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Visceral CLET Final Practice Questions SP 2016 > Final Practice Questions > Flashcards

Final Practice Questions Flashcards

1
Q

63 yo male with shortness of breath, and cough productive small amounts of blood in sputum. This condition is intermittently through last several months

A

Could be TB or bronchogenic carcinoma

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2
Q

56 yo male with acute chest pain. Started one week ago with no trauma and steady course. Pain is 7-8/10, retrosternal and at the front chest area and the left sternal margin. Patient is a smoker for 25 years and smokes up to a pack a day. Pain is associated with cough productive with mucopurulent sputum that started one week ago. 140/90 BP, oral temp 101, pulse 90 bpm.

A

Pneumonia (most appropriate dx)

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3
Q

When auscultating for the carotid artery which part of the stethoscope is best used?

A

Diaphragm and the Bell (for bruits)

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4
Q

Which of the following may indicate fracture of base of skull

A

Battle Sign

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5
Q

Which of the following valvular lesions can cause pulmonary congestion?

A

Mitral stenosis
This leads to left atrial enlargement
and will cause a murmur that is increased during expiration

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6
Q

Tricuspid stenosis may lead to

A

Right atrial enlargement

and

Will cause a murmur that is increased during inspiration

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7
Q

Pulmonic stenosis may lead to —– enlargement

A

RV enlargement

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8
Q

In hyperthyroidism which of the following is likely to happen?

A

Tachycardia

Increased metabolic rate

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9
Q

Pitting edema associated with pathology in ___, ___, and ____

A

heart, liver, and kidney

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10
Q

Stabbing pain –>

A

Pleurisy

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11
Q

Most significant fault in Tetralogy of Fallot that causes cyanosis at birth?

A

Aortic valve overriding on both ventricles

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12
Q

WOTF blood changes usually accompany emphysema?

A

Increased RBC number

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13
Q

Sound normally heard over trachea and main bronchi of lung is

A

bronchial

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14
Q

Emphysema is accompanied by _______ of fingernails, _________ note upon percussion, and decreased tactile _________.

A

clubbing of fingernails, hyperessonant note upon percussion, decreased tactile fremitus

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15
Q

56 yo male with chest pain. Started one week ago, no trauma and steady course. Pain is 7-8/10, retrosternal and at the front chest area and the left sternal margin. Patient is a smoker for 25 years and smokes up to a pack a day. Pain is associated with cough productive with mucopurulent sputum that started one week ago. 140/90 BP, oral temp 99.6, pulse 90 bpm.

The pain is stabbing, localized above the left costal margin, aggravated by deep breathing. Recent onset, 4 days, associated with dry cough that started one week ago. Cough aggravates the condition.

Most appropriate impression ________
Next step?

A

Pleurisy (Stabbing, knife-like pain localized above the left costal margin, aggravated by deep breathing)

Patient may continue with his chiropractic care and closely observe the progress of symptoms and signs with recommendation to see a family physician if the condition worsened

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16
Q

Precordial heaving is a sign of

A

Cor Pulmonale

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17
Q

TB and bronchogenic carcinoma cause

A

hemoptysis

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18
Q

High fevers over 101

“ P, T, N”

A

Pneumonia, Tonsillitis, Nephritis

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19
Q

Carotid artery auscultation – mainly for carotid artery calcification

Is this the only way to dx cacification?
What does the patient do during this exam
and do you use both the diaphragm and bell?

A

Only way to diagnose is stethoscope over carotid
Pt turns head and holds breath
Use both diaphragm and bell

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20
Q

What is the most common valvular lesion of the heart

A

Mitral stenosis caused by pulmonary congestion

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21
Q

FYI Slide

Pitting edema caused by hydrostatic (heart pumping has been compromised – left ventricular failure = orthostatic edema) or loss of osmotic pressure inside BV (albumin – keeps fluid inside) if you lose albumin you lose osmotic pressure and will diffuse into interstitial tissue (liver failure or kidney) liver is sole producer of albumin

Kidney – normal protein but losing it from nephritis = proteinuria  hypoalbuminemia

A

Pitting edema caused by hydrostatic (heart pumping has been compromised – left ventricular failure = orthostatic edema) or loss of osmotic pressure inside Blood vessels (albumin – keeps fluid inside)

If you lose albumin you lose osmotic pressure and plasma proteins will diffuse into interstitial tissue (common in liver failure or kidney failure )

Liver is sole producer of albumin

Kidney – normal protein but losing it from nephritis = proteinuria  hypoalbuminemia

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22
Q

Night fever and night sweats caused by

A

Hodgkin’s disease and TB

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23
Q

Reed Sternberg cells is an associated histopathological finding of which condition?

A

Hodgkin’s

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24
Q

What is the triad of pancytopenia?

A

Leukopenia, thrombocytopenia, anemia

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25
Q

Tetralogy of Fallot

________ ventricular hypertrophy

Ventricular septal defect – movement of blood between Left Ventricle and Right Ventricle – mixing of oxygenated and deoxygenated blood

________ stenosis
most significant fault in the tetralogy is an _____ ______

A

Right ventricular Hypertrophy
VSD mixing of O2 and DeO2 blood
Pulmonary Stenosis
Overriding Aorta

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26
Q

Systems hypertension may lead to _____ enlargement

A

Left Ventricular Enlargement

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27
Q

Decreased tactile fremitus, breath sounds, chest expansion

A

Emphysema

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28
Q 
Malaise (lack of energy)
Polycythemia
Hyperresonant
Usually older patient with Hx of smoking
No movement during respiratory excursion
Barrel chest with decreased chest expansion
A

Emphysema

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29
Q

MC organ abdominal injury is spleen

A

blunt trauma MVA or fall

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30
Q

Bluish coloration around umbilicus indicating

Intra abdominal hemorrhage

A

Cullen’s sign

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31
Q

Melena – peptic/gastric ulcer True or False

A

True

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32
Q

10 yo girl presents with a 4 day history of pain in the knees, hips, shoulders, and wrists. The joints are not swollen, red, or tender. Her temperature is 102. Her mother states that her daughter’s only recent illness was a sore throat 1 month ago. Auscultation of the chest reveals an apical systolic murmur. What does she have?

A

Rheumatic fever

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33
Q

As it relates to Rheumatic fever …..
The causative organism is __________

Antistreptolysin O = ASO positive

This may lead to mitral ______ ______

This can cause ________ congestion

A

Beta hemolytic strep group A

Mitral valve stenosis

Pulmonary Congestion

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34
Q

The ________ impulse is visible, palpable pulsating force against the chest wall caused by Left ventricular contraction and is associated with the S1 sound

A

Apical

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35
Q

Liver cirrhosis —> esophageal varices –> hematemesis (lethal)

Indicating Advanced ______ failure

A

Liver failure

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36
Q

Hep A – transmitted by food, will go away with 0 complications, with proper

A

handwashing

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37
Q

Hep B – transmitted by ______, blood transfusion, sex, mother to child, post hepatitis cirrhosis/fibrosis, condom use/abstinence

A

blood

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38
Q

separation of rectus abdominis – weak abdominal muscles

A

Diastasis recti

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39
Q

Caput medusa – associated with ______ ______ and liver cirrhosis

A

portal hypertension – liver cirrhosis

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40
Q

Helicobacter pylori is strongly related to _______ ulcer – and has melena and hematemesis

A

peptic ulcer
melena
hematemesis

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41
Q

Virchow lymph nodes = gastric carcinoma and

Left ______ _________

A

supraclavicular nodes

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42
Q

You are assessing a patient with abdominal pain and fever. You are performing an abdominal examination to assess for peritoneal signs. WOTF is not a peritoneal sign?

A

Voluntary guarding

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43
Q

In liver disease, the A/G ratio is altered due to decreased amount of __________ __________

A

serum albumin

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44
Q

WOTF lab findings is associated with hepatic jaundice?

A

Direct bilirubin

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45
Q

MCC of bleeding per rectum

A

Hemorrhoids

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46
Q

MC underlying factor for pancreatitis

A

Alcohol abuse

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47
Q

Spasmodic flank pain that radiates to the groin and is accompanied by mild hematuria is most suggestive of

A

ureteral stone

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48
Q

15 yo student presents to the clinic with a 1 day history of nausea and anorexia. He describes the pain as generalized yesterday, but today it has localized to the right lower quadrant. You palpate the left lower quadrant and the patient experiences pain in the right lower quadrant. What is the name of this sign?

A

Rovsing’s Sign

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49
Q

25 yo female veterinarian presents to the clinic for evaluation of flank pain, dysuria, nausea, and fever. A urine pregnancy test is negative. A urine dipstick is positive for leukocytes. On physical examination, what would be the most likely sign expected?

A

Murphy’s punch

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50
Q

40 yo flight attendant presents with abdominal pain. It is worse after eating, especially if she has a meal that is spicy or high in fat. She has tried OTC antacids, but they have not helped the pain. After examining her abdomen, you strongly suspect a condition that requires which sign on examination?

A

Murphy’s sign

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51
Q

Cardiac examination
Apex beat is formed by ___ ______ contraction

Apex beat is normally located at the ____ left ICS mid-clavicular

A

left ventricular

5th

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52
Q

AIDS diagnosis is based on HIV positive status and CD4 count below ____

The time for seroconvergence to HIV positive is believed to be within ___ months

Time of clinical latency which could last up to 10-15 years

Average range of CD4 is ___-____ /mL

A

200/ml

The time for seroconvergence to HIV positive is believed to be within 3 months

Time of clinical latency which could last up to 10-15 years

Average range of CD4 is 500-1500/mL

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53
Q

Headaches

Classic migraine is preceded by an _____

Tension headache has a _____ _____ type pain

The muscle that is implicated in cervicogenic headache is

________ and lacrimation are associated with cluster headaches

A

Aura

Hat Band

Rectus Capitis Posterior Minor

Rhinorrhea and lacrimation are associated with Cluster headaches

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54
Q

MC congenital heart defect

70% of the cases close spontaneously within 2 years

A

VSD

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55
Q

25 yo male with acute abdominal discomfort for several days. Initial evaluation revealed that a tinge of yellowish discoloration in his sclera. Examination reveals tenderness in the right upper quadrant.

Which of the following systems may be suspected as a cause of jaundice?

WTOF inquiries is relevant in the patient’s history?

What is the nature of this jaundice?

A

GI system

Sexual history and illicit drug use
History of ingestion of contaminated food

Infectious

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56
Q

Sense of spinning = vertigo  and is highly suggestive of

A

inner ear issue

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57
Q

Cone of light 7 o’clock

A

Otoscopic exam

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58
Q

Are there any sympathetic Cranial Nerves?

A

No

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59
Q

What are the Autonomic Cranial Nerves?

A

3, 7, 9, 10 – autonomic Cranial nerves

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60
Q

otitis media, wax infiltration, fungus infection that doesn’t affect inner ear

A

Conductive problem in hearing

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61
Q

otitis externa due to constant dampness

A

Swimmer’s ear – otitis externa due to constant dampness

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62
Q

exostosis due to cold weather

A

Surfer’s ear – exostosis due to cold weather

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63
Q

The ear structure that reflects the light while performing otoscopic examination

A

tympanic membrane

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64
Q

Which of the following nerves is not associated with ear pain?

5,7,9, 10, 12

A

CN XI

5, 7, 9 are associated

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65
Q

With of the following will cause lateralization of sound to the right ear during Weber’s Test?

A

Sensorineural loss in the left ear
Conductive hearing loss – sound goes to bad ear
Sensorineural hearing loss – sound goes to good ear

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66
Q

The structure that changes the mechanical impulse into a nerve impulse is the

A

inner ear (ossicles)

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67
Q

WOTF conditions is often a result of surfing/surfer’s ear

A

Exostoses

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68
Q

The structure that is responsible for maintaining the pressure integrity of the middle ear cavity is

A

Eustachian tube

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69
Q

Meniere’s is characterized by

A

Vertigo, hearing loss, and tinnitus

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70
Q

This condition can be described as an abnormal perception of rotation

A

Vertigo

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71
Q

Sudden attacks of whirling vertigo associated with tinnitus and hearing loss with nausea and vomiting at the height of the experience, with hearing loss that persists after the attack best describes

A

Meniere’s disease

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72
Q

WOTF conditions usually presents with vertigo that climaxes in 24-40 hrs with the patient experiencing nausea and vomiting at the height of the problem and finds that being in the horizontal position to limit the problem while raising the head induces the problem?

A

Acute toxic labyrinthitis

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73
Q

This condition is a result of repeated trauma to the pinna and bleeding between the cartilage and the perichondrium

A

Cauliflower ear

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74
Q

In which of the following conditions is a decrease of sodium in the patient’s diet recommended?

A

Meniere’s Disease

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75
Q

While testing the vibration sense, which of the following vibrating tuning fork is applicable?

A

128 Hz

512 Hz is used for hearing

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76
Q

Tinea varcicolor, Monoliasis, Athlete’s foot are three conditions that are caused by

A

a fungus

77
Q

A white patch that can be found on mucous membranes
Usually found in the mouths of heavy smokers
Premalignant

A

Leukoplakia

78
Q

WOTF glands are involved in acne vulgaris?

A

Sebaceous

79
Q

The area in the fundus that represents the highest visual acuity

A

Macula

80
Q

The area in the fundus that represents the blind spot is

A

the disc

81
Q

The normal reaction to the ciliospinal reflex is

A

mydriasis = pupillary dilation

82
Q

The MC pathological condition affecting visual acuity in elderly is

A

presbyopia

83
Q

MS is a neurological disorder characterized by.

WOTF vitamin deficiency has been recently implicated in MS?

A

patchy sclerosis of the CNS

Vitamin D

84
Q

The conjunctiva covers some or all parts except

A

The lid

It does cover the cornea and sclera

85
Q

The term presbyopia is referring to a

A

disorder of the lens

86
Q

This condition often accompanies lipid disorders and presents as a slightly raised yellow flat well-circumscribed plaque in the skin 

A

xanthelasma

87
Q

A patient suffers from left homonymous hemianopia. You suspect a lesion of the?

A

Right optic tract

88
Q

Which muscle is involved with extraocular motion of the right eye towards the right inferior gaze?

A

Superior oblique – down and out

Inferior oblique – up and in

89
Q

Glaucoma is an eye disorder characterized by all of the following except?

A

Papilledema

It is characterized by increased cup:disc ratio, decreased field of vision, and increased intra ocular pressure

90
Q

Hypersecretion of the thyroid gland will lead to

A

Graves Disease

91
Q

WOTF is associated with exophthalmos?

A

Hyperthyroidism

92
Q

The cause of exophthalmos in hyperthyroidism is due to proliferation of the

A

retro bulbar fat

93
Q

Horner’s syndrome is not associated

A

with syphilis

94
Q

WOTF is not a CN lesion?

A

Horner’s syndrome

95
Q

Which CN is involved with extraocular motion of the right eye towards the left lateral gaze?

A

Oculomotor nerve

96
Q

Which muscle is involved with extraocular motion of the right eye towards the left superior gaze?

A

Inferior oblique = up and in

97
Q

The red light reflex is a reliable way to detect the presence of

A

cataract

98
Q

Angular stomatitis (cheilosis) is associated with WOTF vitamin deficiency?

A

Riboflavin = vitamin B2

99
Q

Vitamin B3 deficiency (Niacin)

A

pellagra

100
Q

B12 vitamin deficiency

A

pernicious anemia, demyelination disease

101
Q

What vitamin is associated with night vision?

A

Vitamin A

102
Q

What is the most common type of stoke?

A

Embolic

103
Q

What color changes are associated with Raynaud’s disease?

A

White, blue, red

104
Q

Scurvy is a disorder of the gum due to deficiency of WOTF vitamins?

A

L-ascorbic “Vitamin C”

105
Q

WOTF fundoscopic exam nerve may indicated an increase intracranial pressure?

A

Papilledema

106
Q

The most abundant hormone secreted by the anterior pituitary gland is GH

A

Growth Hormone

107
Q

The pathway for direct light reflex is

A 
Afferent = 2
Efferent = 3
108
Q

Glaucoma is medically managed by

A

Mydriatic eye drops == to dilate the eye to restore fluid flow within the eye

109
Q

Argyll Robertson pupils =

A

neurosyphilis – responds well to dark

110
Q

Right eye, right lateral gaze, what muscle?

A

Abducens

111
Q

Accommodation pathway (Afferent and Efferent)

A

2 afferent 3 efferent

112
Q

What CN’s supply the eye?

A

2-7 CN’s supply the eye

113
Q

20/40 vision

A

person can see at 40 ft what a normal person sees at 20 feet

114
Q

Which lab value would you use for Reiter’s?

A

HLA B27

It is associated with Chlamydia

115
Q

Rhomberg’s (dorsal column) =

A

joint position/pallesthesia

116
Q

Lateral column =

A

pain and temperature

117
Q

Light touch =

A

anterior/posterior columns

118
Q

Poliomyelitis – LMNL or UMNL

A

LMNL

119
Q

Beam of light will follow:

C, AC, L, VC

A

cornea, anterior chamber, lens, vitreous humor

120
Q

Bell’s Palsy – _____ of facial nerve

Hemiplasia – UMNL from stroke affecting _____ nerve

A

LMNL

Hemiplasia – UMNL from stroke affecting facial nerve

121
Q

spastic, decreased muscle strength without atrophy, path reflex

Right side of brain affects left side of body (Vice versa)

A

UMNL

122
Q

Any lesion from brain to pyramidal tract which synapses in anterior horn cell then it becomes

A

LMNL

123
Q

flaccid muscles, no patho reflex, muscle wasting/atrophy, absent reflex

A

LMNL

124
Q

Olfactory center is found in the ______ in the temporal lobe

A

Uncus

125
Q

Temporal lobe migraine where aura is olfactory in origin

A

Temporal lobe epilepsy

Smell something then go into epileptic fit
Due to uncus irritation

126
Q

Visual cortex in

A

occipital lobe

127
Q

Horner’s syndrome =

A

ptosis, miosis, anhydrosis

128
Q

spirochete hidden for several years and likes the CNS – neurosyphilis

A

Tabes dorsalis

129
Q

Lose cerebellum – you will have robotic movements

Dysdiadochokinesia – lost the ability to perform repeated movements such as

Cerebellum controls the ________ side

A

pronation supination / patting

ipsilateral

130
Q

Biggest diseases affect cerebellum

MS likes the optic nerve (optic neuritis) and the ______

A

stroke and MS

Cerebellum

131
Q

Homan’s sign is involved in the diagnosis of

A

DVT

132
Q

While testing hearing, the ______ tuning fork is used

A

512 Hz

133
Q

The facial nerve controls the _____ muscle which raises _______

A

fronatalis

raises the eyebrows

134
Q

Corneal reflex
Afferent =
Efferent =

A

A- 5

E-7

135
Q

Patient presents with hearing loss in his right ear due to Meniere’s disease (SENSORINEURAL) during Weber’s test where would the vibration lateralize?

A

Left ar

136
Q

Parkinson’s disease is characterized by what type of tremors?

A

static/resting tremors

137
Q

A patient suffers from optic chiasm lesion may present with

A

bitemporal hemianopsia

138
Q

L’Hermitte’s sign may indicate _____

Brudzinski’s sign indicates involvement of the ________

A

L’Hermitte’s sign may indicate MS

Brudzinski’s sign indicates involvement of the meninges

139
Q

If a patient experiences difficulty in hip abduction, which DISC is most likely involved?

A

L4 disc L5 NR

140
Q

WOTF describes grade 3 reflex status?

Slightly _________ response, possibility of disease pathology exists

A

increased

141
Q

The autonomic sympathetic nervous system originates from the ____ and _____ regions of the spine

A

thoracic and lumbar

142
Q

WOTF lines is best diagnosis for spinal stenosis?

A

Eisenstein’s

143
Q

Constant low-back pain which is unrelieved by position, activity, or rest is most likely the result of

A

visceral disease

144
Q

WOTF is considered a common and serious complication in patients with Bell’s palsy that requires immediate referral with co-management?

A

Corneal irritation/ulceration

145
Q

29 yo male with left sciatic pain shooting down the lateral aspect of the leg and the top of the foot with antalgic lean to the left. The following tests were positive: Valsalva, SLR on the left, Bragard’s on the left, Kemp’s test the pain is exaggerated upon leaning the patient to the right
What is the clinical impression?

A

Left medial disc L4

146
Q

Which disease affects the anterior horn of the spinal cord?

A

Poliomyelitis

147
Q

Guillan-Barre syndrome is an

A

infectious polyneuritis, ascending type

148
Q

WOTF tests may indicate radiculitis due to neural sleeve adhesions?

A

Shoulder depressor test

149
Q

WOTF may constitute precaution to chiropractic management?

A

Purpura  low platelets = easy bruising / poor clotting – can cause hemarthrosis

150
Q

Which neurological disorder has a regressive course?

A

Bell’s Palsy

151
Q

Parkinson’s disease is characterized by all of the following except
Degeneration of the frontal lobe

A

It is characterized by static tremors, dull mask-like expression, rigidity and weakness

152
Q

WOTF is an UMN in nature

A

Cervical myelopathy

153
Q

The prevalence of instability syndrome associated with long-term RA is believed to be?

A

50%

154
Q

Wolf’s law governs the deposition of calcium in bones through the piezoelectric effect (the bones will remodel in accordance with the stress imposed upon them). WOTF is applicable to soft tissue?

A

Davis’s law

155
Q

Patient presents with claudication, impotence and coldness of the extremities. This is most characteristic of a

A

vascular condition

156
Q

WOTF is the MC presenting complaint of a patient with multiple myeloma?

A

back pain

157
Q

WOTF conditions is characterized by pain that reaches its full intensity almost immediately after its first appearance?

A

Dissecting aneurysm

158
Q

Chest pain that is exacerbated by exercise and is relieved by rest is most likely due to

A

coronary ischemia

159
Q

in a normal heart, the S2 heart sound is the loudest in the

A

aortic and pulmonic areas

160
Q

WOTF is the most likely finding when examining a patient with emphysema?

A

Hyperresonant percussive note

161
Q

WOTF types of skin lesion is commonly associated with psoriasis?

A

SCALES

162
Q

A 35 yo female who is pregnant for the first time presents with frequent severe headaches that are sometimes accompanied by visual disturbances. She has recently been examined by her obstetrician and has gained 70 lbs during the pregnancy. She appears to have some puffiness of the face, fingers, and ankles

Which of the vital signs presented is most significant?

WOTF initial screening procedures is indicated?

WOTF immediate sequela gives the poorest prognosis in this case?

WOTF is the most appropriate initial case management?

A

BP = 140/90

UA

Oliguria

Refer patient to a specialist for further evaluation

163
Q

48 yo female with right-sided low back pain following a misstep off a curb. She has numbness over the right buttock, but the patient’s posture is not antalgic
WOTF is the most accurate initial neurological screening procedure?

WOTF clinical procedures most accurately distinguishes between lumbar joint and sacroiliac involvement?

WOTF complications requires a second opinion or consultation?

A

Deep tendon reflex
Goldthwait’s test
Deterioration of neurological signs

164
Q

36 yo male with low back and right leg pain following a fall off a ladder. He has numbness over the right malleolus and lateral aspect of the small toe of the right foot. The patient’s posture is antalgic with the trunk inclined toward the left.

WOTF examination procedures most effectively tests the motor level corresponding to the dermatome pain pattern described in the case history?

WOTF procedures most accurately determines the presence of increased intrathecal pressure?

WOTF is the most likely location of the nerve root impingement?

WOTF complications is a contraindication to rotational adjustments of the lumbar spine?

A

Achilles tendon reflex
Valsalva maneuver

Lateral to the S1 nerve root

Neurological deficit

165
Q

24 yo male presents with right leg pain. The pain originates on the lateral aspect of his posterior thigh and crosses over to the medial side of his lower leg at the knee. When the pain is most severe, it extends down to the medial aspect of his ankle. He also has vague paresthesias on the medial side of his knee. Examination reveals that light touch, pin prick, and two-point discrimination are decreased on the medial side of the lower leg. He states that he experienced moderate low-back pain for two months and currently the low back pain has subsided considerably; the leg pain has increased. Examination consisting of resisted dorsiflexion and inversion reveals a grade 3/5 weakness on the right side

WOTF muscles is being tested by resisted dorsiflexion and inversion?

WOTF neurological level is the most likely source of these findings?

WOTF screening tests is most likely to demonstrate motor weakness?

A four week treatment program consisting of side-posture spinal adjustments three times per week fails to provide any symptomatic or functional improvement. WOTF courses of action is most appropriate?

A

Tibialis anterior

L4

Heel walk/ Squat and rise

To order additional diagnostic tests and re-evaluate

166
Q

48 yo female complaining of headaches for several months. Her job involves typing, copying, and filing. The headaches started 3 months ago with slow and progressive course. She got worse in the last month. Head movement, leaning forward, coughing and sneezing tend to worsen the attacks. Headache is partially relieved by OTCs. The headaches are mostly behind the eyes, temporal and occipital areas and associated with visual difficulties. Headache is worse in the morning and sometimes during night time. She has a hard time sleeping. No past history of headaches, no trauma, no hospitalization or major illness. Family history: mother used to have headaches and she has a medicine cabinet full of headache pills, father is hypertensive. No other health issues.

WOTF would be the most appropriate initial clinical impression?

What is the appropriate management?

A

Space occupying lesion

Refer to a MD for further evaluation

167
Q

A patient complains of nervousness, fatigue, and weight loss. WOTF systems review findings would support a thyroid dysfunction as the principal mechanism for this condition?

A

Fine tremors, insomnia, and slight bulging of the eyes

168
Q

Patient presents with periodic attacks of vertigo that occurs in the form of a series of attacks over a period of the last 3 months, with few periods of remission of variable duration. The attack consists of dizziness or vertigo. The sensation of spinning may produce nausea, vomiting, sweating, and all they symptoms normally associated with extreme motion sickness. The onset of vertigo may be preceded by a sensation of fullness or pressure in the ear, hearing loss, and ringing of the right ear as described by the patient. The onset is frequently sudden, reaching peak intensity within minutes and lasting for an hour or more before subsiding. Unsteadiness may persist for the following hours or days. Vertigo is specially aggravated by movement.

What is the most appropriate diagnosis?

The proper management for case

A

Meziere’s disease

Initiate chiropractic care
Dietary recommendation

169
Q

45 yo woman noted decreased temperature sensation in her left foot in 2003, which slowly progressed until 2005 when she experienced loss of temperature sensation and noted numbness and a tight feeling below the left L2 dermatome. In the spring of 2006, she noticed motor weakness in her right lower extremity and a burning sensation on the left side that extended over the T10 and L1 dermatomes. She denied any history of trauma or surgery involving the spine. Neurological exam revealed that her right lower extremity was moderately weak. The right patellar and Achilles tendon reflexes were slightly hyperactive and a Babinski sign was present on the right side. She complained of numbness, tightness, and loss of temperature sensation below T6 on the left side, vibration sense is lost at the right malleoli and right tibial tubercle.

What is your diagnostic impression?

What is etiology and pathophysiological mechanism of this case?

A

Brown Sequard Syndrome  same side cord compression
Loss of pain and temperature on the opposite side
Motor loss on the same side

Right sided cord hemi compression

170
Q

The MC malignancy of the spine is

A

Multiple Myeloma

171
Q

62 yo male with past history of chronic alcoholism with multiple episodes of liver trouble in the form of hepatitis B and few episodes of jaundice. He was recently diagnosed by his physician and lab work as compensated liver cirrhosis. A tinge of jaundice is observed in his sclera.

WOTF lab findings may be associated?

A

WOTF lab findings may be associated?

Decreased amount of serum albumin
Serum alkaline phosphatase
Altered A/G ratio
Elevated both direct and indirect bilirubin

172
Q

30 yo male with swelling at the angle of the mandible, slight fever, malaise of three day duration. Upon examination there is hotness, redness, and tenderness with obvious swelling of the right cheek and mandibular angle area.

WOTF lab findings is most likely to help in establishing a clinical impression?

A

Lipase and amylase

Leukocytosis with lymphocytosis (for mumps)

173
Q

45 yo male presented with foot pain about two days ago. Patient wakes up in the mornings with redness and tenderness of the big toe. He can barely walk. Patient indicated that he had several episodes of the same condition in the last six months. Aggravating factors are alcohol and high protein diet

A

Gout

174
Q

14 yo boy presented with multiple episodes of asthmatic attacks. His mother also indicated that he is developing a form of skin rash of which her physician determined it as a possible allergy.

A

Eosinophils

175
Q

19 yo male of Italian descent complaining of acute torticollis which happened yesterday. After initial chiropractic screening and first aid chiropractic management in the form of passive gentle neck mobilization and resisted active neck muscle contraction. He has dramatic improvement. Upon system review he revealed that he gets episodes of yellowish discoloration (jaundice once or twice a year) usually brought on by stress or infection. Currently he has a tinge of jaundice in his sclera. Examination of the liver and gall bladder revealed no abnormalities or tenderness

A

Hemolytic jaundice = increased indirect bilirubin and total bilirubin

176
Q

General osteopenia, mild ESR elevated, 50 yo female, small lytic lesions around pelvis, skull sternum 

Next lab test?

Dx?

A

Next test to order = A/G ratio

Would have hyperglobulinemia!!

177
Q

ANA test  lupus

A

ANA test  lupus

178
Q

High reticulocytic count =

Reticulocytes – RBC with nucleus still in cell

A

pathopneumonic for hemolytic jaundice/anemia

179
Q

Zollinger-Ellison tumor is associated with what?

A

Peptic ulcer

180
Q

Brown Sequard syndrome is associated with WOTF?

Upper motor neuron lesion on the same side of lesion
Loss of pain and temperature on the opposite side of lesion
It is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection of the spinal cord

A

Brown Sequard syndrome is associated with WOTF?

Upper motor neuron lesion on the same side of lesion
Loss of pain and temperature on the opposite side of lesion
It is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection of the spinal cord

181
Q

WOTF presentations can cause a conductive hearing loss?

A

Tympanosclerosis

182
Q

Which muscle is involved with extraocular motion of the right eye towards the right superior gaze?

A

Superior rectus

183
Q

WOTF valvular lesions can cause drop attacks (blackouts)?

A

Aortic stenosis
This leads to Left ventricular enlargement
Will cause a murmur that is increased during expiration

184
Q

The normal reaction to pupillary light reflex is?

A

Bilateral miosis and convergence of the eye

185
Q

WOTF will not be found in the eyelid?

A

Pinguecula – a slow growth caused by the degeneration of the conjunctiva’s collagen fibers.

186
Q

WOTF is associated with leukemia?

A

Marked increase in WBC

187
Q

MC form of skin malignancy =

A

rodent ulcer

188
Q

WOTF will cause lateralization of sound to the left ear during Weber’s Test?

A

Perforated ear drum in left ear  conductive hearing loss

Tympanosclerosis is conductive hearing loss

Visceral CLET Final Practice Questions SP 2016 (1 decks)

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