Pance Questions 16

Question 1

Q–81 Infectious Disease

Kaposi’s sarcoma is the most common type of malignancy present among homosexual or bisexual HIV-infected men. Evidence suggests that it is caused by a sexually transmitted agent other than HIV. That agent is thought to be

a. herpes simplex virus type 2
b. human herpes virus type 8
c. Cytomegalovirus
d. Epstein-Barr virus

Answer 1

A–81 (B) Human herpes virus type 8 is thought to be the causative agent for Kaposi’s sarcoma. Herpes simplex virus type 2 causes genital or perianal ulcerations. It can be spread by direct skin contact. Cytomegalovirus causes disseminated disease and Epstein-Barr virus causes infectious mononucleosis.

Question 2

Q–82 Hematology
Anisocytosis refers to
a. an abnormal variation in the size of red blood cells

b . an abnormal variation in the shape of red blood cells

c. Both
d. Neither

Answer 2

A–82 (A) Anisocytosis refers to an abnormal variation in the size of red blood cells. Poikilocytosis is the term that refers to an abnormal shape of red blood cells.

Question 3

Q–83 Neurology

A good question to ask patients to assess their recent memory function is

a. what is their date of birth
b. what they ate for their last meal
c. how many siblings they have
d. what is 100 minus 6

Answer 3

A–83 (B) Asking a patient what he/she ate for their last meal is a common way to evaluate recent memory. The other choices reflect old, well-learned information.

Question 4

Q–84 General Medicine
Which of the following mechanisms may cause edema?
a. Increased hydrostatic pressure
b. Increased permeability of blood vessels
c. Decreased colloid osmotic pressure
d. (A), (B), and (C) may cause edema

Answer 4

A–84 (D) All of the mentioned mechanisms may result in fluid accumulation in the tissues. Congestive heart failure may increase hydrostatic pressure; acute inflammation can increase permeability of blood vessels, and hypoalbuminemia will decrease colloid osmotic pressure.

Question 5

Q–85 Genetics/General Medicine

All of the following are examples of autosomal dominant disorders EXCEPT

a. albinism
b. familial hypercholesterolemia
c. von Willebrand’s disease
d. Marfan syndrome

Answer 5

A–85 (A) Albinism is an autosomal recessive disorder; all the rest represent an autosomal dominant inheritance pattern.

Question 6

Q–86 Neurology
Korsakoff ’s syndrome is caused by a lack of
a. niacin
b. riboflavin
c. thiamine
d. pyridoxine

Answer 6

A–86 (C) A deficiency of thiamine will cause Korsakoff’s syndrome. This syndrome is manifested by damage to neurons and supporting cells in the central nervous system.

Question 7

Q–87 Psychiatry

The most common type of hallucination experienced by a patient with schizophrenia is

a. auditory
b. visual
c. tactile
d. olfactory

Answer 7

A–87 (A) A patient with schizophrenia most often experiences auditory hallucinations or “hears voices” inside his/her head.

Question 8

Q–88 Pediatric/Orthopedics
The most common cause of hip pain in an adolescent is
a. scoliosis
b. slipped capital femoral epiphysis
c. genu valgam
d. tendon strains

Answer 8

A–88 (B) A slipped capital femoral epiphysis or an apophyseal avulsion is the most common causes of hip pain in an adolescent. Severe genu valgam, aka “knock-knees,” may cause hip discomfort with severe cases, but the severe form is relatively infrequent in its occurrence. In adults, hip pain more often occurs secondary to tendon strains and arthritis. Scoliois is a skeletal deformity of the spine.

Question 9

Q–89 General Medicine/Genetics

Which of the following statements is NOT characteristic of X-linked recessive inheritance?

a. The mutant gene is on an X chromosome.
b. Males are more commonly affected than females.
c. No father-to-son transmission exists.
d. Half of the daughters of an affected father and a normal mother will be carriers.

Answer 9

A–89 (D) All the daughters of an affected father and a normal mother will be carriers because the father will pass on the X chromosome to each.

Question 10

Q–90 General Medicine/Genetics

Which one of the following karyotypes represents Klinefelter’s syndrome?

a. 47, XX, +21 or 47, XY, +21
b. 45, X or 45, XO
c. 47, XXY or 46, XY/47, XXY
d. t(9;22)

Answer 10

A–90 (C) Klinefelter’s syndrome is a condition that occurs in males who have an extra X chromosome in most of their cells and is represented by the karyotype depicted in choice (C). Choice (A) depicts Down syndrome; choice (B) depicts Turner syndrome; and choice (D) represents a structural disorder caused by translocation between chromosomes 9 and 22.

Question 11

Q–91 Pediatrics
The C in TORCH stands for
a. cystic fibrosis
b. cytomegalovirus
c. chlamydia
d. Clostridium difficile

Answer 11

A–91 (B) The C stands for cytomegalovirus, one of the infectious teratogens. The others are: T = Toxoplasmosis; O = Other (hepatitis B, mumps, HIV); R = Rubella; H = Herpes Simplex.

Question 12

Q–92 General Medicine

Which of the following statements most accurately defines “pathophysiology”?

a. Pathophysiology defines changes in individuals that cause their health parameters to fall outside the range of normal.
b. Pathophysiology is an assignment of causes or reasons to a set of phenomena.
c. Pathophysiology is the development or evolution of a disease.
d. Pathophysiology is a study of disordered functions altered by a disease process.

Answer 12

(D) Pathophysiology is a study of the disturbances in normal physiological processes processes which have been altered by disease, abnormality, or condition. Choice (A) is a definition for disease; etiology is the term used in describing causes or reasons leading to a given outcome, choice (B); and pathology is the branch of medicine concerned with the actual study of disease, choice (C).

Question 13

Q–93 Pediatrics

Which of the following are at high risk for developmental dysplasia of the hip?

a. First born males, breech presentation
b. First born females, breech presentation
c. Premature birth, either sex
d. Post-term infants

Answer 13

A–93 (B) Females with a breech presentation are more susceptible to hip dysplasia.

Question 14

Q–94 Pediatric/Orthopedics

Of the three primary causes of rotational “turning-in” or “pigeon-toed” deformities in children, which will spontaneously resolve in most cases?

a. Curved feet (metatarsus adductus)
b. Twisted shins (internal tibial torsion)
c. Twisted thigh bones (femoral anteversion)

d. All of the above

Answer 14

A–94 (D) All of the mentioned rotational deformities usually resolve and reassurance of the parents is most helpful.

Question 15

Q–95 General Medicine

Which of the following has/have been identified as barriers to effective chronic disease care?

a. Lack of patient trust in the medical provider
b. Lack of understanding of treatment regimens
c. Lack of provider time
d. All of the above

Answer 15

A–95 (D) All of the answer choices are barriers to effective chronic disease care. Patients often do not trust their provider because of a perception that the provider is rushed and doesn’t take time to listen effectively to the complaints of the patient. Thorough and accurate education should be provided to patients in order to promote compliance.

Question 16

Q–96 Infectious Disease/Women’s Health

A 26-year-old woman comes to your clinic for a Papani-colaou test and contraceptive discussion. She complains of mild dyspareunia. While doing the Pap smear you also collect a vaginal sample for culture to rule out gonorrhea and chlamydial infection. The culture was negative for both these organisms but Escherichia coli was reported. The patient denied symptoms of urinary tract infection or vaginitis. Should she be treated and, if so, with what drug?

a. Yes, begin amoxicillin.
b. Yes, begin trimethoprim/sulfisoxazole.
c. Yes, begin OTC vaginal douche.
d. No, treatment is unnecessary.

Answer 16

A–96 (D) There is no reason to treat asymptomatic vaginal colonization with E. coli. Colonization is very common in healthy women and there is no data indicating that treatment is beneficial. Vaginal douching is considered an unhealthy behavior that may lead to further infection and should not be encouraged by health care providers.

Question 17

Q–97 Women’s Health

Which of the following descriptions of breast masses is consistent with fibrocystic disease?

a. Firm, rubbery consistency
b. Poorly delineated borders
c. Tender to palpation
d. No variation with menses

Answer 17

A–97 (C) Fibrocystic breast disease is usually tender to palpation, and pain and tenderness increase premenstrually. Masses that are firm and rubbery are consistent with a diagnosis of fibroadenoma and those with poorly delineated, irregular borders are consistent with cancer.

Question 18

Q–98 General Medicine

Which of the following groups of drugs does NOT have independent analgesic activity?

a. SSRIs
b. Tricyclics
c. SNRIs
d. Anticonvulsants

Answer 18

A–98 (A) Selective Serotonin Reuptake Inhibitors (SSRIs) do not have independent analgesic activity as all of the others do.

Question 19

Q–99 Psychiatry
Munchausen syndrome is classified as a(n)
a. anxiety disorder
b. adjustment disorder
c. somatization disorder
d. factitious disorder

Answer 19

A–99 (D) A factitious disorder is a mental disturbance in which a patient intentionally acts mentally or physically ill without any obvious signs or symptoms. Symptoms are either falsified or self-induced by the patient.

Question 20

Q–100 Musculoskeletal
You see a patient with radiographic evidence of osteoarthritis of the knee. Supporting clinical findings of knee joint pain, morning stiffness, decreased range of motion, and local swelling support your diagnosis. Which of the following labs would be most helpful in confirming your diagnosis?
a. CBC
b. Erythrocyte sedimentation rate
c. C-reactive protein
d. None are useful.

Answer 20

A–100 (D) All of the above labs would be within normal limits if the diagnosis of osteoarthritis is correct. CBC is used to evaluate for infection, anemias, or other blood cell disorders. Erythrocyte sedimentation rate (ESR) is sometimes used to evaluate for rheumatoid arthritis. C-reactive protein is measured to indicate inflammation, such as in Rheumatoid Arthritis, autoimmune disease, and heart disease.

Question 21

Q–101 General Medicine/Dermatology
A 35-year-old woman presents with distal onycholysis of the fingers but denies any other symptoms. She denies recent outdoor activities such as gardening. What is your initial approach to identifying the cause of onycholysis?
a. Order a bacterial culture
b. Order a radiograph of the fingers
c. Measure the patient’s thyroxine level
d. Measure the patient’s TSH level

Answer 21

A–101 (D) Onycholysis is the separation of the distal margin of the nail plate from the nail bed. This condition is seen in patients with hyperthyroidism and is referred to as Plummer’s nails. Measurement of the TSH would provide an indication to the underlying pathology. This condition is also seen in patients with yeast or other infections as well as local trauma, but since there is a negative history of outdoor activities and no history of trauma, the most likely diagnosis is hyperthyroidism.

Question 22

Q–102 Dermatology
In performing a physical examination on a 28-year-old fair-skinned female, you note a single dark streak on the left forefinger nail. The patient denies trauma, pain, or other symptoms. Her family history is negative except for mild hypertension in her father. How would you proceed?
a. Dismiss it as a variation of normal
b. Perform a fungal culture
c. Search the body for pigmented lesions
d. Order a biopsy of the nail and underlying tissue

Answer 22

A–102 (D) A single streaked nail in a fair-skinned person may indicate melanoma or dysplastic nevus. In addition to performing a thorough dermatologic examination, the nail and underlying tissue should be biopsied.

Question 23

Q–103 Musculoskeletal
A 32-year-old man presents with a 10-day history of pain, swelling, and redness of the left elbow. He denies recent illness but notes that the problem with his elbow began after a fall while playing basketball. The impact of the fall was on his left elbow. Physical examination reveals a decrease in range of motion in all directions but more limitation with full flexion due to pain. The olecranon is tender to palpation. Radiographs of the elbow are normal. Your working diagnosis is
a. lateral epicondylitis
b. medial epicondylitis
c. olecranon bursitis
d. gouty arthritis

Answer 23

A–103 (C) Patients with bursitis typically have swelling, erythema, and localized pain over the affected bursa both at rest and with motion. Decreased range of motion may also be present. The history of acute trauma is important in differentiating bursitis from tendonitis. Epicondylitis is a painful inflammation of the muscles and soft tissues around the medial (golfer’s elbow) or lateral (tennis elbow) epicondyle. It is brought on by overuse of the muscles. Gout is an arthritic condition caused by elevated levels of uric acid in the bloodstream. Crystals of uric acid precipitate in the joints and cause painful inflammation.

Question 24

Q–104 Musculoskeletal
“Tennis elbow” is the common name applied to
a. lateral epicondylitis
b. medial epicondylitis
c. olecranon bursitis
d. triceps tendinitis

Answer 24

A–104 (A) Lateral epicondylitis is a condition where the outer-part of the elbow becomes painful and tender. It is seen in persons playing tennis but may occur in anyone after repeated motion use of the elbow.

Question 25

Q–105 Musculoskeletal

When treating a patient with osteoporosis with oral bisphosphonates, a potential complication that must be monitored is the

a. development of myeloma
b. mandibular osteonecrosis
c. Paget’s disease
d. renal tubular acidosis

Answer 25

A–105 (B) Osteonecrosis of the mandible has emerged as a potential complication of bisphosphonate therapy. It is prudent to have your patient cleared by his/her dentist prior to beginning bisphosphonate therapy. There is an approximately three times greater risk of osteonecrosis of the jaw in patients taking bisphosphonates than patients not taking the drugs. This may develop after dental extractions and implants, but it may also occur spontaneously.