141. You diagnose a patient with Kaposi sarcoma. Out of the following lab tests, which results do you most likely expect to find? a. Positive HCV b. Reactive RPR c. Positive HBsAg d. Positive HIV

141. D: Positive HIV. Kaposi sarcoma is a type of tumor that often occurs in AIDS patients, originating from infection with herpes virus. Immunosuppression increases the likelihood that patients will develop this tumor. Patients usually have multiple cutaneous lesions, and sometimes this is their first manifestation of AIDS.

143. You are treating a patient who has emphysema with salmeterol. What type of medication is this? a. Steroid b. Short-acting beta-agonist c. Anticholinergic d. Long-acting beta-agonist

143. D: Long-acting beta-agonist. Emphysema and chronic bronchitis are types of chronic obstructive pulmonary disease (COPD), usually related to cigarette smoking. With emphysema, patient’s lungs have lost elastic recoil and are hyperinflated. Beta-agonists relax bronchial smooth muscle.

144. All of the following are true regarding abdominal aortic aneurysms EXCEPT: a. Due to weakening of the arterial wall b. Typically begin above the renal arteries c. Involves the intima, media, and adventitia arterial layers d. Generally considered an aneurysm when diameter is 3 cm or more

144. B: Typically begin above the renal arteries. AAAs usually are below the renal arteries. Risk factors for development of an AAA include male sex, smoking, and older age. Most are asymptomatic but carry the risk of eventually rupturing.

145. A 25-year-old woman reports lower abdominal pain, vaginal discharge, and irregular bleeding. She has never been pregnant. She has a history of chlamydia. On exam, the cervix is erythematous with visible discharge and motion tenderness. What is the most likely diagnosis? a. Endometriosis b. Ovarian cyst c. Cervical cancer d. Pelvic inflammatory disease

145. D: Pelvic inflammatory disease. This condition may be due to sexually transmitted diseases. Microorganisms spread into the upper female genital tract, which can cause pain, discharge, and fever. Diagnosis is suspected clinically in women of reproductive age with risk factors such as multiple sex partners. Patients are treated with antibiotics to cover gonorrhea and chlamydia. Patients may require hospitalization.

146. A 36-year-old man arrives in your office following an accident at work in which he thinks some debris got into his eye. How can you evaluate for corneal abrasions? a. Visual field testing b. Head CT c. Tonometry d. Fluorescein staining

146. D: Fluorescein staining. Corneal abrasions can be caused by trauma, improper contact lens wear, and foreign bodies. Patients will experience pain, tearing, and redness. After using a topical anesthetic, fluorescein stain and a cobalt blue light can be used to illuminate abrasions. Corneal abrasions are treated with antibiotics. A CT may be necessary if an intraocular foreign body is suspected.

147. A 45-year-old man tells you that he has an unreasonable fear of dogs that started about a decade ago after he was attacked by one. Now, he avoids walking on streets where he knows dog owners live. If he sees a dog on TV, he breaks out into sweats and feels anxious. You would like to refer him to a psychologist for therapy. Which therapy modality will be used to treat this patient? a. Cognitive processing therapy b. Exposure therapy c. Psychodynamic therapy d. Dialectical behavior therapy

147. B: Exposure therapy. This patient has a specific phobia of dogs, which consists of an unreasonable and persistent fear that leads to anxiety and avoidance. With the help of a trained clinician, exposure therapy involves having patients face progressively stronger stimuli in a hierarchy, in order to overcome their anxiety. Cognitive processing therapy is usually used in treatment of PTSD, and dialectical behavior therapy is used to treat borderline personality disorder. Psychodynamic therapy is similar to psychoanalysis.

148. Where would you expect a patient with acute pancreatitis to report pain? a. Upper abdomen, radiating to the back b. Right upper quadrant c. Left flank, radiating to lower abdomen d. Left lower quadrant

148. A: Upper abdomen, radiating to the back. Pancreatitis is usually due to biliary tract disease or excessive alcohol use. Pain may be reduced with leaning forward and worsened by coughing. Patients usually also have nausea and vomiting. It is diagnosed with amylase and lipase levels. Treatment is supportive.

149. A 32-year-old white male reports right knee pain and left hip pain for the past 2 weeks. He has also been having pain with urination and discharge. He had a recent gonorrhea infection. On exam, you note swelling and tenderness in the affected joints. You also notice redness of his eyes. ESR is elevated. What is the most likely diagnosis? a. Psoriatic arthritis b. Ankylosing spondylitis c. Reactive arthritis d. Sjögren syndrome

149. C: Reactive arthritis. Formerly known as Reiter syndrome, this is an autoimmune condition that occurs after an initial infection. The initial infection may be sexually transmitted or gastrointestinal. The classic triad of symptoms includes arthritis, conjunctivitis, and urethritis. It usually affects men 20-40 years of age. There may be a genetic predisposition.

150. You are seeing a patient who has a B-type natriuretic peptide (BNP) level of 680. What condition is this elevated lab usually associated with? a. Lung cancer b. Congestive heart failure c. Pancreatitis d. Cirrhosis

150. B: Congestive heart failure. Brain natriuretic peptide (BNP) is secreted by the heart ventricles in response to excessive stretching. The release of this polypeptide is intended to decrease systemic vascular resistance, increase urine production, and lower blood pressure. For patients with congestive heart failure, BNP is usually over 100. The left and/or right ventricular dysfunction of heart failure can cause shortness of breath and peripheral edema. BNP may also be elevated in patients with renal dysfunction.

151. You see a patient with a history of smoking who has metastatic cancer, with the primary site being a perihilar mass. His condition has been complicated by superior vena cava syndrome. Which type of lung cancer does this patient likely have? a. Adenocarcinoma b. Small cell lung carcinoma c. Large cell lung carcinoma d. Squamous cell lung carcinoma

151. B: Small cell lung carcinoma. The other answer choices are types of non–small cell lung carcinoma (NSCLC), which comprise the majority of lung cancers. Small cell lung carcinomas (SCLCs) account for about 15% of lung cancers. In SCLCs, the cells contain neurosecretory granules and may result in paraneoplastic syndromes. SCLC usually begins near the center of the chest. This cancer grows quickly, and patients may present with metastatic disease. It is almost always caused by smoking. Patients present with hemoptysis, shortness of breath, and weight loss. It can be complicated with superior vena cava syndrome due to compression or invasion. Treatment is with chemotherapy and radiation, although prognosis is generally poor.

152. A 50-year-old woman has tingling and pain in her hands that is worse at night. She has worked in a job for years where she does a lot of typing. Phalen test is positive. Which nerve is affected? a. Radial b. Ulnar c. Musculocutaneous d. Median

152. D: Median. This patient has carpal tunnel syndrome (CTS), which is caused by compression of the median nerve. Patients present with paresthesia and pain. It can be unilateral or bilateral. Phalen test is when you ask a patient to put the backs of their hands together, flexing the wrists. This maneuver increases the pressure in the carpal tunnel and symptoms should be elicited if the patient has CTS. It can be treated with surgery.

153. What is a risk factor for development of cholesteatoma? a. Diabetes mellitus b. Frequent antibiotic use c. Loud noise exposure d. Chronic otitis media

153. D: Chronic otitis media. A cholesteatoma is an epithelial cell growth in the middle ear, which can lead to hearing loss and further infection. Patients will have white debris in the middle ear and drainage. Surgery may be necessary because of potential serious complications and recurrence. It can affect patients of any age. Cholesteatomas can also be congenital.

154. Between what ages do epiphyseal plates typically close? a. 2-9 b. 10-17 c. 18-25 d. 26-33

154. C: 18-25. Epiphyseal plates are also known as growth plates and are present at the end of long bones. They are growing zones of cartilage, and the process of bone growth is known as ossification. The epiphyseal plates are replaced by epiphyseal lines when growth is complete—cartilage is replaced by bone, fusing the epiphyses and diaphysis.

155. You are ordering a CT scan for a patient you suspect has a kidney stone. Starting at what size will the stone likely need to be removed surgically? a. 8 mm b. 5 mm c. 3 mm d. 1 mm

155. B: 5 mm. Patients with kidney stones present with flank pain and hematuria. Stones have varying compositions, sizes, and locations. They are diagnosed by noncontrast CT, which can show location and severity of obstruction. For stones less than 5 mm in size, treatment is focused on pain management. Smaller stones usually pass with time. Larger stones have to be surgically removed.

Pance Questions 7 Flashcards by matthew ally

You diagnose a patient with Kaposi sarcoma. Out of the following lab tests, which results do you most likely expect to find?
a. Positive HCV
b. Reactive RPR
c. Positive HBsAg
d. Positive HIV

D: Positive HIV. Kaposi sarcoma is a type of tumor that often occurs in AIDS patients, originating from infection with herpes virus. Immunosuppression increases the likelihood that patients will develop this tumor. Patients usually have multiple cutaneous lesions, and sometimes this is their first manifestation of AIDS.

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A 17-year-old man has had fatigue for the past 2 weeks. He has also been having fever and sore throat. On exam, you note anterior/ posterior cervical lymphadenopathy and splenomegaly. How do you manage this patient based on your suspected diagnosis?
a. Give antibiotics for 1 week.
b. Treat supportively.
c. Administer a steroid injection.
d. Prescribe antifungals.

142. B: Treat supportively. This patient likely has mononucleosis, which is caused by the Epstein-Barr virus. Antibiotics only work for bacterial infections. In this case, treatment is supportive and the condition is usually self-limited. Patients may have symptoms for weeks or months, including fatigue, fever, and lymphadenopathy. It is usually spread by human contact via asymptomatic viral shedding. There is the potential for complications with this condition, including splenic rupture.

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You are treating a patient who has emphysema with salmeterol. What type of medication is this?
a. Steroid
b. Short-acting beta-agonist
c. Anticholinergic
d. Long-acting beta-agonist

D: Long-acting beta-agonist. Emphysema and chronic bronchitis are types of chronic obstructive pulmonary disease (COPD), usually related to cigarette smoking. With emphysema, patient’s lungs have lost elastic recoil and are hyperinflated. Beta-agonists relax bronchial smooth muscle.

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All of the following are true regarding abdominal aortic aneurysms EXCEPT:
a. Due to weakening of the arterial wall
b. Typically begin above the renal arteries
c. Involves the intima, media, and adventitia arterial layers
d. Generally considered an aneurysm when diameter is 3 cm or more

B: Typically begin above the renal arteries. AAAs usually are below the renal arteries. Risk factors for development of an AAA include male sex, smoking, and older age. Most are asymptomatic but carry the risk of eventually rupturing.

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A 25-year-old woman reports lower abdominal pain, vaginal discharge, and irregular bleeding. She has never been pregnant. She has a history of chlamydia. On exam, the cervix is erythematous with visible discharge and motion tenderness. What is the most likely diagnosis?
a. Endometriosis
b. Ovarian cyst
c. Cervical cancer
d. Pelvic inflammatory disease

D: Pelvic inflammatory disease. This condition may be due to sexually transmitted diseases. Microorganisms spread into the upper female genital tract, which can cause pain, discharge, and fever. Diagnosis is suspected clinically in women of reproductive age with risk factors such as multiple sex partners. Patients are treated with antibiotics to cover gonorrhea and chlamydia. Patients may require hospitalization.

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A 36-year-old man arrives in your office following an accident at work in which he thinks some debris got into his eye. How can you evaluate for corneal abrasions?
a. Visual field testing
b. Head CT
c. Tonometry
d. Fluorescein staining

D: Fluorescein staining. Corneal abrasions can be caused by trauma, improper contact lens wear, and foreign bodies. Patients will experience pain, tearing, and redness. After using a topical anesthetic, fluorescein stain and a cobalt blue light can be used to illuminate abrasions. Corneal abrasions are treated with antibiotics. A CT may be necessary if an intraocular foreign body is suspected.

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A 45-year-old man tells you that he has an unreasonable fear of dogs that started about a decade ago after he was attacked by one. Now, he avoids walking on streets where he knows dog owners live. If he sees a dog on TV, he breaks out into sweats and feels anxious. You would like to refer him to a psychologist for therapy. Which therapy modality will be used to treat this patient?
a. Cognitive processing therapy
b. Exposure therapy
c. Psychodynamic therapy
d. Dialectical behavior therapy

B: Exposure therapy. This patient has a specific phobia of dogs, which consists of an unreasonable and persistent fear that leads to anxiety and avoidance. With the help of a trained clinician, exposure therapy involves having patients face progressively stronger stimuli in a hierarchy, in order to overcome their anxiety. Cognitive processing therapy is usually used in treatment of PTSD, and dialectical behavior therapy is used to treat borderline personality disorder. Psychodynamic therapy is similar to psychoanalysis.

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Where would you expect a patient with acute pancreatitis to report pain?
a. Upper abdomen, radiating to the back
b. Right upper quadrant
c. Left flank, radiating to lower abdomen
d. Left lower quadrant

A: Upper abdomen, radiating to the back. Pancreatitis is usually due to biliary tract disease or excessive alcohol use. Pain may be reduced with leaning forward and worsened by coughing. Patients usually also have nausea and vomiting. It is diagnosed with amylase and lipase levels. Treatment is supportive.

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A 32-year-old white male reports right knee pain and left hip pain for the past 2 weeks. He has also been having pain with urination and discharge. He had a recent gonorrhea infection. On exam, you note swelling and tenderness in the affected joints. You also notice redness of his eyes. ESR is elevated. What is the most likely diagnosis?
a. Psoriatic arthritis
b. Ankylosing spondylitis
c. Reactive arthritis
d. Sjögren syndrome

C: Reactive arthritis. Formerly known as Reiter syndrome, this is an autoimmune condition that occurs after an initial infection. The initial infection may be sexually transmitted or gastrointestinal. The classic triad of symptoms includes arthritis, conjunctivitis, and urethritis. It usually affects men 20-40 years of age. There may be a genetic predisposition.

How well did you know this?

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Perfectly

You are seeing a patient who has a B-type natriuretic peptide (BNP) level of 680. What condition is this elevated lab usually associated with?
a. Lung cancer
b. Congestive heart failure
c. Pancreatitis
d. Cirrhosis

B: Congestive heart failure. Brain natriuretic peptide (BNP) is secreted by the heart ventricles in response to excessive stretching. The release of this polypeptide is intended to decrease systemic vascular resistance, increase urine production, and lower blood pressure. For patients with congestive heart failure, BNP is usually over 100. The left and/or right ventricular dysfunction of heart failure can cause shortness of breath and peripheral edema. BNP may also be elevated in patients with renal dysfunction.

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You see a patient with a history of smoking who has metastatic cancer, with the primary site being a perihilar mass. His condition has been complicated by superior vena cava syndrome. Which type of lung cancer does this patient likely have?
a. Adenocarcinoma
b. Small cell lung carcinoma
c. Large cell lung carcinoma
d. Squamous cell lung carcinoma

B: Small cell lung carcinoma. The other answer choices are types of non–small cell lung carcinoma (NSCLC), which comprise the majority of lung cancers. Small cell lung carcinomas (SCLCs) account for about 15% of lung cancers. In SCLCs, the cells contain neurosecretory granules and may result in paraneoplastic syndromes. SCLC usually begins near the center of the chest. This cancer grows quickly, and patients may present with metastatic disease. It is almost always caused by smoking. Patients present with hemoptysis, shortness of breath, and weight loss. It can be complicated with superior vena cava syndrome due to compression or invasion. Treatment is with chemotherapy and radiation, although prognosis is generally poor.

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A 50-year-old woman has tingling and pain in her hands that is worse at night. She has worked in a job for years where she does a lot of typing. Phalen test is positive. Which nerve is affected?
a. Radial
b. Ulnar
c. Musculocutaneous
d. Median

D: Median. This patient has carpal tunnel syndrome (CTS), which is caused by compression of the median nerve. Patients present with paresthesia and pain. It can be unilateral or bilateral. Phalen test is when you ask a patient to put the backs of their hands together, flexing the wrists. This maneuver increases the pressure in the carpal tunnel and symptoms should be elicited if the patient has CTS. It can be treated with surgery.

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What is a risk factor for development of cholesteatoma?
a. Diabetes mellitus
b. Frequent antibiotic use
c. Loud noise exposure
d. Chronic otitis media

D: Chronic otitis media. A cholesteatoma is an epithelial cell growth in the middle ear, which can lead to hearing loss and further infection. Patients will have white debris in the middle ear and drainage. Surgery may be necessary because of potential serious complications and recurrence. It can affect patients of any age. Cholesteatomas can also be congenital.

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Between what ages do epiphyseal plates typically close?
a. 2-9
b. 10-17
c. 18-25
d. 26-33

C: 18-25. Epiphyseal plates are also known as growth plates and are present at the end of long bones. They are growing zones of cartilage, and the process of bone growth is known as ossification. The epiphyseal plates are replaced by epiphyseal lines when growth is complete—cartilage is replaced by bone, fusing the epiphyses and diaphysis.

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You are ordering a CT scan for a patient you suspect has a kidney stone. Starting at what size will the stone likely need to be removed surgically?
a. 8 mm
b. 5 mm
c. 3 mm
d. 1 mm

B: 5 mm. Patients with kidney stones present with flank pain and hematuria. Stones have varying compositions, sizes, and locations. They are diagnosed by noncontrast CT, which can show location and severity of obstruction. For stones less than 5 mm in size, treatment is focused on pain management. Smaller stones usually pass with time. Larger stones have to be surgically removed.

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A 56-year-old man arrives in the emergency department with sudden onset of pain in his right foot. On exam, you note pale, cool skin and are unable to palpate the dorsalis pedis pulse. What is the most likely diagnosis?
a. Acute peripheral arterial occlusion
b. Raynaud phenomenon
c. Deep venous thrombosis
d. Venous insufficiency

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A: Acute peripheral arterial occlusion. Whenever an artery gets blocked, patients present with the “Ps”—pain, pallor, pulselessness, paresthesia, and polar (cold). This patient likely has underlying peripheral arterial disease (PAD), which is due to atherosclerosis, and symptoms depend on the degree of obstruction. Risk factors include hypertension, hyperlipidemia, diabetes, and cigarette smoking. Mild PAD will cause intermittent claudication.

All of the following are true about phenylketonuria EXCEPT:
a. Affected children may give off a mousy body odor.
b. It occurs most often among Jewish patients.
c. Inheritance is autosomal recessive.
d. It may present with seizures.

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157. B: It occurs most often among Jewish patients. Phenylketonuria (PKU) is a genetic condition characterized by elevated phenylalanine due to an enzyme deficiency. It is most common in white populations. The mousy odor is due to a breakdown product of phenylalanine. It may present with seizures, gait disturbance, or hyperactivity. Untreated PKU can lead to intellectual disability. Treatment involves restricting phenylalanine in diet.

Which one of the following antibiotics can be ototoxic?
a. Gentamicin
b. Amoxicillin
c. Levofloxacin
d. Cefprozil

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A: Gentamicin. This is in the aminoglycoside class of antibiotics that has been known to cause ototoxicity in some patients, which can manifest as hearing loss or disequilibrium. Other aminoglycoside antibiotics include streptomycin and tobramycin. Some macrolide antibiotics have also been linked with ototoxicity. Amoxicillin is a penicillin antibiotic, levofloxacin is a quinolone, and cefprozil is a cephalosporin.

Which of the following medications is used to treat an acute gout attack?
a. Methotrexate
b. Colchicine
c. Azathioprine
d. Allopurinol

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B: Colchicine. This medication is an anti-inflammatory and can be used for both prophylaxis and treatment of acute gout attacks. Allopurinol is a xanthine oxidase inhibitor. Xanthine oxidase is responsible for the production of uric acid, so allopurinol helps to lower uric levels and prevent future gout attacks. Allopurinol is not helpful in alleviating acute gout attacks. Methotrexate is used to treat rheumatoid arthritis, and azathioprine is an immunosuppressant.

Where is the murmur of mitral regurgitation best heard on physical exam?
a. Right lower sternal border
b. Left upper sternal border
c. Left fourth intercostal space
d. Heart apex

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D: Heart apex. Mitral regurgitation occurs when blood flows back into the left atrium during systole when the left ventricle contracts. Patients have shortness of breath, fatigue, and palpitations. The murmur is holosystolic, and it may be high or low pitched depending on the severity. The murmur may increase with handgrip or squatting.

A 40-year-old new patient requests to be checked for diabetes since he has a family history. His A1c is 6.7%. Does he meet the criteria for a diabetes diagnosis, and if so how do you treat this patient?
a. No, advise retesting in 3 months

b. Yes, start insulin
c. Yes, start metformin
d. No, advise continued diet and exercise

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C: Yes, start Metformin. A patient is now considered to have diabetes if their hemoglobin A1c is 6.5% or higher. Metformin is in the biguanide class of medications and is considered first-line treatment in those diagnosed with diabetes. It reduces complications and mortality. The main side effect can be gastrointestinal upset. Insulin or other medications may become necessary for some patients who are not able to maintain glucose control on metformin alone.

An 8-year-old boy has had 1 week of itchiness and redness on his forearms. All of the following are in your differential EXCEPT:
a. Urticaria
b. Atopic dermatitis
c. Contact dermatitis
d. Seborrheic dermatitis

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D: Seborrheic dermatitis. The other answer choices are all plausible diagnoses because they can all present with similar symptoms. Urticaria, also known as hives, has many causes. The wheals are red and itchy. Atopic dermatitis also presents with itchiness and erythema. It is an immune-mediated condition. Contact dermatitis is also a possible diagnosis. It is an acute inflammation that can be caused by various irritants, including poison ivy. Seborrheic dermatitis is less plausible as a diagnosis because this occurs where sebaceous glands are present, such as on the face and scalp. It causes dandruff and greasy scaling.

The United States Preventive Services Task Force recommends HIV screening for which of the following patient populations?
a. Only men and women who have had greater than 5 sexual partners
b. All adults over the age of 18
c. Adolescents and adults at increased risk and pregnant women
d. Only those who are symptomatic or request to be tested

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C: Adolescents and adults at increased risk and pregnant women. The USPSTF has an “A (strong) recommendation” to screen for HIV in adolescents and adults at increased risk for infection. Risk factors include men who have had sex with men after 1975, men and women with multiple partners, IV drug use, exchanging sex for money, infected partners, and blood transfusion between 1978 and 1985. A person is also considered to be high risk if they receive health care in a high-risk clinical setting, such as a correctional facility or homeless shelter. The USPSTF makes no recommendation for or against screening in adolescents and adults who are not at increased risk. The USPSTF also has an “A (strong) recommendation” for screening all pregnant women.

Which of the following lab results might you see in a patient with sarcoidosis?
a. Elevated angiotensin-converting enzyme
b. Decreased serum calcium
c. Elevated white blood cells
d. Decreased alkaline phoshatase

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A: Elevated angiotensin-converting enzyme. Sarcoidosis is a condition with an unknown cause that can affect many organ systems. It is characterized by the presence of granulomas in tissue, most often affecting the lungs. The granulomas produce ACE. Elevated ACE is suggestive of diagnosis but can also be nonspecific. Calcium may be elevated because of production of vitamin D analogs. Leukopenia can occur due to a decreased number of circulating lymphocytes. Renal and hepatic involvement can lead to abnormal test results.

165. Which of the following predispose a patient to developing atrial fibrillation? a. Hypertension b. Binge drinking c. Hyperthyroidism d. All of the above

165. **D: All of the above**. Atrial fibrillation is an irregularly irregular heartbeat characterized by weakness, shortness of breath, and palpitations. It is one of the most common arrhythmias. Other causes include congenital heart disorders, COPD, and pericarditis. Stroke can be a complication, so part of treatment involves blood thinners for prevention.

Pance Questions 7 Flashcards

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