done at his well-child checkup. Further testing demonstrates: hemoglobin 7.8 g/dL; hematocrit 22.9%; leukocyte count 12,200/µL with 39% neutrophils, 6% bands, 55% lymphocytes; hypochromia on smear; free erythrocyte protoporphyrin (FEP) 114 µg/dL; lead level 6 µg/dL whole blood; platelet count adequate; reticulocyte count 0.2%; sickle cell preparation negative; stool guaiac-negative; and mean corpuscular volume (MCV) 64 fl.


Which of the following is the most appropriate recommendation?


a- Blood transfusion
b- Oral ferrous sulfat
c- Intramuscular iron dextran
d- An iron-fortified cereal
e- Calcium EDTA

blood smear = frottis sanguin
lead = plomb
sickle cell anemia = drepanocytose
stool guaiac = hemocult [?] (recherche du sang dans les selles)
MCV = VGM

Publié par La Pharmacienne le 15-02-2009 03:21
#38

The answer is b, Oral ferrous sulfate.

Response to a therapeutic trial of iron is an appropriate and cost-effective method of diagnosing iron-deficiency anemia. A prompt reticulocytosis and rise in hemoglobin and hematocrit follow the administration of an oral preparation of ferrous sulfate. Intramuscular iron dextran should be reserved for situations in which compliance cannot be achieved, since this treatment is expensive, painful, and no more effective than oral iron.

Dietary modifications, such as limiting the intake of cow's milk and including iron-fortified cereals along with a mixed diet, are appropriate long-term measures, but they will not make enough iron available to replenish iron stores. The gradual onset of iron-deficiency anemia enables a child to adapt to surprisingly low hemoglobin concentrations. Transfusion is rarely indicated unless a child becomes symptomatic or is further compromised by a superimposed infection.

When the iron available for production of hemoglobin is limited, free protoporphyrins accumulate in the blood. Levels of erythrocyte protoporphyrin (EP) are also elevated in lead poisoning. Iron-deficiency anemia can be differentiated from lead intoxication by measuring blood lead, which should be less than 10 µg/dL.

Publié par La Pharmacienne le 15-02-2009 03:22
#39

Question 03 :

A newborn infant is born with petechiae scattered across his body. His platelet count is noted to be 22,000/µL with a hemoglobin of 12 mg/dL.

Which of the following is most likely to explain this infant's condition?


a- Congenital cytomegalovirus infection
b- Uncomplicated prematurity
c- Chlamydial conjunctivitis
d- Maternal ingestion of aspirin
e- Nasolacrimal duct stenosis

Publié par La Pharmacienne le 15-02-2009 03:24
#40

The answer is a, Congenital cytomegalovirus infection.

Thrombocytopenia and hemolytic anemia, as seen in this patient, are common manifestations of the "TORCH" (toxoplasmosis, other, rubella, cytomegalovirus, and herpes simplex) infections as well as congenital syphilis. Both increased platelet destruction and impaired production of platelets may be the mechanisms involved.

Some mothers who have had ITP and who have high levels of antiplatelet antibody in the maternal plasma can give birth to thrombocytopenic infants because of transplacental crossing of antiplatelet IgG antibody. The syndrome of congenital amegakaryocytic thrombocytopenia and bilateral absence of the radii (thrombocytopenia-absent radius, or TAR, syndrome) is a well-known entity.

Maternal ingestion of aspirin can lead to bleeding in the newborn, not as a result of thrombocytopenia but as a consequence of transient impairment of the infant's platelet aggregation. Neither chlamydial conjunctivitis nor nasolacrimal duct stenosis is usually associated with thrombocytopenia.

Publié par La Pharmacienne le 15-02-2009 03:25
#41

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)

Publié par La Pharmacienne le 15-02-2009 03:27
#42

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

Publié par La Pharmacienne le 15-02-2009 03:29
#43

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

Publié par La Pharmacienne le 15-02-2009 03:30
#44

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.

Publié par La Pharmacienne le 15-02-2009 03:32
#45

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