QUESTION: 65

A24-year-old female is infected with HIV from an unprotected sexual exposure. What is the median time for this patient to develop clinical disease if she is not treated?

6 months
1 year
5 years
10 years
15 years

Answer(s): D

Explanation:

The median time from initial infection with HIV to the development of clinical disease is 10 years. The rate of disease progression is highly variable and directly correlates with HIV RNA levels. With high levels of HIV RNA, the disease progresses faster. During the asymptomatic period of HIV infection, CD4+ cells decline at an average rate of 50 L per year.
Some patients do not progress and show little if any decline in CD4+ counts over time.

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QUESTION: 66

A52-year-old woman has had diabetes mellitus since childhood. She has controlled her glucose well and kept her glycohemoglobin (HgbA1C) below 7% (normal, 26%). For which of the following complications is she still at risk, despite excellent glucose control? A. autonomic dysfunction

coronary heart disease
blindness
peripheral neuropathy
peripheral vascular disease

Answer(s): B

Explanation:

Diabetes mellitus is associated with hyperglycemia, disease of the microvasculature (retinopathy, nephropathy, neuropathy), and macrovascular disease, including CAD and peripheral vascular disease, The Diabetes Control and Complications Trial and other studies have demonstrated that tight control can decrease complications of microvascular disease significantly, but it does not seem to reduce CAD mortality to the same extent.

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QUESTION: 67

A middle-aged White male presents to your office complaining of arthralgias, diarrhea, abdominal pain, and weight loss. On examination, you note generalized increased skin pigmentation.

Which of the following is true regarding Whipple disease?

Acute renal failure is a common complication.
This disease usually strikes young adults before the third decade.
It is predominantly a disease of women.
Microscopic examination of duodenal biopsies show extensive periodic acid-Schiff (PAS) positive material in the lamina propria and villous atrophy.
It is associated with gram-positive cocci.

Answer(s): D

Explanation:

Whipple disease is a systemic illness characterized by arthralgias, diarrhea, abdominal pain, and weight loss. The usual patient is a middle-aged White male. Reported in 1907 by George Whipple, it has been associated with a gram-positive bacillus related to Actinomycetes. The disease can affect nearly every organ system, although it usually involves the GI tract, heart, and CNS. Renal failure is not a common complication.

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QUESTION: 68

A42-year-old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy?

jaundice
asterixis of the hands
spider angiomas on the face and chest
heme-positive stool
positive fluid wave on abdominal examination

Answer(s): B

Explanation:

Hepatic encephalopathy is a syndrome of declining intellectual function, altered state of consciousness, and neurologic abnormalities in the setting of advanced liver disease. Other findings include hyperactivity, delirium, agitation, and personality changes, progressing to confusion, somnolence, and coma. Asterixis (lapses of sustained muscle contraction) or "flapping tremor" is common. Jaundice, spider angiomas, and ascites can be present in alcoholic liver disease without the presence of encephalopathy. Precipitating factors must be looked for and reversed if possible. GI bleeding (due to esophageal varices, gastritis, ulcer, and so forth) increases the nitrogen load in the gut and reduces cerebral perfusion. Excessive diuresis with prerenal azotemia increases extrahepatic circulation of urea and ammonia production, so noncompliance with diuretics would decrease ammonia levels. Lactulose acidifies the stool, traps ammonia and other nitrogenous substances, and decreases their absorption from the gut so excessive lactulose would decrease ammonia levels. Excessive protein intake is a common precipitant.

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QUESTION: 65

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QUESTION: 66

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QUESTION: 67

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QUESTION: 68

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