Which of the following statements is true with respect to adrenal tumors that produce gender symptoms?

Correct Answer: D

Rationale: The correct answer is D because virilizing adrenal tumors are more likely to be malignant in children. This is due to the fact that virilizing tumors can be associated with conditions like adrenocortical carcinoma, which is a malignant tumor. In contrast, feminizing adrenal tumors are not always carcinomas (choice A) and are not the most common type of adrenal tumor (choice B). Additionally, virilizing tumors in women can be localized to different parts of the adrenal gland, not just the cortex (choice C). Therefore, choice D is the most accurate statement among the options provided.

Correct Answer: C

Rationale: The correct answer is C: Seat belts. Flexion-distraction injuries of the thoracolumbar spine are commonly caused by seat belts due to the mechanism of injury during a motor vehicle accident. When a sudden deceleration occurs, the body is restrained by the seat belt while the spine continues to move forward, leading to hyperflexion of the spine. This results in distraction forces at the thoracolumbar junction, causing injury. Blunt trauma (choice A) can cause various types of spinal injuries but is not specifically associated with flexion-distraction injuries. Rotational injury (choice B) typically leads to injuries such as fractures or dislocations, not flexion-distraction injuries. Gunshot wounds (choice D) can cause direct spinal damage, but they do not typically result in flexion-distraction injuries.

Correct Answer: B

Rationale: The correct answer is B: Cyclosporine. Cyclosporine is an immunosuppressant medication commonly used post-bone marrow transplant to prevent graft-versus-host disease. It works by inhibiting T-cell activation and proliferation, reducing the risk of the donor's immune cells attacking the recipient's tissues. Immune globulin (A) is used for passive immunization, not prevention of graft-versus-host reaction. Prophylactic antibiotics (C) are used to prevent infections post-transplant, not graft-versus-host disease. Systemic corticosteroids (D) may be used to treat graft-versus-host disease but are not the first-line prophylactic medication.

Correct Answer: A

Rationale: The correct answer is A because in Cushing's syndrome, there is excess cortisol production leading to hyperglycemia (high glucose) and hypokalemia (low potassium). The high white blood cell count is due to the immunosuppressive effects of cortisol. Option B is incorrect as polycythemia is not typically seen in Cushing's syndrome. Option C is incorrect as low sodium and low potassium are not common findings in Cushing's syndrome. Option D is incorrect as high sodium, high chloride, and high RBCs are not typical features of Cushing's syndrome.

Correct Answer: D

Rationale: The correct answer is D (>90%). Mr. Mettenberger had a reexpansion of his second spontaneous pneumothorax this year, indicating a high recurrence risk. Spontaneous pneumothorax recurrence rates are high, especially in young males. Factors such as smoking history, gender, and prior occurrences contribute to increased risk. Mr. Mettenberger's cessation of smoking reduces but does not eliminate the risk. Choices A, B, and C are too low, given his history and current situation. Choice D is the most appropriate due to the high likelihood of recurrence based on his medical history and risk factors.