Tutor profile: Dr Pritam B.
Subject: Health and Medicine
10)A 4-year-old girl presented with increasing weakness and bleeding gums. Physical examination revealed hepatospenomelaly. A CBC with differential showed a WBC count of 65000 with 43% lymphoblasts and a bone marrow biopsy revealed 92% lymphoblasts. The girl received systemic remission chemotherapy and also intrathecal chemotherapy in order to prevent relapse within the CNS. Which of the following drugs was most likely injected intrathecally? A.Cisplatin B.Paclitaxel C.Etoposide D.Bleomycin E.Methotrexate
1. A female patient was brought to the ER with symptoms of severe calf pain. On a ultrasound examination a diagnosis of Deep vein thrombosis was confirmed. The primary mechanism by which heparin prevents coagulation of blood is: A. Direct inhibition of prothrombin to thrombin conversion B. Facilitation of antithrombin III mediated inhibition of factor Xa and thrombin C. Activation of antithrombin III to inhibit factors IX and XI D. Inhibition of factors XIIa and XIIIa
B. Facilitation of antithrombin III mediated inhibition of factor Xa and thrombin
A 72 year old woman, presents to the dermatology clinic with complaints of itching associated with a red rash on the nape of her neck, scalp, behind her ears and around the nasolabial folds. She has a history of Parkinson’s disease for the last 4 years, for which she is being treated with levodopa , carbidopa and ropinirole. She has experienced the similar symptoms during the previous 2 winters, but did not seek any medical advice. On examination, there is greasy mild scaling over red inflamed skin . What is the most likely medical diagnosis? A. Flexural Psoriasis B. Acne Rosacea C. Tenia corporis & capitis D. Seborrhoeic Dermatitis E. Dermatitis associated with the treatment with levodopa. F. Fixed drug eruption to ropinirole
Seborrhoeic Dermatitis In Adults A Chronic dermatitis due to an inflammatory reaction related to the proliferation of Malassezia furfur, a normal skin inhabitant. Commonly occurs in sebum rich areas of the body, vertex of scalp, nape of the neck, post auricular folds , naso-labial folds , temples and chest. The condition is difficult to treat and recurrences are common. Symptoms -Intermittent symptoms with active phases that manifest as scaling, and itching, -Activity is increased in winter (Due to the inhibitory effect of sunlight effect on Malassezia populations) Physical findings Scalp: Appearance ranging from mild, patchy scaling to widespread, thick, adherent crusts; plaques are rare; lesions may spread from the scalp onto the forehead, the posterior part of the neck, and the postauricular skin Face & body Seborrhoeic skin lesions manifest as scaling over red, inflamed skin; hypopigmentation in blacks individuals. The lesions mainly occur on the oily and hair-bearing areas of the head , face neck and chest. Associated Conditions Seborrhoeic Dermatitis has a strong association with HIV, Parkinson’s Disease and Drug induced Parkinsonism. Treatments : Skin -Topical Antifungal therapies are considered 1st line of treatment – Ketaconazole 2%, naftifine, or ciclopirox creams and gels - Low potency Topical Steroids – mometasone, -Calcinurin inhibitor creams eg Tacrolimus Scalp First line -Over the counter Shampoos containing coal tar, zinc pyrithinone Second line – ketoconazole shampoos Others -Selenium sulfide (2.5%), ciclopirox shampoos Correct Answer : D Seborrhoeic Dermatitis. The patient complaints of itching and a red rash on the sebum rich areas of the body, which presented with characteristic greasy scales on examination; Along with a history of Parkinson disease & previous occurrences during winters , has a significant association with the development of Seborrhoeic dermatitis. Option A- Incorrect: Flexural Psoriasis presents at skin folds armpits, groin, under the breasts, umbilicus (navel),genitals, particularly inside the ear canal, behind the ears, through the scalp. The lesions that are Distinctive with well-defined margins that are red, scaling papules that coalesce to form round-to-oval plaques. Option B-Incorrect: Acne Rosacea presents as erythematous areas of the face, edematous eruptions of papules and pustules (papulopustular eruption) on forehead, cheeks, nose, and eyes. Option C- Incorrect Tenia corporis/Capitis is a Dermatophyte infection of the scalp or body, it presents with scaly, red, and slightly elevated with central clearing lesions with an active border ( leading edge ),vesicles appear at active border when there is active inflammation. Option E-Incorrect: Dermatitis Associated with Levodopa treatment Levodopa has minimal association to the development of dermatitis, Studies have shown the use of levodopa in patients with Parkinson’s disease have decreased the occurrences and the severity of Seborrhoeic dermatitis. Option F -Incorrect: Fixed Drug Eruption to ropinirole Ropinirole has minimal incidence of Fixed drug eruptions
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