Exam 3 Questions

Question 1

select the incorrect statement:

A. mammography when properly done is 80-90% predictive of a breast malignancy

B. breast cysts are most likely to occur after menopause

C. the incidence of breast cancer is 30% by the age of 70

D. diets high in animal fat increase the likelihood of breast cancer

Answer 1

B. breast cysts are most likely to occur after menopause

*they more commonly occur BEFORE menopause

Question 2

select the incorrect statement:

A. the majority of breast cancers are invasive carinomas

B. the pitted surface of a breast cancer is known as “peau d’orange”

C. one protective factor against cervical cancers is use of oral contraceptives for >5 years

D. IUDs increase the likelihood of endometritis caused by chlamydia

Answer 2

C. one protective factor against cervical cancers is use of oral contraceptives for >5 years

*this is actually a risk for cervical cancers, but can decrease risk for ovarian cancers and decrease risk of changes in breast cysts

Question 3

select the incorrect statement concerning preeclampsia:

A. it is a hypertension that usually expresses during the first trimester of pregnancy

B. often associated with diabetes

C. there is some evidence that it is associated with abnormal circulation in the placenta

D. it is classified as a secondary hypertension

Answer 3

A. it is a hypertension that usually expresses during the first trimester of pregnancy

*it occurs no earlier than 20 weeks gestation (2nd trimester)

Question 4

T or F:

progestin only contraceptives are usually not the preferred contraceptive due to a reduce efficacy

Answer 4

T

Question 5

T or F:

increased estrogen levels in combination contraceptives decrease the likelihood of thrombuc formation

Answer 5

false

increase the likelihood

Question 6

T or F:

estrogen-related drugs are sometimes used by postmenopausal women to reduce problems with osteoporosis

Answer 6

true

Question 7

T or F:

smoking by women using combination contraceptives dramatically increases the likelihood of heart attacks

Answer 7

true

Question 8

T or F:

use of contraceptives typically increases problems of acne in young women

Answer 8

false

it can be used as a treatment for acne

Question 9

T or F:

minipills increase the likelihood of having seizures in middle-aged women

Answer 9

false

the minipill is a progestin-only contraceptive that has fewer side affects than combinations, but is less effective

Question 10

T or F:

monophasic contraceptives are designed to most accurately mimic the natural patterns of female hormones of all the combination varieties

Answer 10

false

Question 11

T of F:

chlomiphene is a progesterone antagonist used to prevent multiple births

Answer 11

false

it is a partial estrogen agonist used to promote fertilization and pregnancy (ovulation-inducing); associated with increased risk of twins

Question 12

T or F:

metoclopromide is a D2 dopamine receptor antagonist used to stimulate lactation in new mothers

Answer 12

true

Question 13

T or F:
ketoconazole is used to treat prostate cancer

Answer 13

true

Question 14

which of the following is most likely associated with albers-schonberg disease?

A. mixed stages of osteolysis and osteogenesis

B. impaired osteoclasts leading to blindness and deafness

C. vitamin D deficiency associated with kidney malfunction

D. boney swellings called heberdon nodes

E. hereditary connective tissue disease caused by a mutant fibrillin gene

Answer 14

B. impaired osteoclasts leading to blindness and deafness - also causes anemia and bone fractures

Other answers:

A. mixed stages of osteolysis and osteogenesis - osteitis deformans

C. vitamin D deficiency associated with kidney malfunction - rickets/osteomalacia

D. boney swellings called heberdon nodes - osteoarthritis

E. hereditary connective tissue disease caused by a mutant fibrillin gene - marfan syndrome

Question 15

which of the following is an incorrect statement concerning rhabdomyolysis?

A. typically associated with destruction of nicotine receptors caused by autoimmune responses

B. acute expression involving swollen and tender skeletal muscles

C. often can be associated with the flu

D. can be caused by drugs such as statins

Answer 15

A. typically associated with destruction of nicotine receptors caused by autoimmune responses

Question 16

pyridostigmine is most likely to be used for which of the following disorders?

A. muscular dystrophy

B. muchenne muscular dystonia

C. Rhabdomyolysis

D. myasthenia gravis

Answer 16

D. myasthenia gravis

Question 17

what dermal pathology is most likely to be associated with the following: “female patient presents with skin lesion described as tumorous, extreme rubor and dolor, accompanied by some funcio laesa”

A. lichenification

B. hyperkeratosis

C. acantholysis

D. papule

Answer 17

C. acantholysis - loss of intercellular adhesion keratinocytes (epidermis falls apart and sloughs off)

other answers:

A. lichenification - thickened skin due to repeated rubbing

B. hyperkeratosis - hyperplasia of stratum corneum

D. papule - elevated doem or flat topped <5mm

Question 18

which of the following skin conditions is best described as a delayed reaction contact dermatitis including pruritic, edematous plaques?

A. eczematous dermatitis

B. psoriasis

C. lichen planus

D. impetigo

E. pemphigus

Answer 18

A. eczematous dermatitis

other answers:

B. psoriasis - chronic inflammatory condition, pink/salmon colored plaques, acanthosis in epidermis

C. lichen planus - hyperkeratosis and epidermal hyperplasia, associated with whickam’s striae, oral cavity and extremities

D. impetigo - bacterial infection (staph and strep) on face and extremities

E. pemphigus - acanthosis, blister formation, autoimmune

Question 19

which of the following skin disorders is characterized by the presence of a degenerated epithelial cell known as the tzanck cell?

A. acne vulgaris

B. seborrhea keratosis

C. candida infection

D. pemphigus vulgaris

Answer 19

D. pemphigus vulgaris

Question 20

identify which of the following two statements are correct concerning skin neoplasms:

A. actinic keratosis consists of discolored scaly lesions due to UV-induced thickened stratum corneum

B. dysplastic nevi are typically benign with uniformly pigmented papules and well-defined borders

C. common sites for melanoma metastasis are lungs and liver

D. squamous cell carcinomas do not metastasize and are almost never locally aggressive

Answer 20

A. actinic keratosis consists of discolored scaly lesions due to UV-induced thickened stratum corneum

C. common sites for melanoma metastasis are lungs and liver (also brain)

other answers:

B. dysplastic nevi are typically benign with uniformly pigmented papules and well-defined borders - if >10 lesions there is an increased risk for melanoma, and they have irregular/assymetric borders

D. squamous cell carcinomas do not metastasize and are almost never locally aggressive - it is true that they do not metastasize, but they have intermediate local aggression

Question 21

which of the following bone-related tumors is not malignant?

A. ewing sarcoma

B. fibrous dysplasia

C. osteosarcoma

D. chondrosarcoma

Answer 21

B. fibrous dysplasia

Question 22

which of the following muscle relaxing drugs is not matched to its appropriate mechanisms?

A. baclofen is a GABA B agonist

B. dantrolene relaxes muscles by altering calcium trafficking

C. succinylcholine depolarizes ganglionic nicotine receptors through over-stimulation

D. D-tubocurarine blocks musclarinic cholinergic receptors

Answer 22

D. D-tubocurarine blocks musclarinic cholinergic receptors - it blocks nicotinic receptors

Question 23

which of the following drugs is not used to treat acne vulgaris?

A. vitamin B12 supplements

B. tretinoin

C. oral contraceptives

D. salicylic acid

Answer 23

A. vitamin B12 supplements

other answers:

B. tretinoin - aka retin A, it is a vitamin A derivative, increase exfoliation and clears follicles, reduce sebum production

C. oral contraceptives - estrogen/progesterone combination

D. salicylic acid - topical keratolytic, removes keratin layer and opens sebaceous glands (also used as wart removers)

Question 24

which of the following concerning rheumatoid arthritis is incorrect?

A. it is the most common form of autoimmune disease

B. it is present in some degree in most people >65 years of age

C. more likely in females than in males

D. it is more common in caucasians than asians

E. it is treated by drugs that block TNF systems

Answer 24

B. it is present in some degree in most people >65 years of age

*this is describing osteoarthritis; onset age of RA is 25-50 years of age

Question 25

which of the following is not a DMARD used to treat rheumatoid arthritis diseases such as arthritis?

A. etanercept

B. carisoprodol

C. methotrexate

D. infliximab

Answer 25

B. carisoprodol

*antispasmotic; muslce relaxant/sedative that may have some dependence problems

Question 26

which of the following is least likely to be used to treat gout?

A. diuretics

B. allopurinol

C. indomethacin

D. colchicine

Answer 26

A. diuretics

Question 27

which of the following is classified as a combound bone fracture?

A. bone is splintered

B. the displaced bone fragments are not aligned

C. the overlying tissue is left intact

D. the bone fragments extend into overlying skin

Answer 27

D. the bone fragments extend into overlying skin - compound and open fracture are the same thing

other answers:

A. bone is splintered - comminuted

B. the displaced bone fragments are not aligned - displaced

C. the overlying tissue is left intact - closed

Question 28

which of the following statements about glaucoma is incorrect?

A. can be caused by either elevated production or reduced outflow of aqueous humor

B. narrow-angle glaucoma is associated with a narrow space between the iris and cornea

C. typically detected by using tonometry measures

D. causes blindness by damaging the rods and cones of the eye

Answer 28

D. causes blindness by damaging the rods and cones of the eye

*glaucoma can cause blindness, but it does so by the pupil becoming fixed, causing damage to the optic nerve and retinal ganglion cells, resulting in blindness; loss of vision begins laterally and moves centrally

Question 29

select the incorrect statement concerning age-related macular degeneration:

A. smoking increases risk

B. initial symptoms include loss of central vision

C. progress of the disease is faster in the dry vs wet variety

D. occurs in ~10% of patients >80 years of age

Answer 29

C. progress of the disease is faster in the dry vs wet variety

*occurs faster in wet

Question 30

select the incorrect statement concerning otitis media

A. it is an acute infection most often caused by staph aureus

B. often causes pain that can be confused with sinus or dental origin

C. can cause vertigo and tinnitus

D. preferred treatment when possible is amoxicillin with or without clavulonate

Answer 30

A. it is an acute infection most often caused by staph aureus

*most often caused by strep. pneumoniae

some notes:

• acute otitis media is what is caused be strep. pneumoniae infection, whereas chronic with effusion is caused by fluid trapped in the middle ear
• treatment for acute otitis media is antibiotics as described in choice D, whereas chronic with effusion is treated via drainage when needed

Question 31

which of the following has not been established as a cause for cancer?

A. lack of response to growth inhibitory cues

B. h. pylori infection

C. nitrosamines in food

D. EBV virus

E. hepatitis B and C

F. reduction in estrogen

Answer 31

F. reduction in estrogen

*increase in estrogen can cause breast cancer

other answers:

A. lack of response to growth inhibitory cues - true

B. h. pylori infection - can cause gastric adenocarcinoma

C. nitrosamines in food - true

D. EBV virus - associatd with B cell lymphomas (burkitt’s) and nasopharyngeal carcinoma

E. hepatitis B and C - can cause damage that can lead to hepatocellular carcinoma

Question 32

which of the following is not associated with paraneoplastic syndrome?

A. hypercalcemia

B. flushing and diarrhea

C. occurs in ~10% of malignancies

D. shut down of adrenal glands

E. increase in ADH activity and diuresis

Answer 32

D. shut down of adrenal glands

*should be hyperactive (hypercortisolism/cushing’s)

Question 33

which of the following is not associated with making it possible for a tumor to survive (two answers)?

A. increase in the release of VEGF

B. reduced release of bFGF

C. loss of P53

D. activation of APC

Answer 33

B. reduced release of bFGF

D. activation of APC

Question 34

among epithelial tumors, what is the single feature that best distinguishes a carcinoma that is likely to metastasize from a precursor lesion from one that will not?

A. invasion of the stroma

B. lateral expansion on tissue surface

C. mitotic figures

D. presence of inflammatory infiltrate

Answer 34

A. invasion of the stroma

Question 35

which of the following statements about chemotherapy drugs are correct (multiple correct)?

A. methyltrexate analogs interfere with DNA formation and the production of key proteins

B. vinca alkaloids inhibit formation of the tubulin polymerization cytoskeleton component necessary for cell division

C. doxorubicin is used to treat breast cancer

D. cyclophosphamide is an antibiotic with antibiotic properties

E. alkylating agents are carcinogenic in nature

F. estrogen antagonists are used to treat prostate cancer

G. procarbazine selectively inactivates P53 protein products

Answer 35

correct:

A. methyltrexate analogs interfere with DNA formation and the production of key proteins

B. vinca alkaloids inhibit formation of the tubulin polymerization cytoskeleton component necessary for cell division

C. doxorubicin is used to treat breast cancer

E. alkylating agents are carcinogenic in nature

other answers:

D. cyclophosphamide is an antibiotic with antibiotic properties - it is not an antibiotic, it is an alkylating agent

F. estrogen antagonists are used to treat prostate cancer - steroid synthesis inhibitors (ketoconazole) treat prostate cancer; estrogen antagonists (tamoxifen) treats breast cancers

G. procarbazine selectively inactivates P53 protein products - procarbazine is a nitrosourea used to treat brain tumors, and in combination with decarbazine to treat hodgkins

Question 36

which of the following cancers is most likely to produce and release mucin in the GI tract?

A. small cell lung carcinoma

B. liposarcoma

C. carcinomas in situ from the liver

D. carcinoid tumors

Answer 36

D. carcinoid tumors

Question 37

which of the following is the proper name for a malignancy of the stomach parietal cells?

A. adenosarcoma

B. hepatoma

C. adenocarcinoma

D. carcinoma in situ

Answer 37

C. adenocarcinoma

other answers:

A. adenosarcoma - we didn’t talk about this

B. hepatoma - malignancy of hepatocytes

D. carcinoma in situ - not invasive and doesn’t metastasize

Question 38

select the incorrect statement concerning lymphomas:

A. hodgkins type is identified by the presence of reed-sternberg cells

B. burkitt’s lymphoma is a slow-growing cancer linked to epstein-barr infection

C. decarbazine is used with combination regimens to treat

D. treatment for hodgkin’s lymphoma is much improved

Answer 38

B. burkitt’s lymphoma is a slow-growing cancer linked to epstein-barr infection

*it is a fast-growing cancer linked to EBV; begins with B cells

Question 39

suzie is 17 years of age with a history of severe acne problems. she presents to your office for a cleaning and you notice that her skin is dry but much clearer since her last visit 3 months ago.

what is the likely explanation of the dramatic improvement in her skin?

A. she has outgrown the acne problem

B. she has eliminated sweets and nuts from her diet

C. she is using OTC benzoyl perozide-containing products

D. she is being prescribed oral isotrenitoin

E. she is using steroids

Answer 39

D. she is being prescribed oral isotrenitoin

*systemic vitamin A derivative, also called accutane, contraindicated in pregnancy due to major birth defects

Question 40

suzie is 17 years of age with a history of severe acne problems. she presents to your office for a cleaning and you notice that her skin is dry but much clearer since her last visit 3 months ago. you determine she is taking isotretinoin. which of the following are likely to be relevant issues that you will need to keep in mind for future treatment (2 answers)?

A. an increased likelihood of oral and perioral sores resulting in diminished oral self-care

B. greater likelihood of developing impacted 3rd molars

C. diminshed response to local anesthetics

D. increased changes of heart flutter due to vasoconstrictors included in the local anesthetics

E. problems with xerostomia

Answer 40

A. an increased likelihood of oral and perioral sores resulting in diminished oral self-care

E. problems with xerostomia

Question 41

mr. snow is 61 years old, a long-time fisherman and a regular patient with good oral home care. on routine oral-facial examination you notice for the first time that he has a dark irregular pigmented lesion on the upper lip which he claims has been changing in texture, color, and size during the past 6 months. what should you do?

A. refer him to a dermatologist to have it examined as soon as possible

B. tell him to keep an eye on it over the next 6 months and see if it continues to grown and change colors

C. tell him he likely has a basal cell carcinoma and he needs to go see a surgeon to have it removed

D. take a biopsy and send it to a pathology lab for analysis

Answer 41

A. refer him to a dermatologist to have it examined as soon as possible

can also be D. take a biopsy and send it to a pathology lab for analysis

Question 42

mr. snow is 61 years old, a long-time fisherman and a regular patient with good oral home care. on routine oral-facial examination you notice for the first time that he has a dark irregular pigmented lesion on the upper lip which he claims has been changing in texture, color, and size during the past 6 months. it is determined to be a skin cancer that requires chemotherapy. what is the most likely diagnosis?

A. squamous cell carcinoma

B. basal cell carcinoma

C. keratoma

D. melanoma

Answer 42

D. melanoma

*due to the aggressive nature of the lesion, including rapid changes in color, texture, and size, and also the dark pigmentation, it is most likely a melanoma

Question 43

how is dental management of a patient with melanoma who is receiving chemotherapy affected?

A. the procedures for treatment will increase the likelihood of periodontal disease and caries

B. the procedures for treatment will increase the likelihood of only periodontal disease

C. the procedures for treatment likely will require full mouth extractions and dentures just to be safe

D. it will increase the likelihood of colds and respiratory infections but have little direct impact on how you treat this patient

Answer 43

A. the procedures for treatment will increase the likelihood of periodontal disease and caries

Question 44

when is the best time to take care of pre-existing major dental work on a patient with melanoma who intends to begin chemotherapy?

A. try to complete all major dental work 1-3 weeks before the patient begins treatment for the cancer

B. do the dental work after the cancer treatment begins for better patient cooperation

C. wait until the treatment is complete and the patient has recovered

D. do the dental work at the convenience of the patient; timing is not that critical

Answer 44

A. try to complete all major dental work 1-3 weeks before the patient begins treatment for the cancer

Question 45

which of the following is most likely to result in a patient who had his colon removed due to cancer?

A. problem with absorbing vitamin A and D

B. unable to absorbe alcohol after drinking

C. diarrhea

D. constipation

Answer 45

C. diarrhea

*water is absorbed in the colon, so if the patient has no colon, they will not absorb as much water, causing diarrhea

other answers:

A. problem with absorbing vitamin A and D - occurs in the duodenum

B. unable to absorb alcohol after drinking - occurs in the stomach

D. constipation

Question 46

T or F:

GERD and acid reflux are the same thing

Answer 46

false

GERD is chronic, acid reflux is acute

Question 47

T or F:

symptoms of GERD are made worse by an empty stomach, excessive use of caffeine, and reclined head of the bed

Answer 47

true

also increased age, obesity, fatty foods, alcohol/smoking, large meals, and some drugs

Question 48

T or F:

daily use of omeprazole is likely to help reduce tooth erosion associated with GERD

Answer 48

true

omeprazole is a PPI used to treat the symptoms of GERD by disrupting hydrogen exchange for K in gastric parietal cells, which blocks production and release of HCl into gut.

Question 49

T or F:

cimetidine helps reduce acid reflux due to its rapid antacid neutrralizing properties

Answer 49

false

cimetidine (tagamet) is not an antacid, it is an H2 receptor blocker, so while it does reduce acid reflux, its mechanism is to reduce gastric secretions by blocking H2 receptors in gut

Question 50

T or F:

proton pump inhibitors have no effect on digestion

Answer 50

false

the side effects of PPIs include diarrhea, increase in food allergies, oral sores/ulcers, and they interfere with digestion

Question 51

T or F:

gastric polyps can become dysplastic and develop into adenocarcinoma

Answer 51

true

Question 52

select the correct answer concerning peptic ulcer disease

A. most gastric/duodenal ulcers are caused by pneumonococcal bacteria

B. this condition can cause hematamesis and bloody stools

C. regular use of sodium bicarbonate has been proven to cure most cases of peptic ulcers

D. use of H2 blockers and proton pump inhibitors often worsen peptic ulcer symptoms

Answer 52

B. this condition can cause hematamesis and bloody stools

other answers:

A. most gastric/duodenal ulcers are caused by pneumonococcal bacteria - most are caused by h. pylori

C. regular use of sodium bicarbonate has been proven to cure most cases of peptic ulcers - sodium bicarbonate treats symptoms only; it is not a cure for peptic ulcers

D. use of H2 blockers and proton pump inhibitors often worsen peptic ulcer symptoms - these are used to treat symptoms

Question 53

T or F:

irritable bowel syndrome is the most common chronic intestinal disorder

Answer 53

true

makes up 20% of all chronic intestinal disorders

Question 54

T or F:

antacids are effective in relieving irritable bowel syndrome symptoms

Answer 54

false

1. Typically symptomatic (i.e., deal with diarrhea or constipation with diet and anti-stress changes)
2. Drugs: only linaclotide (Linzess) is FDA-approved for IBS with constipation

Question 55

T or F:
one of the major difference between crohn’s disease and ulcerative colitis is the presence or lack of intestinal strictures

Answer 55

true

crohns has strictures, ulcerative colitis does not

Question 56

T or F:

bisacodyl is an effective OTC medication to treat self-limiting diarrhea

Answer 56

false

bisacodyl is a laxative used to treat constipation

treatment for diarrhea:

• Loperamine- Imodium; mild opioid agonist: if severe, can use strong opioid agonists
• Bismuth subsalicylate (e.g., Pepto-bismol)
• Anti-cholinergics such as atropine

Question 57

T or F:

celiac sprue is an immune-related damage to small bowels and mouth triggered by gluten

Answer 57

true

Question 58

identify the two things which most likely would help to relieve problems associated with occasional esophageal reflux in your patient:

A. eating larger, but less frequent meals

B. stopping the use of caffeine

C. losing weight

D. use NSAIDs when the stomach is upset

E. sleep fully reclined

F. H1 antagonist

Answer 58

B. stopping the use of caffeine

C. losing weight

other answers:

A. eating larger, but less frequent meals - should eat smaller, more frequent meals

D. use NSAIDs when the stomach is upset - avoid NSAIDs; instead can use H2 blockers, antacids, or PPIs to treat symptoms

E. sleep fully reclined - elevate head of the bed

F. H1 antagonist - H2 antagonist

Question 59

select the incorrect statement concerning diabetic retinopathy:

A. appears similar to hypertensive retinopathy

B. manifests “cotton wool spots” caused by hyperemia

C. blindness caused by new microvascularization

D. lipid-rich yellow exudate on the retina caused by micro-aneurisms

Answer 59

B. manifests “cotton wool spots” caused by hyperemia

*diabetic retinopathy does manifest “cotton wool spots”, but it is due to ischemia, not hyperemia