3-year-old boy is brought to the office by his mother for follow-up after an emergency department visit for a lower extremity fracture


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3-year-old boy is brought to the office by his mother for follow-up after an emergency department visit for a lower extremity fracture.

One week ago, the patient fell while running on the stairs and was found to have a closed tibial fracture. He was placed in a cast and

has been doing well since. His history is also notable for a femur fracture shortly after learning to walk at age 13 months. The patient

has speech delay and mild hearing loss. His mother has had multiple fractures since childhood and has hearing loss as well. Vital

signs are normal. Height and weight are at the 5th and 20th percentiles, respectively Examination shows a young boy with no

dysmorphic features. Bilateral upper and proximal lower extremities have 5/5 strength. Hypermobility of the joints in the hands is

noted. The right leg is casted from below the knee to the foot, and capillary refill of the toes is <2 seconds. Based on this clinical

presentatio n, this patient most likely has a defect in which of the following genes?

  • QA Oystrophin
  • 0 B. Fibrillin-1
  • 0 C. Fibroblast growth factor receptor 3
  • 0 D. Fragile X mental retardation 1
  • 0 E. Type I collagen

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32-year-cid man is admitted to the hospital after being found standing on the edge of a bridge He appears severely depressed and

says that his life is over. The patient is in financial ruin, and his wife recently left him and took their children. He is crying, is unable to

sleep, has no appetite, and continues to express hopelessness and suicidal thoughts He was taking phenelzine for depression but

stopped the medicatioo a month ago due to side effects. In the hospital, the patient is started on sertraline. The next day, after calling

his wife, he becomes agitated aod starts to blame himself for destroying his life and family. The patient is started on olanzapine for

worsening agitation during the first 3 days, after which he is noticeably calmer but unable to get out of bed. He appears confused and

does oot respond to questions appropriately The patient is diaphoretic Temperature is 40.1 C (104.1 F), blood pressure is 167/97

mm Hg, and pulse is 112/min. As staff members attempt to get him out of bed, they notice that his arms and legs are stiff and difficult

to bend. Which of the following is the most likely cause of this patient’s symptoms?

  • Catatonia
  • Drug-drug interaction
  • Malignant hyperthermia
  • Olanzapine
  • Sertraline

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