Pance Questions 18 Flashcards
Q–131 Respiratory
A 14-year-old boy presents with a fever, sore throat, and right ear pain. The patient is drooling and his speech is muffled, a so-called “hot potato” voice. A CT scan shows the right tonsil to be displaced toward the midline. The most likely diagnosis is
a. epiglotitis
b. peritonsilar abscess
c. streptococcal pharyngitis
d. tonsillitis
A–131 (B) The description is classic for peritonsilar abscess, which is usually seen in adolescents and young adults. Epiglotitis is more common in children two to eight years of age. Patients also have drooling with this condition, but the problem involves the epiglottis, not the tonsils per se. In streptococcal pharnygitis, one sees tonsilar exudates, tender anterior adenopathy, and fever. Drooling is not a feature.
Q–132 General Medicine
The ethics of medicine is based on four principles and as a health care provider you will be routinely faced with making ethical decisions, especially in caring for geriatric patients. One principle refers to the duty to do good for others, and specifically to avoid harm in the process. This principle is referred to as
a. autonomy
b. justice
c. beneficence
d. nonmaleficience
A–132 (C) Beneficence means the act of doing good. Autonomy refers to one’s right to control one’s destiny. Justice focuses on nondiscrimination and the duty to treat individuals fairly, and nonmaleficience involves doing no harm and avoiding negligence that may lead to harm.
Q–133 Respiratory/EENT
A patient presents with symptoms consistent with sinusitis. Since only a small fraction of cases are bacterial in origin, you decide to treat this patient as if he has a viral sinusitis. All of the following treatment modalities are indicated EXCEPT
a. analgesics
b. topical heat
c. decongestants
d. antihistamines
A–133 (D) Antihistamines can thicken secretions and impair drainage and are therefore contraindicated. Analgesics are appropriate to prescribe for pain relief; topical heat will provide comfort for the patient; and decongestants are the primary therapeutic modality as they promote drainage.
Q–134 Neurology
A 28-year-old has been admitted to the hospital with a diagnosis of pancreatitis. On day three of the admission, he becomes acutely delirious. He is combative, tremulous, diaphoretic, and reports “seeing bugs” on his bed. What is the most likely diagnosis?
a. Opiate intoxication
b. Acute alcohol withdrawal
c. Sepsis
d. Acute paranoid schizophrenia
A–134 (B) The symptoms displayed by this patient are typical of acute alcohol withdrawal. His hospitalization with pancreatitis is also due to alcohol ingestion. With opiate intoxication, the patient would most likely be comatose with respiratory depression. If he were septic, he might have shaking chills, but a fever should also be present. Patients with acute paranoid schizophrenia may have visual hallucinations and may be combative, but there is no history to support this diagnosis.
Q–135 Gastroenterology
The gold standard test for fecal fat analysis is the
a. D-xylose absorption test
b. bile acid breath test
c. microscopic study of stool for increase in fat globules
d. quantitative measurement of fecal fat
A–135 (D) Stool is collected for three days and a quantitative measure of fecal fat performed. A D-xylose absorption test is done if the quantitative fecal fat is abnormal. The bile acid breath test is used for steatorrhea caused by suspected bacterial overgrowth. A microscopic study of stool is limited by the accuracy of the microscopist.
Q–136 Radiology
Which of the following is NOT considered a nuclear medicine scan?
a. HIDA study
b. Colonic transit study
c. Myocardial perfusion study
d. Bone density study
A–136 (D) A bone density study uses a very low level x-ray. This test should not be confused confused with a bone scan, which is a nuclear medicine test that involves a radioactive tracer being injected into the bone. The other studies are nuclear medicine scans.
Q–137 Radiology
You need a chest X-ray that will provide the best possible view of the apices of the patient’s lungs. You would order a
a. frontal view or posterior-anterior (PA) view
b. lateral view
c. decubitus view
d. lordotic view
A–137 (D) A lordotic view is used to visualize the apices of the lung. PA and lateral views are standard X-ray views and a decubitus view is useful for differentiating pleural effusions from consolidations.
Q–138 General Medicine
You need to order IV fluids for your patient. The IV set delivers 15 drops/ml and you determine that the patient should receive 125 ml/hour. Your order will instruct the nurse to administer a 1000 ml bag of IV solution every
a. 4 hours
b. 6 hours
d. 8 hours
d. 12 hours
A–138 (C) If the patient is to receive 125 ml/hour of fluid, it will take 8 hours to deliver 1000 ml.
Q–139 General Medicine/Genetics
The karyotype of an individual can be illustrated as a written expression. As such, a normal female and a normal male may be expressed by which written expression?
a. 44, XX and 44, XY
b. 46, XX and 46, XY
c. 46, XXX and 46, XXY
d. 44, XXY and 44, XYY
A-139 (B) The correct expression for a normal female is 46 XX and for a normal male, 46 XY. Karyotype refers to the chromosomal makeup of an individual. There are 44 autosomes and 2 sex chromosomes in the human genome for a total of 46; 23 derived from each parent. The sex of an offspring is determined by the sex chromosome carried in the sperm.
Q–140 Infectious Disease/Pediatrics
You see a baby that weighs 26 pounds. He has otitis media and you decide to treat him with 50 mg/kg/day of antibiotic suspension. The antibiotic is available in a concentration of 250 mg/5 ml. You want the mother to dose him every 8 hours. What dose will you prescribe?
a. 50 mg
b. 10 ml
c. 4 ml
d. 7.5 mg
A–140 (C) The mother would give the baby 4 ml of antibiotic suspension every 8 hours. 26 lbs/2.2 kg = 12 rounded up. 12 kg × 50 mg = 600/3 doses = 200 mg per dose. 200 mg/x ml = 250 mg/5 ml = 4 ml q 8 hours.
Q–141 Endocrinology
Insulin U-100 is manufactured in 10 ml vials. The concentration is
a. 100 units/10 ml
b. 10 ml/100 units
c. 100 units/1 ml
d. 10 units/10 ml
A–141 (C) U-100 means that for every 1 milliliter there are 100 units of insulin. This allows injections of very small quantities of fluid.
Q 142 Endocrinology
The insulin with the longest duration of action is
a. lispro
b. regular
c. NPH
d. Levemir
A–142 (D) Levemir insulin has a duration of action of up to 24 hours. Lispro is a rapid acting insulin and has a duration of activity of 3–5 hours. Regular insulin is classified as short acting and lasts for 6–8 hours, and NPH has an intermediate range of activity of 18–20 hours.
Q–143 General Medicine/Immunology
Skin testing can be done to identify the substances (allergens) that trigger an allergic reaction in a given patient. If a patient scheduled for skin testing were taking a second generation antihistamine, he should discontinue the drug how many days prior to the testing?
a. 45–60 days
b. 20–30 days
c. 2–3 days
d. 3-10 days
A–143 (D) Antihistamines interfere with the development of the wheal and flare reaction and second generation antihistamines should be discontinued 3 to 10 days prior to skin testing. First-generation antihistamines may be stopped 2 to 3 days prior to testing.
Q–148 General Medicine
In addition to being a risk factor for heart disease, elevated homocysteine levels have been associated with which of the following?
a. Dementia
b. Parkinson’s disease
c. Iron deficiency anemia
d. Colon cancer
A–148 (A) An association between elevated homocysteine levels and impaired cognitive function and dementia has been documented. Conversely, Parkinson’s disease (PD) per se is not associated with elevated homocysteine levels but levodopa used in treating PD has been associated with elevation of homocysteine. Regarding choices (C) and (D), there is some evidence to suggest that folic acid deficiency (not iron) associated with hyperhomocysteinemia may increase the risk of developing colorectal cancer in patients who have inflammatory bowel disease.
Q–149 Dermatology
This condition is characterized by episodic, asymmetrical, non-pitting swelling of loose tissue, usually skin. It is usually nonerythematous and nonpruritic, and may be painless. It may persist for 24 hours or longer. Gastrointestinal involvement can cause crampy abdominal pain followed by watery diarrhea. This is descriptive of
a. anaphylaxis
b. dietary protein enterocolitis
c. angioedema
d. cutaneous porphyria
A–149 (C) Angioedema is basically a cutaneous form of an allergic reaction. In a full anaphylactic reaction, there is an explosive release of inflammatory mediators into skin, the respiratory tract, and the circulatory system resulting in urticaria, wheezing, and hypotension. Dietary protein enterocolitis is most often seen in infants one to three months of age with intolerance to dietary protein. Patients will have recurrent vomiting and diarrhea. Cutaneous porphyria typically causes photosensitivity and blistering. It may be accompanied by itching, swelling, and increased hair growth on areas such as the forehead. Often, there is no abdominal pain, which distinguishes it from other porphyrias.
