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Rosh Review Practice Questions and Answers | 100% Pass Which of the following patients is at greatest risk of developing West Nile meningoencephalitis? 22-year-old man status postrenal transplant 3-year-old girl who is unvaccinated 58-year-old man with diabetes and hypertension 82-year-old w...

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  • September 15, 2024
  • 126
  • 2024/2025
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©SOPHIABENNETT
EXAM_SOLUTIONS GUARANTEED SUCCESS 2024/2025 ACADEMIC YEAR




©SOPHIABENNETT 9/3/24 2024/2025

, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM



Rosh Review Practice Questions and
Answers | 100% Pass


Which of the following patients is at greatest risk of developing West Nile

meningoencephalitis?




22-year-old man status postrenal transplant

3-year-old girl who is unvaccinated

58-year-old man with diabetes and hypertension

82-year-old woman with dementia - Answer✔️✔️-Correct Answer ( D )

Explanation:



West Nile virus is a zoonotic infection that first appeared in the U.S. along the eastern

seaboard in 1999 but can now be found nationwide. West Nile encephalitis (WNE) is

endemic in the Middle East, Africa, and Asia. Birds serve as the primary host, and it is

transmitted by the bite of a mosquito. WNE usually occurs in the summer, when

mosquitoes, wild migratory birds, and humans are in close proximity outdoors. Most

people infected with West Nile virus are asymptomatic. When present, symptoms are

typically mild and include fever, headache, and fatigue. Severe disease, however, can

cause central nervous system manifestations including meningitis, encephalitis, and

myelitis. The biggest risk factor, by far, for neuroinvasive West Nile disease is advanced

age.

Page | 1

, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM




There are a handful of confirmed cases of transmission via organ transplantation or

blood transfusion. Although immunosuppression (A and C) puts people at increased risk

and invasive disease in young children can be more severe (B), West Nile

meningoencephalitis is far more common in the geriatric population than in any other

group.

Question: What is the typical distribution of weakness caused by West Nile

meningoencephalitis? - Answer✔️✔️-Answer: Asymmetric; isolated facial involvement

may also be seen.



Rapid Review



West Nile Virus

Mosquitos

Summer/fall

Flulike sx, URI sx, rash

Complication: meningoencephalitis

Which of the following is associated with pernicious anemia?



Homocysteine levels are decreased

Methylmalonic acid is increased


Page | 2

, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM


Normocytic erythrocytes

Vitamin B12 elevation - Answer✔️✔️-Correct Answer ( B )

Explanation:



Vitamin B12 is found in animal products and binds to intrinsic factor (IF) secreted by

gastric parietal cells. This complex is absorbed in the terminal ileum. Pernicious anemia

is an autoimmune disorder in which antibodies act against intrinsic factor and gastric

parietal cells leading to chronic atrophic gastritis and decreased production and function

of intrinsic factor. This subsequently leads to vitamin B12 deficiency. In vitamin B12

deficiency, serum methylmalonic acid is increased. In elderly patients, this form of

megaloblastic anemia is one of the leading causes of vitamin B12 deficiency. Pernicious

anemia is associated with other immunologic diseases such as Sjögren's syndrome,

Hashimoto's disease, type 1 diabetes mellitus, and celiac disease. It is also associated

with an increased risk for gastric cancer and carcinoid tumors. Vitamin B12 deficiency

caused by dietary deficiency or malabsorption is rare. Dietary causes of deficiency are

limited to elderly people who are already malnourished. Since the 1980s, the

malabsorption of vitamin B12 has become rare, due to the decreasing frequency of

gastrectomy and surgical resection of the terminal small intestine Other disorders

associated with vitamin B12 malabsorption include deficiency in the exocrine function of

the pancreas after chronic pancreatitis (usually alcoholic), lymphomas or tuberculosis of

the intestine, Crohn's disease, Whipple's disease, and celiac disease. Uncommon

etiology also includes nitrous oxide anesthesia and abuse.




Page | 3

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