Pance Questions 13 Flashcards
- You are about to perform a lumbar puncture on a patient with suspected meningitis. Between which vertebral levels should you insert the needle?
a. L3 and L4
b. L1 and L2
c. S1 and S2
d. S3 and S4
- A: L3 and L4. The needle can be inserted between L3 and L4 or between L4 and L5— these sites are below the termination of the spinal cord. The patient is placed in the lateral or prone position. The needle is passed in between the spinous processes into the epidural space, and further advancement punctures the dura and arachnoid matter. The needle enters the subarachnoid space and usually pushes away the spinal nerve roots without problems. Then cerebrospinal fluid can be aspirated for analysis.
- A 45-year-old woman has a painless lump in her neck. On exam, you note a thyroid nodule. Biopsy reveals thyroid cancer. What is the most likely type?
a. Follicular
b. Papillary
c. Medullary
d. Anaplastic
- B: Papillary. This accounts for 70% to 80% of thyroid cancers. It is usually seen in women 30-60 years of age. Most thyroid cancers present as asymptomatic nodules, and diagnosis is by fine-needle aspiration biopsy. Treatment is by surgical removal. Follicular and anaplastic carcinoma are more common among elderly patients. Medullary carcinoma is often familial.
- A 72-year-old woman arrives for routine follow-up. You notice that her height has actually decreased over the past few years. On exam, the mid to upper part of her back has a “hump” deformity. What does this patient have?
a. Scoliosis
b. Lordosis
c. Swayback
d. Kyphosis
- D: Kyphosis. This is an abnormal curvature of the vertebral column in the thoracic region. It can be caused by osteoporosis in elderly patients, producing a “dowager’s hump.” Scoliosis is an abnormal lateral curvature along with a rotational element. It may be present at birth or be a manifestation of a nerve condition, tumor, or disc protrusion. Lordosis is an abnormal curvature in the lumbar region, which is also called a swayback deformity.
- Which medication can be used to treat moderate pulmonary cryptococcosis in an immunocompromised patient?
a. Fluconazole
b. Nystatin
c. Terbinafine
d. Selenium
- A: Fluconazole. Cryptococcosis is a fungal infection usually seen in AIDS patients and other immunocompromised patients. Pulmonary infection may present with fever, cough, and shortness of breath. The infection can disseminate to the skin, meninges, joints, and internal organs. It is diagnosed by culture. The antifungal medications fluconazole or amphotericin B are used in treatment depending on the severity and spread of disease. Patients who are immunocompetent may not require treatment for localized pulmonary infection.
- What does ocular tonometry evaluate for?
a. Glaucoma
b. Strabismus
c. Cataract
d. Retinoblastoma
- A: Glaucoma. Tonometry is used to measure intraocular pressure. Different types of tonometers are used by eye care professionals. Glaucoma is a disease of the optic nerve related to abnormal drainage of aqueous humor, which can cause increased ocular pressure. This results in decreased vision in the peripheral fields and potential blindness.
- A 24-year-old woman arrives in the emergency department. She reports having food poisoning and says that she has been vomiting for the past 3 days, but today she noticed blood in her vomit. Upper endoscopy shows a superficial tear in the esophagus but no active bleeding. How do you treat this patient?
a. Prescribe omeprazole
b. No other intervention needed at this time
c. Order a barium esophagography
d. Laparotomy
- B: No other intervention needed at this time. This patient likely has a Mallory-Weiss tear, which is a superficial tear at the gastroesophageal junction caused by vomiting. The bleeding will usually stop on its own and will not require intervention.
- What is the approximate therapeutic range for lithium?
a. 5.2– 5.8 mEq/ L
b. 3.5– 4.5 mEq/ L
c. 1.5– 3.0 mEq/ L
d. 0.6– 1.2 mEq/ L
- D: 0.6– 1.2 mEq/ L. Lithium is used in the treatment of bipolar disorder. Serum lithium levels must be monitored to avoid toxicity. The lab should be drawn 8-12 hours after the patient’s last dose. Thyroid and renal function should also be monitored.
- A 21-year-old man has discharge from his penis and painful urination. You do a urethral swab wet mount and see flagellated pear-shaped organisms under the microscope. What does this signify?
a. Chlamydia
b. Trichomoniasis
c. Giardiasis
d. Gonorrhea
- B: Trichomoniasis. This is a sexually transmitted infection with the protozoan Trichomonas vaginalis. Men are usually asymptomatic, or they may have urethritis resulting in discharge or dysuria. The organism is harder to detect in men than women. It is treated with metronidazole. Giardiasis is also caused by a flagellated protozoan, but this organism causes infection of the gastrointestinal tract.
- You are examining a patient who has yellowing of the eyes, an enlarged spleen, spider angiomas, and a rounded firm abdomen with enlarged veins. What does this patient likely have?
a. Cirrhosis
b. Hepatitis A
c. Cholecystitis
d. HIV
- A: Cirrhosis. This is a liver disorder that can be confirmed histologically. It is characterized by widespread fibrosis due to cell damage. Causes include long-term alcohol abuse, chronic hepatitis B or C infection, biliary obstruction, and malnutrition. Increased pressure in the portal vein leads to splenomegaly and varicose veins. Progressive liver failure leads to fluid retention producing ascites. The inability to break down blood products manifests as jaundice. Patients are more at risk of bleeding because of decreased production of clotting proteins.
Q–15 Infectious Diseases The most common pathogen causing community acquired pneumonia (CAP) is
a. Streptococcus pneumoniae
b. Mycoplasma pneumoniae
c. Hemophilus influenza
d. Klebsiella pneumoniae
A–15 (A) Streptococcus pneumoniae causes 20–50% of the cases of CAP; Mycoplasma pneumoniae is responsible for 10–30%; Hemophilus influenza 5–10%; and Klebsiella pneumoniea 1–3% of the cases.
Q–16 Emergency Medicine The diagnosis of appendicitis is MOST likely to be missed in which age group?
a. 1–6 years
b. 11–20 years
c. Over 65 years
d. Both (A) and (C) are correct.
A–16 (D) Young children have difficulty in expressing their symptoms clearly and elderly patients may have a reduced inflammatory reaction, making diagnosis more difficult in these age groups. Appendicitis reaches its peak between the ages of 10 and 20, and approximately 80% of cases occur before the age of 45.
- *Q–17 Women’s Health/Reproductive** Which of the following antibiotics are known to cause fetal harm if given to a pregnant woman?
a. Azithromycin
b. Clindamycin
c. Gentamicin
d. Ceftriaxone
A–17 (C) Gentamicin and other aminoglycosides may be ototoxic to a fetus. The other drugs listed have no overt toxicity reported to date.
- *Q–18 Infectious Disease** In a sulfonamide allergic patient who has an uncomplicated cystitis due to Escherichia coli, the drug of choice is
a. bactrim DS
b. ampicillin
c. metronidazole
d. cephalexin
(B) Ampicillin is the drug of choice when the patient is allergic to sulfa drugs. Bactrim contains sulfamethoxazole. Neither metronidazole nor cephalexin would be considered in this patient.
Q–19
Cardiovascular Homocysteine is derived from the breakdown of essential amino acids and if elevated elevated > 12 mmol/L is an independent risk factor for heart and blood vessel disease. Elevated levels may be seen in patients taking
a. metformin
b. carbamazepine
c. oral contraceptives
d. all of the above
A–19 (D) All of the drugs listed may elevate homocysteine to > 15 mmol/l, which is a dangerous level.
Q–20 General Medicine/Radiology Increased whiteness on a CT scan is referred to as “hyperdensity” or high attenuation. All of the following are causes of hyperdensities EXCEPT
a. calcification
b. ossification
c. acute hemorrhage
d. fat
(D) Fat shows as increased darkness and is referred to as “hypodensity” or low attenuation. All the others show as hyperdensities.
