174. An 8-year-old girl is brought to the physician because of an 8-year history of stretchy skin. She is at the 50th percentile for height and weight. Physical examination shows smooth skin that is velvety to the touch, extends easily, and snaps back after release. There are multiple thin, stretched scars over the forehead, elbows, knees, and shins. Range-of- motion testing shows hypermobility of the hand and knee joints. Her mother has similar findings. Genetic testing of the patient's lymphocytes shows a 16-nucleotidé deletion in a collagen 5A1 (COL5A1) allele. The mRNA product of COL5A1 in both the nucleus and cytoplasm is assessed in cultured skin fibroblasts. Results show a 50% level of mutated mRNA in the nucleus and 0% level of mutated mRNA in the cytoplasm. Based on these findings, which of the following disease mechanisms is most likely in this patient? A) Alternate splice site created B) Decreased stability of mRNA C) Increased translation D) Increased ubiquitination of abnormal peptide E) Prevention of transcription of the mutated allele
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- James Dunn is a 40-year-old African American man. He presents to the physician’s office today complaining of headache. His vital signs during triage are as follows: blood pressure 165/90 mm Hg, heart rate 80 beats/minute, temperature 98.5F, weight 125 kg (275 lb), and height 5 ft 11 in. He currently has no other diagnosed medical conditions. The physician gives Mr. Dunn a prescription for lisinopril/hydrochlorothiazide (Prinzide) 10/12.5 mg with directions to take one tablet by mouth daily in the morning. (Learning Objectives 1, 3, 4, 8) 1. In which stage of hypertension would you place Mr. Dunn? 2. What lifestyle modifications should Mr. Dunn be encouraged to follow? 3. What class of antihypertensive is lisinopril/hydrochlorothiazide? 4. What would you tell Mr. Dunn about his new medication?Being overweight or obese is a health concern for children. Indicate two factors that pose risks for being overweight in childhood. Indicate two possible consequences for overweight children. Discuss a possible treatment or intervention for overweight children. Explain what parents/caregivers can do to reduce the chance of children becoming overweight or obeseMrs. Thomas was on vacation out of state when she stepped off a curve and injured her left ankle. Due to severe pain she was seen at an urgent care center where she underwent a left ankle x-ray, which was negative. She was diagnosed with a left sprained ankle. A walking boot was provided to stabilize and protect her left ankle. She was provided with appropriate discharge instructions and instructed to follow up with her primary care physician upon returning home. When she presented her BlueCross BlueShield insurance card at check out, Mrs. Thomas was informed that the physician who provided treatment is a nonparticipating provider (nonPAR) and that the urgent care center accepts credit cards for payment in full. The total due was $1,500, and Mrs. Thomas assured the office staff that her insurance company would reimburse the urgent care center for services provided. The office staff further explained that their providers had not signed a contract with her insurance, and thus Mrs. Thomas…
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- A 50 year old male is experiencing fatigue, dizziness, and headaches with a rapid decline in his visual acuity. He treats his hypertension and type 2 diabetes with medications. His brow and jaw are enlarged (proganthism), his hands and feet and fingers are wide. His wedding ring no longer fits on his finger. He is obese and has a deep voice. -His lab tests show high blood glucose, high GH, high IGF1, normal prolactin, and low testosterone.There was a pituitary mass seen on his CT scan. What accounts for the patients proganthism? a.) High growth hormone levels after epiphyseal plate closure cause thickening of bone structure b.) low testosterone leads to increased bone growth and density c.) normal bone growth with aging d.) Low IGF=-1 stimulates bone growthCharacteristic Rheumatoid Arthritis Osteoarthritis Systemic manifestations Inflammatory disease Symmetric presentation Pain at rest Laboratory abnormality84. A 35-year-old man comes to the physician because of a 3-day history of tingling in his fingers and muscle cramps. Tapping over the facial nerve produces ipsilateral contraction of the facial muscles. His serum calcium concentration is 7.2 mg/dL. Serum concentrations of vitamin D and 25-hydroxycholecalciferol are within the reference range, serum 1,25-dihydroxycholecalciferol concentration is 5 pg/mL (N=18-65). Disease in which of the following is the most likely cause of this patient's findings? A) Bone B) Gut C) Kidney D) Liver E) Lungs F) Skin