LE6

Question 1

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

Answer 1

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.

Question 2

2. 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

Answer 2

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.

Question 3

3. 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

Answer 3

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.

Question 4

4. True or false: The greatest incidence of weight loss is seen among patients with cystic tumors.
   A. False
   B. Maybe
   C. True

Answer 4

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.

Question 5

5. The most common malignant cause of unintentional weight loss is:
   A. Pulmonary
   B. Hematologic
   C. Gastrointestinal
   D. Hepatobiliary

Answer 5

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.

Question 6

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

Answer 6

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.

Question 7

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

Answer 7

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.

Question 8

8. 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

Answer 8

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.

Question 9

9. 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

Answer 9

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.

Question 10

10. 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

Answer 10

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.

Question 11

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

Answer 11

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.

Question 12

12. 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

Answer 12

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.

Question 13

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

Answer 13

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.

Question 14

14. 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

Answer 14

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.

Question 15

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

Answer 15

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.

Question 16

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

Answer 16

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.

Question 17

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

Answer 17

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.

Question 18

18. 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

Answer 18

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.

Question 19

19. 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

Answer 19

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.

Question 20

20. 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

Answer 20

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.

Question 21

21. 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

Answer 21

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.

Question 22

22. 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)

Answer 22

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.

Question 23

23. 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)

Answer 23

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.

Question 24

24. True or false: Hyponatremia is very common occurring in up to 22% of hospitalized patients.
    A. Maybe
    B. True
    C. False

Answer 24

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.

Question 25

25 True or false: Hyponatremia is subdivided into three groups: hypovolemic, euvolemic and hypervolemic. A. Maybe B. True C. False

Answer 25

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.

Question 26

26. The most common cause of euvolemic hyponatremia. A. Burns B. SIAD (syndrome of inappropriate antidiuresis) C. Drugs such as furosemide D. Intraabdominal surgery

Answer 26

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.

Question 27

27. Beer potomania is a cause of: A. Hyponatremia with low solute intake B. Hyponatremia with expanded blood volume C. Hyponatremia with euvolemia

Answer 27

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.

Question 28

28. 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

Answer 28

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.

Question 29

29. Target correction of serum sodium per day is: A. >10mm/24 hours B. >20mm/12 hours C. >5mm/12 hours D. >5mm/24 hours

Answer 29

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.

Question 30

30. 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

Answer 30

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.

Question 31

31. The oropharyngeal dysphagia that results into nasal regurgitation and pulmonary aspiration is: A. Odynophagia B. Transfer dysphagia C. Aphagia D. Globus pharyngeus

Answer 31

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.

Question 32

32. 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

Answer 32

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.

Question 33

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

Answer 33

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.

Question 34

34. 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

Answer 34

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.

Question 35

35. 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

Answer 35

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.

Question 36

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

Answer 36

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.

Question 37

37. 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

Answer 37

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.

Question 38

38. 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

Answer 38

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.

Question 39

39. 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

Answer 39

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.

Question 40

40. 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

Answer 40

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.

Question 41

41. 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

Answer 41

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).

Question 42

42. 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

Answer 42

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.

Question 43

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

Answer 43

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.

Question 44

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

Answer 44

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.

Question 45

45. 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

Answer 45

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.

Question 46

46. 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

Answer 46

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.

Question 47

47. Oliguria is defined as: A. Urine output <400cc/day B. Urine output <100cc/day C. Urine output >500cc/day D. Urine output <500cc/day

Answer 47

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.

Question 48

48. 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

Answer 48

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.

Question 49

49. Hematuria may be caused by: A. Only stones and prostatitis B. Stones C. All of the above D. Prostatitis E. Tuberculosis

Answer 49

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.

Question 50

50. 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

Answer 50

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.

Question 51

51. 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

Answer 51

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).

Question 52

52. 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

Answer 52

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.

Question 53

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

Answer 53

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.

Question 54

54. 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

Answer 54

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.

Question 55

55. 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

Answer 55

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.

Question 56

56. 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

Answer 56

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.

Question 57

57. 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

Answer 57

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".

Question 58

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

Answer 58

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.

Question 59

59. The most common cause of ascites: A. Cirrhosis B. Nephrotic syndrome C. Cardiac ascites D. Peritoneal carcinomatosis

Answer 59

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.

Question 60

60. 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

Answer 60

**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.

Question 61

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

Answer 61

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.

Question 62

62. 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

Answer 62

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.

Question 63

63. 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

Answer 63

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.

Question 64

64. 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

Answer 64

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.

Question 65

65.Endocrinopathy/endocrinopathies associated with constipation: A. None of the above B. Hypercalcemia C. Hypothyroidism D. Pregnancy E. All of the above

Answer 65

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).

Question 66

66. Neurologic disease/s commonly associated with chronic constipation: A. Spinal cord injury B. Multiple sclerosis C. Parkinsonism D. AOTA

Answer 66

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.

Question 67

67. Cardiac medication associated with chronic constipation: A. Angiotensin receptor blockers B. Calcium channel blockers C. Nitrates D. ACE inhibitors

Answer 67

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.

Question 68

68. Generalized muscle disease associated with chronic constipation: A. Pelvic floor dysfunction B. Amyloidosis C. Progressive systemic sclerosis D. Rectal prolapse

Answer 68

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.

Question 69

69. The thermoregulatory center that controls body temperature and dictates fever is located in the: A. Thalamus B. Infundibulum C. Pituitary gland D. Hypothalamus

Answer 69

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.

Question 70

70. 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

Answer 70

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.

Question 71

71. The most common cause of hyperpyrexia is: A. Intracerebral tumor B. Local trauma to the head C. Intracranial bleeding D. Sepsis or severe infection

Answer 71

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.

Question 72

72. 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

Answer 72

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.

Question 73

73. True or false: Heat stroke is a medical emergency. IV antipyretics is the treatment of choice. A. Maybe B. True C. False

Answer 73

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.

Question 74

74. Temperature-pulse dissociation is seen in: A. Typhoid fever B. Brucellosis C. None of the above D. All of the above E. Leptospirosis

Answer 74

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.

Question 75

75. Hematologic parasite that causes fever every three (3) days: A. Schistosoma japonicum B. Plasmodium malariae C. Plasmodium falciparum D. Plasmodium vivax

Answer 75

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)

Question 76

76. 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

Answer 76

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.

Question 77

77. 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

Answer 77

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.

Question 78

78. The most common cause of Fever of unknown origin is: A. Rheumatologic diseases B. Vasculitis C. Neoplasm D. Infection

Answer 78

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.

Question 79

79. 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

Answer 79

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.

Question 80

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

Answer 80

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.

Question 81

81. 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

Answer 81

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.

Question 82

82. 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

Answer 82

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).

Question 83

83. 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

Answer 83

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.

Question 84

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

Answer 84

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.

Question 85

85. 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

Answer 85

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.

Question 86

86. Normal life span of red blood cells: A. 80 days B. 60 days C. 160 days D. 120 days

Answer 86

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.

Question 87

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

Answer 87

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.

Question 88

88.A reticulocyte index greater that 2.5 indicates: A. Hemolysis and bleeding only B. Abnormal red cell morphology C. Bleeding D. Hemolysis

Answer 88

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.

Question 89

89.A reticulocyte index of less than 2.5 indicates: A. Bleeding B. Hemolysis and bleeding only C. Abnormal red cell morphology D. Hemolysis

Answer 89

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.

Question 90

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

Answer 90

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.

Question 91

91. 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

Answer 91

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.

Question 92

92. 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

Answer 92

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.

Question 93

93. 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

Answer 93

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.

Question 94

94. 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

Answer 94

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.

Question 95

95. 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

Answer 95

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.

Question 96

96. 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

Answer 96

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.

Question 97

97. 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

Answer 97

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.

Question 98

98. 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

Answer 98

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.

Question 99

99. 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

Answer 99

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.

Question 100

100. 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

Answer 100

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.