Pance Questions 17 Flashcards
Q–106 Endocrinology
The American Diabetes Association has set goals for optimal management of diabetes and potential comorbidities. Which of the following represents those goals?
a. Hemoglobin A1c ≤ 6%; LDL Cholesterol ≤ 130 mg/dL; blood pressure ≤ 140/90 mmHg
b. Hemoglobin A1c ≤ 7%; LDL Cholesterol≤ 100 mg/dL; blood pressure < 130/80 mmHg
c. Hemoglobin A1c ≤ 6%; LDL Cholesterol ≤ 130 mg/dL; blood blood pressure ≤ 120/80 mmHg
d. Hemoglobin A1c ≤ 8%; LDL Cholesterol ≤ 150 mg/dL; blood pressure ≤ 140/90 mmHg
A–106 (B) Current recommendations are as stated for persons over age 40 who do not have active cardiovascular disease.
Q–107 Musculoskeletal
A positive Finkelstein’s test is diagnostic for de Quervain tenosynovitis trochanteric bursitis iliotibial band syndrome meniscal injury for
a. de Quervain tenosynovitis
b. trochanteric bursitis
c. iliotibial band syndrome
d. meniscal injury
A–107 (A) De Quervain tenosynovitis is the inflammation of the tendons on the side of the wrist at the base of the thumb. Pain can be recreated when the thumb is folded across the palm and the fingers are flexed over the thumb. This is a positive Finkelstein maneuver.
Q–108 Dermatology
Which of the following statements is true regarding ichthyosis?
a. Mildly pruritic; present during winter months only
b. Well-defined patches and plaques of scale and erythema
c. Asymptomatic, occurs year round, aggravated by dry weather
d. Petechial or pruritic eruption; may or may not be localized to the skin
A–108 (C) Ichthyosis is the term to describe severe, persistent problems with dry skin. This condition can range from very mild to life threatening.
Q–109 Dermatology
Koilonychia best describes nails with which appearance?
a. Infection of the nail fold
b. Atrophy of the nail plate
c. Brittle nails that often split vertically
d. Thin, concave nails with raised ridges
A–109 (D) Koilonychia describes nails that are thin and concave (spoon nails) with horizontal ridges. They often result from iron deficiency anemia.
Q–110 Hematology/Pharmacology
You have a patient who takes prednisone chronically. What effect will the prednisone have on the CBC?
a. Leukocytosis
b. Leukopenia
c. Eosinophilia
d. Lymphocytosis
A–110 (A) Corticosteroids, e.g., prednisone, increase blood levels of leukocytes causing leukocytosis. They decrease eosinophils, basophils, monocytes, and lymphocytes by redistributing them to lymphoid tissue from the circulation.
Q–111 Hematology
Which of the following conditions may cause an eosinophilia?
a. Allergic reactions
b. Parasitic infections
c. Cushing’s syndrome
d. Both (A) and (B) are correct.
A–111 (D) The most common cause of eosinophilia worldwide is parasitic infections. Other conditions, such as allergies and certain tumors, may also increase eosinophils.
Q–112 Hematology
Which one of the following conditions is most likely to cause a lymphocytosis?
a. Lupus erythematosus
b. HIV
c. Mononucleosis
d. Hodgkin’s disease
A–112 (C) Viral infections, such as mononucleosis, are the most common causes of lymphocytosis. Lupus is a collagen vascular disease; HIV is a virus but actually causes a profound decrease in lymphocytes; and Hodkins’s is a lymphoma.
Q–113 Gastrointestinal
In a patient with achalasia, a barium swallow will show
a. Schatzki rings
b. protrusion of the stomach through the opening at the esophagus and/or the diaphragm
c. dilation of the esophagus with a beaklike narrowing at the esophagogastric junction
d. irregular borders and sharp angles of the esophagus
A–113 (C) Choice (A) is a normal finding. Choice (B) describes a hiatus hernia, and choice (D) is descriptive of esophageal cancer.
Q–114 Gastrointestinal
The highest levels of carcinoembryonic antigen (CEA) are typically seen in patients with
a. diverticulitis
b. pancreatic cancer
c. cirrhosis
d. colon cancer
A–114 (D) Colon cancer typically causes the highest elevation of CEA. However, elevated levels may be present in all the above conditions. The limitation of a CEA measurement is its poor sensitivity and specificity.
Q–115 General Medicine/Laboratory medicine
An elevated prostate-specific antigen (PSA) is non-specific, but a 30% increase in one year is more likely to indicate
a. benign prostatic hypertrophy
b. prostate cancer
c. prostatitis
d. cystitis
A–115 (B) PSA measurements must be interpreted in relationship to age and ethnicity, but a huge increase in a measurement trend likely indicates the presence of cancer. Further tests are usually necessary to confirm the diagnosis. A man with cystitis (choice D) should have no inherent change in PSA.
Q–116 Hematology
You are checking laboratory reports from patients previously seen in your office. A WBC differential is reported as follows: Total WBC 11,000; 64.7% neutrophils; 23.3% lymphocytes; 7.2% monocytes; 2.8% eosinophils; and 0.6% basophils. Based on these results, you could assume that the patient has
a. an infection
b. a normal differential
c. an allergic condition
d. high levels of lead in the blood
A–116 (B) The numbers are within the range of normal. Total WBC level is slightly increased (normal is 4,500 to 10,000).
Q–117 Gastrointestinal
Which of the following statements is/are true regarding Barrett’s esophagus? a. It is a sequel of chronic alcohol ingestion.
b. Columnar epithelium extends proximal to the gastroesophageal junction.
c. It is a sequel of chronic GERD.
d. Both (B) and (C) are true.
A–117 (D) Barrett’s esophagus is a condition in which the esophagus changes so that some of its lining is replaced by a type of tissue (columnar) similar to that normally found in the intestine. It is associated with the very common condition of gastroesophageal reflux disease or GERD.
Q–118 Gastrointestinal
A patient presents with dysphagia and odynophagia; both are presenting symptoms in 60%–95% of patients with infectious esophagitis. The patient reports nausea, vomiting, diarrhea, fever, and weight loss as well. Which of the following agents is most likely the cause of this patient’s condition?
a. Candida albicans
b. Herpes simplex
c. Cytomegalovirus
d. All of the above present with these symptoms.
A–118 (C) Cytomegalovirus (CMV) esophagitis often is only one component of a generalized CMV infection, which is consistent with this patient’s report. In contrast, Candida albicans and Herpes simplex esophagitis usually are not associated with infection in other organs, and systemic symptoms are uncommon.
Q–119 Endocrinology
Which of the following drugs would you NOT prescribe for a patient diagnosed with acute intermittent porphyria?
a. Acetaminophen
b. Glipizide
c. Phenobarbital
d. Temazepam
A–119 (C) Phenobarbital and other barbiturates have been implicated in acute attacks of porphyria. Other anticonvulsant drugs may also precipitate an attack. Acetaminophen, glipizide, and temazepam are safe to prescribe in patients with a history of porphyria.
Q–120 Gastroenterology
The term “backwash ileitis” refers to superficial inflammation of the most distal terminal ileum. This condition may be seen in patients with
a. ulcerative colitis
b. Crohn’s disease
c. diverticulitis
d. salmonella infectious colitis
A–120 (A) Ulcerative colitis, by definition, involves the colon. However, in patients who have chronic ulcerative colitis, the terminal ileum may show inflammatory and ulcerative changes also. It is termed “backwash ileitis” to distinguish it from involvement of the ileum in Crohn’s disease.
