Internal-Medicine

Questions: 15–31 233
Questions 21 through 23
(A)
(B)
(C)
allergic reaction caused by sensitized
mast cells
may be mediated by drug effect on
kinin system
final mediator of symptoms are
leukotrienes
For each patient with symptoms after taking a new
medication, select the most likely mechanism.
21. A 23-year-old man has a reaction after being
given oral penicillin for a sore throat. (SELECT
ONE)
22. A 56-year-old woman is given an angiotensinconverting
enzyme (ACE) inhibitor for control
of hypertension and develops a reaction consisting
of urticaria. (SELECT ONE)
23. A 23-year-old man has an exacerbation of
asthma when he takes aspirin for a headache.
(SELECT ONE)
Questions 24 through 30
(A)
(B)
(C)
(D)
(E)
(F)
human lymphocyte antigen (HLA) B27
HLA DR4
HLA DR3
HLA B17
HLA B8
multigenic disorder
Match the following diseases with the appropriate
HLA.
24. A 29-year-old man presents with severe back
pain and a red eye. The pain is located in his
lower back and gluteal area, and is associated
with morning stiffness that improves after several
hours. On examination, he has limited forward
flexion and tenderness of the ischial
tuberosities. (SELECT ONE)
25. A 24-year-old woman has a facial skin lesion,
thrombocytopenia, arthralgia, and pericarditis.
(SELECT ONE)
26. A 12-year-old child has severe deforming
arthritis of the hands. (SELECT ONE)
27. A 14-year-old girl presents with weight loss,
increased thirst, and urination. Her laboratory
tests reveal hyperglycemia and a mildly
increased anion gap metabolic acidosis.
(SELECT ONE)
28. A 22-year-old man with iritis, balanitis, urethritis,
and arthritis. (SELECT ONE)
29. A 27-year-old woman has severe symmetrical
small joint arthritis. She notices 1 hour of morning
stiffness and swelling with redness in her
wrists and hand joints. The distal finger joints
are spared. X-rays of the hands reveal early
bone erosion in some of the joints. (SELECT
ONE)
30. A 33-year-old policeman develops acute asymmetric
arthritis involving his left knee and
ankle and right ankle. The pain in the feet prevents
him from walking. He recalls having a
diarrheal illness 3 weeks ago. (SELECT ONE)
Questions 31 through 36
(A) B-cell deficiency/dysfunction
(B) mixed T- and B-cell deficiency/
dysfunction
(C) T-lymphocyte deficiency/dysfunction
(D) neutropenia
(E) chemotaxis
(F) C3 (complement 3) deficiency
For each patient with a medical condition, select
the most likely immune dysfunction.
31. A 73-year-old man has a history of recurrent
pneumonias. He now complains of bone discomfort
in his back and chest. X-rays reveal
multiple lytic lesions and his serum protein
electrophoresis has an IgG spike of 12 g/dL.
(SELECT ONE)