A 25-year-old just had a colonoscopy and was diagnosed with Crohn disease. Which of the following is consistent with this diagnosis?
- A. Right lower quadrant cramping
- B. Severe bloody diarrhea
- C. Nausea and vomiting
- D. Mostly affects the rectum
Correct Answer: A
Rationale: Crohn's disease is a type of inflammatory bowel disease that can affect any part of the digestive tract. Right lower quadrant cramping is consistent with Crohn's disease as it commonly involves the terminal ileum, which is located in the right lower quadrant of the abdomen. Severe bloody diarrhea is more characteristic of ulcerative colitis, another type of inflammatory bowel disease. Nausea and vomiting are not specific symptoms of Crohn's disease. Crohn's disease can affect any part of the digestive tract, not just the rectum, so it is not accurate to say it mostly affects the rectum.
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Women who have breast cancer due to a BRCA1 gene mutation are usually:
- A. positive for human epidermal growth factor receptor 1 and 2.
- B. negative for estrogen receptor.
- C. positive for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2.
- D. negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2.
Correct Answer: D
Rationale: Women with breast cancer due to a BRCA1 gene mutation commonly have a triple-negative breast cancer subtype, which means they are negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2). This subtype tends to be more aggressive and harder to treat. Choice A is incorrect as they are typically negative for HER2. Choice B is incorrect because they are usually negative for estrogen receptor. Choice C is incorrect as they are usually negative for progesterone receptor and HER2.
Which of the following women is at highest risk for the development of endometrial cancer?
- A. A 50-year-old postmenopausal woman with a history of high-risk human papillomavirus
- B. A 45-year-old woman who is obese and has a menstrual pattern consisting of periods of amenorrhea and infrequent periods
- C. A 40-year-old woman who is overweight and has hypertension
- D. A 55-year-old woman who smokes
Correct Answer: B
Rationale: The correct answer is a 45-year-old woman who is obese and has a menstrual pattern consisting of periods of amenorrhea and infrequent periods. Obesity and prolonged exposure to estrogen unopposed by progesterone due to infrequent ovulation are significant risk factors for endometrial cancer. Choices A, C, and D do not directly correlate with the increased risk of endometrial cancer. Postmenopausal status alone (Choice A), overweight with hypertension (Choice C), and smoking (Choice D) are not the primary risk factors for endometrial cancer.
Which of the following birthmarks usually fade or regress as the child gets older?
- A. Hemangiomas
- B. Congenital dermal melanocytosis (i.e., Mongolian spots)
- C. Macular stains
- D. Hemangiomas, congenital dermal melanocytosis (i.e., Mongolian spots), and macular stains
Correct Answer: D
Rationale: The correct answer is Hemangiomas, congenital dermal melanocytosis (i.e., Mongolian spots), and macular stains. These three types of birthmarks are known to fade or regress as the child gets older. Hemangiomas are vascular birthmarks that often shrink and disappear over time. Congenital dermal melanocytosis, commonly known as Mongolian spots, usually fade by adolescence. Macular stains, also called salmon patches, tend to lighten and fade as a child grows. The other choices are incorrect because they do not typically fade or regress with age.
Which of the following is a common cause of mechanical small intestine obstruction?
- A. Infection
- B. Postoperative adhesions
- C. Tumors
- D. Foreign body
Correct Answer: B
Rationale: Postoperative adhesions are a common cause of mechanical small intestine obstruction. Adhesions can form after abdominal surgery, causing bands of scar tissue that may twist or pull the intestines, leading to obstruction. This is a more common cause compared to infection, tumors, or foreign bodies. Infection may lead to inflammation but is not a typical cause of mechanical obstruction. Tumors and foreign bodies can cause blockages but are less common than postoperative adhesions.
A 30-year-old has poorly controlled asthma and is taking prednisone 10 mg by mouth once a day. He has been on this regimen for 6 weeks. Abrupt withdrawal or discontinuation of this medication can cause:
- A. adrenal crisis
- B. hypercortisolism
- C. ACTH stimulation
- D. thyroid crisis
Correct Answer: A
Rationale: Abrupt withdrawal or discontinuation of prednisone, a corticosteroid, can lead to adrenal crisis. This occurs due to the suppression of the adrenal glands' natural cortisol production caused by prolonged exogenous steroid administration. Adrenal crisis presents with symptoms such as weakness, fatigue, abdominal pain, and hypotension. Hypercortisolism (Cushing syndrome) results from chronic excessive exposure to cortisol, not abrupt withdrawal. ACTH stimulation would be expected in response to low cortisol levels, not as a direct consequence of prednisone withdrawal. Thyroid crisis (thyroid storm) is associated with severe hyperthyroidism and is not directly related to corticosteroid withdrawal.