NRNP 6541 MIDTERM AND FINAL EXAMS LATEST VERSIONS 2024 /NR
6541 REAL EXAM QUESTIONS AND CORRECT ANSWERS WITH RATIO
NALES
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(4) A 15-year-old female has a 1-month
history of urinary frequency without dy-
suria and recent onset of an itchy rash
beneath both breasts. She has been
A. The obese adolescent in this case has
gaining weight over the past year and
findings of diabetes mellitus. Her cuta-
regularly complains of fatigue. She is
neous candidiasis is likely an indication
febrile with a weight greater than the 99th
of secondary immunosuppression relat-
percentile and has an erythematous,
ed to hyperglycemia. In diabetes, hyper-
macular rash beneath both breasts char-
glycemia promotes neutrophil dysfunc-
acterized by satellite lesions. UA is sig-
tion, and circulatory insufficiency con-
nificant for 2+ glucosuria, but no pyuria.
tributes to ineffective neutrophil chemo-
Which of the following is the most likely
taxis during infection. HIV infection is
diagnosis?
possible and antibody testing might be
A. Diabetes mellitus
reasonable, but this scenario is most
B. Fanconi syndrome
consistent with hyperglycemia.
C. Human immunodeficiency virus
D. Occult malignancy
E. Severe combined immunodeficiency
(SCID)
(4) A mother notes her 6-week-old son's
umbilical cord is still attached. His ac- C. You suspect leukocyte adhesion de-
tivity and intake are normal; there has ficiency (LAD) as the etiology of this
been no illness or fever. Delivery was at child's problem. LAD is an inheritable
term without problems. His examination disorder of leukocyte chemotaxis and
is notable for a cord without evidence adherence characterized by recurring
of separation and a shallow, 0.5cm ul- sinopulmonary, oropharyngeal, and cu-
ceration at the occiput without discharge taneous infections with delayed wound
or surrounding erythema. Mother de- healing. Neutrophila is common with
clares that the "sore," caused by a scalp WBC counts of typically more than
probe, has been slowly healing since 50,000 cells/mm. Severe, life-threatening
birth and was deemed unremarkable at infection is possible with Staphylococcus
his 2-week checkup. Which of the follow- species, Enterobacteriaceae, and Can-
ing is consistent with this child's likely dida species. Good skin and oral hygiene
diagnosis? are important; broad-spectrum antimi-
A. Defective humoral response crobials and surgical debridement are
B. Functional leukocyte adherence gly- early consideration with infection.
coproteins
, NRNP 6541 MIDTERM AND FINAL EXAMS LATEST VERSIONS 2024 /NR
6541 REAL EXAM QUESTIONS AND CORRECT ANSWERS WITH RATIO
NALES
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C. Marked neutrophilia
D. Normal wound healing
E. Purulent abscess formation
(4) A 6-month-old girl is seen after an
emergency room visit for decreased in-
take, emesis, and watery diarrhea for
the past 3 days. She was diagnosed
yesterday with "stomach flu" and giv-
en IV fluids. She is doing better today
with improved intake and resolution of
C. SCID is an autosomal recessive or
her emesis and diarrhea. The father is
X-linked disorder of both humoral and
concerned about her thrush since birth
cellular immunity. Serum immunoglobu-
(despite multiple courses of an oral an-
lins and T cells are often markedly di-
tifungal) and that she has been hos-
minished or absent. Thymic dysgenesis
pitalized twice for pneumonia over the
is also seen. Recurring cutaneous, gas-
past 4 months. Her weight has dropped
trointestinal, or pulmonary infections oc-
from the 50th percentile on her 4-month
cur with opportunistic organisms such as
visit to the 5th percentile today. She
cytomegalovirus (CMV) and PCP. Death
has no findings consistent with dehy-
typically occurs in the first 12 to 24
dration, but she does appear to have
months of life unless bone marrow trans-
some extremity muscle wasting. Her ex-
plantation is performed.
amination is remarkable for buccal mu-
cosal exudates and hyperactive bowel
sounds. Vital signs and the remainder
of her examination are normal. You sus-
pect severe combined immunodeficien-
cy (SCID). Which of the following is con-
sistent with the diagn
(4) You are called urgently to examine
a term, 2-hour-old newborn who has
B. DiGeorge syndrome is caused by a
had temperature instability, difficulty with
22q11 microdeletion. This syndromic im-
feeding, and a suspected seizure. He
munodeficiency is characterized by de-
has atypical facies (wide-set eyes, a
creased T-cell production and recurring
prominent nose, and a small mandible),
infection. Findings include characteristic
a cleft palate, and a holosystolic mur-
facies and velocardiofacial defects such
mur. Stat laboratory tests and chest ra-
diograph reveal marked hypocalcemia, a
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