1/9/2023 0 Comments Usmle practice test answersWhich of the following best describes this patient’s condition?Ī. The dihydrorhodamine test is positive, and the myeloperoxidase staining reveals diminished staining. Along with a swab culture, the physician orders a dihydrorhodamine test and myelin peroxidase staining for a suspected primary immunodeficiency. Wet mount microscopy is positive for yeast. Examination shows vulvovaginal erythema with cottage cheese-like plaques. Her vital signs are as follows: the blood pressure is 115/80 mm Hg, the heart rate is 78/min, the respiratory rate is 15/min, and the temperature is 35.5☌ (97.7☏). She is not sexually active and does not take any medication. She also has had several episodes of oral candidiasis in the past. She used to treat these symptoms with topical ketoconazole cream, but this time it failed to help. She reports that these episodes have occurred 6–7 times a year since the age of 5. Expression of selectins on the surface of endothelial cellsĬ. Formation of tight bounds between leukocytes and endothelial selectinsĮ. Inhibition of the interaction between platelet endothelial cell adhesion molecules (PECAMs) on the surfaces of leukocytes and endothelial cellsĪ 16-year-old girl presents to her physician with itching, soreness, and irritation in the vulvar region. Tight adhesion of leukocytes to the endothelial cellsī. Inhibition of which of the following processes is the best explanation for such adverse effects?Ī. She is concerned about the side effects of this drug, among which is increased susceptibility to the upper respiratory tract and urinary tract infections. The patient is prescribed a drug that is an inhibitor of ɑ4-integrin (CD49d) for the prevention of relapses. The rest of the examination is unremarkable. Neurological examination reveals brisk deep reflexes (3+ equal) and decreased strength (4/4) in the upper limbs. Her blood pressure is 120/80 mm Hg, the heart rate is 63/min, the respiratory rate is 14/min, and the temperature is 36.7☌ (98.0☏). Today, she only complains of slight fatigue with upper and lower extremity weakness. She was successfully treated with methylprednisolone pulse therapy and discharged. She was diagnosed with relapsing-remitting multiple sclerosis 2 months ago when she suffered the 2nd episode of optic neuritis. fumigatusĪ 21-year-old woman presents to her physician for a regular follow-up visit. Suppression of the innate immune system by A. Suppression of the production of IgM by A. Suppression of the production of IgA by A. Impaired immune response due to medicationī. Which of the following is the most likely mechanism responsible for the biopsy findings?Ī. Flexible bronchoscopy is performed and the bronchoalveolar lavage sample from the medial segment of the right lower lobe shows neutrophils, with the fungal preparation showing Aspergillus fumigatus. Video-assisted thoracoscopy is performed, and a biopsy from the right lower lobe is taken, which shows plugging of the terminal bronchioles with mucus, inflammatory cells, and fungal vascular invasion. Chest X-ray shows multiple nodules bilaterally in the lower lobes. His respiratory failure progressively worsens, and on day 2 of admission, he requires mechanical ventilator support. In the emergency department, he was started on broad-spectrum antibiotics and bronchodilators. He works as a sales executive and visited Hawaii a month ago. He is a lifelong non-smoker and drinks alcohol occasionally on weekends. His medications include amlodipine, lisinopril, inhaled fluticasone, salmeterol, and oral prednisone. His medical history is significant for severe persistent asthma, hypertension, and several bouts of community and hospital-acquired pneumonia. Students: Educators’ Pro Tips for Tough TopicsĪ 45-year-old man is transferred to the intensive care unit from the emergency department for acute respiratory failure.Fundamentals of Nursing: Clinical Skills.
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