You are contacted by an attorney representing a client who has been charged with child abuse and whom faces loss of her child and 15 years in prison. The record indicated that the child was 4 years old and presented to the ER room with a broken arm and a broken leg. There also appeared to be multiple previous fractures. Now, you examine the child and find blue sclera, a sunken chest wall, severe scoliosis, and you observe a triangular face and prominent forehead. You confirm that there have been multiple previous fractures by evaluating the previous X-rays. This is a genetic disorder. 

• What      is the most likely genetic disease that this presents and why?
• What      is the molecular basis of this disease?
• Before,      calling the police what should the initial clinician have done?

Johnny is a 5-year-old Asian boy who is brought to a family practice office with a “runny” nose that started about 1 week ago but has not resolved.  He has been blowing his nose quite frequently and “sores” have developed around his nose.  His mother states, “The sores started as ‘big blisters’ that rupture; sometimes, a scab forms with a crust that looks like “dried maple syrup” but continues to seep and drain.”  She is worried because the lesions are now also on his forearm.  Johnny’s past medical and family histories are normal.  He has been febrile but is otherwise asymptomatic.  The physical examination was unremarkable except for moderate, purulent rhinorrhea and 0.5- to 1-cm diameter weeping lesions around the nose and mouth and on the radial surface of the right forearm.  There is no regional lymphadenopathy.

• Write      a differential of at least three (3) possible diagnoses and explain how      each may be a possible answer to the clinical presentation above.      Remember, to list the differential in the order of most likely to less      likely.
• Based      upon what you have at the top of the differentials how would you treat      this patient?      
• When      would you allow the student back to school? Elaborate on your reasoning?

Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104 F, She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms. 

• Write      three (3) differential diagnoses?
• What      are some of the complications of this disease, assume that the top of your      differential is the definitive?
• Assume      that the second item you place on your differential is the definitive      diagnosis. What are some complications of that disease?

1. Considering the pathophysiology of osteoporosis, which cytokines and hormones decrease receptor activator of RANKL expression?(Points : 2)

2. Rhabdomyolysis is characterized by (Points : 2)

3. Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat a compound displaced fracture of the tibia and fibula? (Points : 2)

4. Considering the pathophysiology of osteoporosis, what are the effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts? (Points : 2)

5. What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon? (Points : 2)

6. Which statement is false about giant cell tumors? (Points : 2)

7. What pattern of bone destruction is described as not well defined and not easily separated from normal bone? (Points : 2)

8. The pain experienced in Legg-Calvé-Perthes disease is referred to as involving (Points : 2)

9. In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis, which is considered the “path of least resistance.” What factor makes this route for bacteria the path of least resistance? (Points : 2)

10. Molecular analysis has demonstrated that osteosarcoma is associated with (Points : 2)

11. Ewing sarcoma arises from (Points : 2) 

12. Which serum laboratory test is elevated in all forms of osteogenesis imperfecta? (Points : 2)

13. The _____ is cartilage that retains the ability to form and calcify new cartilage and deposit bone until the skeleton matures. (Points : 2)

14. Osteochondrosis is caused by a(n) (Points : 2)

15. An insufficient dietary intake of vitamin _____ can lead to rickets in children. (Points : 2)

16. In latex allergies, which immunoglobulin is associated with an immediate reaction? (Points : 2)

17. Chickenpox may be followed years later by (Points : 2)

18. Cutaneous vasculitis develops from the deposit of _____ in small blood vessels as a toxic response allergen. (Points : 2)

19. Which malignancy is characterized by slow-growing lesions that usually have depressed centers and rolled borders and are frequently located on the face and neck? (Points : 2)

20. Scleroderma is more common in women and is associated with a(n) (Points : 2)

21. Thrush is a superficial infection that commonly occurs in children and is caused by (Points : 2)

22. What is the cause of chickenpox? (Points : 2)

23. Which vascular anomaly is a congenital malformation of dermal capillaries that does not fade with age? (Points : 2)

24. What is a common source of tinea corporis? (Points : 2)

25. Which contagious disease creates a primary skin lesion that is a pinpointed macule, papule, or wheal with hemorrhagic puncture site?(Points : 2)