CME Resources Exam 2 With Complete Solutions

. A 3 year old boy presents to the ER with persistent fever over more than 5 days with temp as high as 103 F. He was seen in clinic 2 days after onset of fever, no etiology was found, and this was thought to be viral. Today, however, he woke with bilateral "pink eye" and cracked bleeding lips with desquamation of the palms and soles of his feet. On PE you note a strawberry tongue, bilateral cervical adenopathy, bilateral injected conjunctiva without discharge and dry fissured lips. Which of the following is the most likely complication of this condition? a. sydenham's chorea b. cardiomyopathy c. coronary artery aneurysm d. mesenteric arteritis e. mitral valve insufficiency - ANSWER c. coronary artery aneurysm Classic features of Kawasaki's syndrome include fever, age less than 5 years, conjunctivitis, mucous membrane abnormalities, desquamation of superficial epidermis of palms and soles, or marked erythema, morbilliform rash and cervical lymphadenopathy. - Coronary artery aneurysm occurs in about 25% of untreated or undiagnosed patients and is a major complication of Kawasaki's syndrome, which is a vasculitic - type autoimmune disease. -(A) Sydenham's chorea is a complication of untreated strep group A and causes abnormal involuntary movements of the limbs and body. -(B) Cardiomyopathy is incorrect, although it can occur as a result of many viruses in the young; it's onset is more insidious occurring months after the initial attack on the myocardium. -(D) Mesenteric arteritis can also result from vasculitic- type autoimmune disorder, but Kawasaki's syndrome favors the coronary circulation. -(E) Mitral valve insufficiency is incorrect because this patient does not have characteristics of this disease, which include past evidence of infection with group A beta hemolytic streptococcus resulting in rheumatic heart disease. 2. A 47 year old Male construction worker was lifting a 75 pound bag of cement when he twisted and injured his back. He presents complaining of lumbar back pain with radiating pain in his right lower extremity. He denies any other trauma, did not fall, has no loss of bladder/ bowel function. He had never injured his back before. On PE, he has normal sensation to light touch throughout the lower extremity with the exception of decreased sensation over the heel and lateral border of his foot. Lower extremity strength is measured as follows: Quads 5/5 Guteals 5/5 Peroneals 3/5 EHL 5/5 EDL 5/5 Gastrocnemius / soleus 4/5 Based upon this assessment, the most likely nerve root injured would be: a. L3 b. L4 c. L5 d. S1 e. S2 - ANSWER d. 3. A 20 year old presents with a hard mass on his right testicle. There has been no previous infection or trauma to the scrotum. However, the patient has a past medical history of an undescended testicle. You suspect that this is testicular cancer. Select the answer below that pairs the most common histology with its corresponding hormone marker. a. Seminoma, no increase in AFP b. Nonseminoma, decrease in HCG c. Nonseminoma, no increase in LDH d. Seminoma, decrease in CA-19-9. e. Adenomatous, increase in CA-125 - ANSWER a. - AFP is never elevated in pure seminomas. - Cryptorchidism predisposes a Male to a 5% lifetime risk of testicular cancer, with seminoma being the most common form in this case - the right testicle is the key here. -(B) HCG can occasionally be elevated with non-seminomas, as well as be slightly higher than a level for a seminoma. -(C) LDH can be elevated in either seminomas or nonseminomas. -(D) and (E) Neither CA-19-9 nor CA-125 are genetic markers for testicular cancer.