-SS DNA virus
- Human pathogen is parvo virus B-19
Clinical manifestations
- Erythema infectiosum
fifth disease
Slapped cheek appearance
- Arthropathy
- Transient aplastic crisis in chronic hemolytic disease patient
- In immunodeficient patient it causes chronic anemia with reticulocytopenia
- Fetal infection leading to nonimmunohydrops fetalis
- Hemophagocytic syndrome
Q 1. An 86-year-old woman with chronic obstructive pulmonary disease (COPD), congestive heart failure, and insulin-requiring type 2 diabetes mellitus is admitted to the intensive care unit with an exacerbation of her COPD. She is intubated and treated with glucocorticoids and nebulized albuterol. She is also continued on her glargine insulin, aspirin, pravastatin, furosemide, enalapril, and metoprolol. On hospital day 8, parenteral nutrition is begun via catheter in the subclavian vein. Her insulin requirements increase on hospital day 9 due to episodes of hyperglycemia. On hospital day 10, she develops rales and an increasing oxygen requirement. A chest radiograph shows bilateral pulmonary edema. Laboratory data show hypokalemia, hypomagnesemia, and hypophosphatemia and a normal creatinine. Her weight has increased by 3 kg since admission. Urine sodium is <10 meq/dL. All of the following changes in her nutritional regimen will improve her volume status except
A.combination of glucose and fat in the parenteral nutrition mixture
B. decreasing the sodium content of the mixture to <40 meq per day
C.increasing the protein content of the parenteral nutrition mixture
D.reducing the overall glucose content
ANSWER . C
Q 2. A new study has been published showing a benefit of 25 mg/day of vitamin X. The recommended estimated average requirement of vitamin X is 10 mg/day, 2 standard deviations below the amount published in the study. The tolerable upper limit of vitamin X is unknown. Your patient wants to know if it is safe to consume 25 mg/day of vitamin X. Which is the most appropriate answer?
A.Two standard deviations above the estimated average requirement defines the tolerable upper limit.
B. 25 mg/day is probably too much vitamin X in 1 day.
C.25 mg/day is statistically in a safe range of the estimated average requirement.
D.The study was not designed to assess safety and therefore should not influence practice
ANSWER . C
Q 3. An elevation in which of the following hormones is consistent with the effects of anorexia nervosa?
A.Cortisol
B. Gonadotropin-releasing hormone (GnRH)
C.Leptin
D.Thyroxine (T4)
E. Thyroid-stimulating hormone (TSH)
ANSWER. A
Q 4. Which of the following statements regarding anorexia nervosa (AN) and bulimia nervosa (BN) is true?
A.Patients with the purging subtype of BN tend to be heavier than those with the nonpurging subtype.
B. Patients with the restricting subtype of AN are more emotionally labile than those with the purging subtype.
C.Patients with the restricting subtype of AN are more likely to abuse illicit drugs than those with the purging subtype.
D.The mortality of BN is lower than that of AN
ANSWER . D
Q 5. You are seeing a pediatric patient from Djibouti in consultation who was admitted with a constellation of symptoms including diarrhea, alopecia, muscle wasting, depression, and a rash involving the face, extremities, and perineum. The child has hypogonadism and dwarfism. You astutely make the diagnosis of zinc deficiency, and laboratory test confirm this (zinc level <70 µL/dL). What other clinical findings is this patient likely to manifest?
A.Dissecting aortic aneurysm
B. Hypochromic anemia
C.Hypoglycemia
D.Hypopigmented hair
E. Macrocytosis
ANSWER. D
Q 6. You are rotating on a medical trip to impoverished areas of China. You are examining an 8-year-old child whose mother complains of him being clumsy and sickly. He has had many episodes of diarrheal illnesses and pneumonia. His “clumsiness” is most pronounced in the evening when he has to go outside and do his chores. On examination, you notice conjunctival dryness with white patches of keratinized epithelium on the sclera. What is the cause of this child’s symptoms?
A.Autoimmune neutropenia
B. Congenital rubella
C.Spinocerebellar ataxia (SCA) type 1
D.Vitamin A deficiency
E. Vitamin B1 deficiency
ANSWER. D
Q 7. After being stranded alone in the mountains for 8 days, a 26-year-old hiker is brought to the hospital for evaluation of a right femoral neck fracture. He has not had anything to eat or drink for the past 6 days. Vital signs are within normal limits. Weight is 79.5 kg, which is 1.8 kg less than he weighed 6 months ago. Laboratory data show a creatinine of 2.5 mg/dL, blood urea nitrogen of 52 mg/dL, glucose 96 mg/dL, albumin 4.1 mg/dL, chloride 105 meq/L, and ferritin on 173 ng/mL. Which of the following statements is true regarding his risk of malnourishment?
A.He has protein-calorie malnutrition due to the rate of weight loss.
B. He has protein-calorie malnutrition due to his elevated ferritin.
C.He is at risk, but a normal individual can tolerate 7 days of starvation.
D.He is not malnourished because he is not hypoglycemic after 6 days of no food or water
ANSWER. C
Q 8. You are doing rounds in the intensive care unit on an intubated patient who is recovering from a stroke and has diabetic gastroparesis. When suctioning the patient in the morning, she coughs profusely, with thick green secretions. You are concerned about the possibility of aspiration pneumonia. All of the following measures are useful in preventing aspiration pneumonia in an intubated patientexcept
A.combined enteral and parenteral nutrition
B. elevating the head of the bed to 30°
C.physician-directed methods for formula advancement
D.post-ligament of Treitz feeding
ANSWER. C
Q 9. Which of these features represents a critical distinction between anorexia nervosa and bulimia nervosa?
A.Binge eating
B. Electrolyte abnormalities
C.Self-induced vomiting
D.Underweight
ANSWER. D
Q 10. You are counseling a patient who is recovering from long-standing anorexia nervosa (AN). She is a 22-yearold woman who suffered the effects of AN for 8 years with a nadir body mass index of 17 kg/m2 and many laboratory abnormalities during that time. Which of the following characteristics of AN is least likely to improve despite successful lasting treatment of the disorder?
A.Amenorrhea
B. Delayed gastric emptying
C.Lanugo
D.Low bone mass
E. Salivary gland enlargement
ANSWER. D
