Pance Questions 15

Question 1

Q–56 Surgery

Success rates for a healthy pregnancy following reversal of fallopian tube ligation are reported to be between

a. 75–100%
b. 20–70%
c. 10–50%
d. 5–7%

Answer 1

A–56 (B) Success rates for a healthy pregnancy following reversal of tubal ligation approach 20–70%. However, there is an increased risk of ectopic pregnancy in women undergoing such procedures.

Question 2

Q–57 Women’s Health
The normal vaginal pH range of women during their reproductive age is
a. 6.5–8.5
b. 3.5–4.5
c. 5.0–7.0
d. 2.0–3.0

Answer 2

A–57 (B) Women during their reproductive years, have a vaginal pH between 3.5 and 4.5. Before puberty and after menopause, the vaginal pH ranges from 6–8.

Question 3

Q–58 Infectious Disease

You see a 28-year-old woman with a complaint of vaginitis. On physical examination, you observe a copious “frothy” discharge with a rancid odor along with petechiae in the upper vagina and on the cervix. Your most likely diagnosis is:

a. candidiasis
b. bacterial vaginosis
c. gonorrhea
d. trichomoniasis

Answer 3

A–58 (D) The above description fits most closely with a diagnosis of trichomoniasis. The pH of the vaginal discharge would probably be >4.5. Candidiasis presents with a white, “cottage cheese-like” discharge; bacterial vaginosis with a thin, gray to white, adherent discharge and a fishy odor. Gonorrhea causes a malodorous, purulent discharge which may be overlooked by the patient until pelvic infection occurs.

Question 4

Q–59 Infectious Disease

The most common sexually transmitted bacterial disease is

a. Chlamydia trachomatis
b. Neisseria gonorrhoeae
c. Herpes simples,
d. Type 2 HIV/AIDS

Answer 4

(A) Chlamydia trachomatis is the most common sexually transmitted bacterial disease. The most common STI overall is HPV.

Question 5

Q–60 Infectious Disease

You have an 18-year-old hospitalized patient with confirmed pelvic inflammatory disease secondary to Neisseria gonorrhea. Your initial therapy should be

a. streptomycin 500 mg every 12 hours
b. doxycycline 100 mg every 12 hours
c. ceftriaxone 250 mg IM every 12 hours plus doxycy-M cline 100 mg P.O. every 12 hours
d. cefoxitin 2 g IV every 6 hours plus doxycycline

Answer 5

A–60 (D) Patients sick enough to require hospitalization would more likely be treated with cefoxitin plus doxycycline. Choice (C) is more commonly used in an outpatient. Neither (A) nor (B), as single therapy, is recommended in pelvic inflammatory disease.

Question 6

Q–61 Infectious Disease

Which of the following statements about the human papillomavirus is/are correct?

a. It is a DNA virus.
b. It is species specific and only infects humans.
c. Sequelae of HPV infection may take years to develop.
d. All of the above are correct.

Answer 6

(D) All the statements are true.

Question 7

Q–62 Infectious Disease

The chancre of primary syphilis develops approximately 10–60 days after infection with Treponema pallidum. If left untreated, the ulcer will heal and secondary syphilis may develop within

a. 4–8 weeks after the primary chancre first appears
b. 2–3 weeks after the primary chancre first appears
c. 1–10 years after the primary infection
d. 6 months after the primary infection

Answer 7

A–62 (A) Four to eight weeks after the primary chancre appears, manifestations of secondary syphilis occur.

Question 8

Q–63 Dermatology

A patient comes to your clinic with complaints of malaise, anorexia, and an asymptomatic maculopapular rash. The rash has the appearance of “money spots.” You immediately think of which diagnosis?

a. Erythema multiforme
b. Secondary syphilis
c. Stevens-Johnson syndrome
d. Erythema nodosum

Answer 8

A–63 (B) Secondary syphilis is characterized by low-grade fever, headache, malaise, sore throat, anorexia, and a diffuse, symmetric, asymptomatic maculopapular rash sometimes referred to as “money spots.” The rash is usually seen on the palms and soles. Erythema multiforme is a type of allergic rash that appears in response to medications, illness, or infections. The lesions are often referred to as “target lesions” due to the concentric rings the lesions produce. Stevens-Johnson syndrome is a potentially deadly skin disease that usually results from a drug reaction. Erythema nodosum presents as reddish, painful lumps as it represents inflammation of fat423 e see cells under the skin.

Question 9

Q–64 Anatomy

Uterine procidentia describes a condition whereby the

a. uterus descends beyond the vulva
b. urethra becomes detached from the endopelvic fascia
c. small bowel herniates through the vaginal wall
d. uterus prolapses

Answer 9

A–64 (A) When the uterus descends beyond the vulva, it is termed uterine procidentia.

Question 10

Q–65 Urology

All of the following are surgical procedures used in treating urinary incontinence incontinence EXCEPT the

a. Burch suspension
b. S-lift
c. Kelly-Kennedy procedure
d. Marshall-Marchetti-Krantz procedure

Answer 10

A–65 (B) The S-lift is a mini-facelift that provides an overall lift to the neck and lower third of the face.

Question 11

Q–66 Infectious Disease

In laboratory evaluation of a patient suspected of having a urinary tract infection, cultures of urine samples that show colony counts of more than for a single organism generally indicate infection.

a. 10,000
b. 50,000
c. 100,000
d. 500,000

Answer 11

A–66 (C) Colony counts of more than 100,000 for a single organism generally indicate infection. However, counts as low as 10,000 for E. coli are associated with infection when symptoms are present.

Question 12

EQ–67 Women’s Health

• *E**ndometriosis is a common finding in women with infertility and it has various clinical presentations. The “gold standard” in making a diagnosis of endometriosis is
  a. a complete medical history
  b. a complete physical examination
  c. a CT scan of the pelvic floor
  d. none of the above

Answer 12

A–67 (D) Precisely because of the diverse presentations of endometriosis, establishing a diagnosis requires direct visualization of the lesions either at the time of laparoscopy or via tissue biopsy.

Question 13

Q–68 Surgery
Extirpative surgery for endometriosis is reserved for which kind of cases?
a. Women who wish to become pregnant in the future.
b. Women whose disease is very extensive.
c. Women who have completed their family and wish definitive therapy.
d. Both (B) and (C) are cases for extirpative surgery.

Answer 13

A–68 (D) Extirpative or definitive surgery is reserved only for cases in which the disease is so extensive that conservative therapy is not feasible and there is a presence of intractable pelvic pain or in women who have completed their family and wish definitive therapy.

Question 14

Q–69 Women’s Health
A 27-year-old woman presents with a spontaneous bloody nipple discharge. She has no previous personal history or family history of breast cancer. The most likely diagnosis is
a. mastalgia
b. fibroadenoma
c. cancer
d. intraductal papilloma

Answer 14

A–69 (D) Intraductal papillomas are fibrovascular tumors arising in the ducts of the breast. The patient presents with a spontaneous bloody, serous, or cloudy nipple discharge. Mastalgia refers to pain in the breast. A fibroadenoma is usually a solitary lesion that is slow growing that may need excision but often is managed medically. Breast cancers most often present as a mass initially, and discharge is a late occurrence associated with poor prognosis.

Question 15

Q–70 Surgery
An endometrial ablation refers to
a. a surgical procedure to resect the endometrial lining to reduce menstrual bleeding
b. a procedure to evaluate the surface of the cervix when malignancy is suspected
c. the delivery of highly energetic light beams to the endometrium to facilitate tissue destruction
d. the passage of a small, hollow tube through the cervix with subsequent aspiration of endometrial tissue for examination.

Answer 15

A–70 (A) Answer (B) refers to a colposcopy, (C) to laser vaporization, and (D) to endometrial biopsy.

????????????? I think this is wrong!!!!!!!!!!!

Question 16

Q–71 Psychiatry
To treat a psychiatric patient effectively, the interviewer must make a reliable and accurate diagnosis. Which of the following interviewing skills/techniques would be appropriate in interacting with such a patient?
a. Question the patient in terms of genetic, temperamental, biological, developmental, social, and psychological influences in his/her life.
b. Placing chairs without any furniture between the clinician and the patient.
d. Leaving the door to an interview room open.
d. All of the above are appropriate techniques when interviewing a psychiatric patient.

Answer 16

A–71 (D) Depending upon the presentation of the patient, all of the mentioned techniques may be useful. The clinician must learn as much as possible about the patient while building trust with the patient. The manner in which furniture is arranged helps to build trust. For example, the chairs should be of equal height so neither person looks down on the other. If the patient is potentially dangerous, it is appropriate to leave the door to the interview room open and even to post a third individual outside or even inside the door. For legal and medical reasons, an adequate written record of the patient’s treatment must be maintained. Taking notes during the interview is also appropriate.

Question 17

Q-72

Women’s Health A peau d ’orange appearance of the skin of the breast indicates

a. edema of breast caused by blocked lymph drainage
b. advanced or inflammatory carcinoma
c. previous radiation treatments for breast cancer both
d. (A) and (B) are correct answers

Answer 17

A–72 (D) A peau d’orange discoloration of the breast indicates carcinoma and is caused by blockage of lymph drainage. Previous radiation of the skin as needed for treatment of breast cancer may result in redness of the skin.

Question 18

Q–73 Psychiatry

Which of the following procedures can be used to induce a panic attack in a patient with panic disorder?

a. Dexamethasone Suppression Test
b. Ice-water lavage
c. Lactate provocation
d. Have the patient eat a banana, avocado, or other foods high in serotonin.

Answer 18

A–73 (C) Up to 72% of patients with panic disorder have a panic attack when administered an IV injection of sodium lactate. This test may also be used to trigger flashbacks in patients with post-traumatic stress disorder.

Question 19

Q–74 Psychiatry

Which of the following substances can be detected by a urine drug screen?

a. Amphetamines
b. Marijuana c. Barbiturates
d. All of the above

Answer 19

A–74 (D) All the substances can be detected by a urine drug screen. Accuracy of the test, however, depends on the length of time since the patient encountered the substance.

Question 20

Q–75 Psychiatry

Which of the following statements most closely identifies delirium?

a. An unpleasant mood
b. Inability or difficulty in describing or being aware of one’s emotions or mood
c. Bewildered, confused, disoriented reaction associated with fear and hallucination
d. Increased motor and psychological activity that is unpleasant

Answer 20

A-75 (C) Response (A) describes dysphoria; response (B) describes alexithymia, and response (D) is descriptive of tension.

Question 21

Q–76 Neurology
Which of the following best describes absence seizures?
a. No disruption in consciousness; onset during childhood; a partial seizure
b. Consciousness is interrupted; manifested by isolated jerks; onset during childhood
c. Onset in childhood; disruption of consciousness; no convulsive movements
d. A generalized seizure; onset in early adulthood; convulsive movements present

Answer 21

A–76 (C) Absence (petit mal) seizures are a type of generalized seizure that usually begins between the ages of five and seven years and ceases by puberty. The patient has brief disruptions of consciousness but does not lose consciousness altogether. He/she may or may not have twitching of the eyes or slight jerking movements.

Question 22

Q–77 Neurology

Multiple sclerosis is characterized by which of the following?

a. Lesions are present in the white matter of the central nervous system.
b. It is more common in men than women.
c. It has an onset in the 40–50 age group.
d. It is associated with cognitive symptoms but not with behavioral symptoms.

Answer 22

A–77 (A) Multiple sclerosis is characterized by many symptoms, pathophysiologically related to multifocal lesions in the white matter of the CNS. It is more common in women, with onset more often between the ages of 20 and 40 years. It is associated with both cognitive and behavioral symptoms.

.

Question 23

Q–78 Neurology
Creutzfeldt-Jakob disease is:
a. a degenerative brain disease thought to be caused by a slow virus infection
b. a genetic disorder characterized by an accumulation of fatty acid derivatives in the brain
c. an inherited neurological disease characterized by motor and sensory neuropathy
d. a hereditary muscle disease that weakens the muscles that move the body

Answer 23

A–78 (A) Creutzfeldt-Jakob disease is a rare degenerative brain disease thought to be caused by a slow virus infection, although a definitive organism has not been identified in people with the disease. It usually first appears between ages 20 and 70, with the average age of the onset of symptoms in the late 50s, and death usually occurs within one year of diagnosis. Answer (B) is descriptive of Tay-Sachs disease and answer (C) of Charcot-Marie-Tooth disease. Answer (D) is descriptive of muscular

Question 24

Q–79 Gastroenterology/Neurology

A father brings in his 31-year-old son, Robert, who is apathetic. The father states that Robert sleeps all day and is awake at night. He further states that Robert has been drinking alcohol heavily for the past couple of years. On physical examination, you note asterixis, and the laboratory evaluation of ammonia is elevated. A diagnosis you must consider is

a. Reye’s syndrome
b. uremic encephalopathy
c. hepatic encephalopathy
d. muscular exertion

Answer 24

A–79 (C) In this scenario, the most likely diagnosis is hepatic encephalopathy. Reye’s syndrome is seen in children but may also cause an elevation in ammonia levels. There is no history to indicate uremic encephalopathy such as renal failure.Muscular exertion can elevate ammonium levels but would not be associated with asterixis.

Question 25

Q–80 Infectious Disease

Which of the following criteria may be used for a case definition of AIDS?

a. CD4+ T cell counts <200/mm3
b. CD4+ T cell counts <14% of total T cells, regardless of symptomatology
c. Presence of AIDS-related opportunistic infection
d. Any of the above.

Answer 25

A–80 (D) Either (A), (B), or (C) can be used for a case definition of AIDS.