LE6 Flashcards
1.A 30 year old female sought consultation due to weight loss of 5% in three month. She claimed to have fever to touch but when she checked her thermometer it was always normal. She can finish 3 plates full of food in one sitting and would not even gain weight. She tried taking appetite stimulants to gain weight during that time but to no avail. She defecates at least 3x in a day. On occasion, she had palpitations. During examination, patient was normotensive tachycardic, afebrile. Clear breath sounds, normal neuro exam except for presence of noticeable tremors.
What is the most likely cause of her weight loss?
A. Anxiety disorder
B. Hyperthyroidism
C. Ischemic heart disease
D. Diabetes mellitus
Hyperthyroidism (B)
The patient’s symptoms of weight loss despite increased appetite, frequent defecation, palpitations, and the presence of tremors, along with being normotensive but tachycardic, strongly suggest hyperthyroidism. These are classic symptoms of an overactive thyroid gland, which increases metabolism. Anxiety disorder, ischemic heart disease, and diabetes mellitus can have some overlapping symptoms but do not fit the overall clinical picture as well as hyperthyroidism does.
- A 35 year old patient lost weight for 3 months. He noticed that he is not gaining weight despite of his increased appetite and passion for food. He even bragged to his friends of his remarkable insatiable appetite. But when he weighed himself, he lost 15 pounds in 3 months.
He claims he drinks lots of water because he urinates at least 3-4 x at night. Among the most common causes of weight loss, what is the most likely cause of his problem?
A. Diabetes
B. Malignancy
C. Hyperthyroidism
D. Munchausen syndrome
Diabetes (A)
The description of significant weight loss despite an increased appetite, along with polyuria (urinating 3-4 times at night) and polydipsia (drinking lots of water), points towards uncontrolled diabetes mellitus, likely type 1 given the weight loss context, or possibly type 2 if there is an underlying insulin resistance with insufficient insulin production over time. Malignancy, hyperthyroidism, and Munchausen syndrome are differential diagnoses but the specific symptoms mentioned align most closely with diabetes.
- A 60 year old man noticed that he lost weight since his clothes don’t fit him as they used to and had to wear suspenders to keep his pants from falling. His appetite has not changed, nor did he change is physical activities. He now weighs 120 lbs from 140 lbs. How much weight loss is clinically significant?
A. 3% of body weight loss in 6-12 months
B. At least 5 pounds in 6-12 months
C. 5% body weight in 24 months
D. At least 10 pounds in 6-12 months
D. At least 10 pounds in 6-12 months
This answer aligns with the definition of clinically significant weight loss, which is often considered to be a loss of more than 5% of body weight over 6 to 12 months, or specifically, at least 10 pounds in the same timeframe. In the scenario described, the man lost 20 pounds (from 140 lbs to 120 lbs), which significantly exceeds the minimum criteria for clinically important weight loss. This indicates a need for further medical evaluation to identify any underlying causes.
- True or false: The greatest incidence of weight loss is seen among patients with cystic tumors.
A. False
B. Maybe
C. True
False (A)
The statement regarding the greatest incidence of weight loss being seen among patients with cystic tumors is too specific and not universally true. Weight loss can be a symptom of many conditions, including but not limited to malignancies (not just cystic tumors), chronic diseases such as COPD or heart failure, psychiatric conditions, and infectious diseases. Therefore, stating it is the greatest in incidence among patients with cystic tumors without specifying the context is misleading.
- The most common malignant cause of unintentional weight loss is:
A. Pulmonary
B. Hematologic
C. Gastrointestinal
D. Hepatobiliary
Gastrointestinal (C)
The most common malignant cause of unintentional weight loss is typically associated with gastrointestinal cancers. This is because tumors in the GI tract can cause a decrease in nutrient absorption and a general systemic response that often leads to weight loss. Pulmonary, hematologic, and hepatobiliary malignancies can also cause weight loss, but GI malignancies are more directly associated with changes in appetite, nutrient absorption, and metabolic rate, making them a more common cause of significant weight loss.
6.All elderly patients with unintentional weight loss should be asked to do the mini-mental state exam to identify patients with:
A. stroke with disorientation
B. Anxiety
C. Depression
D. Dementia
D. Dementia
The Mini-Mental State Examination (MMSE) is a widely used tool for assessing cognitive function and can help in identifying patients with cognitive impairments such as dementia. Unintentional weight loss in elderly patients could be related to several factors, including cognitive decline, where the individual may forget to eat or how to prepare food. While stroke, anxiety, and depression can also affect nutritional status, the MMSE specifically targets cognitive impairment, making dementia the most directly relevant condition to assess in the context of unintentional weight loss when cognitive decline might be a contributing factor.
7 .Sarcopenia is a major manifestation of unintentional weight loss. It is defined as:
A. prerenal contraction of intravascular volume due to inadequate hydration
B. loss of muscle mass alone
C. loss of appetite
D. a syndrome of weight loss, loss of muscle and adipose tissue, anorexia and weakness
B. Loss of muscle mass alone
Sarcopenia is defined as the loss of skeletal muscle mass and strength with aging. It is a major component of the frailty syndrome and contributes to the risk of adverse outcomes such as falls, fractures, physical disability, and reduced quality of life among older adults. While sarcopenia can be associated with other conditions like weight loss, anorexia, and weakness, the core definition centers on the loss of muscle mass alone.
- Cachexia is another major manifestation of unintentional weight loss defined as:
A. a syndrome of weight loss, loss of muscle and adipose tissue, anorexia and weakness
B. prerenal contraction of intravascular volume due to inadequate hydration
C. loss of muscle mass
D. loss of appetite
A. A syndrome of weight loss, loss of muscle and adipose tissue, anorexia and weakness
Cachexia is a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass. The presence of cachexia is indicative of a severe underlying condition, such as cancer, chronic kidney disease, heart failure, or chronic obstructive pulmonary disease (COPD), and is associated with poor prognosis. Cachexia includes a combination of weight loss, muscle and adipose tissue loss, anorexia, and weakness, distinguishing it from other forms of weight loss.
- True or false: It is better to advise patients to consume supplements between meals rather than with a meal.
A. True
B. False
C. Maybe
A. True
Advising patients to consume supplements between meals rather than with meals can be beneficial, particularly for those who need to gain weight or prevent unintentional weight loss. Consuming supplements between meals can help increase overall caloric intake without causing the individual to feel too full to eat their regular meals, thereby providing additional nutrients and calories that might not be achieved if supplements were taken with meals, potentially leading to increased satiety and decreased intake of nutrient-dense foods.
- among the common endocrine problems listed below, which of the following will not lead to unintentional weight loss?
A. diabetes insipidus
B. hypothyroidism
C. hyperthyroidism
D. diabetes mellitus
B. Hypothyroidism
Among the options listed, hypothyroidism is the condition that typically does not lead to unintentional weight loss; it is more commonly associated with weight gain or difficulty losing weight due to a decreased metabolic rate. Hyperthyroidism, diabetes mellitus, and, to a lesser extent, diabetes insipidus can all lead to unintentional weight loss. Hyperthyroidism increases metabolism, diabetes mellitus may lead to weight loss due to the body’s inability to properly utilize glucose, and diabetes insipidus involves significant fluid loss that might contribute to weight loss, though it’s not a primary symptom like in the other conditions mentioned.
11.The area postrema, also known as the Chemoreceptor Trigger Zone, responds to the bloodborne stimuli such as emetogenic drugs, bacterial toxins, uremia, hypoxia and ketoacidosis. The area postrema is located in the:
A. Pons
B. Cerebrum
C. Medulla
D. Hypothalamus
C. Medulla
The area postrema, known as the Chemoreceptor Trigger Zone (CTZ), is located in the medulla oblongata. It is responsible for detecting toxins and other substances in the blood and cerebrospinal fluid, triggering the vomiting reflex when necessary. This area’s location allows it direct access to the bloodstream and cerebrospinal fluid to monitor for emetogenic substances.
- High resolution esophageal manometry should be ordered among GERD patients if:
A. Patient has chronic GERD >5 years duration with good response to therapy
B. Surgery is contemplated in the presence of low les pressure and failure to therapy
C. Patient is a newly diagnosed GERD case and need to evaluate probable response to antacids and prokinetics
D. GI tuberculosis is being entertained as a causative factor
B. Surgery is contemplated in the presence of low LES pressure and failure to therapy
High-resolution esophageal manometry is a diagnostic tool used to evaluate the motility of the esophagus and the function of the lower esophageal sphincter (LES). It is particularly indicated for GERD patients when surgical intervention is being considered, especially in cases where there is low LES pressure contributing to reflux and when medical therapy has failed to alleviate symptoms. This test helps in assessing the esophagus’ motility patterns, aiding in the surgical planning and determination of the best treatment approach.
13.Which of the following phenomena is/are exhibit/s volitional control?
A. Emesis
B. All of the above regurgitation
C. Rumination and regurgitation only
D. Rumination
D. Rumination
Rumination is a condition characterized by the voluntary or semi-voluntary bringing up of food from the stomach into the mouth, which may then be re-chewed, re-swallowed, or spit out. Unlike emesis (vomiting), which is an involuntary reflex, rumination involves a degree of volitional control and does not typically involve nausea or gastrointestinal distress. Regurgitation, in the context of gastroesophageal reflux, is generally not under voluntary control. Therefore, among the options provided, rumination is the phenomenon that exhibits volitional control.
- True or false: Regurgitation is the effortless repeated passage of gastric contents into the mouth which may be rechewed and swallowed.
A. False
B. True
C. Maybe
A. False
Regurgitation, as described, is more accurately associated with rumination syndrome rather than being a general characteristic of regurgitation related to gastroesophageal issues. In gastroesophageal regurgitation, the content moves from the stomach back into the esophagus and possibly the mouth, but it is not typically rechewed and swallowed again. Rumination syndrome involves the effortless regurgitation of recently ingested food into the mouth, where it may be rechewed, reswallowed, or spit out.
15.A patient was brought to your attention due to vomiting within an hour of eating. The most likely differential diagnoses to consider are:
A. Rumination syndrome
B. Zenker’s diverticulum or achalasia
C. Colonic and distal intestinal obstruction
D. Gastroparesis and pyloric obstruction
D. Gastroparesis and pyloric obstruction
Vomiting within an hour of eating suggests a disorder affecting the stomach’s ability to empty properly. Gastroparesis, characterized by delayed gastric emptying in the absence of a mechanical obstruction, and pyloric obstruction, which is a physical blockage at the stomach outlet, are common conditions that can cause these symptoms. Both conditions can lead to early satiety, nausea, and vomiting soon after meals, making them likely differential diagnoses in this scenario.
16.A 68 year old patient with weight loss, low grade fever and vomiting of feculent material was brought to the ER by a concerned friend. The possible problem of feculent emesis is due to:
A. Zenker’s diverticular or achalasia
B. Gastroparesis and pyloric obstruction
C. Rumination syndrome
D. Colonic and distal intestinal obstruction
D. Colonic and distal intestinal obstruction
Feculent emesis (vomiting of material that smells or looks like feces) suggests a severe form of intestinal obstruction, where the obstruction is so distal that the contents of the intestine have nowhere to go but back up. This condition is more consistent with colonic or distal intestinal obstruction rather than issues related to the upper digestive tract like Zenker’s diverticulum, achalasia, gastroparesis, pyloric obstruction, or rumination syndrome.
17.Extraperitoneal disorder/s that can cause nausea and vomiting is/are:
A. Cerebrovascular bleeding
B. All of the above
C. Myocardial infarction with or without heart failure
D. Orthopedic surgery
E. None of the above
B. All of the above
Extraperitoneal disorders that can cause nausea and vomiting include a wide range of conditions that affect the body outside of the abdominal cavity. This includes cerebrovascular bleeding (such as a hemorrhagic stroke), myocardial infarction (heart attack) with or without heart failure, and even significant events like orthopedic surgery due to the stress and pain they cause, which can stimulate the vomiting center in the brain.
- The most common cause/s of indigestion (dyspepsia) is/are:
A. all of the above
B. gastroesophageal reflux
C. functional dyspepsia
D. none of the above
A. All of the above
B. Gastroesophageal reflux (GERD): This condition, where stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus), is a well-known cause of indigestion. The backwash (acid reflux) can irritate the lining of your esophagus, leading to discomfort.
C. Functional dyspepsia: This is characterized by signs and symptoms of indigestion that have no obvious cause. It’s a common condition that leads to a feeling of fullness or discomfort in the upper abdomen.
- Alarm symptoms in GERD that necessitate further investigation (upper Gl endoscopy):
A. unexplained weight loss
B. none of the above
C. all of the above
D. jaundice
E. dysphagia or odynophagia
C. All of the above
Alarm symptoms in GERD that necessitate further investigation include unexplained weight loss, dysphagia (difficulty swallowing), odynophagia (painful swallowing), and jaundice (though less commonly associated directly with GERD, it could indicate a more serious underlying condition). These symptoms suggest a more serious underlying condition that could require immediate attention, including but not limited to esophageal cancer or severe esophagitis.
- Indication of Endoscopy among patients >50 years old and >5 years of heartburn is:
A. assess response to acid suppressants
B. assess prior to fundoplication
C. to screen for Barrett’s esophagus
D. AOTA
C. To screen for Barrett’s esophagus
In patients over 50 years old who have had more than 5 years of heartburn, an indication for endoscopy is to screen for Barrett’s esophagus, a condition where the esophageal lining changes, potentially increasing the risk of developing esophageal adenocarcinoma. Screening for Barrett’s esophagus in this demographic is crucial for early detection and management of potential precancerous changes.
- Endogenous solutes like glucose and urea lead to osmotic diuresis by:
A. All of the above
B. Impairing tubular reabsorption of water
C. None of the above
D. Impairing tubular reabsorption of sodium and chloride
B. Impairing tubular reabsorption of water
Endogenous solutes like glucose and urea can lead to osmotic diuresis by increasing the osmolarity of the tubular fluid, which impairs the tubular reabsorption of water. This process pulls water into the renal tubules, preventing its reabsorption and leading to increased urine output.
- The most appropriate resuscitation fluid for hyponatremic hypovolemic patients is:
A. D5 water
B. Lactated ringer’s solution
C. Colloid solution such as IV albumin
D. Plain normal saline solution (NSS)
D. Plain normal saline solution (NSS)
For hyponatremic hypovolemic patients, the most appropriate resuscitation fluid is typically isotonic saline (0.9% sodium chloride), or plain normal saline solution (NSS). This choice helps to restore both the volume and sodium deficits without risking further dilution of serum sodium levels.
- Hypernatremic hypovolemic patients with Diabetes Insipidus should receive which resuscitation fluid?
A. Lactated ringer’s solution
B. Colloid solution such as IV Albumin
C. D5 water
D. Plain normal saline solution (NSS)
C. D5 water
For hypernatremic hypovolemic patients, especially those with Diabetes Insipidus, the goal is to correct the water deficit. D5 water (5% dextrose in water) is often used to provide free water and help lower the serum sodium concentration. The choice of fluid depends on the patient’s specific needs and underlying conditions, but D5 water can be appropriate for addressing the free water deficit in hypernatremia.
- True or false: Hyponatremia is very common occurring in up to 22% of hospitalized patients.
A. Maybe
B. True
C. False
B. True
Hyponatremia is indeed very common in hospitalized patients, occurring in up to 22% of such individuals. It is the most common electrolyte disorder encountered in clinical practice, particularly among the elderly and those with underlying health conditions.
25 True or false: Hyponatremia is subdivided into three groups: hypovolemic, euvolemic and hypervolemic.
A. Maybe
B. True
C. False
B. True
Hyponatremia is indeed subdivided into three groups based on volume status: hypovolemic, euvolemic, and hypervolemic. This classification helps in understanding the underlying cause of hyponatremia and guiding appropriate treatment. Hypovolemic hyponatremia occurs with sodium and water loss, euvolemic hyponatremia occurs when there is normal body sodium but excess water, and hypervolemic hyponatremia occurs with sodium and water gain, with water gain exceeding sodium gain.
- The most common cause of euvolemic hyponatremia.
A. Burns
B. SIAD (syndrome of inappropriate antidiuresis)
C. Drugs such as furosemide
D. Intraabdominal surgery
B. SIAD (syndrome of inappropriate antidiuresis)
SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion) is a condition where there is excessive release of antidiuretic hormone (ADH) leading to water retention, which dilutes the sodium in the body, causing hyponatremia without affecting the body’s volume status, hence euvolemic hyponatremia.
- Beer potomania is a cause of:
A. Hyponatremia with low solute intake
B. Hyponatremia with expanded blood volume
C. Hyponatremia with euvolemia
A. Hyponatremia with low solute intake
Beer potomania is a condition characterized by poor dietary intake and excessive beer consumption, which provides a large volume of fluid with very little solute. This can lead to hyponatremia due to the dilution of serum sodium, as the kidneys are unable to excrete the excess water due to the lack of solute (mainly sodium and potassium) needed to produce urine.
- True or false: Chronic hyponatremia increases the risk of bony fractures owing to the associated neurologic dysfunction and to a hyponatremia-associated reduction in bone density.
A. False
B. True
C. Maybe
B. True
Chronic hyponatremia can lead to neurologic dysfunction, which increases the risk of falls and, consequently, fractures. Additionally, there is evidence to suggest that hyponatremia is associated with a reduction in bone density, further increasing the risk of fractures.
- Target correction of serum sodium per day is:
A. >10mm/24 hours
B. >20mm/12 hours
C. >5mm/12 hours
D. >5mm/24 hours
D. >5mm/24 hours
The recommended rate of correction for serum sodium to avoid the risk of osmotic demyelination syndrome (ODS) is to increase serum sodium by no more than 10-12 mmol/L in the first 24 hours and not more than 18 mmol/L in the first 48 hours. A target of >5 mmol/L in 24 hours is a safe initial goal, ensuring gradual correction.
- Beer potomania treatment is:
A. Colloid solution and increase dietary salt intake to 2.5g/day
B. D5 water and increase daily salt intake to 2.5g/day
C. Intravenous normal saline solution and resumption of normal diet
D. Lactated ringer’s solution and restrict sodium intake to less than 2g/day
C. Intravenous normal saline solution and resumption of normal diet
The treatment for beer potomania involves addressing the hyponatremia and its underlying cause. Administering intravenous normal saline can help correct the hyponatremia, while resuming a normal diet helps provide the necessary solutes (especially sodium) that were deficient, aiding in the normalization of serum sodium levels.
- The oropharyngeal dysphagia that results into nasal regurgitation and pulmonary aspiration is:
A. Odynophagia
B. Transfer dysphagia
C. Aphagia
D. Globus pharyngeus
B. Transfer dysphagia
Transfer dysphagia (or oropharyngeal dysphagia) involves difficulty in the initiation of swallowing, and it can lead to symptoms such as nasal regurgitation and pulmonary aspiration due to poor control of the food bolus in the pharyngeal phase of swallowing.
- The is the foreign body sensation localized in the neck but does not interfere with swallowing and can sometimes be relieved by swallowing.
A. Aphagia
B. Globus pharyngeus
C. Transfer dysphagia
D. Odynophagia
B. Globus pharyngeus
Globus pharyngeus is the sensation of a lump or foreign body in the throat that does not actually interfere with swallowing and can sometimes be relieved by swallowing. This sensation is often more noticeable when the individual is not eating.
33.A patient complained of severe cough with swallowing. This presentation is a sign of which disease?
A. Tracheoesophageal fistula
B. Pulmonary malignancy
C. Achalasia
D. GERD
A. Tracheoesophageal fistula
A tracheoesophageal fistula can cause severe coughing with swallowing due to the abnormal connection between the esophagus and the trachea, allowing food and liquids to enter the trachea and potentially the lungs, leading to coughing and risk of aspiration.
- A patient sought consultation due to hoarseness. Upon review, the hoarseness occurred after patient had dysphagia. What is the most likely cause of the hoarseness?
A. Damage to the larynx
B. All of the above
C. Food obstruction
D. Damage to the recurrent laryngeal nerve
D. Damage to the recurrent laryngeal nerve
Hoarseness following dysphagia could be indicative of damage to the recurrent laryngeal nerve, which innervates the muscles of the larynx. This damage could be secondary to various causes, including surgical procedures, tumors, or other pathologies that affect the nerve’s function.
- A patient complaining of dysphagia with a prolonged history of heartburn most likely has:
A. Schatzki ring
B. Eosinophilic esophagitis with a history of atopy
C. All of the above
D. Peptic stricture or esophageal adenocarcinoma
D. Peptic stricture or esophageal adenocarcinoma
A patient with a prolonged history of heartburn (suggestive of chronic gastroesophageal reflux disease, GERD) is at risk of developing complications such as peptic stricture or esophageal adenocarcinoma, both of which can lead to dysphagia. Chronic exposure of the esophagus to stomach acid can cause damage that leads to the narrowing of the esophagus (stricture) or the development of cancer, both of which can impede the passage of food.
36.The correct sequence of abdominal examination is:
A. Auscultation, percussion, inspection, palpation
B. Percussion, palpation, inspection, auscultation
C. Inspection, auscultation, palpation, percussion
D. Inspection, palpation, percussion, auscultation
C. Inspection, auscultation, palpation, percussion
The correct sequence of abdominal examination is to start with inspection, followed by auscultation (to avoid altering bowel sounds that might occur with palpation or percussion), then palpation, and finally percussion. This sequence is designed to minimize discomfort and avoid altering the findings, especially bowel sounds, before they are assessed.
- The pain associated with swallowing in odynophagia is due to:
A. Foreign body sensation in the neck
B. Anticipatory anxiety about food bolus obstruction
C. Mucosal ulceration within the oropharynx or esophagus
D. Esophageal obstruction
C. Mucosal ulceration within the oropharynx or esophagus
Odynophagia, or painful swallowing, is often due to mucosal ulceration within the oropharynx or esophagus. This condition can be caused by infections, inflammatory diseases, or the ingestion of irritants, leading to pain upon swallowing.
- The inability to swallow in Aphagia implies:
A. Psychological anxiety to food aspiration
B. Complete obstruction of the esophagus
C. Mucosal ulceration
D. Psychological anticipatory anxiety of food bolus obstruction
B. Complete obstruction of the esophagus
Aphagia, the inability to swallow, implies a severe impairment or obstruction in the swallowing mechanism. This could be due to a complete obstruction of the esophagus, among other causes, which prevents the passage of solids and liquids.
- The distal esophagus is innervated by:
A. None of the above
B. All of the above
C. Excitatory and inhibitory neurons from the esophageal myenteric plexus
D. Lower motor neurons of the Vagus nerve
C. Excitatory and inhibitory neurons from the esophageal myenteric plexus
The distal esophagus is innervated by excitatory (such as acetylcholine) and inhibitory (such as nitric oxide) neurons from the esophageal myenteric plexus. These neurons regulate the motility of the esophagus.
- The lower esophageal sphincter (LES) is contracted at rest because of excitatory ganglionic stimulation and its intrinsic myogenic tone.
A. Maybe
B. True
C. False
B. True
The statement is true. The lower esophageal sphincter (LES) is contracted at rest due to its intrinsic myogenic tone and excitatory ganglionic stimulation, primarily from acetylcholine. This contraction prevents the reflux of gastric contents into the esophagus. Relaxation of the LES occurs during swallowing to allow the passage of food into the stomach.
- True or false: The glomerular filtration rate is directly proportional to the urine creatinine excretion and inversely to plasma creatinine.
A. Maybe
B. True
C. False
C. False
The glomerular filtration rate (GFR) is not directly proportional to urine creatinine excretion. GFR is a measure of how much blood the kidneys filter each minute, and it’s estimated from the plasma creatinine levels, among other factors. While urine creatinine excretion can reflect muscle mass and dietary intake, GFR is inversely related to plasma creatinine concentration under steady-state conditions (i.e., the higher the plasma creatinine, the lower the GFR).
- Azotemia is defined as:
A. Changes in sensorium accompanied with urinary retention
B. Urinary retention and elevation of plasma creatinine
C. Retention of nitrogenous waste
D. Reduction in the glomerular filtration rate
C. Retention of nitrogenous waste
Azotemia is defined as the retention of nitrogenous wastes in the blood, such as urea nitrogen and creatinine, which are normally excreted by the kidneys. It is a condition that indicates impaired kidney function.
43 Patients develop symptoms of uremia until renal dysfunction is severe with a glomerular filtration rate of < 15ml/min.
A. False
B. True
C. Maybe
B. True
Patients often do not develop overt symptoms of uremia until renal dysfunction becomes severe, typically when the GFR drops below 15 mL/min. Uremia is a clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with the loss of kidney function.
44.A B/C ratio or BUN/plasma creatinine ratio of >20:1 indicates:
A. Prerenal azotemia
B. All of the above
C. Obstructive uropathy
D. Intrinsic renal failure
A. Prerenal azotemia
A BUN (blood urea nitrogen)/plasma creatinine ratio of >20:1 typically indicates prerenal azotemia, a condition where the cause of kidney dysfunction is due to a decrease in blood flow to the kidneys (e.g., from dehydration, heart failure) and not to damage within the kidney itself. This condition leads to increased reabsorption of urea nitrogen relative to creatinine in the proximal tubules.
- Urinary sediments are important in the urinalysis. The presence of hyaline and granular casts indicates:
A. Diabetic nephropathy
B. Prerenal cause of renal dysfunction such as CHF or cirrhosis
C. Hypertensive nephrosclerosis
D. Acute tubular necrosis
D. Acute tubular necrosis
The presence of hyaline and granular casts in the urine can indicate acute tubular necrosis (ATN), among other conditions. ATN is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure. Hyaline casts can be seen in normal urine, but their presence along with granular casts, especially in larger numbers, can indicate tubular damage.
- The presence of cellular debris, tubular epithelial casts and muddy brown granular casts indicates:
A. Diabetic nephropathy
B. Acute tubular necrosis
C. Hypertensive nephrosclerosis
D. Prerenal cause of renal dysfunction such as CHF or cirrhosis
B. Acute tubular necrosis
The presence of cellular debris, tubular epithelial casts, and muddy brown granular casts in the urine is indicative of acute tubular necrosis (ATN). ATN is a condition where there is damage to the tubule cells of the kidneys, which can lead to acute kidney failure. These urinary sediments are characteristic findings in ATN due to the sloughing of injured tubular epithelial cells.
- Oliguria is defined as:
A. Urine output <400cc/day
B. Urine output <100cc/day
C. Urine output >500cc/day
D. Urine output <500cc/day
A. Urine output <400cc/day
Oliguria is defined as a urine output of less than 400 milliliters (cc) per day. It is a common clinical sign of reduced kidney function or acute kidney injury, indicating a significant decrease in glomerular filtration or urine production.
- False positive proteinuria on dipstick test may be due to:
A. Ph >7.0 and concentrated urine
B. None of the above
C. Contamination with blood in the urine
D. All of the above
D. All of the above
False positive results for proteinuria on a dipstick test can be due to various factors, including a highly alkaline pH (>7.0), highly concentrated urine, and contamination with blood. These factors can interfere with the chemical reactions on the dipstick, leading to a false indication of protein in the urine.
- Hematuria may be caused by:
A. Only stones and prostatitis
B. Stones
C. All of the above
D. Prostatitis
E. Tuberculosis
C. All of the above
Hematuria, or blood in the urine, can be caused by a wide range of conditions, including stones (such as kidney stones or bladder stones), prostatitis (inflammation of the prostate gland), and tuberculosis (a bacterial infection that can affect the kidneys). Therefore, all of the listed options are potential causes of hematuria.
- Glomerulonephritis is :
A. None of the above
B. Presence of dysmorphic RBCs, RBC casts and Protein excretion of >500mg/day
C. Hyaline casts or muddy casts and RBC of 2-5/HPF protein excretion of > 100mg/day
D. hyaline casts and RBC 2-5/HPF
B. Presence of dysmorphic RBCs, RBC casts and Protein excretion of >500mg/day
Glomerulonephritis is characterized by the presence of dysmorphic red blood cells (RBCs), RBC casts in the urine, and protein excretion of more than 500 mg/day. These findings suggest glomerular damage or inflammation, leading to the leakage of RBCs and protein into the urine.
- Jaundice is the presence of hyperbilirubinemia which is a sign of:
A. Liver disease and biliary obstruction
B. Liver disease
C. Disorders of bilirubin metabolism and liver disease
D. Liver disease, hemolytic disorders and disorders of bilirubin metabolism
D. Liver disease, hemolytic disorders, and disorders of bilirubin metabolism
Jaundice, characterized by the yellowing of the skin and eyes, is caused by hyperbilirubinemia. It can result from liver disease (affecting bilirubin processing), hemolytic disorders (increasing bilirubin production), and disorders of bilirubin metabolism (affecting how bilirubin is processed and excreted).
- Stigmata of advanced alcoholic liver disease includes:
A. None of the above
B. Gynecomastia, parotid gland enlargement and testicular atrophy
C. All of the above
D. Spider nevi, palmar erythema, Dupuytren’s contractures and caput medusae
C. All of the above
Stigmata of advanced alcoholic liver disease include a range of physical findings such as spider nevi, palmar erythema, Dupuytren’s contractures, caput medusae, gynecomastia, parotid gland enlargement, and testicular atrophy. These signs reflect the chronic effects of alcohol on the liver and other endocrine organs.
53.A 28 year old medical student was brought to the ER due to sudden onset of right upper quadrant pain. Patient was noted to be slightly icteric. He was positive for Murphy’s sign.
What is the likely cause of his abdominal pain?
A. Splenomegaly
B. Cholecystitis
C. Hepatitis
D. Pancreatitis
B. Cholecystitis
Given the presentation of right upper quadrant pain, slight icterus, and a positive Murphy’s sign (pain or halt in inspiration when the gallbladder is palpated), the likely cause of the abdominal pain is cholecystitis, which is inflammation of the gallbladder, often due to gallstones blocking the cystic duct.
- A patient had multiple petechiae, palmar erythema and ictericia. He was given multiple doses of parenteral vitamin K but prothrombin time remained to be prolonged. The failure of vitamin K to correct prothrombin time indicates:
A. Severe hepatocellular injury
B. Hemolytic anemia
C. Severe biliary tract obstruction
D. Pancreatic head carcinoma
A. Severe hepatocellular injury
The failure of vitamin K to correct prothrombin time (PT) indicates severe hepatocellular injury. Vitamin K is necessary for the synthesis of clotting factors by the liver. If PT does not correct with vitamin K administration, it suggests that the liver’s ability to synthesize clotting factors is significantly impaired, typically due to extensive liver cell damage.
- A patient with complained of sudden onset of abdominal pain and jaundice. The gold standard for identifying choledocholithiasis is:
A. Computed tomographic scan of the abdomen
B. Endoscopic ultrasound
C. Endoscopic retrograde cholangiopancreatography
D. Magnetic resonance cholangiopancreatography
C. Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP is considered the gold standard for identifying choledocholithiasis (stones in the common bile duct). It allows for direct visualization of the bile and pancreatic ducts, and it can also be therapeutic, as stones can be removed during the procedure. Other modalities like magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) are less invasive and can be used for diagnosis, but ERCP has the added benefit of allowing for intervention.
- A patient had multiple petechiae, palmar erythema and icteria. He was given multiple doses of parenteral vitamin K but prothrombin time remained prolonged. The failure of the vitamin K to correct prothrombin time indicates:
A. Severe hepatocellular injury
B. Hemolytic anemia
C. Severe billiary tract obstruction
D. Pancreatic head carcinoma
A. Severe hepatocellular injury
The failure of vitamin K to correct prothrombin time (PT) despite multiple doses indicates severe hepatocellular injury. Vitamin K is necessary for the synthesis of several clotting factors. If PT does not correct after administration, it suggests the liver’s capacity to synthesize clotting factors is significantly compromised, typically due to extensive liver damage.
- The major causes of abdominal swelling:
A. Fluid and neoplasm
B. Fat and fetus
C. Flatus and feces
D. None of the above
E. All of the above
E. All of the above
The major causes of abdominal swelling include fluid (ascites), fat (obesity), fetus (pregnancy), flatus (gas), feces (impaction or constipation), and neoplasm (tumors). These are collectively remembered by the mnemonic “The 6 Fs”.
58.A 35 year old female patient sought consultation due to an incidental finding of supraclavicular lymphadenopathy. On history, she complained of increasing abdominal girth but had repeated negative pregnancy tests. Transvaginal ultrasound done one week prior to consultation in your clinic was normal. What is the most likely cause of the supraclavicular lymphadenopathy?
A. It is most likely tuberculous in origin and manageable with anti-Koch’s medication
B. It is called Virchow’s node suggestive of intraabdominal malignancy
C. It is Sister Mary Joseph’s nodes highly indicative of Laenac’s cirrhosis
D. It is Sister Mary Joseph’s nodes suggestive of intraabdominal malignancy
B. It is called Virchow’s node suggestive of intraabdominal malignancy
Supraclavicular lymphadenopathy, particularly in the left supraclavicular area (Virchow’s node), is often suggestive of intraabdominal malignancy. This is due to the lymphatic drainage from the abdominal cavity to the left supraclavicular node. The presence of such a node, especially with increasing abdominal girth and negative pregnancy tests, raises suspicion for an underlying malignancy.
- The most common cause of ascites:
A. Cirrhosis
B. Nephrotic syndrome
C. Cardiac ascites
D. Peritoneal carcinomatosis
A. Cirrhosis
The most common cause of ascites is cirrhosis. Ascites, the accumulation of fluid in the peritoneal cavity, is often due to portal hypertension associated with cirrhosis, leading to the sequestration of fluid.
- Chylous ascitic fluid after paracentesis indicates:
A. All of the above none of the above
B. A result of lymphatic disruption from cirrhosis, tumor or TB
C. Triglyceride level >200mg/dl and often > 1000mg/dL
D. A result of lymphatic damage due to trauma
A. All of the above
Chylous ascitic fluid, characterized by its milky appearance due to a high triglyceride content, indicates disruption or damage to the lymphatic system. This can occur for several reasons:
- Cirrhosis, tumor, or TB: These conditions can cause lymphatic obstruction or disruption, leading to the leakage of lymph into the abdominal cavity.
- Triglyceride level >200mg/dl and often > 1000mg/dl: This is a diagnostic criterion for chylous ascites, as the milky appearance is due to the high concentration of triglycerides.
- Lymphatic damage due to trauma: Physical injury to the abdominal area can damage lymphatic vessels, causing lymph to leak into the peritoneal cavity.
Therefore, chylous ascites can result from any of these conditions, making “All of the above” the correct answer.
61.Overflow diarrhea is:
A. Frequent passage of small volume of stool associated with rectal urgency, tenesmus or feeling of incomplete evacuation
B. Occur in nursing home patients due to fecal impaction
C. Passage of liquid or unformed stools of more than 4 Weeks duration
D. Involuntary discharge of fecal material caused by neuromuscular disorders or structural anorectal problems
B. Occur in nursing home patients due to fecal impaction
Overflow diarrhea is a condition where liquid stool from the proximal colon leaks around a fecal impaction, often seen in nursing home patients or those with severe constipation. This can lead to the paradoxical presentation of diarrhea in the context of underlying constipation and fecal impaction.
- Occlusive or nonocclusive ischemic colitis often presents as:
A. Tenesmus and watery mucoid stools followed by constipation
B. Upper abdominal pain followed by alternating diarrhea and constipation
C. Lower abdominal pain preceding watery then bloody diarrhea
D. Vague abdominal pain followed by localization at the periumbilical area and mucoid stools
C. Lower abdominal pain preceding watery then bloody diarrhea
Ischemic colitis, whether occlusive or nonocclusive, typically presents with lower abdominal pain followed by the passage of watery diarrhea that may become bloody. This sequence of symptoms reflects the progression of ischemic injury to the colonic mucosa.
This presentation is characteristic because ischemic colitis involves a reduction in blood flow to the colon, leading to symptoms that start with abdominal pain (typically lower abdominal pain due to the involvement of the colon) and progress to watery diarrhea, which can become bloody as the condition worsens and the mucosal lining of the colon is damaged.
- Indications for further evaluation in a patient with profuse diarrhea with dehydration:
A. All of the above
B. None of the above
C. Bloody stools, elderly and immunocompromised patients
D. Fever and recent antibiotic use
E. Failure to improve after 48 hours and community outbreaks
A. All of the above
Indications for further evaluation in a patient with profuse diarrhea and dehydration include bloody stools, age extremes (especially the elderly and immunocompromised patients), fever and recent antibiotic use, failure to improve after 48 hours, and occurrence during community outbreaks. These factors suggest a more serious underlying condition or a risk of significant complications.
- One of the most common causes of chronic diarrhea in adults:
A. Lactase deficiency
B. Traveler’s diarrhea
C. Abuse of laxatives for weight management
D. Infectious diarrhea
A. Lactase deficiency
One of the most common causes of chronic diarrhea in adults is lactase deficiency, also known as lactose intolerance. This condition leads to the inability to properly digest lactose, a sugar found in milk and dairy products, resulting in symptoms such as diarrhea, gas, and bloating after consuming dairy.
65.Endocrinopathy/endocrinopathies associated with constipation:
A. None of the above
B. Hypercalcemia
C. Hypothyroidism
D. Pregnancy
E. All of the above
E. All of the above
Several endocrinopathies are associated with constipation, including hypothyroidism (reduced thyroid hormone levels slow down many bodily processes, including digestion), hypercalcemia (high calcium levels can reduce motility in the gastrointestinal tract), and pregnancy (hormonal changes and physical pressure from the growing uterus can slow bowel movements).
- Neurologic disease/s commonly associated with chronic constipation:
A. Spinal cord injury
B. Multiple sclerosis
C. Parkinsonism
D. AOTA
D. AOTA
Neurologic diseases such as spinal cord injury, multiple sclerosis, and Parkinsonism are commonly associated with chronic constipation due to their impact on the nervous system’s control over bowel movements.
- Cardiac medication associated with chronic constipation:
A. Angiotensin receptor blockers
B. Calcium channel blockers
C. Nitrates
D. ACE inhibitors
B. Calcium channel blockers
Calcium channel blockers are known to be associated with chronic constipation. They can decrease the contractility of the bowel, leading to slower transit times.
- Generalized muscle disease associated with chronic constipation:
A. Pelvic floor dysfunction
B. Amyloidosis
C. Progressive systemic sclerosis
D. Rectal prolapse
C. Progressive systemic sclerosis (Scleroderma)
Progressive systemic sclerosis (scleroderma) is a generalized muscle disease that can be associated with chronic constipation due to its effects on the smooth muscle of the gastrointestinal tract, leading to decreased motility.
- The thermoregulatory center that controls body temperature and dictates fever is located in the:
A. Thalamus
B. Infundibulum
C. Pituitary gland
D. Hypothalamus
D. Hypothalamus
The hypothalamus is the thermoregulatory center that controls body temperature and dictates fever. It acts as the body’s thermostat, integrating signals from the body and adjusting temperature accordingly.
- True or False: It is recommended that monitoring of body temperature in a patient with fever should be done at regular intervals and may use different sites for measuring body temperature.
A. Maybe
B. False
C. True
B. False
Given the clarification about the importance of consistency in measuring body temperature to accurately track temperature trends over time, it’s more accurate to say that while monitoring body temperature at regular intervals is crucial, using the same site for measurement is recommended to ensure consistency. Variations between different body sites can lead to discrepancies in temperature readings, making it difficult to accurately assess a patient’s fever trend. Therefore, the statement as provided would be considered false, emphasizing the importance of consistency in the site of temperature measurement for accurate monitoring.
- The most common cause of hyperpyrexia is:
A. Intracerebral tumor
B. Local trauma to the head
C. Intracranial bleeding
D. Sepsis or severe infection
D. Sepsis or severe infection
The most common cause of hyperpyrexia (extremely high fever) is sepsis or severe infection. Hyperpyrexia is typically defined as a body temperature of 41.1°C (106°F) or higher and is more commonly associated with severe infections than with intracranial causes.
- Which of the following is a manifestation of hyperpyrexia or heat stroke?
A. Excessive sweating
B. Cool pale clammy skin
C. Absence of sweating
D. Muscle cramps
C. Absence of sweating
One of the manifestations of hyperpyrexia or heat stroke is the absence of sweating. In the context of heat stroke, the body’s temperature regulation mechanisms fail, and despite the high body temperatures, the skin may become dry due to the cessation of sweating.
- True or false: Heat stroke is a medical emergency. IV antipyretics is the treatment of choice.
A. Maybe
B. True
C. False
C. False
Heat stroke is indeed a medical emergency that requires immediate treatment to cool the patient and support vital functions. However, IV antipyretics are not the treatment of choice for heat stroke. The primary treatment focuses on rapidly lowering the body temperature through external cooling methods and supportive care, not primarily through antipyretics.
- Temperature-pulse dissociation is seen in:
A. Typhoid fever
B. Brucellosis
C. None of the above
D. All of the above
E. Leptospirosis
D. All of the above
Temperature-pulse dissociation, also known as relative bradycardia, is seen in conditions like typhoid fever, brucellosis, and leptospirosis. It is characterized by a slower-than-expected heart rate despite the presence of fever.
- Hematologic parasite that causes fever every three (3) days:
A. Schistosoma japonicum
B. Plasmodium malariae
C. Plasmodium falciparum
D. Plasmodium vivax
B. Plasmodium malariae
Plasmodium malariae is the hematologic parasite that causes fever every three (3) days, also known as a quartan fever pattern. This pattern is characteristic of malaria caused specifically by Plasmodium malariae infection.
- A. Schistosoma japonicum: This is not a cause of malaria; it causes schistosomiasis, also known as bilharzia, a different parasitic disease characterized by urinary or intestinal symptoms depending on the species.
- B. Plasmodium malariae: This species of Plasmodium causes quartan malaria, characterized by a fever pattern that recurs every three days (72 hours). This is because the life cycle of P. malariae in the red blood cells is approximately 72 hours long, leading to the synchronous rupture of infected cells and the release of new parasites into the bloodstream, causing fever. (3 DAYS)
- C. Plasmodium falciparum: This species causes the most severe form of malaria and can lead to irregular fever patterns, often more frequent than every three days. P. falciparum infections can cause cerebral malaria and severe anemia, among other complications.
- D. Plasmodium vivax: This species causes tertian malaria, where fevers typically occur every 48 hours. Like P. falciparum, P. vivax invades red blood cells, but its life cycle leads to fever patterns distinct from those of P. malariae. (2 DAYS)
- Antipyretics such as nsaids and ASA inhibit fever by:
A. All of the above
B. Inhibition of transcription of mrna needed for pyrogenic cytokines
C. None of the above
D. Interfere with cyclooxygenase needed by the arachidonic acid to form prostaglandins
E. Inhibition of phospholipase interfering with the release of arachidonic acid from the phospholipids in cell membrane
D. Interfere with cyclooxygenase needed by the arachidonic acid to form prostaglandins
Antipyretics such as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) and ASA (Aspirin) reduce fever by inhibiting the enzyme cyclooxygenase (COX). This inhibition prevents the conversion of arachidonic acid to prostaglandins, which are involved in the fever response by acting on the hypothalamus to increase body temperature.
- Criteria for diagnosing Fever of unknown origin:
A. Illness duration for 3 or more weeks
B. Fever >39C on at least three occasions
C. Can be diagnosed in immunocompromised patients
D. Admitted in the hospital for three weeks after an exhaustive laboratory investigation
A. Illness duration for 3 or more weeks
This criterion is consistent across both the traditional and updated definitions of FUO. It emphasizes the prolonged nature of the fever without a diagnosis despite appropriate investigations. The other options provided either do not align with the updated definition (such as the specification about immunocompromised patients) or relate to details that are part of the broader diagnostic process rather than specific criteria for FUO (such as hospital admission duration and the exact temperature threshold).
Based on the new definition you’ve provided for Fever of Unknown Origin (FUO), the criteria for diagnosing FUO have been updated to include:
- Fever greater than 38.3°C (101°F) on at least two occasions.
- Illness duration of more than or equal to 3 weeks.
- No known immunocompromised state.
- Diagnosis remains uncertain after a thorough history taking, physical examination, and following obligatory investigations, which include a comprehensive list of laboratory tests and imaging studies.
- The most common cause of Fever of unknown origin is:
A. Rheumatologic diseases
B. Vasculitis
C. Neoplasm
D. Infection
D. Infection
Infections are among the most common causes of Fever of Unknown Origin (FUO), especially in global contexts. While neoplasms, rheumatologic diseases, and vasculitis are also significant causes, infections historically have been the leading category for FUO.
- Antibiotics, anti-koch’s therapy and corticosteroids should not be given in patients with fever of unknown origin because it will inhibit the identification of fastidious organisms in cultures.
A. True
B. False
C. Maybe
A. True
Administering antibiotics, anti-Koch’s therapy (for tuberculosis), and corticosteroids without a definitive diagnosis can mask underlying diseases by temporarily improving symptoms or inhibiting the growth of fastidious organisms in cultures, making the identification of the underlying cause more difficult.
80.TRUE OR FALSE: Antibiotics, corticosteroids and anti-TB medications can be given to patients with fever of unknown origin if the patient is clinically unstable or rapidly deteriorating.
A. True
B. False
C. Maybe
A. True
In cases where a patient with fever of unknown origin is clinically unstable or rapidly deteriorating, it may be necessary to initiate empirical treatment with antibiotics, corticosteroids, or anti-TB medications even without a definitive diagnosis. This approach is taken to stabilize the patient and prevent further deterioration, even though it might complicate the diagnostic process. The priority in these situations is to address the immediate risk to the patient’s health.
- True or false: In diagnosing the cause of anemia in a patient, race is not that important such as family history or drug and alcohol intake.
A. Maybe
B. False
C. True
B. False
In diagnosing the cause of anemia, race can be important because certain genetic conditions leading to anemia, such as sickle cell disease or thalassemia, have higher prevalence rates in specific racial or ethnic groups. Therefore, considering race, along with family history, drug, and alcohol intake, can provide valuable context in the diagnostic process.
- The mean cell volume uses which CBC parameter in its formula:
A. Red blood cell count
B. White blood cell count
C. Hemoglobin
D. Hematocrit
D. Hematocrit
Mean Cell Volume (MCV) uses the Hematocrit (Hct) and Red Blood Cell count (RBC) in its formula. MCV is calculated as (Hematocrit [%] / Red Blood Cell count [in millions per microliter]) × 10, giving the volume in femtoliters (fL).
- Which red blood cell indices indicate whether the anemia is normochromic or hypochromic?
A. Mean cell hemoglobin concentration
B. Mean cell volume
C. Reticulocyte count
D. Mean cell hemoglobin
A. Mean cell hemoglobin concentration (MCHC)
MCHC indicates whether the anemia is normochromic or hypochromic. It measures the concentration of hemoglobin in a given volume of packed red blood cells, providing information about the color (chromicity) of the cells.
84.Which red blood indices indicate whether the anemia is microcytic or macrocytic?
A. Mean cell volume
B. Mean cell hemoglobin concentration
C. Reticulocyte count
D. Mean cell hemoglobin
A. Mean cell volume (MCV)
MCV indicates whether the anemia is microcytic (small cells), normocytic (normal-sized cells), or macrocytic (large cells). It measures the average volume of red blood cells.
- The cause of anemia in chronic renal failure is the lack of which hormone?
A. Erythropoietin
B. Growth hormone
C. Progesterone
D. Thyrotropin-releasing hormone
A. Erythropoietin
The cause of anemia in chronic renal failure is primarily due to a lack of erythropoietin, a hormone produced by the kidneys that is essential for the production of red blood cells in the bone marrow.
- Normal life span of red blood cells:
A. 80 days
B. 60 days
C. 160 days
D. 120 days
D. 120 days
The normal lifespan of red blood cells is about 120 days. After this period, they are typically removed from circulation by the spleen.
87.A reticulocyte count of 2% indicates:
A. A need for peripheral blood smear
B. A need for bone marrow biopsy
C. Normal daily replacement of the circulating red blood cell population
D. Inadequate marrow response to moderate anemia
C. Normal daily replacement of the circulating red blood cell population
A reticulocyte count of 2% is generally considered within the normal range, indicating a normal daily replacement rate of the circulating red blood cell population. Reticulocytes are immature red blood cells, and their proportion in the blood reflects the bone marrow’s activity in producing new red blood cells.
88.A reticulocyte index greater that 2.5 indicates:
A. Hemolysis and bleeding only
B. Abnormal red cell morphology
C. Bleeding
D. Hemolysis
A. Hemolysis and bleeding only
A reticulocyte index greater than 2.5 typically indicates an appropriate bone marrow response to anemia, commonly seen in conditions like hemolysis or acute bleeding, where there is an increased production of reticulocytes to compensate for the loss or destruction of red blood cells.
89.A reticulocyte index of less than 2.5 indicates:
A. Bleeding
B. Hemolysis and bleeding only
C. Abnormal red cell morphology
D. Hemolysis
C. Abnormal red cell morphology
A reticulocyte index of less than 2.5 suggests that the bone marrow response to anemia is inadequate, which could be due to a variety of causes, including iron deficiency, chronic disease, or bone marrow disorders that affect red cell production. Abnormal red cell morphology can be a feature of various anemias but is not directly indicated by a low reticulocyte index. The reticulocyte index primarily reflects the bone marrow’s response to anemia, not specific morphological abnormalities.
90 True of Iron deficiency:
A. Iron deficiency is a hypoproliferative disorder
B. All of the above
C. None of the above
D. Iron deficiency is a maturation disorder that can present with microcytic or macrocytic anemia
A. Iron deficiency is a hypoproliferative disorder
Iron deficiency anemia is considered a hypoproliferative disorder because the lack of iron leads to a reduced production of red blood cells. It is characterized by microcytic anemia, where the red blood cells are smaller than normal.
- The presence of cervical lymphadenopathies indicates:
A. Infection of the scalp
B. Tuberculous in origin
C. Thorough ENT examination
D. Conjunctival infections and cat-scratch disease
C. Thorough ENT examination
The presence of cervical lymphadenopathies often warrants a thorough ENT (Ear, Nose, and Throat) examination, as it can be indicative of infections or conditions affecting areas drained by cervical lymph nodes, including the throat, ears, and respiratory tract.
- True about steroids in the approach to lymphadenopathy:
A. Steroids should only be used in the presence of pharyngeal obstruction that may interfere with the breathing of the patient
B. Steroids can be used if diagnosis is uncertain
C. Steroids may be used to alleviate the pain associated with tender lymphadenopathy
D. Steroids may be used to reduce the size of the lymph node for excision
A. Steroids should only be used in the presence of pharyngeal obstruction that may interfere with the breathing of the patient
Steroids may be used in specific cases where lymphadenopathy causes significant pharyngeal obstruction, potentially interfering with breathing. Their use should be cautious and based on specific indications because steroids can mask symptoms and complicate the diagnosis of underlying conditions.
- Which of the following factors has a positive predictive value in the work-up of lymphadenopathy:
A. Soft small lymph nodes of less than 1.0 cm2
B. Supraclavicular nodes
C. Tender lymph nodes
D. Patients younger than 40 years old
B. Supraclavicular nodes
The presence of enlarged supraclavicular nodes has a positive predictive value for malignancy in the work-up of lymphadenopathy. Supraclavicular lymphadenopathy is more likely to be associated with serious underlying conditions, including malignancies, than lymphadenopathy in other regions.
- Which of the following factors has a negative predictive value in the management of lymphadenopathy and indicates follow-up in 2-4 weeks for re-evaluation?
A. Nonhard texture
B. Nodes >2.25cm2
C. Nontender lymphadenopathy
D. Supraclavicular nodes
A. Nonhard texture
A nonhard texture of lymph nodes, along with other benign features such as being tender and small, often indicates a benign process. Patients with such lymphadenopathy may be advised follow-up in 2-4 weeks for re-evaluation to see if the lymphadenopathy resolves or changes, which can help in distinguishing benign from more serious conditions.
- True of the splenic anatomy:
A. Accessory spleen is present in 50% of the population and brought about by the failure of migration to its adult location
B. Attached to the kidney via the gastrolienal ligament
C. It is a reticuloendothelial organ that arises from series of hillocks
D. Attached to the stomach via the lieonorenal ligament
C. It is a reticuloendothelial organ that arises from series of hillocks
The spleen is a reticuloendothelial organ involved in filtering blood, immune response, and blood cell destruction. It develops embryologically from mesenchymal cells in the dorsal mesogastrium, not from a failure of migration or through ligaments attaching it to the kidney or stomach. The correct ligaments are the gastrosplenic ligament, which connects the spleen to the stomach, and the splenorenal (lienorenal) ligament, connecting the spleen to the kidney.
- The differential diagnosis/diagnoses for a palpable spleen of >8cm below the subcostal margin:
A. All of the above
B. None of the above
C. Polycythemia vera
D. Autoimmune hemolytic anemia
E. Sarcoidosis
A. All of the above
A palpable spleen more than 8cm below the costal margin can be indicative of various conditions, including polycythemia vera, autoimmune hemolytic anemia, and sarcoidosis, among others. These conditions can cause splenomegaly due to different mechanisms, such as increased blood cell turnover, inflammation, or infiltration of the spleen.
- True of splenectomy:
A. Splenectomy is done for symptom control in patients with chronic myelogenous leukemia and lessen blood transfusion
B. Splenectomy is done in all trauma cases to prevent splenic rupture
C. Splenectomy is done for diagnostic purposes
D. Splenectomy is done for staging in bone marrow dysfunction
A. Splenectomy is done for symptom control in patients with chronic myelogenous leukemia and lessen blood transfusion
Splenectomy may be performed for various reasons, including symptom control in hematological disorders like chronic myelogenous leukemia (CML) to reduce symptoms and the need for blood transfusions. It is not performed in all trauma cases or solely for diagnostic purposes or staging in bone marrow dysfunction without other indications.
- The immediate post-splenectomy hematologic finding for 2-3 weeks is:
A. Leukopenia and thrombocytopenia
B. Leukocytosis and thrombocytosis
C. Leukocytosis and normocytic normochromic anemia
D. Leukopenia and microcytic hypochromic anemia
B. Leukocytosis and thrombocytosis
Following splenectomy, an immediate hematologic finding often includes leukocytosis (increased white blood cell count) and thrombocytosis (increased platelet count) due to the removal of the spleen’s role in filtering and sequestering these cells.
- The recommended vaccination 2 weeks before elective splenectomy:
A. Pneumoccal vaccine and vaccination against Beta-hemolytic streptococcus and H. Influenzae
B. Pneumoccal vaccination, vaccination against N. Meningitidis and H. Influenzae
C. Pneumococcal vaccine and vaccine against N. Gonorrhea and H. Influenzae
D. Pneumoccocal vaccine, BCG vaccination, MMR Vaccination
B. Pneumococcal vaccination, vaccination against N. Meningitidis and H. Influenzae
Before elective splenectomy, it is recommended to vaccinate against pathogens that pose a higher risk of infection in asplenic individuals. This includes vaccines against pneumococcus, Neisseria meningitidis, and Haemophilus influenzae type b.
- It is well known that the most serious side effect of splenectomy is infection. Which organs are most commonly affected?
A. Nasopharynx, lungs and skin
B. Gastrointestinal, skin and brain
C. Lungs, skin and blood
D. Lungs, pericardium and urinary tract
C. Lungs, skin and blood
The most serious side effect of splenectomy is an increased risk of infection, particularly from encapsulated bacteria. The organs most commonly affected include the lungs (pneumonia), skin (wound infections), and blood (bacteremia/sepsis), reflecting the spleen’s role in filtering bacteria from the blood and its involvement in the immune response.
