Day 10
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1. Which of the following is the most likely explanation for the dental abnormalities in bulimia nervosa (BN)?  
(A)  self-induced physical trauma 
(B)  self-induced vomiting 
(C)  excess cortisol levels 
(D)  osteoporotic changes 
(E)  estrogen deficiency.Explain
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2.  A 23-year-old woman presents with weight loss and chronic diarrhea. She appears unwell and cachectic. Routine laboratory tests reveal a low hemoglobin level and an increased international normalized ratio (INR).The liver enzymes are normal, but the albumin and calcium levels are low, suggesting generalized malnutrition. Which of the following is the most appropriate initial diagnostic test for malabsorption? (A)  xylose absorption 
(B)  Schilling test 
(C)  x-ray studies 
(D)  stool fat quantitation 
(E)  small intestinal biopsy . Differentiate 

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3. A 33-year-old man has never been vaccinated for hepatitis B. Serologic tests reveal negative hepatitis B surface antigen (HBsAg) and positive antibody to surface antigen. Which of the following conditions does this serologic pattern best fit with? 
(A)  previous hepatitis B infection 
(B)  chronic active hepatitis 
(C)  acute hepatitis B infection 
(D)  poor prognosis 
(E)  need for vaccine to hepatitis B . Justify
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4.  An 18-year-old woman was diagnosed 7 years earlier with precocious pseudopuberty secondary to ovarian tumor. Physical examination reveals oral and lingual dark pigmentation. Which of the following is the most likely diagnosis? 
(A)  Peutz-Jeghers syndrome 
(B)  Gardner’s syndrome 
(C)  Lynch syndrome 
(D)  Juvenile polyposis 
(E)  Turcot’s syndrome . Explain
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5. A 63-year-old man has stools positive for occult blood. Which of the following is the most likely location of bowel cancer? 
(A)  cecum 
(B)  sigmoid 
(C)  transverse colon 
(D)  appendix 
(E)  ascending colon .Why?
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