About Tea and Toasts

 

A 70 year-old English lady that lives alone is admitted to the hospital for evaluation of a leg wound that is not healing properly. The patient also complains of pain in muscle and bones. On the examination, you find some hemorrhagic lesions in the skin, including ecchymosis in buttocks and both legs and petechiaes in other areas of the skin. The nails show splinter hemorrhages. When asked about her dietetic habits, the patient refers that she is too old to eat so much, so she has a very frugal lunch and dinners based mainly in tea and toasts.

Laboratory examinations show normal blood coagulation tests and Hemoglobin of 9.8 g/dL

 

The treatment for the condition described above should consist mainly in the administration of the following vitamin:

 

a)     Ascorbic Acid

b)     Biotin

c)      Folic Acid

d)     Pantothenic acid

e)     Niacin

f)       Vitamin B1

g)     Vitamin B2

h)    Vitamin B6

i)       Vitamin B12

j)       Vitamin D

k)     Vitamin E

l)       Vitamin K

Q: About a patient with a glucagonoma.

 

Mouse Islet of Langerhans immunostained for Glucagon

 

Assume that you find a patient with a glucagon-secreting pancreatic tumor (glucagonoma). Which one of the following is most likely to result from hyperglucagonemia?

 

a)     Decreased lipolysis

 

b)     Hyperglycemia

 

c)      Increased muscle protein synthesis.

 

d)     Increased liver glycolytic rate

 

e)     Increased glycogenesis

Q: About an adult patient with jaundice

 

While attending a 21 years old male black patient who complains of abdominal pain, you observe a pale light yellow color of the skin and sclerotics. You suspect that the patient has jaundice; urine dipstick test is negative for bilirrubin but positive for urobilinogen.

 

When laboratory reports of blood tests arrive, they show the following results:

 

- Hematocrite: 28% (reference range from 41% to 53%)

 

- Hemoglobin: 8 g/dL (13.5-17.5 g/dL)

 

- Alanin aminotransferase (ALT) : 12 U/L (reference range 8-20 U/L)

 

- Aspartate aminotransferase (AST): 18 U/L (reference range 8-20 U/L)

 

- Alkaline Phosphatase (ALP): 80 U/L (reference range: 44-147 U/L)

 

- Total Bilirrubin: 3.5 mg/dL (normal = 0.1 to 1 mg/dL)

 

- Direct bilirrubin 0.2 mg/dL (normal from 0 to 0.3 mg/dL).

 

 

Which of the following options are compatible with the results shown above?

 

a)     jaundice of prehepatic cause

 

b)     jaundice of hepatic cause  because of deficiency in the intake of bilirrubin

 

c)      jaundice of hepatic cause because of deficiency in the conjugation of bilirrubin

 

d)     jaundice of hepatic cause because of deficiency in the excretion of bilirrubin from the hepatocyte.

 

e)     jaundice of posthepatic cause (extrahepatic biliary obstruction)