AIPGMEE 2015

In which one of the following locations might a
lesion cause a left superior homonymous
quadrantanopia?
a. Frontal lobe
b. Parietal lobe
c. Left eye
d. Temporal lobe
e. None of the above
Answer: d. This visual field loss localizes a lesion in
either the right inferior occipital or right temporal lobe
(see Fig. 12-10). Single ocular lesions do not produce
homonymous defects. When this visual field defect,
which neurologists occasionally label “pie in the sky,”
stems from a temporal lobe lesion, complex partial seizures
may be comorbid.

AIPGMEE 2015

After divorce, children may demonstrate all of the following EXCEPT:

• A feeling of being overburdened by residence in two homes
• Withdrawal
• Indifference at times of reunions
• Academic deterioration
• Expectations that the parents will never get back together

School-aged children may respond with evident depression, may seem indifferent, or may be markedly angry. Other children appear to deny or avoid the issue, behaviorally or verbally. Most children cling to the hope that the actual placement or separation is not real and is only temporary. The child may experience guilt by feeling that the loss, separation, or placement represents rejection and perhaps punishment for misbehavior. Children may protect a parent and assume guilt, believing that their own “badness” caused the parent to depart. (See e16-1.)

AIPGMEE 2015

Which of the following muscles can effectively squeeze urine from the male urethra at the end of micturition?

• Ischiocavernosus muscle
• Bulbospongiosus muscle
• Deep transverse perineal muscle
• Superficial transverse perineal muscle
• Pubococcygeus muscle

The bulbospongiosus muscle covers the bulb of the penis in the superficial perineal space. The urethra, distal to the urethral sphincter, is within the bulb of the penis. Contraction of the muscle squeezes the bulb against the inferior surface of the urogenital diaphragm and thus squeezes the urethra. The ischiocavernosus muscle covers the crus of the penis and squeezes it against the urogenital diaphragm and the ischiopubic ramus. However, because the urethra is not within the crus of the penis, contraction of this muscle has no effect on the urethra. The deep transverse perineal muscle is part of the muscular layer of the urogenital diaphragm but is not in contact with the urethra. The superficial transverse perineal muscle is in the superficial perineal space and does not contact the urethra. The pubococcygeus muscle is part of the muscle layer of the pelvic diaphragm and also does not contact the urethra

AIPGMEE 2015

A T cell undergoing activation has begun to express receptors for IL-2. The IL-2 that will bind to these receptors is produced by:

• T cells
• Natural killer (NK) cells
• Dendritic cells
• Follicular epithelium cells
• Antigen presenting cells

IL-2 is produced by CD4⁺ T cells and, to a lesser degree, by CD8⁺ T cells.

AIPGMEE 2015

A T cell undergoing activation has begun to express receptors for IL-2. The IL-2 that will bind to these receptors is produced by:

• T cells
• Natural killer (NK) cells
• Dendritic cells
• Follicular epithelium cells
• Antigen presenting cells

IL-2 is produced by CD4⁺ T cells and, to a lesser degree, by CD8⁺ T cells.

AIPGMEE 2015

A 13-month old male has decreased numbers of B cells and very low levels of all isotypes of immunoglobulins. This patient would be expected to be unable to clear infections by

• Extracellular bacteria (e.g., Streptococcus spp).
• Intracellular bacteria (e.g., Mycobacterium spp)
• Intracellular protozoa
• Viruses
• Fungi

B cells make antibodies and are the precursors of plasma cells that both synthesize and secrete antibodies. Antibodies are the primary means for inhibiting and killing extracellular bacteria. This patient is likely to have Bruton disease, an agammaglobulinemia that results in increased susceptibility to infection with encapsulated bacteria.

Recommendations for use of antenatal corticosteroids

Recommendations for use of antenatal corticosteroids

The benefits of antenatal administration of corticosteroids to fetuses at risk of preterm delivery vastly outweigh the potential risks. These benefits include not only a reduction in the risk of RDS, but also a substantial reduction in mortality and IVH.

All fetuses between 24 and 34 weeks of gestation at risk of preterm delivery should be considered candidates for antenatal treatment with corticosteroids.

The decision to use antenatal corticosteroids should not be altered by fetal race or gender or by the availability of surfactant replacement therapy.

Patients eligible for therapy with tocolytics should also be eligible for treatment with antenatal corticosteroids.

Treatment consists of either two doses of 12 mg of betamethasone given intramuscularly 24 hours apart or four doses of 6 mg of dexamethasone given intramuscularly 12 hours apart. Optimal benefit begins 24 hours after initiation of therapy and lasts seven days.

Because treatment with corticosteroids for less than 24 hours is still associated with significant reductions in neonatal mortality, RDS, and IVH, antenatal corticosteroids should be given unless immediate delivery is anticipated.

In premature rupture of membranes at less than 30 to 32 weeks of gestation in the absence of clinical chorioamnionitis, antenatal corticosteroid use is recommended because of the high risk of IVH at these early gestational ages.

In complicated pregnancies where delivery prior to 34 weeks of gestation is likely, antenatal corticosteroid use is recommended unless there is evidence that corticosteroids will have an adverse effect on the mother or delivery is imminent.

RDS: respiratory distress syndrome; IVH: intraventricular hemorrhage.

Adapted from: data in the Report of the Consensus Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. National Institute of Child Health and Human Development. November 1994. NIH Publication No. 95-3784.
Antenatal Corticosteroids Revisited: Repeat Courses—National Institutes of Health Consensus Development Conference Statement, August 17–18, 2000. Obstet Gynecol 2001; 98:144-150.