Pance Questions 11 Flashcards
1
Q
- Which of the following arteries provides blood supply to the heart itself?
a. Left circumflex
b. Right marginal
c. Left anterior descending
d. All of the above
A
- D: All of the above. The coronary arteries supply oxygen-rich blood to the myocardium. The arteries originate from the aorta, stemming off just after the aorta exits the left ventricle. There is
2
Q
- What is a Schilling test used for?
a. Detecting the presence of antibodies on the surface of RBCs
b. Testing for iron deficiency
c. Determining whether vitamin B12 is being absorbed normally
d. Measuring different types of hemoglobin in the blood
A
- C: Determining whether Vitamin B12 is being absorbed normally. The test is done in several different stages, where patients are given radioactive and nonradioactive B12 orally and by injection and then in combination with other substances. Urine is collected to measure if Vitamin B12 is normally absorbed. Low B12 can occur from lack of intrinsic factor due to pernicious anemia, malabsorption, bacterial overgrowth, or pancreatic insufficiency. Answer choice A describes the Coombs test. Answer choice B is related to the total iron binding capacity, and answer choice D describes hemoglobin electrophoresis.
3
Q
- A 17-year-old male adolescent has had fever, abdominal pain, and nausea for 4 days. He notes that he had gone swimming in a local pond several weeks prior. He is not sexually active. On exam, he is noted to have jaundice of the eyes. His ALT is elevated. What is the most likely diagnosis?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
A
243. A: Hepatitis A. This is spread by the fecal-oral route and can be transmitted through contaminated food or water. Infections are self-limited and confer immunity to reinfection. There is no specific treatment. IgM antibodies are present with acute infection, and IgG antibodies persist afterwards, signifying immunity. IgG antibodies are also found in the blood after vaccination. HBV is usually transmitted through blood or sex, and HCV is commonly transmitted through blood. Hepatitis D is less common and co-occurs with HBV.
4
Q
- Which of the following is a risk factor for placenta previa?
a. Gestational diabetes
b. Use of oxytocin
c. Previous cesarean sections
d. Cervical cancer
A
- C: Previous cesarean sections. Placenta previa is an obstetric complication in which the placenta is implanted in the lower part of the uterus near the internal os. It usually happens during the second or third trimester and can lead to bright red vaginal bleeding. The exact cause is unknown although several risk factors have been identified. These include previous uterine damage (multiple pregnancies, abnormalities, surgeries, cesarean deliveries), smoking during pregnancy, increased maternal age, and twin pregnancy.
5
Q
- You have been treating patient with refractory depression who would like to try electroconvulsive therapy. What is a potential well-documented effect of the procedure that he should be aware of?
a. Development of obstructive sleep apnea
b. Increased risk of brain cancer
c. Cognitive and memory dysfunction
d. Chronic diarrhea
A
- C: Cognitive and memory dysfunction. Electroconvulsive therapy (ECT) is a psychiatric treatment in which seizures are induced in anesthetized patients. It is used for treatment of severe depression that has not responded to other modalities. The exact mechanism for how it works remains unknown. Proper informed consent should be obtained prior to the procedure.
6
Q
- A 27-year-old woman has had left eye redness for the past 3 days. On exam, you note conjunctival erythema and a yellowish discharge from the eye with crusting. Vision is intact, and nasal passages are clear. How do you treat this patient?
a. Moxifloxacin
b. Betadine
c. Diphenhydramine
d. Olopatadine
Chloramphenicol
A
- A: Moxifloxacin. Conjunctivitis, also known as pink eye, is inflammation that can be caused by bacteria, viruses, or allergies. This patient likely has bacterial conjunctivitis due to the presence of purulent eye discharge. It is commonly caused by staphylococci or streptococci, and is highly contagious. Viral conjunctivitis usually presents with watery discharge and lymphadenopathy. Steroids may be helpful, and povidone-iodine (Betadine) is sometimes used off-label in treatment. Allergic conjunctivitis would be bilateral and accompanied by other allergy symptoms such as itchy eyes, congestion, and sneezing. It can be alleviated with antihistamines such as olopatadine.
7
Q
- What is the basic pathophysiology of shock?
a. Low blood pressure
b. Excess norepinephrine
c. Inadequate cellular oxygen supply
d. Retention of fluids
A
- C: Inadequate cellular oxygen supply. The causes of shock may differ (decreased blood volume, decreased cardiac output, vasodilation) but the pathophysiology is the same. Patients with low blood pressure are not necessarily in shock, although low blood pressure can be a sign of shock. Shock is hypoperfusion of vital tissues that causes inadequate oxygen supply so that cells shift to anaerobic metabolism, leading to accumulation of lactic acid and cellular dysfunction. The body makes attempts to compensate, including vasoconstriction and increased retention of water and sodium. Patients can present with altered mental status, tachycardia, tachypnea, cyanosis, diaphoresis, and weak pulses. Persistent shock leads to irreversible damage and cell death.
8
Q
- At what gestational age are maternal serum genetic screening tests usually offered to pregnant women?
a. 15-20 weeks
b. 21-24 weeks
c. 24-28 weeks
d. 28-32 weeks
A
- A: 15-20 weeks. Maternal serum screening can identify women at increased risk of having a child with a neural tube defect, Down syndrome, or trisomy 18. Elevated levels of maternal alpha-fetoprotein suggest spina bifida or anencephaly. The “triple screen” can detect risk of Down syndrome by testing alpha-fetoprotein, beta-human chorionic gonadotropin, and estriol. Some labs include inhibin A for a “quad screen.
9
Q
- You are performing CPR and notice that the chest is not rising whenever you do rescue breaths. You ensure that the head and neck are in the right position, but you are still not seeing chest movement. What is a possible reason for this?
a. Drug overdose
b. Cardiac arrest
c. Pulmonary hemorrhage
d. Foreign body aspiration
A
- D: Foreign body aspiration. Obstruction with a foreign body will cause marked resistance when doing mouth-to-mouth or bag ventilation. If the object is not able to be removed in the oropharynx, then the Heimlich maneuver or chest compressions will need to be done.
10
Q
- All of the following medications are nephrotoxic EXCEPT:
a. Gentamicin
b. Amphotericin B
c. Mycophenolate
d. Penicillin
A
- C: Mycophenolate. This medication is an immunosuppressant used to prevent organ transplant rejection. Certain medications can cause subtle injury to the kidneys or overt renal failure. The kidney’s role in filtration exposes cells to significant concentrations of drugs, which can lead to changes in function and structure. Damage can be reversible or chronic. Gentamicin and amphotericin B can cause tubular toxicity, and penicillin can cause interstitial inflammation.
11
Q
- A 50-year-old man with a history of rheumatic fever arrives for follow-up. Upon exam, you hear a holosystolic murmur at the heart apex. What does this signify?
a. Aortic regurgitation
b. Mitral stenosis
c. Aortic stenosis
d. Mitral regurgitation
A
- D: Mitral regurgitation. This is when the mitral valve between the left atrium and left ventricle is incompetent, so that blood flows backwards during systole. Rheumatic fever is a common cause for this condition. Aortic stenosis produces a crescendo-decrescendo ejection murmur best heard at the left upper sternal border. Aortic regurgitation is when blood is flowing in the wrong direction from the aorta back into the left ventricle— it would cause a diastolic murmur. Mitral stenosis is a narrowing of the valve between the left atrium and left ventricle, and the rumbling murmur would also occur during diastole.
12
Q
- You are seeing a patient who was recently diagnosed with exocrine pancreatic cancer. He has been told that surgery is not an option. You are having a discussion about end-of-life care, and he wants to know what his 5-year survival rate is. What is the approximation you tell him?
a. 5%
b. 25%
c. 40%
d. 65%
A
- A: 5%. Patients with pancreatic cancer present with abdominal pain, loss of appetite, weight loss, and jaundice. They have a poor prognosis because disease is often advanced when they are diagnosed. The majority of patients are surgically unresectable. Symptomatic treatment is important. Depending on the stage of cancer, 5-year survival rate is roughly between 1% and 15%. If the cancer is localized and able to be removed surgically, 5-year survival rate can approach 25%.
13
Q
- Which of the following is a correct pairing?
a. Cranial nerve I - optic
b. Cranial nerve IV - trigeminal
c. Cranial nerve VIII - vestibulocochlear
d. All of the above
A
- C: Cranial nerve VIII – vestibulocochlear. Cranial nerve I is the olfactory nerve, and cranial nerve IV is the trochlear nerve. The optic nerve is cranial nerve II, and the trigeminal nerve is cranial nerve V.
14
Q
- You are ordering fasting labs for a patient as part of routine follow-up. What is the range for diagnosis of of impaired fasting glucose according to the American Diabetes Association?
a. < 100 mg/ dL
b. 100-125 mg/ dL
c. 126-140 mg/ dL
d. > 140 mg/ dL
A
- B: 100-125 mg/ dL. A patient is considered to have impaired fasting glucose if the lab value is between 100 and 125 mg/ dL. This is also known as pre-diabetes. Less than 100 mg/ dL is considered normal. Diabetes can be diagnosed if fasting plasma glucose is 126 mg/ dL or greater, if oral glucose tolerance test is 200 mg/ dL or greater, or if hemoglobin A1c is 6.5% or greater.
15
Q
- A 32-year-old male patient has been in a cast for a tibial fracture. Today he presents with excruciating pain in the anterior leg. On exam, the leg is pale and pulses are weak. His report of pain seems to be out of proportion to what is found on physical exam. What is the most likely diagnosis?
a. Peripheral arterial disease
b. Deep venous thrombosis
c. Fibula fracture
d. Compartment syndrome
A
- D: Compartment syndrome. This occurs usually after an injury when bleeding or swelling of the tissues increases pressure within a compartment of the body. The fascia layers do not stretch, so blood flow is compromised, which can cause ischemia and lead to further edema. Compartment syndrome presents similarly to peripheral arterial disease, in that there can be paresthesia, pallor, and pulselessness. However, with compartment syndrome the pain is usually out of proportion to what is expected. It is an emergency and requires fasciotomy to relieve the pressure.
