Interstitial Lung Diseases and Sarcoidosis MCQs

When the pleura, and hence the lung-chest wall system, are intact, the inward elastic recoil of the lung opposing the outward elastic recoil of the chest wall results in a subatmospheric (negative) pressure with the pleural space. When one reaches lung volumes in excess of ~70% of the total lung capacity, the chest wall recoil is also inward. Reference: Ganong, pp 665-655. Levitzky, pp 17-23, 29-31.

Tinea capitis occurs most commonly in children 3-7 years old. Children with tinea capitis usually present with well-demarcated scaly patches in which hair shafts are broken off right above the skin; alopecia can result. Reference: Harrison's Principles of Internal medicine, 21st edition Ch: 219 Pg 1691

The given patient has an LMN type of weakness without any sensory symptoms and with associated androgen insensitivity as evidenced by the gynecomastia and the sub fertility. This is classical of the Spinobulbar muscular atrophy or the Kennedy syndrome. It is an X linked disorder and is associated with CAG trinucleotide repeats on the androgen receptor gene on the X chromosome. CGG trinucleotide repeats is seen in Fragile X syndrome. It is associated with mental retardation. There may be ataxia and ovarian failure associated with it. GAA trinucleotide repeats are seen in Friedrich's Ataxia. CTG trinucleotides are seen in Myotonic dystrophy. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 347, Pg: 3415

In this case, parathyroid hormone is virtually in the normal range (less than 20 pg/ml suggestive of PTH independent hypercalcemia) and his renal function is normal, so there is nothing to suggest a diagnosis of the milk-alkali syndrome/CRF. Hypercalcaemia is found in 10% of established cases of sarcoid, and may eventually lead to nephrocalcinosis. The cause is increased 1 alpha-hydroxylation of vitamin D by sarcoid macrophages in the granuloma, in addition to that taking place in the kidney. Other granulomatous conditions like tuberculosis, histoplasmosis and berylliosis also cause hypercalcemia by this mechanism Reference: Harrison's Principles of Internal Medicine 21 st edition Page 3180

Ans. is 'b' i.e., EHEC [Ref Harrison 18thle p. 1084] Fever with RBC and pus in stools suggest inflammatory diarrhea. Amongst the given options EHEC causes invasion.

Initial treatment of orthostatic hypotension (OH) includes: Patient education: Mechanisms and stresses of OH High salt diet (10-20 gm/day) Compression garments Correct anemia Raise the head end of bed 10 cm to reduce supine hypertension Maintain postural stimuli Learn physical counter - Maneuvers Reference: Harrison 20 th pg.127

The gene defect in cystic fibrosis is in a mutation on chromosome 7. The inheritance is autosomal recessive so the other child without symptoms has not inherited two CF genes. Pulmonary disease develops over a few months after birth. Common infective organisms are pneumococcus, Haemophilus influenzae and Pseudomonas aeruginosa. Reference : Harrison's Principles of Internal medicine, 21st edition Ch: 291 Pg 2176

Commonest occupational extrinsic allergic alveolitis, due to thermophilic actinomycetes. Crackles are typically heard at the bases. Eosinophilia can be seen but is not typical. Immunoglobulin levels are frequently elevated but not a Para protein. P02 may be decreased particularly with exercise. A restrictive pattern on LF studies is seen. Reference : Harrison's Principles of Internal Medicine, 21 st Ed, Ch: 288, Pg: 2160