5. A 9-month-old boy is brought to the emergency department because of high fever.

Breath sounds are diminished in the lungs, and a chest x-ray film shows lobar
pneumonia. Probable streptococcal pneumonia is demonstrated in Gram stain of
sputum and then later confirmed by culture. The child responds to antibiotic therapy. A
detailed history is taken during the admission, which reveals that this is the third
episode of pneumonia in this young child; the two previous episodes occurred at 6 and
71/2 months of age. One of the mother's brothers had died of infection at age 9.
Immunoglobulin studies demonstrate the following:
IgG 80 mg/dL [normal 723-1685 mg/dL]
IgA 60 mg/dL [normal 81-463 mg/dL]
IgM 20 mg/dL [normal 48-271 mg/dL]
Studies of the lymphocyte population demonstrate normal numbers of T cells and
markedly decreased B cells. Which of the following is the most likely diagnosis?
A. Bruton agammaglobulinemia
B. Common variable immunodeficiency
C. DiGeorge syndrome
D. Transient hypogammaglobulinemia of infancy
E. Wiskott-Aldrich syndrome

6. A 32 year-old man with a history of panic disorder who works as a salesman returns to
his psychiatrist after several weeks of treatment with paroxetine. While he has noted
significant improvement in his symptoms, he still notes residual anxiety when put into
social situations in which he has to speak in public or become the center of attention.
He has been taking the medication as prescribed and has not missed any doses. Given
that he had some improvement on his current medication regimen, which of the
following would be the most appropriate next step in management?
A. Cognitive-behavior therapy
B. Electroconvulsive therapy
C. Medication change
D. Psychoanalysis

E. Seeing the patient more often for supportive psychotherapy