A father brings his 3-year-old son to the pediatrician because he is concerned about his health. He states that throughout his son's life he has had recurrent infections despite proper treatment and hygiene. Upon reviewing the patient's chart, the pediatrician notices that the child has been infected multiple times with S. aureus, Aspergillus, and E. coli. Which of the following would confirm the most likely cause of this patient's symptoms?
AIncreased IgM, Decreased IgG, IgA, and IgE
BNegative nitroblue-tetrazolium test
CPositive nitroblue-tetrazolium test
DNormal dihydrorhodamine (DHR) flow cytometry test
EIncreased IgE and IgA, Decreased IgM
A pathologist receives a skin biopsy specimen from a patient who is suspected to have developed graft-versus-host disease (GVHD) following allogeneic stem-cell transplantation. The treating physician informs the pathologist that he is specifically concerned about the diagnosis as the patient developed skin lesions on the 90th-day post-transplantation and therefore, by definition, it should be considered a case of acute GVHD. However, the lesions clinically appear like those of chronic GVHD. The pathologist examines the slide under the microscope and confirms the diagnosis of chronic GVHD. Which of the following findings on skin biopsy is most likely to have helped the pathologist to confirm the diagnosis?
AComplete separation of the dermis and epidermis
BFocal vacuolization in the basal cell layer
CLymphocytic infiltration of the superficial dermis
DHypergranulosis
EDiffuse vacuolization in the basal cell layer
A 38-year-old woman comes to the physician for the first time because of a 2-year history of lower back pain and fatigue. She also says that she occasionally feels out of breath. Her symptoms are not associated with physical activity. She has seen multiple physicians over the past year. Extensive workup including blood and urine tests, abdominal ultrasound, MRI of the back, and cardiac stress testing have shown no abnormalities. The patient asks for a medication to alleviate her symptoms. Which of the following is the most appropriate response by the physician?
AI would like to refer you to a psychiatric specialist to start behavioral psychotherapy.
BYour symptoms are suggestive of a condition called somatic symptom disorder.
CI would like to investigate your shortness of breath by performing coronary artery catheterization.
DYour desire for pain medication is suggestive of a medication dependence disorder.
EI would like to assess your symptoms causing you the most distress and schedule monthly follow-up appointments.
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