Med 1 - Finals Flashcards
- True statements on the NEW definition of Fever of Unknown origin EXCEPT:
A. fever >38.3C or 101F on at least 2 occasions
B. no known immunocompromised state
C. must be admitted at the hospital for 2 weeks with extensive diagnostic work-up
D. illness duration of 3 weeks or more
C. must be admitted at the hospital for 2 weeks with extensive diagnostic work-up
The definition of Fever of Unknown Origin (FUO) has been updated over time. The typical criteria include a fever of >38.3°C on several occasions, lasting for at least three weeks, with no clear diagnosis after one week of inpatient investigation or two to three outpatient visits. The statement about needing to be hospitalized for two weeks is not a standard part of the definition.
- The following are indications for further evaluation in a patient with dehydration secondary to profuse diarrhea EXCEPT:
A. Bloody stools, elderly, and immunocompromised
B. presence of community outbreaks and failure to improve after 48 hours
C. fever and recent antibiotic use
D. none of the above
D. none of the above.
All options listed are valid reasons for further evaluation in dehydration secondary to diarrhea. These include risk factors and signs of potentially severe or complicated conditions.
- The most common malignant cause of unintentional weight loss is:
A. gastrointestinal malignancy
B. osteosarcoma
C. hematologic
D. breast cancer
A. gastrointestinal malignancy.
Unintentional weight loss is often associated with malignancies, with gastrointestinal cancers such as those of the pancreas, stomach, and esophagus being among the most common causes.
- True or false: A palpable spleen always indicates the presence of a disease.
A. Maybe
B. True
C. False
C. False.
While a palpable spleen can indicate underlying disease, it is not always the case. In some individuals, particularly those who are slim, a normal spleen may be palpable without any disease.
- Hematuria may be caused by:
A. nephrolithiasis
B. tuberculosis
C. prostatitis
D. all of the above
D. all of the above.
Hematuria can be caused by a variety of conditions affecting the urinary tract or kidneys, including nephrolithiasis (kidney stones), tuberculosis affecting the genitourinary system, and prostatitis.
- A patient with diabetes insipidus was admitted due to signs of dehydration secondary to hypovolemia. Serum sodium was elevated at 150 mg/dl. Which resuscitation fluid is most appropriate for this case?
A. D5 water
B. albumin infusion
C. normal saline solution
D. lactated ringer’s solution
A. D5 water.
For a patient with hypernatremia and diabetes insipidus, hypotonic fluids such as D5W (5% dextrose in water) are typically used to carefully correct the sodium imbalance.
- A 29-year-old construction worker sought ER consultation due to vomiting of 3 days duration. He had undocumented weight loss. He claimed he wants to eat but keeps vomiting previously ingested food within one hour of eating. The patient is severely dehydrated with blood pressure of 90/60, tachycardic with thready pulse. The problem is most likely secondary to:
A. gastroparesis with pyloric obstruction
B. colonic and distal intestinal obstruction
C. achalasia
D. Zenker’s diverticulum
A. gastroparesis with pyloric obstruction.
Given the symptoms of persistent vomiting soon after eating, gastroparesis with pyloric obstruction is a likely cause, potentially leading to delayed gastric emptying and mechanical blockage.
- False positive proteinuria on Dipstick test may be secondary to:
A. all of the above
B. pH 7.0
C. blood contamination
D. concentrated urine
A. all of the above.
Dipstick tests for proteinuria can give false positives under several conditions, including alkaline urine (high pH), presence of red blood cells (blood contamination), and highly concentrated urine.
- A patient sought consultation due to three (3) bouts of feculent vomitus. The underlying problem of this patient is:
A. colonic and distal intestinal obstruction
B. achalasia
C. pyloric obstruction with gastroparesis
D. Zenker’s diverticulum
A. colonic and distal intestinal obstruction.
Feculent vomitus, which is vomit with a fecal odor, is typically indicative of a distal intestinal obstruction, where the bowel contents have become stagnant and decomposed.
- Immediate hematologic finding in the first 2 weeks post-splenectomy EXCEPT:
A. thrombocytosis
B. aplastic anemia
C. leukopenia and thrombocytopenia
D. leukocytosis
C. leukopenia and thrombocytopenia.
In the immediate post-splenectomy period, typical hematologic findings include leukocytosis and thrombocytosis, not leukopenia (decrease in white blood cells) and thrombocytopenia (decrease in platelets). These are the opposite of what is commonly observed:
Leukocytosis (an increase in white blood cell count) and thrombocytosis (an increase in platelet count) are typical immediate responses following splenectomy.
Aplastic anemia (B) is a condition where the bone marrow fails to produce sufficient new cells to replenish blood cells and is not a direct or typical immediate consequence of splenectomy.
- Which of the following statements below is true regarding kidney function and creatinine levels?
A. the glomerular filtration rate is directly proportional to the urinary creatinine excretion and inversely proportional to the plasma creatinine.
B. the glomerular filtration rate is inversely proportional to the plasma creatinine and urinary creatinine excretion
C. the glomerular filtration rate is directly proportional to the plasma creatinine and urinary creatinine excretion
D. the glomerular filtration rate is directly proportional to the plasma creatinine and inversely proportional to the urinary creatinine excretion
A. the glomerular filtration rate is directly proportional to the urinary creatinine excretion and inversely proportional to the plasma creatinine.
A. The glomerular filtration rate (GFR) is inversely proportional to the plasma creatinine concentration—meaning, as GFR decreases, plasma creatinine increases. GFR is also directly proportional to urinary creatinine excretion under steady state conditions. This means as GFR increases, more creatinine is cleared from the blood and excreted in the urine.
- The underlying cause of anemia in renal failure is:
A. iodine deficiency
B. folic acid deficiency
C. bone marrow failure
D. inadequate erythropoietin
D. inadequate erythropoietin.
In chronic renal failure, the kidneys’ ability to produce erythropoietin is compromised. Erythropoietin is crucial for the production of red blood cells in the bone marrow. Its deficiency leads to anemia, a common complication in chronic kidney disease.
- A patient sought consultation due to difficulty in swallowing. He was diagnosed with GERD 15 years prior to consultation and has been symptomatic but was lost to follow-up and was self-medicating PRN in between consultations. His last consultation was 10 years ago. The dysphagia is most likely due to:
A. peptic stricture
B. chemical pneumonitis
C. eosinophilic esophagitis
D. Schatzi ring
A. peptic stricture.
Chronic GERD can lead to the formation of a peptic stricture, which is a narrowing of the esophagus due to scar tissue formed as a result of prolonged acid exposure. This would explain the progressive difficulty in swallowing solid foods.
- A 65-year-old male complained of progressive difficulty of breathing aggravated by physical exertion. He had a non-productive cough of 3 months duration. He denies any intake of maintenance medications, no history of diabetes or hypertension. He is a smoker 10 sticks a day for 20 years. On examination, the patient was tachypneic, with wheezes on both lung fields, hyperresonant on both lung fields. Chest x-ray showed widened intercostal spaces, a tubular heart, and flattening of the diaphragm. What is your diagnosis?
A. community-acquired pneumonia
B. Pneumothorax
C. chronic bronchitis
D. emphysema
D. emphysema.
The symptoms and clinical findings—progressive breathlessness, non-productive cough, wheezing, hyperresonance on lung fields, and characteristic X-ray findings of widened intercostal spaces, tubular heart, and flattened diaphragm—are indicative of emphysema, a type of chronic obstructive pulmonary disease (COPD), especially given the history of long-term smoking.
- One of the most common causes of chronic diarrhea in adults is:
A. traveler’s diarrhea
B. lactase deficiency
C. abuse of laxatives for weight control
D. Option 4
B. lactase deficiency.
Lactase deficiency, or lactose intolerance, is a common cause of chronic diarrhea following the ingestion of dairy products in individuals who lack the enzyme lactase.
- Relative bradycardia or temperature-pulse dissociation can be seen in the following EXCEPT:
A. none of the above
B. leptospirosis
C. all of the above
D. brucellosis
E. Typhoid fever
A. none of the above.
Relative bradycardia, also known as Faget’s sign (temperature-pulse dissociation), is seen in conditions like typhoid fever, leptospirosis, and brucellosis. All options listed are correct, and thus, the option “none of the above” is the suitable answer.
- Occlusive or non-occlusive ischemic colitis often presents as:
A. vague abdominal pain localizing to the upper left quadrant of the abdomen
B. upper abdominal pain followed. by alternating diarrhea and constipation
C. lower abdominal pain preceding watery then bloody diarrhea
D. tenesmus with watery mucoid stools followed by constipation
C. lower abdominal pain preceding watery then bloody diarrhea.
Ischemic colitis typically presents with sudden onset of lower abdominal pain followed by the development of bloody diarrhea, reflecting colonic ischemia.
- The major causative factors of abdominal swelling EXCEPT:
A. fetus and fat
B. flatus and feces
C. none of the above
D. fluid and neoplasm
C. none of the above.
The classic causes of abdominal distension include the “Five Fs”: Fluid, Fetus, Fat, Feces, and Flatus. “Neoplasm” is also a recognized cause, so “none of the above” is correct.
- Blood parasite that has cyclical fever every four (4) days is:
A. Trypanosoma cruzi
B. Plasmodium malariae
C. Plasmodium falciparum
D. Plasmodium vivax
B. Plasmodium malariae.
Plasmodium malariae, one of the parasites that cause malaria, is known for causing a fever every 72 hours or every fourth day, known as a quartan fever.
- Which of the following does NOT exhibit volitional control?
A. emesis
B. rumination
C. regurgitation
D. all of the above
A. emesis
- A patient with renal impairment will develop symptoms of uremia when the estimated glomerular filtration rate is:
A. <30 mg/dL
B. <15 mg/dL
C. <45 mg/dL
D. <60 mg/dL
B. <15 mg/dL
Rationale: Uremic symptoms typically become apparent when the glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m², which indicates severe renal impairment or kidney failure.
- Failure of vitamin K to correct prothrombin time in a patient with multiple petechiae, palmar erythema, and jaundice is:
A. severe biliary obstruction
B. pancreatic head carcinoma
C. hemolysis
D. severe hepatocellular injury
D. severe hepatocellular injury
Rationale: In the presence of severe hepatocellular damage, such as in advanced liver disease, the liver’s ability to utilize vitamin K to synthesize clotting factors is compromised, hence vitamin K will not correct the prolonged prothrombin time.
- Indications for splenectomy include the following EXCEPT:
A. correction of cytopenias in immune-mediated hypersplenism
B. for diagnosis in unexplained splenectomy
C. for symptom control
D. staging in Hodgkin’s disease for stage I and II where radiotherapy is contemplated
B. for diagnosis in unexplained splenectomy
- A 55-year-old patient complained of sudden onset of difficulty of breathing. He was diagnosed with pulmonary tuberculosis two (2) weeks prior to consultation and was taking quadruple anti-TB medications with good compliance. On examination, the patient was in distress, tachypneic, clear breath sounds on the right lung, absent breath sounds on the left lung, hyperresonant on the left lung. What is the most likely cause of the problem?
A. pleural effusion
B. pneumothorax
C. pulmonary congestion
D. pulmonary consolidation
B. pneumothorax
Rationale: The clinical findings of distress, tachypnea, absent breath sounds on one side, and hyperresonance suggest pneumothorax, likely a complication related to the underlying lung disease or a side effect of treatment.
- Vaccinations recommended prior to elective splenectomy EXCEPT:
A. Pneumococcal vaccination
B. vaccination against H. influenzae
C. none of the above
D. vaccination against Neisseria meningitidis
C. none of the above
Rationale: Vaccinations against pneumococcal diseases, H. influenzae type b, and Neisseria meningitidis are all recommended prior to splenectomy to prevent severe infections, given the spleen’s role in fighting encapsulated bacteria.
- A patient sought consultation due to coughing of one (1) week duration. He noticed that initially the cough was triggered by food or fluid intake which progressed to coughing even with swallowing without any food or fluid intake. The underlying problem is probably secondary to:
A. gastroesophageal reflux disease
B. tracheobronchial fistula
C. pulmonary malignant new growth
D. achalasia
B. tracheobronchial fistula
Rationale: The progression from cough triggered by food or fluid intake to cough during swallowing suggests a possible tracheobronchial fistula, where there is an abnormal connection between the trachea and the esophagus.
- Neurologic disorder associated with chronic constipation:
A. spinal cord injury
B. all of the above
C. parkinsonism
D. multiple sclerosis
B. all of the above
Rationale: Chronic constipation can be associated with various neurological disorders including spinal cord injuries, parkinsonism, and multiple sclerosis due to effects on autonomic and voluntary control of bowel movements.
- A 25-year-old student sought consultation due to generalized body weakness. She is complaining of progressive easy fatigability with ordinary physical activities of 3 months duration. She denies any change in bowel or bladder habits, no weight change, no change in menstrual cycle. She has insomnia but attributes the lack of sleep from studying for the finals. On examination, she has pale palpebral conjunctivae, anicteric sclerae, with a grade 3/6 murmur at the fourth intercostal space parasternal border. Her palms and soles are pale, with good +2 pulses. Her palmar crease is lighter than the surrounding skin. What is the possible hemoglobin level of this patient?
A. 12 g/dL
B. 10 g/dL
C. 8 g/dL
D. 14 g/dL
C. 8 g/dL
Rationale: The description of progressive easy fatigability, pale conjunctivae and palmar creases, along with a murmur suggest significant anemia. A hemoglobin level of 8 g/dL is consistent with moderate anemia, which aligns with these clinical signs.
- Minimental status examination should be given to elderly patients with unintentional weight loss to identify the presence of:
A. schizophrenia
B. anorexia nervosa and bulimia
C. dementia
D. major depressive disorder with suicidal ideation
C. dementia
Rationale: A Mini-Mental State Examination (MMSE) is a brief test used to screen for cognitive impairment and is appropriate to identify dementia in elderly patients presenting with unintentional weight loss, among other symptoms.
- Non-gastrointestinal disorders that may cause nausea and vomiting include the following:
A. meningitis and intracranial hemorrhage
B. myocardial infarction with or without symptoms of heart failure
C. orthopedic surgery
D. all of the above
D. all of the above
Rationale: Nausea and vomiting can be caused by a variety of non-GI conditions including central nervous system issues such as meningitis, cardiovascular events like myocardial infarction, and even post-operatively, such as after orthopedic procedures.
- The most common cause of ascites is:
A. kwashiorkor
B. nephrotic syndrome
C. cirrhosis
D. cardiac ascites
C. cirrhosis
Rationale: Cirrhosis is the leading cause of ascites. It results from increased pressure in the blood vessels of the liver (portal hypertension) and a decrease in albumin synthesis, which disturbs the fluid balance, leading to fluid accumulation in the abdominal cavity.
- Most common cause of fever of unknown origin is:
A. atypical presentation of an infection
B. vasculitis
C. neoplasm
D. rheumatoid arthritis
A. atypical presentation of an infection
Rationale: Infections are the most common cause of fever of unknown origin (FUO), particularly when they present atypically. This can include infections hidden in the abdomen, pelvis, or bone that are not immediately evident.
- Jaundice is a sign of the following conditions EXCEPT:
A. none of the above
B. hemolytic disorders
C. liver disease
D. disorders of bilirubin metabolism
A. none of the above
Rationale: Jaundice can indeed be a sign of hemolytic disorders, liver disease, and disorders of bilirubin metabolism. All of these conditions can cause an increase in bilirubin levels, leading to jaundice.
- A patient with lymphadenopathy can be given steroids when:
A. reduction in size is necessary prior to excision biopsy
B. there is pharyngeal obstruction that interferes with respiration
C. steroids can alleviate the pain
D. diagnosis is uncertain
B. there is pharyngeal obstruction that interferes with respiration
Rationale: Steroids can be used to quickly reduce inflammation and swelling in cases where lymphadenopathy causes acute complications such as airway obstruction. It’s crucial to manage such life-threatening conditions swiftly.
- Chylous ascitic fluid during paracentesis means:
A. lymphatic damage due to trauma
B. lymphatic disruption from cirrhosis, tumor, or tuberculosis
C. all of the above
D. triglyceride level >200mg/dl and often >1000mg/dL
C. all of the above
Rationale: Chylous ascites indicates lymphatic damage or disruption, which can be caused by trauma, tumors, cirrhosis, or infections such as tuberculosis. It’s characterized by a milky appearance of the ascitic fluid and high triglyceride levels.
- A patient with fever, abdominal pain, and jaundice sought consultation at the ER. The gold standard for identifying choledocholithiasis is:
A. endoscopic retrograde cholangiopancreatography
B. endoscopic ultrasound
C. whole abdominal ultrasound
A. endoscopic retrograde cholangiopancreatography (ERCP)
Rationale: ERCP is the gold standard for diagnosing and often treating choledocholithiasis as it allows both visualization and intervention, such as stone removal.
- A patient complained of epigastric pain radiating to the back. The patient was positive for Murphy’s sign. What is the cause of the abdominal pain?
A. glomerulonephritis
B. nephrolithiasis
C. alcoholic liver disease
D. Acute cholecystitis
D. Acute cholecystitis
Rationale: A positive Murphy’s sign is indicative of acute cholecystitis, which is inflammation of the gallbladder. This condition typically presents with epigastric pain radiating to the back.
- Signs of advanced alcoholic liver disease include:
A. asterixis, spider nevi, parotid gland enlargement
B. testicular atrophy and palmar erythema
C. all of the above
D. gynecomastia, Dupuytren’s contracture
C. all of the above
Rationale: Advanced alcoholic liver disease can manifest with a variety of signs including asterixis (flapping tremor of the hands), spider nevi, parotid gland enlargement, testicular atrophy, palmar erythema, gynecomastia, and Dupuytren’s contracture.
- A 45-year-old female was complaining of multiple palpable nodes at the supraclavicular area. Transvaginal ultrasound was normal and negative pregnancy test. She has no cough, no fever, denies any weight loss. She does not have diabetes or hypertension. What is the possible cause of the supraclavicular lymphadenopathy?
A. Sister Mary Joseph’s nodes indicative of Laennec’s cirrhosis
B. Virchow’s nodes suggestive of intraabdominal malignancy
C. None of the above
D. Sister Mary Joseph’s nodes suggestive of intraabdominal malignancy
B. Virchow’s nodes suggestive of intraabdominal malignancy
Rationale: Virchow’s nodes, found in the left supraclavicular area, are classically associated with intraabdominal malignancies, particularly those of the stomach, as part of the lymphatic drainage from the abdominal cavity.
- Which of the medications listed is associated with chronic constipation?
A. calcium channel blockers
B. angiotensin receptor blockers
C. aspirin
D. nitrates
A. calcium channel blockers
Rationale: Calcium channel blockers are known to cause constipation as a side effect. They reduce the contraction of the smooth muscles in the intestines, thereby slowing intestinal motility.
- A 65-year-old female collapsed at the lobby of the hospital after visiting a friend at the ICU. She was rushed to the ER, BP was 30 palpatory, and the ECG tracing showed the following (see image). What is the first thing that must be done?
A. defibrillation
B. schedule for pacemaker insertion
C. give Atropine 1 mg IV
D. cardioversion
A. defibrillation
Rationale: Assuming the ECG shows a shockable rhythm such as ventricular fibrillation or pulseless ventricular tachycardia, immediate defibrillation is the most critical and lifesaving step.
- An 18-year-old was complaining of recurrent palpitations. During the interview, the patient again had another episode of palpitations. Rhythm strip showed the attached ECG tracing. BP is 120/70mmHg, RR 20 CPM, afebrile, clear breath sounds. What is the first thing that you should do in this case?
A. give isosorbide dinitrate 5 mg sublingual
B. check for absence of carotid bruit and do carotid massage
C. schedule patient for pacemaker insertion
D. schedule patient for implantable cardiac defibrillator
B. check for absence of carotid bruit and do carotid massage
Rationale: Carotid massage can be attempted in a stable patient to assess and potentially terminate certain types of supraventricular tachycardia (SVT) if no carotid bruits are present (which would suggest carotid artery disease).
The ECG strip you provided shows a regular rhythm with each QRS complex being preceded by a P wave, and the rate appears to be relatively fast. The consistent pattern without dropped beats or significant irregularity suggests a tachyarrhythmia, likely a supraventricular tachycardia (SVT) given the age and symptoms of the patient.
Given this information and the options provided, the appropriate initial management in this clinical scenario would be:
- Correct Answer: B. check for absence of carotid bruit and do carotid massage.
Rationale:
1. Carotid Massage: This non-invasive procedure can be an effective first-line intervention for certain types of supraventricular tachycardia (SVT). It acts by stimulating the vagus nerve, which can help slow the heart rate and potentially terminate the tachycardia. This maneuver should only be performed after ensuring there is no carotid bruit, which could indicate carotid artery disease, making manipulation of the carotid artery potentially dangerous.
-
Alternative options:
- Isosorbide dinitrate: This would not be appropriate as it is typically used for angina (chest pain due to heart disease) and not for arrhythmias.
- Pacemaker insertion: This is generally used for bradyarrhythmias (slow heart rates) and not for managing acute tachycardia.
- Implantable cardiac defibrillator (ICD): An ICD is for life-threatening ventricular arrhythmias, not typically indicated in the acute management of SVT in a young, otherwise healthy individual.
The use of carotid massage here serves as a diagnostic and potentially therapeutic tool in a controlled setting where the patient can be monitored for response and any adverse effects. If this maneuver fails to resolve the palpitations or if the patient’s condition worsens, immediate medical intervention and further cardiac evaluation might be necessary.
- Identify the attached ECG strip.
A. sinus rhythm with premature atrial contraction with compensatory pause
B. second degree atrioventricular block Mobitz type 1
C. second degree atrioventricular block Mobitz type 2
D. third degree atrioventricular block
B. second degree atrioventricular block Mobitz type 1
This strip demonstrates a pattern where most P waves are followed by QRS complexes, but with some P waves not followed by QRS complexes, suggesting an AV block. The PR interval appears to lengthen progressively until a QRS complex is dropped. This pattern is indicative of a second degree AV block, specifically Mobitz Type I (Wenckebach).
- A patient at the ER suddenly complained of chest pains and palpitations. The patient was immediately hooked to the cardiac monitor which showed the attached tracing. What is the management for this case?
A. magnesium sulfate
B. defibrillation
C. pacemaker insertion
D. esmolol IV
A. magnesium sulfate
Rationale:
Magnesium Sulfate: This is the treatment of choice for Torsades de Pointes, even if blood magnesium levels are normal. Magnesium serves as an effective agent for terminating Torsades de Pointes by reducing the excitability of the myocardium, thereby stabilizing cardiac membranes and helping to restore normal rhythm.
- A patient was sent to your clinic due to ECG findings during her annual physical examination. Attached is the ECG strip. What is the correct management?
A. magnesium sulfate
B. pacemaker insertion
C. defibrillation
D. none of the above
D. none of the above
Rationale:
- A (Magnesium sulfate): There is no indication for magnesium sulfate, as there are no signs of torsades de pointes or hypomagnesemia-related arrhythmias.
- B (Pacemaker insertion): Not indicated as there is no evidence of bradyarrhythmia or heart block that would require pacing.
- C (Defibrillation): Not appropriate as there are no signs of ventricular fibrillation or unstable ventricular tachycardia.
- D (None of the above): This is the correct choice as the ECG shows a normal sinus rhythm without any abnormalities that would require intervention. The patient should continue routine observation and management as per usual health care guidelines, considering this ECG as part of a normal annual examination.
This ECG indicates a healthy heart rhythm, and no immediate cardiac interventions are required. However, it is always important to correlate ECG findings with the patient’s clinical symptoms and medical history to ensure comprehensive care.
- A 78-year-old female complained of recurring headache and bitemporal hemianopia. The lesion causing the blindness is located at the:
A. right optic nerve
B. right occipital lobe
C. optic chiasm
D. right perichiasmal area
C. optic chiasm
Rationale: Bitemporal hemianopia, where vision is lost in the outer half of both eyes, is typically caused by a lesion at the optic chiasm, often due to a pituitary tumor impinging on the optic nerves.
- A patient complained of left homonymous hemianopia. The lesion is located at the:
A. right optic tract
B. optic chiasm
C. right optic nerve
D. right occipital lobe
A. right optic tract
Rationale:
- Left homonymous hemianopia refers to the loss of the left visual field in both eyes. This type of visual field loss suggests a lesion that affects the right side of the visual pathway after the optic chiasm. This is because the right optic tract carries all the visual information from the left visual field of both eyes.
- Optic Chiasm (Option B): A lesion here typically causes bitemporal hemianopia (loss of the outer halves of the visual field in both eyes) due to the crossing of the nasal fibers from both eyes.
- Right Optic Nerve (Option C): Damage to the right optic nerve would lead to total blindness in the right eye only, not a field defect in both eyes.
- Right Occipital Lobe (Option D): While damage to the right occipital lobe can indeed cause a left homonymous hemianopia, the optic tract is generally more centrally located in the brain and more likely to affect both eyes uniformly, making it the more precise location for the described symptom.
Thus, a lesion in the right optic tract is the most accurate answer for the described symptom of left homonymous hemianopia, affecting the visual pathway post-chiasm, where fibers are no longer divided by hemifield from each eye but are instead completely contralateral.
- Headache is a common complaint of patients. Which of the following is a pain-producing cranial structure?
A. falx cerebri
B. pial veins
C. brain parenchyma
D. choroid plexus
A. falx cerebri
Pain-Producing Cranial Structures:
- Scalp
- Meningeal arteries
- Dural sinuses
- Falx cerebri
- Proximal segments of the large pial arteries
Non-Pain Producing Structures:
- Ventricular ependyma
- Choroid plexus
- Pial veins
- Brain parenchyma
- Which of the following neurologic findings points to lower motor neuron weakness?
A. (+) fasciculations, decreased muscle tone, severe muscle atrophy, absent Babinski sign
B. (+) spasticity, (+) Babinski sign, no fasciculations
C. no fasciculations, absent Babinski sign, proximal muscle weakness
D. absent Babinski sign, normal muscle stretch reflex, absent muscle atrophy
A. (+) fasciculations, decreased muscle tone, severe muscle atrophy, absent Babinski sign
Rationale: Lower motor neuron signs include fasciculations, decreased muscle tone, muscle atrophy, and a normal or absent Babinski sign.
- Diseases affecting the upper lumbar spine tend to refer pain to the following areas EXCEPT:
A. lumbar region
B. anterior thighs
C. buttocks
D. groin
C. buttocks
Rationale: Diseases affecting the upper lumbar spine (such as L1-L2) typically cause pain in the anterior thigh and groin region, not typically in the buttocks, which is more commonly associated with lower lumbar spine issues.
- Diseases affecting the lower lumbar spine tend to produce pain in the following areas:
A. buttocks
B. anterior thighs
C. groin
D. lumbar region
A. buttocks
Rationale: Conditions affecting the lower lumbar spine (such as L4-L5, L5-S1) tend to produce symptoms in the lower back and buttocks, often radiating down to the legs due to sciatic nerve irritation.
- A patient complained of low back pain and a straight leg-raising maneuver was done. Which side should the pain be reproduced if the nerve root affected is on the left?
A. ipsilateral
B. contralateral
C. pain is referred to the buttocks
D. none of the above
A. ipsilateral
- Rationale: The straight leg raise test, when positive, typically reproduces pain on the same side (ipsilateral) of the affected nerve root. If the affected nerve root is on the left, pain would be reproduced on lifting the left leg.
