Clinical Diagnosis Test

Question 1

A 6-month-old boy is brought to the physician because of left knee swelling for 24 hours. Three months ago, he had three large hematomas on his forehead that resolved without treatment. His two sisters and his mother have no history of similar symptoms. His mother’s maternal uncle and her brother died before the age of 30 years of massive cerebral hemorrhages. Physical examination shows deep ecchymoses over the buttocks and severe swelling of the left knee. The most likely explanation for these findings is a deficiency of which of the following?

Accepted Answer

Factor VIII (antihemophilic factor)

Answer

The correct answer is Factor VIII (antihemophilic factor). The patient's symptoms, including deep ecchymoses, severe knee swelling (hemarthrosis), and forehead hematomas, are classic signs of a severe bleeding disorder. The family history, with affected males (maternal uncle, brother) dying of cerebral hemorrhages, strongly suggests an X-linked recessive inheritance pattern. Factor VIII deficiency (Hemophilia A) is the most common X-linked recessive bleeding disorder, characterized by spontaneous bleeding into joints and deep tissues. Other options represent different bleeding disorders with distinct inheritance patterns or clinical presentations.

Question 2

A 56-year-old man has had a small, slowly growing nodule on his chin during the past 3 years. The lesion is 1.3 cm in diameter, the center is ulcerated, and the border is waxy. Examination of tissue obtained on excision of the lesion is most likely to show which of the following?

Accepted Answer

Basal cell carcinoma

Answer

The correct answer is Basal cell carcinoma. The description of a 'small, slowly growing nodule on his chin during the past 3 years' with a 'center is ulcerated, and the border is waxy' is highly characteristic of a basal cell carcinoma (BCC). BCCs are common on sun-exposed areas and often present as pearly or waxy nodules with rolled borders and central ulceration. Other options like actinic keratosis, melanoma, seborrheic keratosis, and squamous cell carcinoma have different typical presentations or growth patterns.

Question 3

A 23-year-old woman comes to the physician because of a 5-month history of intermittent discharge from both breasts. Her last menstrual period was 6 months ago. She takes no medications and is otherwise healthy. She has never been sexually active. Physical examination shows scant white fluid expressible from the breasts bilaterally. Serum studies are most likely to show an increase in which of the following hormone concentrations?

Accepted Answer

Prolactin

Answer

The correct answer is Prolactin. The patient's symptoms of intermittent bilateral breast discharge (galactorrhea) and amenorrhea (no menstrual period for 6 months) are classic signs of hyperprolactinemia. Elevated prolactin levels inhibit gonadotropin-releasing hormone (GnRH), leading to decreased LH and FSH, which in turn causes anovulation and amenorrhea. Therefore, an increase in prolactin concentration is the most likely hormonal finding. Other hormones listed are typically decreased or not directly responsible for this specific constellation of symptoms.

Question 4

A 39-year-old man has the acute onset of pain, corneal clouding, and diffuse redness in the left eye. There is no discharge. Vision is 20\/20 in the right eye and 20\/100 in the left eye. The left pupil is dilated. Which of the following is the most likely cause of these findings?

Accepted Answer

Acute glaucoma

Answer

The correct answer is Acute glaucoma. The acute onset of severe pain, corneal clouding, diffuse redness, vision loss, and a dilated pupil in one eye are hallmark symptoms of acute angle-closure glaucoma. This condition involves a sudden increase in intraocular pressure, leading to corneal edema (clouding) and optic nerve damage. Other options like hordeolum, conjunctivitis, corneal abrasion, or subconjunctival hemorrhage present with different symptom profiles and typically do not involve corneal clouding, vision loss, or a dilated pupil in this acute manner.

Question 5

A 65-year-old woman comes to the physician because of a 2-day history of a high temperature, chills, and headache. She was diagnosed with multiple myeloma 6 months ago. Her temperature is 39°C (102.2°F), pulse is 90\/min, and blood pressure is 150\/80 mm Hg. Examination shows lethargy and severe neck rigidity; no other abnormalities are noted. Which of the following organisms is most likely to be found on Gram stain of cerebrospinal fluid?

Accepted Answer

Streptococcus pneumoniae

Answer

The correct answer is Streptococcus pneumoniae. The patient presents with classic symptoms of meningitis (fever, chills, headache, lethargy, neck rigidity). Her diagnosis of multiple myeloma indicates an immunocompromised state, specifically impaired humoral immunity (hypogammaglobulinemia), which increases susceptibility to encapsulated bacteria. Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults and is a significant concern in immunocompromised individuals. While Listeria monocytogenes is also a concern in immunocompromised patients, S. pneumoniae remains the most prevalent cause of bacterial meningitis in adults overall.

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Uncategorized Practice Test

Clinical Diagnosis Test