combank 200 question comsay

Question 1

27 yo female.

presents with pelvic mass

recent miscarriage

physical exam: unilateral, palpable adnexal mass on the left.

labs: elevated B-hCG

Answer 1

theca lutein cyst

note they are usually bilateral and result from over stimulation of B HCG

Question 2

51 yo perimenopausal female presents with pelvic mass

PE: unilateral palpable adnexal mass on the left.

labs: inc T4, T3

Answer 2

struma ovarii

Question 3

48 yo perimenopausal female presents with pelvic mass

physical exam shows abdominal fluid wave, and mild tachypnea

pelvic exam reveals unilateral palpable adnexal mass on the left.

Answer 3

ovarian fibroma

they are the most common sex cord stromal tumors,

consist of proliferating spindle shaped fibroblast.

pure fibromas are benign solid neoplasms usually unilat, usually occur after menopause

fibromas are associated with meigs syndrome

(triad of ovarian fibroma w/ ascites and pleural effusion

Question 4

xamination reveals a posterior fibular head on the left. What is the correct set up for treatment of a left posterior fibular head with high velocity low amplitude?

Answer 4

the pt s left hip and knee flexed to 90 degrees w/ the MCP of the physicians right hand on the posterior aspect of the left fibular head.

the physicians left hand is used to lock the pts left foot inot dorsiflexion, eversion, and external rotation

incorrect answer: the pts left hip and knee flexed to 90 degrees with the MCP of the index finger of the physicians right hand on the posterior aspect of the left fibular head. the physicians left hand is used to lock the pts left foot into dorsiflexion, inversion (eversion), and internal rotation (external rotation)

Question 5

Acetazolamide

which side effect is correct

A. elevated plasma chloride

B. hypercalcemia

C. increased anion gap

D. Vertigo and hearing loss

Answer 5

elevated plasma chloride

others should be

normal anion gap metaboic acidosis —> hyperchloremic state

hypokalemia

does not effect Calcium

Question 6

transudate pleural effusions

in CHF are usually bilateral.

what do you expect for

protein, LDH, fluid

Answer 6

fluid is clear

low protein

low LDH

Question 7

what is causing the pleural effusion in a pt with CHF?

Answer 7

increased capillary hydrostatic pressure

bc chf the left vent does not have large enough output to match the input of blood. the blood backs up into the left atrium adn then pulmonary veins and arteries. this increases hydrostatic pressure w/in pulmonary caps.

Question 8

describe the changes in bone in pagets disease

not defective bone mineralization (osteomalacia) or decreased bone density (osteoporosis)

Answer 8

defect bone remodeling

Question 9

with a patient with CML t(9;22)

the most likely additional finding upon histological analysis is a?

A. negative leukocyte alkaline phosphatase stain

B. positive myeloperoxidase stain

Answer 9

negative leukocyte alkaline phosphatase stain

not myeloperoxidase bc its in AML (myeloperoxidase is an enzyme in azurophilic granules of neutrophils and in the lysomsomes of monocytes).

Question 10

pt with schizophrenia

this diagnosis is assocaited with which alteration in neurotransmitters?

A. decreased nor epi, serotonin, and dopamine

B. dec serotonin

C. increased dopamine

Answer 10

increased dopamine

wrong answers

dec nor epi, dopamine, serotonin = depression

serotonin dec = depression.

Question 11

2-year-old Caucasian male is seen multiple times by his pediatrician for recurrent viral and fungal infections. Complete metabolic panel reveals hypocalcemia. Chest radiograph is shown in the exhibit. Which of the following cell surface markers would most likely be absent from a sample of his cells circulating in the blood?

Answer 11

CD3

DiGeorge syndrome results from a lack of development of the thymus and parathyroid glands, which causes hypocalcemia, tetany, and recurrent viral and fungal infections. CD3-expressing T cells will be absent in the blood in patients with DiGeorge syndrome.

Question 12

14 yo male.

two month hx of progressively worsening dyspnea, productive cough, and wheezing.

PE: bilat hyperresonance to percussion, dec breath sounds bilat, distant heart sound.

slight distention of abdomen along with palpable abdominal fluid wave.

chest xray: inc ant-post diameter, w/ bilateral flattening of diaphragm.

labs: ALT 113, AST 96, total bilirubin 3.4

diagnosis?

Answer 12

panacinar emphysema.

not asthma

Question 13

A 48-year-old male with a history of alcohol abuse presents to his primary care physician with complaints of increased bruising and ankle swelling. Physical examination reveals ascites and jaundice, and a skin lesion is noted, as shown in the exhibit. Of the following clinical developments, the one that occurs via the same pathophysiologic mechanism as the patient’s skin manifestation is

Answer 13

gynecomastia

spider telangiectasia. It is caused by excess estrogen due to the inability of the liver to properly metabolize it. Gynecomastia, also a common finding in chronic liver disease, is also a manifestation of excess estrogen.

Question 14

palpation of his back reveals a structure running longitudinally across the top of the spinous processes.

it feels dense adn more fibrous than the surround muscles. what is the structure

Answer 14

supraspinous ligament

Question 15

person with Chronic kidney disease stage III

has osteoporosis why?

Answer 15

inability of 1 alpha - hydroxylase to produce calcitriol

Question 16

pt with trendelenburg gait

this gait is the result of muscle weakness of the?

A. hip abductors

B. hip adductors

C. hip extensors

D. hip flexors

Answer 16

hip ABductors (glut med/min)

incorrect

B. hip adductors (adductor brevis, longus, magnus, minimus, pectineus, gracilis, obturator externus (L2-L4)

C. HIP extensors (glut maximus (L4-S1)

D. hip flexion (iliopsoas, rectus femoris, gracilis, sartorius)

Question 17

describe what you expect to see in VHL

Answer 17

Von Hippel-Lindau syndrome is characterized by hemangioblastomas of the central nervous system and the retina. Presentation is variable but may include hematuria, v_isual deficits or visceral symptom_s. This disease causes bilateral renal cell carcinoma in 50% of patients. Patients may also have tumors of the adrenal gland and pancreas

Question 18

unilateral headache, pain with jaw movement, inc ESR

HLA-DR4

pathogenesis of the most likely diagnosis includes

Answer 18

granulomatous inflammation w/ giant cells

pt has giant cell arteritis

remember associated w/ polymyalgia rheumatica

Question 19

A 66-year-old male with a past medical h_istory of hypertension, hyperlipidemia, and diabetes mellitus_ presents with the complaints of l_ower leg pain_ upon exertion. The pain is a cramping and aching feeling felt in his bilateral calves that is relieved by rest. The pathophysiology of his condition most likely involves

Answer 19

atherosclerosis

incorrect (venous valvular incompetence)

Arterial claudication is characterized by leg pain that is consistently reproduced with exercise and relieved with rest. The diagnosis of peripheral artery disease is confirmed with an ankle-brachial systolic pressure index measurement.

Question 20

pt with carpal tunnel is most likely experiencing paresthesia in?

A. dorsal side of the second digit bw the MCP and PIP

B. Dorsal side of the second digit distal to the DIP

Answer 20

dorsal side of the seocnd digit distal to DIP

Question 21

A 55-year-old Caucasian female presents to her primary care physician with complaint of abdominal fullness for the past three years, and a dull abdominal pain. Upon physical examination, she is found to have ascites. Computed tomography is obtained and reveals anovarian mass with multiple deposits of similar material in the peritoneum. A biopsy is obtained and reveals that the mass is malignant.

A. granulosa cell tumor

B germ cell tumor

C. tumor of epithelial origin

Answer 21

diagnosis

tumor of epithelial origin

(papillary serous cystadenocarcinoma)

they are most common primary overian malignancy (75%) and often present at advanced stage w/ metastasis.

commonly assocaited with intraperitoneal deposits.

Question 22

A 60-year-old female, with a history of Bell’s palsy, presents with a severe, sharp, stabbing pain in her lower jaw and teeth. The pain comes in episodes that last for a few seconds to minutes at a time. It is triggered by chewing and yawning.

it can be said that the nerve associated w/ the pain

A. passes through foramen rotundum

B. innervates the temporalis muscle

Answer 22

CN V3 –> ​innervates the temoralis muscle.

also provides sensation to the lower jaw and teeth and motor to the muscles of mastication

excits the cranium through the foramen ovale

incorrect - maxillary branch of CNV passes through the foramen rotunum and provides sensation to the upper jaw and teeth.

Question 23

A 68-year-old male undergoes a colonoscopy to evaluate for occult colonic bleeding. Numerous sigmoid polyps are identified. Structural examination is likely to find a parasympathetic viscerosomatic reflex at

A. OA

B upper lumbar

C. mid sacral

Answer 23

(distal transverse colon, descending colon, sigmoid colon, and rectum)

parasympathetic innervation from sacral nerve roots exiting at the level of S2-S4

Question 24

A 49-year-old African American woman presents with gradual onset and fluctuation of weakness over the past six months. The patient first noticed difficulty in walking up and down stairs, which progressively worsened and came to involve combing her hair in the morning. The patient reports no associated pain with these movements. Review of systems is significant for shortness of breath with physical exertion out of proportion to her normal level. Osteopathic examination shows that ribs 2-5 minimally expand with inspiration, although they have adequate recoil with expiration. A muscle biopsy was obtained as shown in the exhibit. The most likely cause of this patient’s weakness is

Answer 24

polymyositis

This picture shows the degeneration of muscle fibers caused by the Anti-Jo-1 antibodies in polymyositis. In polymyositis, the cellular infiltrate is predominantly within the fascicle with inflammatory cells invading individual muscle fibers. Histopathology shows focal endomysial infiltration by CD8+ T lymphocytes and macrophages, capillary obliteration, endothelial cell damage, and increased amounts of connective tissue dueto muscle fiber necrosis

Question 25

A 14-year-old female presents to the office with the complaint of worsening shortness of breath at night. History reveals the symptoms are associated with a feeling of tightness in her chest and she uses inhaled albuterol once-to-twice a week for episodes of daytime dyspnea. Physical examination reveals scatteredwheezes bilaterally but no rales or rhonchi. The most appropriate treatment to thin mucous secretions is

A. rib raising

B. myofascial release to the thoracic inlet

Answer 25

rib raising

Rib raising decreases (normalizes) sympathetic tone in diseases like asthma.

thoracic inlet (It does not specifically address the sympathetic nervous system to the pulmonary system and therefore would not thin secretions.)