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Download DemoVendor: USMLE
Certifications: USMLE Certifications
Exam Code: USMLE-STEP-1
Exam Name: United States Medical Licensing Step 1
Updated: Jan 02, 2025
Q&As: 847
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Amedical student was bitten by infected ticks. In a week, he developed a high fever, headache, muscular aches, nausea, and splenomegaly. Five days later his symptoms subsided. However, 1 week later all his previous symptoms returned. During the next 9 days he went through a recovery and another relapse followed by a final recovery. The overall temperature curve of his illness is shown in below figure. Which of the following is the most likely etiological agent?
A. Borrelia burgdorferi
B. B. recurrentis
C. Leptospira interrogans
D. T. carateum
E. T. pertenue
Correct Answer: B
Section: Microbiology/Immunology The endemic form of relapsing fever is transmitted by ticks infected by B. recurrentis. Relapsing fever begins with headache, high fever, muscle aches, and splenomegaly. It has a unique fever curve due to the emergence of various antigenic types of B. recurrentis. B. burgdorferi (choice A) causes a distinct spreading circular rash with a clear center, which is called erythema chronicum migrans. L. interrogans (choice C) is transmitted by rat urine and causes leptospirosis. This disease is associated with jaundice, uremia, and aseptic meningitis. T. carateum (choice D) is the cause of pinta, which is characterized by hyperpigmentation of the skin. T. pertenue (choice E) is transmitted by contact with infected persons and is characterized by the development of cauliflowerlike skin lesions.
A 3-year-old child arrives at the hospital in severe respiratory distress. Periorbital edema is also noted. Blood analysis reveals decreased levels of C4 and decreased levels of C1 inhibitor. This complement deficiency is likely to lead to which of the following conditions?
A. angioedema
B. an increased susceptibility to pyogenic infections
C. bacteremia
D. decreased production of anaphylatoxins
E. enhancement of antibody production
Correct Answer: A
Section: Microbiology/Immunology Deficiency in the inhibitor of the first component of complement (C1) is associated with angioedema, because this condition leads to the production of anaphylatoxins C3a, C4a, and C5a. These anaphylatoxins act on mast cells, which release large amounts of histamine. Production of histamine increases capillary permeability resulting in edema. Enhanced susceptibility to pyogenic infections has been attributed to C3 and C5C8 components of complement. Bacteremia is a term used to indicate the presence of bacteria in the blood. Thus it has nothing to do with the first component of complement (choice C). Inherited deficiencies of C3 and C5C8 have been associated with increased susceptibility to pyogenic infections, but not the first component of complement (choice B). Complement can act synergistically with antibody to modify its action, but not its production (choice E). The conversions of the third (C3) and fifth (C5) components of complementby the C3 and C5 convertases to C3a and C5a anaphylatoxins lead to the increased production of anaphylatoxins (choice D) seen with C1 inhibitor deficiency.
Which of the following antiviral drugs is correctly associated with the appropriate primary toxicity?
A. amantadine--neutropenia
B. didanosine--pancreatitis
C. ribavirin--hepatitis
D. ritonavir--hemolytic anemia
E. zidovudine--CNS stimulation, GI complaints
Correct Answer: B
Section: Pharmacology Didanosine causes pancreatitis in a significant number of patients treated for AIDS. Amantadine (choice A) is used in the prevention and treatment of influenza and causes CNS stimulation and light headedness. Ribavirin (choice C) is used for the treatment of respiratory syncytial virus in infants and causes dose-dependent hemolytic anemia in about 10% of patients. Ritonavir (choice D), a protease inhibitor used in AIDS, causes hepatitis. Zidovudine (choice E), another drug used in AIDS, causes neutropenia as its primary doselimiting effect.
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