Day 21
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1.   A 27-year-old graduate student, recently married, who comes into the clinic for a routine pelvic exam and PAP smear. During the course of the exam, the gynecology doctor performing the exam obtains the PAP smear, but also obtains cervical cultures for gonorrhea and chlamydia. The examination concludes uneventfully.Several weeks later, Margaret receives a postcard indicating that the PAP smear was normal, with no evidence of dysplasia, but that the cervical culture for gonorrhea was positive. The card instructs her to come into the clinic to discuss treatment, and that "public health authorities" have been notified for contact tracing. The young woman is terrified that her husband will be contacted and complains to the Director of the student health clinic. As the Director of the clinic, how would you handle Margaret’s complaint? a. Inform her that the culture was a routine procedure that is performed on everybody who comes for a routine Pap smear. b. Tell her how lucky she is that her gonorrhea was discovered and can now be successfully treated. c. Inform her that the treatment of gonorrhea will benefit her and her husband. d. Apologize to her for the error in obtaining the cervical culture without her consent. Explain
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2.  A 50-year-old male without a significant past medical history or recent exposure to alcohol presents with mid epigastric abdominal pain, nausea, and vomiting. The physical examination is remarkable for the absence of jaundice and any other specific physical findings. Which of the following is the best strategy for screening for acute pancreatitis? A. Measurement of serum amylase B. Measurement of serum lipase C. Measurement of both serum amylase and serum lipase D. Isoamylase level analysis E. Magnetic resonance imaging. Why?
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3.  A 30-year-old nursing student presents with confusion, sweating, hunger, and fatigue. Blood sugar is noted to be 40 mg/dL. The patient has no history of diabetes mellitus, although her sister is an insulin-dependent diabetic. The patient has had several similar episodes over the past year, all occurring just prior to reporting for work in the early morning. On this evaluation, the patient is found to have high insulin levels and a low C peptide level. The most likely diagnosis is a. Reactive hypoglycemia b. Early diabetes mellitus c. Factitious hypoglycemia d. Insulinoma
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4.  An 18-month-old-old girl is separated from her parents for about 1 month following a natural calamity. The child develops severe depression following this episode. What is the name of this phenomenon? A. Vulnerable child syndrome 
B. Anaclitic depression C. Separation anxiety disorder D. None of the above. Differentiate given choices and give related rubrics.
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5. A 19-year-old first-year college student reports that she feels very sleepy by 6 or 7 in the evening and has to go to bed. She says that she wakes up very early in the morning and finds herself to be more alert then. What best describes this sleep pattern? A. Delayed sleep phase syndrome 
 B. Advanced sleep phase syndrome 
C. Hypersomnia D. None of the above. Explain your answer
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