Cystic Fibrosis - Questions For Step1

27/04/2015
Anewbornmalechildpresentswithrespiratorydistressintheneonatalunit.HisXrayshows
Q:1 lefthemithoraxwithmultipleairfilledstructuresandmediastinalshifttotheright.Whichof
thefollowingrepresentsthemostlikelydiagnosis?
A: Cysticfibrosis
B: StreptococcalPneumonia
C: CongenitalTumourofLungs
D: Congenitaldiaphragmatichernia
CorrectAns:D
Explanation
Diaphragmaticherniainaneonateisevidencedbythepresenceofbowelsinthethorax,characterisedby
multipleairfilledstructures.Thepleuroperitonealcanalisadefectinthediaphragmwhichallowsthecontents
oftheabdomentoenterthethorax.Themediastinalstructuresarepushedtotheoppositesideleadingtothe
contralateralmediastinalshift.Herniaisontheleftsidein90%ofthecases.Poorprognosisdependsuponthe
presenceofstomachinthethoraxandthedegreeofhypoplasiaofthelungs.
Ref:RadiologicalImagingoftheNeonatalChestByVeronicaB.Donoghue,PerG.Bjornstad,2007,Pages157
158PediatricRadiologicalSigns,Volume1ByMichaelGrnebaum,Page283RadiologicalImagingofthe
NeonatalChestByVeronicaB.Donoghue,2ndEdition,Page104.
SampleQuestionsonCysticFibrosisonNEETExamPattern.ForsampleQuestionsonNEETExam,
USMLE,PLABandFMGE(MCIScreening)Pleasevisitwww.medicoapps.org
Q:2
A40yearold,moderatelyobesemanpresentswithapersistentproductivecough.Thecough
hasbeenpresentforseveralweeks,butrecentlythemannotedthathissputumhasassumed
agreenishcolor.Furtherquestioningelicitsahistoryofproductivecough,usuallyinthewinter
months,overthepastseveralyears.Hehassmokedtwopacksofcigarettesperdaysincehe
was16yearsold.Onexamination,themanisfebrile(100F),andcoarserhonchiand
wheezescanbeappreciatedbilaterally.WhichofthefollowingistheMOSTlikelydiagnosis?
A: Bronchogeniccarcinoma
B: Chronicbronchitiswithsuperimposedinfection
C: Cysticfibrosis
D: Emphysema
CorrectAns:B
Explanation
Thediagnosisofchronicbronchitisrequiresthepresenceofchronicproductivecoughforoveratleast3
monthsoftheyearfor2successiveyears.Thesymptomsinthispatient(greenproductivesputum,fever)
suggestthathehasanacuteinfectionsuperimposedonchronicbronchitis(historyofcigarettesmoking,history
ofexcessivemucusproductionovermanyyears).Histologically,themucusproducingglandsinthebronchi
wouldshowhyperplasiaandhypertrophyandextendtoagreaterdepthinthebronchialwall,resultingina
higherReidindex(ratioofthicknessofmucusglandtothicknessofbronchialwall).
Althoughthepatientisasmokerandisatincreasedriskforbronchogeniccarcinoma,thisisunlikelytobethe
causeofhissymptoms.Hemoptysisandweightlossmightalsobepresentifhehadcancer.
Cysticfibrosispresentsearlierinlifeandmaybeassociatedwithsevereproductionofmucus,especiallyif
bronchiectasissupervenes.Theageofthepatientandtherelativelateonsetofdiseaseprecludethisdiagnosis.
Thispatientmayalsohaveemphysema,aschronicbronchitisandemphysemaareoftencoexistent.However,
althoughpureemphysemamightcausedyspnea,itwouldnotbeassociatedwithafeveroraproductivecough.
Ref:TallmanT.A.(2011).Chapter67.AcuteBronchitisandUpperRespiratoryTractInfections.InJ.E.Tintinalli,
J.S.Stapczynski,D.M.Cline,O.J.Ma,R.K.Cydulka,G.D.Meckler(Eds),Tintinalli'sEmergencyMedicine:A
http://neetpgquiz.medicoapps.org/index.php?tid=17
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ComprehensiveStudyGuide,7e.
Q:3
A30yearoldmanundergoesalungbiopsy,whichshowsmultiplenodularlesionsconsisting
oflargeepithelioidcellssurroundedbylymphocytesandfibroblasts.Thereisanareaof
necrosisinthecenterofsomenodules.NumerousacidfastbacilliaredemonstratedbyZiehl
Neelsenstainingwithinthecytoplasmofepithelioidcells.Silverstainsforfungiarenegative.
WhichofthefollowingistheMOSTlikelyconditionthatpredisposedthepatienttothis
pulmonarydisease?
A: Acquiredimmunodeficiencysyndrome(AIDS)
B: Commonvariableimmunodeficiency
C: Cysticfibrosis
D: Depressedlevelofconsciousness
CorrectAns:A
Explanation
Thelesionshownisanecrotizinggranulomadevelopingasaresultofinfectionbyacidfastbacilli(mostlikely
mycobacteria).Granulomatousinflammationisaspecializedformofchronicinflammation,whichbeginswiththe
uptakeofforeignantigensbymacrophages.ThesecellsprocessandpresenttheantigentohelperTlymphocytes,
whichinturnactivatemacrophagesbyinterferonsecretion.Granulomasmaybeduetoinfectiousand
noninfectiouscauses.Usually,infectiousgranulomasarenecrotizingandnoninfectiousgranulomasarenon
necrotizing,buttherearemanyexceptionstothisrule.Amongtheinfectiouscauses,mycobacterial
infectionsareoftheutmostimportance,especiallyinpatientswithAIDS.Fungimayalsocause
granulomas,whichmaybeofthenecrotizingornonnecrotizingtype.Bydefinition,however,caseating
necrosisispathognomonicofmycobacterialinfection.
Alsoknow:
Commonvariableimmunodeficiencyisoneofthemostcommonformsofcongenitalimmunedeficiency
syndrome.Itisduetoinabilityoflymphocytestomatureintoplasmacells.Consequently,levelsof
immunoglobulinsaredepressed,andpatientssufferfromdepressedhumoralimmunity.Cellmediatedimmunity
(onwhichgranulomaformationislargelydependent)isintact.
Cysticfibrosispredisposestorecurrentbronchopneumoniaanddevelopmentofbronchiectasis.
Depressedlevelofconsciousnesspredisposestoaspirationofgastriccontentsanddevelopmentofaspiration
pneumonia.Sheetsofmacrophagesareoftenobserved,butnotnecrotizinggranulomas(unlessthereare
additionalpredisposingconditions,suchasAIDS).
Ref:ChandrasomaP.,TaylorC.R.(1998).Chapter7.DeficienciesoftheHostResponse.InP.Chandrasoma,C.R.
Taylor(Eds),ConcisePathology,3e.
Q:4
A30yearoldmanundergoesalungbiopsy,whichshowsmultiplenodularlesionsconsisting
oflargeepithelioidcellssurroundedbylymphocytesandfibroblasts.Thereisanareaof
necrosisinthecenterofsomenodules.NumerousacidfastbacilliaredemonstratedbyZiehl
Neelsenstainingwithinthecytoplasmofepithelioidcells.Silverstainsforfungiarenegative.
WhichofthefollowingistheMOSTlikelyconditionthatpredisposedthepatienttothis
pulmonarydisease?
A: Acquiredimmunodeficiencysyndrome(AIDS)
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27/04/2015
B: Commonvariableimmunodeficiency
C: Cysticfibrosis
D: Depressedlevelofconsciousness
CorrectAns:A
Explanation
Thelesionshownisanecrotizinggranulomadevelopingasaresultofinfectionbyacidfastbacilli(mostlikely
mycobacteria).Granulomatousinflammationisaspecializedformofchronicinflammation,whichbeginswiththe
uptakeofforeignantigensbymacrophages.ThesecellsprocessandpresenttheantigentohelperTlymphocytes,
whichinturnactivatemacrophagesbyinterferonsecretion.Granulomasmaybeduetoinfectiousand
noninfectiouscauses.Usually,infectiousgranulomasarenecrotizingandnoninfectiousgranulomasarenon
necrotizing,buttherearemanyexceptionstothisrule.Amongtheinfectiouscauses,mycobacterial
infectionsareoftheutmostimportance,especiallyinpatientswithAIDS.Fungimayalsocause
granulomas,whichmaybeofthenecrotizingornonnecrotizingtype.Bydefinition,however,caseating
necrosisispathognomonicofmycobacterialinfection.
Alsoknow:
Commonvariableimmunodeficiencyisoneofthemostcommonformsofcongenitalimmunedeficiency
syndrome.Itisduetoinabilityoflymphocytestomatureintoplasmacells.Consequently,levelsof
immunoglobulinsaredepressed,andpatientssufferfromdepressedhumoralimmunity.Cellmediatedimmunity
(onwhichgranulomaformationislargelydependent)isintact.
Cysticfibrosispredisposestorecurrentbronchopneumoniaanddevelopmentofbronchiectasis.
Depressedlevelofconsciousnesspredisposestoaspirationofgastriccontentsanddevelopmentofaspiration
pneumonia.Sheetsofmacrophagesareoftenobserved,butnotnecrotizinggranulomas(unlessthereare
additionalpredisposingconditions,suchasAIDS).
Ref:ChandrasomaP.,TaylorC.R.(1998).Chapter7.DeficienciesoftheHostResponse.InP.Chandrasoma,C.R.
Taylor(Eds),ConcisePathology,3e.
Q:5 Whichofthefollowingisanautosomaldominantmetabolicdisorder?
A: Cysticfibrosis
B: Phenylketonuria
C: a1antitrypsindeficiency
D: Familialhypercholestrolemia
CorrectAns:D
Explanation
Familialhypercholesterolemiaisthemostcommonautosomaldominantinheriteddisorderofmetabolism.Itis
characterizedbyelevatedplsmaLDLClevelsabove95thpercentileforageandgender,duetoimpaired
internalizationofLDLparticlescausedbyalterationinLDLreceptor.Theclinicalhallmarksofthediseaseincludes
tendonxanthomas,xanthelasma,cornealarcusandprematureatherosclerosis.Individualswithtwomutated
LDLreceptoralleles(FHhomozygotes)havemuchhigherLDLClevelsthanthosewithonemutantallele(FH
heterozygotes).
Ref:ClinicalCardiogeneticsByH.F.Baars,Page310AZofSyndromesandInheritedDisorders:AManualfor
Health,SocialByPatriciaGilbert,3rdEdition,Page211212EncyclopediaofFamilyHealthByDavidB.Jacoby,
3rdEdition,Page448MayoClinicGastroenterologyandHepatologyBoardReviewByStephenHause,4th
Edition,Page328
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WhichofthefollowingismorefrequentlyassociatedwithKlebsiellapneumoniaethanwith
Pseudomonasaeruginosa?
A: Artificialventilation
B: Cysticfibrosis
C: Diabetesmellitus
Q:6
D: Upperlobecavitation
CorrectAns:D
Explanation
Klebsiellapneumoniaeisawellrecognizedcauseofcommunityacquiredlobarpneumonia
associatedwithcavitation.Itisfoundtypicallyinalcoholicmalesover40yearsofagewithunderlying
diabetesorobstructivelungdisease.KlebsiellapneumoniaemimicsStreptococcuspneumoniaeasa
pulmonarypathogenexceptthatKlebsiellahasagreatertendencytoprogresstolungabscessand
empyema.Pseudomonasaeruginosaisusuallyassociatedwithpatientsonventilators,particularlyin
intensivecareunits.Immunocompetentpatientsusuallyhavebilateralbronchopneumoniawithout
cavitarylesions.
ArtificialventilationisclassicallyassociatedwithP.aeruginosainfection.Theorganismthrivesina
wetenvironmentsuchasrespirators,cleaningsolutions,disinfectants,sinks,vegetables,flowers,
endoscopes,andphysiotherapypools.
P.aeruginosaisaveryimportantpathogen.Mucoidstrainsofthisorganisminfecttheairwaysinpatients
withcysticfibrosis,leadingtoacuteexacerbationsandchronicprogressionoflungdamage.
Bothorganismscausediseaseinassociationwithdiabetes.Klebsiellapneumoniaeproducespulmonary
diseaseandP.aeruginosacausesnecroticskinulcersindiabetics.
Ref:BrooksG.F.(2013).Chapter15.EntericGramNegativeRods(Enterobacteriaceae).InG.F.Brooks
(Ed),Jawetz,Melnick,&Adelberg'sMedicalMicrobiology,26e.
Q:7 Meconiumileusisassociatedwith:
A: Cysticfibrosis
B: Infantofdiabeticmother
C: Hypothyroidism
D: Noneoftheabove
CorrectAns:A
Explanation
Infantswithcysticfibrosishavecharacteristicpancreaticenzymedeficienciesandabnormalchloridesecretionin
theintestinethatresultintheproductionofviscous,waterpoormeconium.Meconiumileusoccurswhenthis
thick,highlyviscousmeconiumbecomesimpactedintheileumandleadstohighgradeintestinalobstruction.
Ref:Schwartzsprincipleofsurgery9thedition,chapter39.
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Q:8
Physicalexaminationofaneonateisremarkableforaholosystolicmurmur.Thereisno
cyanosis.Echocardiographydemonstratesanostiumprimumdefectinthelowerpartofthe
interatrialseptumthatisaccompaniedbymalformationsoftheadjacentatrioventricular
valves.Theselesionsaremostlikelyassociatedwithwhichofthefollowingdisorders?
A: Cysticfibrosis
B: Downsyndrome
C: Gaucherdisease
D: Marfansyndrome
CorrectAns:B
Explanation
Themostcommontypeofatrialseptaldefectistheostiumsecundumtype.ChildrenwithDownsyndrome,
however,arefrequentlyafflictedwiththeostiumprimumtypeofatrialseptaldefects,whichmaybe
accompaniedbytricuspidandmitralvalvemalformations.Morecomplexatrioventricularseptaldefectsmayalso
occurinthisdisorder.Childrenexhibitingtheselesionsshouldbespecificallyevaluatedforchromosomal
abnormalities.Clinically,thelesionsproducelefttorightshuntswithlatecyanosis(aftertherightventricle
hypertrophiesinresponsetodevelopinglungdiseasefromtheincreasedbloodflowinthepulmonarysystem).
NeithercysticfibrosisnorGaucherdiseaseisspecificallyassociatedwithcardiovasculardefects.
DissectingaorticaneurysmisassociatedwithMarfansyndrome.
Ref:TsaicA.C.,ManchesterD.K.,EliasE.R.(2012).Chapter37.Genetics&Dysmorphology.InW.W.Hay,Jr.,
M.J.Levin,R.R.Deterding,J.J.Ross,J.M.Sondheimer(Eds),CURRENTDiagnosis&Treatment:Pediatrics,21e.
Anewbornmalechildpresentswithrespiratorydistressintheneonatalunit.HisXrayshows
Q:9 lefthemithoraxwithmultipleairfilledstructuresandmediastinalshifttotheright.Whichof
thefollowingrepresentsthemostlikelydiagnosis?
A: Cysticfibrosis
B: StreptococcalPneumonia
C: CongenitalTumourofLungs
D: Congenitaldiaphragmatichernia
CorrectAns:D
Explanation
Diaphragmaticherniainaneonateisevidencedbythepresenceofbowelsinthethorax,characterisedby
multipleairfilledstructures.Thepleuroperitonealcanalisadefectinthediaphragmwhichallowsthecontents
oftheabdomentoenterthethorax.Themediastinalstructuresarepushedtotheoppositesideleadingtothe
contralateralmediastinalshift.Herniaisontheleftsidein90%ofthecases.Poorprognosisdependsuponthe
presenceofstomachinthethoraxandthedegreeofhypoplasiaofthelungs.
Ref:RadiologicalImagingoftheNeonatalChestByVeronicaB.Donoghue,PerG.Bjornstad,2007,Pages157
158PediatricRadiologicalSigns,Volume1ByMichaelGrnebaum,Page283RadiologicalImagingofthe
NeonatalChestByVeronicaB.Donoghue,2ndEdition,Page104.
Q:10 Allofthefollowingrepresentdisordersorproteinmisfolding,EXCEPT:
A: Alzheimer'sdisease
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B: Tuberculosis
C: Cysticfibrosis
D: CreutzfeldtJakobdisease
CorrectAns:B
Explanation
Tuberculosisisnotduetoproteinmisfolding.
Abnormalfoldingofproteinsleadtopathologicprocessincludinglossoffunctionorgainoftoxicactivity,which
resultfromaccumulationofmisfoldedandaggregatedproteininspecifictissue.Tissuedepositionofmisfolded
proteinresultincellimpairementanddeathleadingtoclinicalsymptomsinaffectedindividual.
Ref:CurrentHypothesesandResearchMilestonesinAlzheimer'sDiseaseByRicardoB.Maccionipage172
Q:11 Sweatchloridesareincreasedin:
A: Addison'sdisease
B: Conn'ssyndrome
C: Cysticfibrosis
D: Phaeochromocytoma
CorrectAns:C
Explanation
Cysticfibrosisisadiseaseoftheexocrineglands,withtherespiratoryandgastrointestinaltractsbeingmost
affected.AdiagnostichallmarkisthepresenceofhighamountsofNaClinsweat,reflectingan
underlyingabnormalityinexocrineglandfunction.Allotheroptionssweatchlorideisnormal.
Ref:MurrayR.K.,GrosscP.L.(2011).Chapter57.BiochemicalCaseHistories.InD.A.Bender,K.M.Botham,P.A.
Weil,P.J.Kennelly,R.K.Murray,V.W.Rodwell(Eds),Harper'sIllustratedBiochemistry,29e.
Q:12 Sweatchloridesareincreasedin:
A: Addison'sdisease
B: Conn'ssyndrome
C: Cysticfibrosis
D: Phaeochromocytoma
CorrectAns:C
Explanation
ThediagnosisofCFrestsonthecombinationofclinicalcriteriaandabnormalCFTRfunctionasdocumentedby
sweattests,nasalPDmeasurements,andCFTRmutationanalysis.ElevatedsweatClvaluesarenearly
pathognomonicforCF.ThesweatconcentrationvaluesforCl(andNa+)varywithage,but,typically,aCl
concentrationof>70meq/LinadultsdiscriminatesbetweenCFandotherlungdiseases.
Ref:BoucherR.C.(2012).Chapter259.CysticFibrosis.InD.L.Longo,A.S.Fauci,D.L.Kasper,S.L.Hauser,J.L.
Jameson,J.Loscalzo(Eds),Harrison'sPrinciplesofInternalMedicine,18e.
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Apatientpresentswithdecreasedvitalcapacityandtotallungvolume.Whatisthemost
Q:13 probablediagnosis?
A: Bronchiectasis
B: Sarcoidosis
C: Cysticfibrosis
D: Asthma
CorrectAns:B
Explanation
Decreasedvitalcapacityanddecreasedtotallungvolumearefeaturesofrestrictivelungdisease.Sarcoidosisis
theonlyrestrictivelungdiseaseamongsttheoptionsprovided.
Ref:HarrisonsPrinciplesofInternalMedicine,17thEdition,Page1588&1589.
Q:14 Apatientdiagnosedtohavebronchiectasisdevelopsfeaturesofnephroticsyndrome.Whatis
themostprobablediagnosis?
A: SLE
B: Cysticfibrosis
C: Amyloidosis
D: HIV
CorrectAns:C
Explanation
Amyloidosisisawellknowncauseofnephroticsyndromeandrenalfailure,which
isusuallyassociatedwithchronicinflammatorydisease(e.g.rheumatoidarthritis),
chronicinfections(e.g.tuberculosisandbronchiectasis)orfamilialMediterranean
fever(FMF).Alloftheseconditionsareassociatedwithelevatedcirculatinglevels
ofserumamyloidA(SAA).SAAisoneoftheacutephaseproteinsininflammation
andisaprecursorofAAamyloid.
Q:15 WhichoneofthefollowingdisorderisinheritedinanAutosomalDominantmanner?
A: Cysticfibrosis
B: Sicklecellanemia
C: G6PDdeficiency
D: Hereditaryspherocytosis
CorrectAns:D
Explanation
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Hereditaryspherocytosisisadisorderinheritedinanautosomaldominantmanner.Thehallmarkfeatureof
HSerythrocytesislossofmembranesurfacearearelativetointracellularvolume,resultinginthespheroidal
shapeanddecreaseddeformabilityoftheredcell.
Lossoferythrocytesurfacearearesultsfromincreasedmembranefragilitycausedbydefectsinproteinsofthe
erythrocytemembrane,suchankyrin,band3,betaspectrin,alphaspectrin,andprotein4.2.Childrenmostly
presentwithfeaturesofanemia,andonexaminationsshowsjaundice,splenomegaly.
Investigation:Peripheralsmearshowsspherocyteslackingcentralpallor,lesscommonlyanisocytosisand
poikolocytosisarenoted.CBCshowsmildtomoderateanemia,normalMCV,increasedMCHC,increasedRDW
andOsmoticfragilitytestispositive.
Ref:HarrisonsPrincipleofInternalMedicine,16thEdition,Pages501,875,878,2147WilliamHematology,8th
Edition,Chapter45BlueprintsPediatricsByBradleyS.Marino,5thEdition,Pages1089
Q:16 WhichoneofthefollowingdisorderisinheritedinanAutosomalDominantmanner?
A: Cysticfibrosis
B: Sicklecellanemia
C: G6PDdeficiency
D: Hereditaryspherocytosis
CorrectAns:D
Explanation
Hereditaryspherocytosisisadisorderinheritedinanautosomaldominantmanner.Thehallmarkfeatureof
HSerythrocytesislossofmembranesurfacearearelativetointracellularvolume,resultinginthespheroidal
shapeanddecreaseddeformabilityoftheredcell.
Lossoferythrocytesurfacearearesultsfromincreasedmembranefragilitycausedbydefectsinproteinsofthe
erythrocytemembrane,suchankyrin,band3,betaspectrin,alphaspectrin,andprotein4.2.Childrenmostly
presentwithfeaturesofanemia,andonexaminationsshowsjaundice,splenomegaly.
Investigation:Peripheralsmearshowsspherocyteslackingcentralpallor,lesscommonlyanisocytosisand
poikolocytosisarenoted.CBCshowsmildtomoderateanemia,normalMCV,increasedMCHC,increasedRDW
andOsmoticfragilitytestispositive.
Ref:HarrisonsPrincipleofInternalMedicine,16thEdition,Pages501,875,878,2147WilliamHematology,8th
Edition,Chapter45BlueprintsPediatricsByBradleyS.Marino,5thEdition,Pages1089
Q:17 Themostcommoninheriteddisorderamongthefollowingis:
A: Wilson'sDisease
B: Antitrypsindeficiency
C: Cysticfibrosis
D: Hemochromatosis
CorrectAns:D
Explanation
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Hemochromatosisisthemostcommoninheriteddisorder,withthegeneticsusceptibilityforthediseaseidentified
in1in250individuals.
Wilson'sdiseasein1in30,000.Othersareevenrare
Ref:Harrison,E18,P2603.
Apatientpresentswithdecreasedvitalcapacityandtotallungvolume.Whatisthemost
Q:18 probablediagnosis?
A: Bronchiectasis
B: Sarcoidosis
C: Cysticfibrosis
D: Asthma
CorrectAns:B
Explanation
Decreasedvitalcapacityanddecreasedtotallungvolumearefeaturesofrestrictivelungdisease.Sarcoidosisis
theonlyrestrictivelungdiseaseamongsttheoptionsprovided.
Ref:HarrisonsPrinciplesofInternalMedicine,17thEdition,Page1588&1589.
Q:19 Pigmentgallstonesusuallynotseenin:
A: Gilbert'ssyndrome
B: Alcoholiccirrhosis
C: Cysticfibrosis
D: Clofibratetherapy
CorrectAns:D
Explanation
Clofibratetherapy:Increasedbiliarysecretionofcholesterol,leadstocholesterolgallstones.
Pigmentstonesaremorecommoninpatientswhohavechronichemolyticstates),livercirrhosis,Gilbert's
syndrome,orcysticfibrosis.
Reference:
HarrisonsPrinciplesofInternalMedicine,18thEdition,Page2618
Q:20 Themostcommoninheriteddisorderofcholangiocyteinjuryis:
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A: Cysticfibrosis
B: Dubinjohnson
C: CriglernajjartypeII
D: Wilsondisease
CorrectAns:A
Explanation
Themostcommoninheriteddisorderofcholangiocyteinjuryiscysticfibrosis.
ItaffectssecretoryepitheliaandislinkedtomutationsintheCFTRgene,whichencodesthecysticfibrosis
transmembraneconductanceregulatorionchannelprotein.Cholestaticdiseaseoccursin30%ofadultswiththis
disorder.
Ref:SleisengerandFordtran's,E9,P329
Q:21 Strontiumranelateisapprovedfortreatmentof:
A: Asthma
B: Cysticfibrosis
C: UTI
D: Osteoporosis
CorrectAns:D
Explanation
StrontiumranelateisapprovedinseveralEuropeancountriesforthetreatmentofosteoporosis.Itincreasesbone
massthroughouttheskeletoninclinicaltrials,thedrugreducedtheriskofvertebralfracturesby37%and
nonvertebralfracturesby14%.Itappearstobemodestlyantiresorptive,whileatthesametimenotcausingas
muchofadecreaseinboneformation(measuredbiochemically).
Ref:Harrisonsprincipleofinternalmedicine17thedition,chapter338.
Q:22 Theclinicalsituationsinwhichintestinalabsorptionisincreasedamongthefollowing?
A: Wilsondisease
B: Perniciousdisease
C: Chroniccalcificpancreatitis
D: Cysticfibrosis
CorrectAns:A
Explanation
Almostallclinicalproblemsareassociatedwithdiminishedintestinalabsorptionofoneormoredietarynutrients.
TheonlyclinicalsituationsinwhichabsorptionisincreasedisWilsondisease,inwhichabsorptionofcopperis
increased.
ALSONOTE:
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Anotherexampleishemochromatosisinwhichironabsorptionisincreased.
Ref:Harrison,E18,P2460.
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