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.