A) hydroxychloroquine
B) mercaptopurine
C) adalimumab
D) abatacept
The correct answer is C) adalimumab.
While the traditional "first-line" treatment for Rheumatoid Arthritis (RA) is often Methotrexate, this specific scenario includes two critical "red flags" that push the treatment toward more aggressive therapy: High Disease Activity and Erosions on Radiograph.
Why Adalimumab is the Best Choice Here
According to the American College of Rheumatology (ACR) guidelines, the presence of erosions (permanent bone damage) and high disease activity signals a poor prognosis. In these cases, clinicians often skip over mild agents and go straight to Biologic DMARDs (bDMARDs) or a combination of conventional DMARDs.
Adalimumab (Humira): This is a TNF-alpha inhibitor. It is highly effective at slowing the progression of joint damage (radiographic progression) and reducing high disease activity quickly.
The "Erosion" Factor: Once bone erosions are visible on an X-ray, the goal of therapy shifts from just "reducing pain" to "preventing disability." Biologics like Adalimumab are superior at stopping further bone destruction compared to milder agents.
Analyzing the Other Options
A) Hydroxychloroquine: This is a "mild" conventional DMARD. It is generally reserved for patients with low disease activity and no erosions. It would be insufficient for this patient’s high-risk profile.
B) Mercaptopurine: This is primarily used in oncology or Inflammatory Bowel Disease (IBD). It is not a standard-of-care treatment for Rheumatoid Arthritis.
D) Abatacept: While Abatacept is a biologic DMARD (T-cell costimulation modulator), it is typically used if a patient fails a TNF inhibitor (like Adalimumab) or Methotrexate first. In many clinical pathways, TNF inhibitors are the preferred initial biologic choice due to more extensive long-term data.
Clinical Context
In a real-world board exam, you might also see Methotrexate as an answer. However, between the options provided, Adalimumab is the only one potent enough to address both high activity and existing structural damage (erosions).
A)p value
B)odds ratio
C)hazard risk
D)relative risk
The correct answer is A) p value.
In the context of statistical hypothesis testing, the p-value is the specific metric used to determine whether a result is "statistically significant" or if it could have occurred by sheer luck.
The Role of the P-Value
The p-value measures the strength of the evidence against the null hypothesis (H₀).
- If the p < 0.05, we conclude the result is statistically significant (unlikely to be due to chance).
- If the p ≥ 0.05, we conclude the result is not statistically significant.
Why the other options are different:
The other three options (B, C, and D) are measures of effect size or association, not significance. They tell you how much a risk increases or decreases, but they don't inherently tell you if that change is statistically reliable without an accompanying p-value or confidence interval.
| Metric | What it Tells You | Example |
| P-Value | Significance: Is this result real or a fluke? | "The 10% improvement was not due to chance (p=0.02)." |
| Odds Ratio (OR) | Association: The odds of an event happening in one group vs. another. | "Smokers have 5x higher odds of lung cancer." |
| Relative Risk (RR) | Probability: The ratio of the probability of an event occurring in an exposed group vs. a non-exposed group. | "Patients on Drug X had 50% less risk of a heart attack." |
| Hazard Ratio (HR) | Timing: The risk of an event happening over a specific period of time. | "Patients on the new drug lived twice as long before progression." |
Summary:
Think of it this way: Odds Ratio, Relative Risk, and Hazard Risk describe the magnitude of the relationship, while the p-value provides the statistical "stamp of approval" that the relationship actually exists.
The correct answer is A) 3.5 liter.
To find the estimated amount of plasma, you simply multiply the person's body weight by the provided plasma volume constant (55-55 ml/kg).
The Calculation
Plasma volume is estimated as: 50–55 mL/kg
For a 70-kg male: 70×50=3500 mL
3500 mL=3.5 liters
So the estimated plasma volume is approximately 3.5 liters.
Quick Reference:
Total blood volume ≈ 70 mL/kg
Plasma ≈ 50–55 mL/kg
Extracellular fluid ≈ 20% of body weight
A)CD1 lymphocytes
B) CD2 lymphocytes
C)CD3 lymphocytes
D)CD4 lymphocytes (T lymphocytes)
The correct answer is D) CD4 lymphocytes (T lymphocytes).
In the context of Human Immunodeficiency Virus (HIV), the CD4+ T cell (also known as a "T-helper cell") is the primary target for the virus.
How HIV Targets CD4 Cells
The HIV virus uses a specific protein on its surface (gp120) to "lock onto" the CD4 receptor found on the surface of these T lymphocytes. Once attached, the virus enters the cell, hijacks its genetic machinery to make copies of itself, and eventually destroys the cell.
Understanding the Progression to AIDS
The transition from an HIV infection to AIDS is officially defined by the status of these specific cells:
The Threshold: A healthy adult typically has a CD4 count between 500 and 1,500cells/mm³.
The Definition of AIDS: When the CD4 count drops below 200cells/mm³, or when the patient develops specific "opportunistic infections," the clinical diagnosis becomes AIDS.
Why the other options are incorrect:
A) CD1: These are involved in presenting lipid antigens to T cells, but are not the primary target of HIV.
B) CD2: This is a surface antigen found on all T cells and Natural Killer (NK) cells; it acts as an adhesion molecule but is not the viral entry point.
C) CD3: This is a protein complex that is part of the T-cell receptor on all mature T lymphocytes. While CD4 cells have CD3, HIV specifically requires the CD4 co-receptor to enter the cell.
Clinical Correlation:
Because CD4 cells are the "generals" of the immune system—coordinating the response of B cells and cytotoxic T cells—their destruction leaves the body vulnerable to infections that a healthy immune system would easily fight off (like Pneumocystis pneumonia).
appropriate suggestion for her?
A-To start chemotherapy with very low doses and less frequency
B- To go with the option of surgery immediately
C-To discuss the risk and benefit with the patient and take the decision
D-To force the patient to receive chemotherapy and wear synthetic hair extensions
- Respect for Autonomy: The patient has the absolute right to make decisions about her own body, even if those decisions seem "unwise" to the medical team.
- Informed Consent: A patient cannot truly exercise autonomy unless they fully understand the consequences. The healthcare provider's role is to ensure she understands the prognosis of untreated cancer versus the side effects of the treatments.
- Exploring Alternatives: Discussing risks and benefits allows the provider to offer middle-ground solutions, such as fertility-sparing surgery (if applicable) or "cold capping" to prevent hair loss during chemotherapy.
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