Pance Questions 9

Question 1

191. You are counseling a patient about the benefits of smoking cessation. Which of the following could you include in your discussion of conditions that are associated with smoking?
     a. Bladder carcinoma
     b. Nephrolithiasis
     c. Polycystic kidney disease
     d. Interstitial cystitis

Answer 1

191. A: Bladder carcinoma. Smoking is the most common risk factor. It is more common in men and white people, and incidence increases with age. Bladder cancer is also associated with certain medications and chronic irritation. Patients usually present with hematuria. Polycystic kidney disease is hereditary. The cause is unknown for interstitial cystitis. Kidney stones are not caused by cigarette smoking.

Question 2

192. What is the physiology behind urticaria?
     a. Impaired venous drainage
     b. Sebaceous duct obstruction
     c. Histamine release
     d. Spread of bacterial infection

Answer 2

192. C: Histamine release. Urticaria, also known as hives, can be acute or chronic, and has a number of causes. Patients present with erythema and pruritic wheals. It is treated mainly with antihistamines including cetirizine, hydroxyzine, and diphenhydramine.

Question 3

193. You are seeing a 45-year-old male patient for the second time. The average of his two blood pressure readings in office is 135/ 78. How would you classify this?
     a. Normal
     b. Prehypertension
     c. Stage 1 hypertension
     d. Stage 2 hypertension

Answer 3

193. B: Prehypertension. According to the Joint National Committee, blood pressure is considered normal if systolic is below 120 and diastolic is below 80. Prehypertension is a systolic BP between 120-139 or a diastolic BP between 80-89. Stage 1 hypertension is a systolic BP between 140-159 or a diastolic BP between 90-99. Stage 2

Question 4

194. A blood test for CA-125 may be ordered for a patient if which condition is suspected?
     a. Ovarian cancer
     b. Incompetent cervix
     c. Uterine prolapse
     d. Primary amenorrhea

Answer 4

194. A: Ovarian cancer. CA-125 is a tumor marker that may be elevated in patients with specific types of cancers. It can be used to detect ovarian cancer or to monitor response to treatment, although it is not used as a widespread screening tool because of lack of high sensitivity and specificity. The test can produce false positives and false negatives.

Question 5

195. What medication is typically prescribed to patients for recurrent Raynaud phenomenon?
     a. Furosemide
     b. Prednisone
     c. Gabapentin
     d. Nifedipine

Answer 5

195. D: Nifedipine. Raynaud phenomenon is a vasospastic disorder that affects the fingers or toes. When exposed to cold or stress, skin turns white because of reduced blood flow and then turns blue because of oxygen depletion. Skin eventually turns red as blood flows back in. Patients experience pain and tingling. This phenomenon is often linked to some connective tissue disorders. Calcium channel blockers, such as nifedipine, have been shown to be helpful because they open up blood vessels.

Question 6

196. You are seeing a patient who takes sulfasalazine for ulcerative colitis. What is a potential side effect of this medication?
     a. Pancreatitis
     b. Oligospermia
     c. Blindness
     d. Priapism

Answer 6

196. B: Oligospermia. Sulfasalazine is a sulfa drug used in the treatment of inflammatory bowel disease. It is thought to be anti-inflammatory and acts as a disease-modifying antirheumatic drug (DMARD). It is also used to treat rheumatoid arthritis.Other potential side effects include GI upset, headache, itching, rash, blood dyscrasia, and hepatotoxicity. Other potential side effects include GI upset, headache, itching, rash, blood dyscrasia, and hepatotoxicity.

Question 7

197. In a 24-hour period, how many milligrams of excreted albumin in urine is considered to be macroalbuminuria?
     a. > 300
     b. > 200
     c. > 100
     d. > 50

Answer 7

197. A: > 300 mg. Macroalbuminuria is a relatively high rate of urinary excretion of albumin. This means that protein is being leaked that can signify kidney damage or diabetes. It is considered microalbuminuria when the value is between 30 and 300 mg— this is an early sign of progressive cardiovascular and renal disease.

Question 8

198. Which of the following is an indication for open reduction and internal fixation (ORIF) surgery?
     a. Hip fracture
     b. Displaced fracture of both radius and ulna
     c. Displaced intra-articular fracture of the knee
     d. All of the above

Answer 8

198. D: All of the above. In open reduction and internal fixation (ORIF), reduction refers to how the fracture is realigned, and it can be open or closed. Open reduction means that there is a surgical procedure rather than just closed manipulation or traction. Fixation can be internal or external. Internal fixation involves plates and screws that are put on the bones, compared with external fixation that involves frames and halos.

Question 9

199. A 39-year-old man has left elbow pain that has been present for 2 weeks. He cannot recall a specific injury. On exam, you note bogginess around the elbow and pain elicited with elbow flexion. There is no erythema. What is the most likely diagnosis?
     a. Gout
     b. Biceps tendon rupture
     c. Olecranon bursitis

d. Osteoarthritis

Answer 9

199. C: Olecranon bursitis. This is an inflammation of the bursa that can occur due to trauma, repetitive stress, or rheumatoid arthritis. Patients present with pain that is worse with increased flexion. It is treated with NSAIDs and activity modification. Sometimes, the bursa will need to be aspirated or surgically excised.

Question 10

200. You order an echocardiogram on a patient who has congestive heart failure. What would you expect his ejection fraction to be?
     a. 80%
     b. 65%
     c. 55%
     d. 40%

Answer 10

200. D: 40%. An echocardiogram is an ultrasound of the heart. It can be used to evaluate valves, chambers, wall movement, cardiac output, and ejection fraction. The ejection fraction is the amount of blood pumped out of the ventricle with each heartbeat. The normal value is generally between 55% and 70%. Lower ejection fractions manifest clinically as heart failure.

Question 11

201. Which of the following is NOT usually recommended in the management of fibrocystic changes of the breasts?
     a. Increase caffeine intake
     b. Restrict foods containing methylxanthine
     c. Use mild diuretics intermittently
     d. Take danazol regularly

Answer 11

201. A: Increase caffeine intake. Fibrocystic changes are characterized by a benign dense texture and pain of the breasts. Causes include fibrosis, hyperplasia, and cysts. It is more common among women with early menarche or who are nulliparous. It usually presents with bilateral cyclic diffuse pain and engorgement. Studies are mixed regarding the efficacy of dietary modifications used in management, but a possible intervention is to restrict caffeine intake and foods containing methylxanthines. Some women respond to hydrochlorothiazide, and danazol is a synthetic steroid used off-label for treatment.

Question 12

202. You are reading through a chart and notice “hemiballismus” documented in the neurological section of the physical exam. What does this refer to?
     a. Slowness of movements and reflexes
     b. Involuntary violent flinging movements of the extremities
     c. Dance-like irregular movements
     d. Rhythmic limb movements

Answer 12

202. B: Involuntary violent flinging movements of the extremities. Hemiballismus is rare and due to a decrease of subthalamic nucleus activity, which results in decreased suppression of undesired movements. Answer choice A describes bradykinesia, which is usually seen in patients with Parkinson disease. Answer choice C describes chorea of Huntington disease. Answer choice D describes clonus.

Question 13

203. What is contained in the hormonal intrauterine device?
     a. Ethinyl estradiol
     b. Mestranol
     c. Levonorgestrel
     d. Estradiol valerate

Answer 13

203. C: Levonorgestrel. Intrauterine devices (IUDs) are a commonly used method of contraception. It is a T-shaped device and contains levonorgestrel or copper that is released continuously. The IUD renders the uterine environment hostile and prevents fertilization. The IUD lasts for about 5 years. The other answer choices are compounds related to estrogen.

Question 14

204. Which imaging modality is most often used for detecting the presence of kidney stones?
     a. MRI
     b. Cystoscopy
     c. KUB
     d. Ultrasound

Answer 14

204. C: KUB. Most kidney stones are radiopaque and will show up on x-ray. KUB film stands for kidney, ureter, and bladder. Sometimes a noncontrast spiral CT scan is done or an intravenous pyelogram (IVP), which involves contrast. KUB is less expensive.

Question 15

205. A 32-year-old woman has had progressive redness and swelling for the past week in the area under her right eye close to the side of her nose. The area is tender to palpation. Tearing and discharge are present. Vision is intact. What is the most likely diagnosis?
     a. Dacryocystitis
     b. Orbital cellulitis
     c. Pinguecula
     d. Chalazion

Answer 15

205. A: Dacryocystitis. This is due to an obstruction of the nasolacrimal duct. Patients have erythema, edema, and tenderness of the lacrimal sac. Patients may be febrile and have mild conjunctivitis. Treatment is with warm compresses and antibiotics. Surgery may be required to create a fistula for tear flow. Orbital cellulitis would present with edema of the eyelid. Pinguecula occurs on the eye itself, and chalazion usually occurs on the upper eyelid.

Question 16

206. A 27-year-old woman has had persistent fever after returning from a trip to Africa. Plasmodium ovale is seen in the peripheral blood smear. How can this patient be treated?
     a. Chloroquine
     b. Metronidazole
     c. Sulfadiazine
     d. Albendazole

Answer 16

206. A: Chloroquine. Plasmodium ovale is a species of protozoa that causes malaria. Malaria is caused by four species of Plasmodium, and it is spread by mosquitoes. It causes fever and anemia in humans. Possible complications include cerebral disease, pulmonary edema, renal failure, and sepsis. It is especially dangerous in children and pregnant women. Treatment depends on which species is causing the infection and whether antibiotic resistance is present. Chloroquine has been widely used in treatment and prevention.

Question 17

207. What would you expect to find while performing a physical examination of a patient with only left-sided left-sided heart failure?
     a. Jugular venous distention
     b. Hepatomegaly
     c. Lung crackles
     d. Pedal edema

Answer 17

207. C: Lung crackles. Left-sided heart failure involves pulmonary congestion because fluid backs up in the lungs. Right-sided heart failure causes fluid to accumulate peripherally. Eventually, fluid overload will become generalized with either type of heart failure.

Question 18

208. A 2-year-old boy arrives in your office in October with a barking cough present for the past 3 days. On exam, you note retractions and hear a high-pitched sound with inspiration. There is no drooling or sputum production, and you do not notice pharyngeal swelling. What do you suspect?
     a. Croup
     b. Bronchiectasis
     c. Acute bronchitis
     d. Peritonsillar abscess

Answer 18

208. A: Croup. This is an acute inflammatory disease involving the upper airway. It is most common in children 3 to 36 months of age. Most cases occur in the fall and winter. Causative agents include parainfluenza, adenovirus, and echovirus. Inspiratory stridor indicates airway obstruction. Bronchiectasis usually has a chronic daily cough with sputum production.

Question 19

209. All of the following are indications for biosynthetic valve replacement EXCEPT:
     a. Women who wish to become pregnant
     b. Younger than 65 years
     c. Contraindication for anticoagulation
     d. Endocarditis

Answer 19

209. B: Younger than 65 years. Valve replacements can be a mechanical prosthetic or biosynthetic. Tissue grafts only have a life expectancy of 10-15 years so they should not be used in younger patients because another operation would be necessary. Mechanical prosthetics require use of warfarin, so pregnant women should have biosynthetic replacement because they cannot take warfarin.

Question 20

210. Approximately how many women will experience domestic violence in their lifetime?
     a. 5%
     b. 15%
     c. 25%
     d. 40%

Answer 20

210. C: 25%. Screening for domestic violence in the health care setting should be routine, either by questionnaire or interview. Domestic violence includes intimidation, physical assault, sexual assault, dominance, and abusive behavior. It can result in physical injury, psychological trauma, and even death. About 85% of domestic violence victims are women.

Question 21

211. A patient has extreme thirst and excessive urination. Urine is diluted with no glucose present. Serum blood glucose is normal, although sodium level is elevated. What is the most likely diagnosis based on this information?
     a. Diabetes insipidus
     b. Urinary tract infection
     c. Diabetes mellitus
     d. Acute renal failure

Answer 21

211. A: Diabetes insipidus. This condition is due to deficiency of antidiuretic hormone (ADH), or a nephrogenic cause. Patients present with increased thirst, polyuria, hypernatremia, and dehydration. Diagnosis can be confirmed with 24-hour urine collection, serum labs, and a vasopressin challenge test. Diabetes insipidus (DI) can present similarly to diabetes mellitus (DM), although elevated glucose would be present with DM.

Question 22

212. Which of the following results from an arterial blood gas test would suggest respiratory acidosis?
     a. pH of 7.5
     b. Decreased PaCO2
     c. pH of 7.4
     d. Increased PaCO2

Answer 22

212. D: Increased PaCO2. Arterial blood gas readings are normally taken from the radial or femoral artery. Parameters that are examined include pH, partial pressure of oxygen, and partial pressure of carbon dioxide. The pH will tell if the patient is acidotic or alkalotic. The lung or kidneys counteract the initial disorder by compensatory mechanism. Respiratory acidosis results from hypoventilation, which causes increased carbon dioxide concentration in the blood and decreased pH. Acidemia is when pH is less than 7.35.

Question 23

213. You are looking at an x-ray of a child’s fractured radius. Your supervising physician says it is a Salter-Harris type II fracture. What bone structures does this fracture effect?
     a. Physis, metaphysis, and epiphysis
     b. Physis and epiphysis
     c. Physis and metaphysis
     d. Physis only

.

Answer 23

213. C: Physis and metaphysis. Fractures of the growth plate, or physis, in children are described by the Salter-Harris classification system. Salter-Harris I fractures affect the physis only. Salter-Harris II fractures affect the physis and metaphysis. Salter-Harris III fractures affect the physis and epiphysis. Salter-Harris IV fractures affect the physis, metaphysis, and epiphysis. Salter-Harris V fractures are crush injuries.

Question 24

214. A 30-year-old man has rectal pain and reports bright red blood on the tissue paper after defecation. Upon inspection, you see a small area of swelling and erythema near the rectum. What prescription will provide some relief for this patient?
     a. Mesalamine
     b. Loperamide
     c. Rifaximin
     d. Docusate

Answer 24

214. D: Docusate. This is a stool softener that can help the patient avoid straining during bowel movements. This patient likely has hemorrhoids that are caused by dilated veins in the rectum. Patients present with irritation and bleeding. They may become thrombosed or protrude. Treatment can also include warm sitz baths, increased fiber intake, and NSAIDs for pain. In some cases, sclerotherapy or surgery may be required.

Question 25

215. Metoprolol is used to treat which of the following?
     a. Severe bradycardia
     b. Hypertension
     c. Third-degree AV block
     d. All of the above

Answer 25

215. B: Hypertension. Metoprolol is a beta-blocker and is used to treat angina, stable heart failure, and hypertension. It is contraindicated in patients with sinus bradycardia, second- or third-degree atrioventricular (AV) block, cardiogenic shock, severe peripheral arterial circulatory disorders, and sick sinus syndrome.