Pathophysiology 2 Flashcards
(161 cards)
1
Q
The kidney excretes nitrogenous wastes in the form of BUN, this is made in the:
○ A: Liver
○ B: Kidney
○ C: Heart
○ D: Colon
A
A: Liver
§ In LR Failure- BUN↓, NH₃↑ § Protein>N>NH₃>LR>BUN>KD>Excretion
2
Q
• Sperm production by the seminiferous tubular cells is controlled by:
○ A: LH ○ B: FSH ○ C: Testosterone ○ D: Estrogen
A
○ B: FSH
○ LH & FSH- from anterior pituituary gland
§ FSH-Seminiferous tubular cells-Sperm
§ LH-Testosterone-Leydic cells
3
Q
• In chronic renal failure, the anemia is d/t:
○ A: lack of erythropoetin ○ B: lack of renin ○ C: persistent hematuria ○ D: repeated blood testing
A
○ A: lack of erythropoetin
§ Stimulates bone marrow RBC production
4
Q
• The active form of vitamin D is made in the:
○ A: Liver ○ B: Lung ○ C: Kidney ○ D: Skin
A
○ C: Kidney
○ Source vit D= sun + food
§ LR convert to 25 D
§ KD convert to 1,25 D (active form)
5
Q
• During a normal menstrual cycle, ovulation occurs on:
○ A: first day ○ B: 14th day ○ C: 28th day ○ D: 7th day
A
○ B: 14th day
§ Ovulation- d/t LH surge § Maximum fertility= days 14-21 +/-
○ 1st day= day of 1st bleed
○ 28th day= cycle completion
○ 7th day= end of bleed (5-7 days)
6
Q
• In type 2 Diabetes Mellitus
○ A: there is no insulin ○ B: patients cannot utilize insulin properly ○ C: the insulin produced is biologically inactive ○ D: none of the above
A
○ B: patients cannot utilize insulin properly
7
Q
• Chronic complications of Diabetes Mellitus include all except:
○ A: heart disease ○ B: kidney disease ○ C: liver disease ○ D: blindness
A
○ C: Liver disease
○ HKBL² § Heart disease § Kidney disease § Blindness § Limb loss
8
Q
• Acute complications of diabetes include all except:
○ A: DKA ○ B: Hypoglycemia ○ C: Acute pancreatitis ○ D: infections
A
○ C: acute pancreatitis
○ DKA= diabetic ketoacidosis
○ Infections d/t WBC’s not functioning as well
9
Q
• The commonest kind of kidney stone is:
○ A: calcium stones ○ B: triple phosphate stones ○ C: uric acid stones ○ D: cystine stones
A
○ A: calcium stones= 80%
○ Triple phosphate (struvite)- w/ chronic UTI
○ Uric acid stone- w/ gout, any disease w/ ↑cellular nucleus destruction
10
Q
• RBC casts are seen in diseases of the:
○ A: kidneys ○ B: urinary bladder ○ C: prostate ○ D: urethra
A
○ A: kidneys
§ Urinary casts of Loop of Henle
□ KD rel UTI
§ UB- no urinary cast
11
Q
• In nephrotic syndrome, all are present except:
○ A: proteinuria
○ B: edema
○ C: hematuria
○ D: hyperlipidemia
A
○ C: hematuria- (nephritic syndrome)
○ “O for PRO”
○ Nephrotic syndrome § Proteinuria (>3.5/24hrs) § Hypoproteinemia § Hyperlipidemia § Edema (d/t low oncotic pressure)
12
Q
• Calcium containing urinary stones may be present in:
○ A: hyperparathyroidism ○ B: Repeated urinary tract infection ○ C: Increase intake of dietary calcium ○ D: gout
A
○ A: hyperparathyroidism
§ ↑PTH- Ca↑ d/t PTH stim breakdown of bones by osteoclasts
○ Rpt UTI- struvite/triple phosphate stones
○ Gout- ↑Uric acid- uric acid stones
13
Q
• Pedal edema in patients w/ nephrotic syndrome is d/t:
○ A: lack of intravascular oncotic pressure
○ B: the KD disease that causes impairment of water excretion
○ C: there is HT disease
○ D: none of the above
A
○ A: lack of intravascular oncotic pressure
§ d/t severe proteinuria > hypoproteinemia
14
Q
• What are the causes of acute pancreatitis?
A
○ GB disease
○ Alcohol
○ Trauma
○ Mumps
○ GB + Alcohol= 80%
15
Q
• What are acute complications of Diabetes mellitus?
A
○ DKA
○ Hypoglycemia
○ Infection
16
Q
• Pre-renal kidney failure results from:
○ A: obstruction ○ B: dehydration ○ C: Renal parenchymal problem ○ D: none of the above
A
○ B: dehydration
○ Pre-renal= dehydration
○ Post-renal= obstruction
17
Q
• In hypocalcemia:
○ A: Trousseau's sign may be present ○ B: is caused by hyperparathyroidism ○ C: Is caused by hyperthyroidism ○ D: need not be corrected
A
○ A: Trousseau’s sign may be present
§ Sign of latent tetany observed in patients w/ low calcium- blood pressure cuff placed around arm and inflated to pressure greater than systolic blood pressure and held for 3 minutes-will occlude brachial artery-will induce spasm hand and forearm muscles-wrist and metacarpophalangeal joints flex, DIP and PIP joints extend, and the fingers adduct.
§ Or Chvostek- facial nerve tapped at angle of jaw (i.e. masseter muscle), facial muscles on same side face will contract
§ Hyperparathyroidism > hypercalcemia
§ Hyperthyroidism> no rel. calcium
18
Q
• The differential diagnosis of a scrotal mass include:
○ A: inguinal hernia ○ B: cancer of the testicle ○ C: hydrocele ○ D: all of the above
A
○ D: all of the above
○ D/D scrotal mass: § Inguinal hernia § Hydrocele § Spermatocele § Hematoma/trauma § Orchitis § Epididymitis § Cancer
19
Q
• Severe pain in the testicular area may be caused by:
○ A: hematoma of the testicle ○ B: torsion of the testicle ○ C: epididymitis ○ D: all of the above
A
○ D: all of the above
○ Testicular cancer usually painless
○ D/D Testicular pain: § Hematoma/trauma § Torsion of testicle (check @ 12) § Epididymitis § Hydrocele § Varicocle § Inguinal hernia
20
Q
• If the blood sugar falls below 30 mg% there may be:
○ A: confusion ○ B: convulsion ○ C: coma ○ D: all of the above
A
○ D: all of the above
21
Q
• Causes of hematuria include
○ A: Kidney stone ○ B: Cancer of the urinary bladder ○ C: cancer of the kidney ○ D: all of the above
A
○ D: all of the above
§ KD stone- hematuria + pain § UB cancer- no pain, only hematuria, normal CT § KD cancer- no pain, blood, + w/ CT
○ D/D hematuria: § Infection (UB/KD) § Stones § Cancer (no pain) § Trauma (pt. history) § Menstrual contamination
22
Q
• In Klinefelter’s Syndrome, which one of the following is present:
○ A: cancer of the testicle ○ B: infertility ○ C: testicular enlargement ○ D: Increased levels of testosterone
A
○ B: infertility § XXY § male § Testicular shrinkage/atrophy § Gynecomastia § ↓testosterone § ↑FSH § ↑LH
23
Q
• Melanoma ABC’s
A
○ A malignant tumor of melanocytes
§ Melanocytes= cells that produce melanin (give skin color)
§ Causes 75% deaths rel. skin cancer
§ ABC's: □ A: asymmetry □ B: borders (irregular) □ C: color (varigated) □ D: diameter (>6mm) □ E: evolving over time
24
Q
• S/S Acute glomerular nephritis:
A
○ Hematuria
○ Proteinuria
○ Acute renal failure
○ Good prognosis
○ “hey people a cute girl”
25
• Repeated vaginal yeast infection may be d/t:
○ A: congenital problem
○ B: diabetes mellitus
○ C: herpes infection
○ D: chronic urine infection
○ B: diabetes mellitus
§ Acute complications D.M.
□ DKA
□ Hypoglycemia
□ Infection
26
• The hormone produced by the pancreas is:
○ A: glucagon
○ B: glycogen
○ C: gastrin
○ D: thyroxin
○ A: glucagon
○ Glycogen= stored form of glucose
○ Gastrin= ST secretion
○ Thyroxin= thyroid secretion
27
Many of the women of a village in South America are found to have large goiters. The conclusion that can be made from that observation is that:
○ A: the region is low in iodine
○ B: There is a carcinogen present resulting in a high incidence of thyroid cancer
○ C: No conclusions can be made w/o biopsy
○ D: all of the above
○ A: The region is low in iodine
28
Unlike ovulation in the female, testosterone production in men, can continue until age:
○ A: 50
○ B: 60
○ C: 70
○ D: may continue indefinitely
○ D: may continue indefinitely
29
The commonest malignant testicular tumor is:
○ A: Seminoma
○ B: Teratoma
○ C: Leydig cell tumor
○ D: Lymphoma
○ A: Seminoma
○ Teratoma= ovarian malignancy forms from dermoid cyst
30
• In type 2 Diabetes Mellitus
○ A: there is no insulin
○ B: patients cannot utilize insulin properly
○ C: The insulin produced is biologically inactive
○ D: none of the above
○ B: patients cannot utilize insulin properly
31
Risk factors for the cancer of the urinary bladder include:
○ A: Undescended testicle
○ B: human papiloma virus infection
○ C: unclean personal hygiene
○ D: tobacco use
○ D: tobacco use
```
○ Tobacco related cancers:
§ Esophagus
§ Bladder
§ Mouth
§ Lung
```
32
The acute complications of Diabetes include all except:
○ A: DKA
○ B: Hypoglycemia
○ C: Acute pancreatitis
○ D: infections
○ C: acute pancreatitis
○ Acute complications of D.M.:
§ DKA
§ Hypoglycemia
§ Infections
33
Tertiary syphilis can lead to:
○ A: aneurysm of the aorta
○ B: Dementia
○ C: Tabes dorsalis
○ D: all of the above
○ D: all of the above
○ Primary syphilis:
§ Chancre (lesions)
○ Secondary:
§ Systemic s/s
○ Tertiary:
§ Dementia
§ Aortic aneurysm
§ Tabes dorsalis
34
RBC casts are seen in diseases of the:
○ A: Kidneys
○ B: Urinary Bladder
○ C: Prostate
○ D: Urethra
○ A: kidneys
| § From loop of henle
35
In nephrotic syndrome, all are present except:
○ A: proteinuria
○ B: edema
○ C: hematuria
D: hyperlipidemia
○ C: hematuria
```
○ Nephrotic syndrome (O for PRO)
§ Proteinuria >3.5g/24 hrs
§ Hypoproteinemia
§ Edema
§ Hyperlipidemia
```
36
Name the cancer of the kidney in infants:
○ Wilm's tumor
37
Calcium containing urinary stones may be present in:
○ A: hyperparathyroidism
○ B: Repeated urinary tract infections
○ C: increase intake of dietary calcium
○ D: gout
○ A: hyperparathyroidism
§ ↑PTH goes to bone, stimulates osteoclasts- crush bone- release Ca
○ Repeat UTI> Struvite/Triple Phosphate
○ Gout> ↑Uric acid
38
• In hypocalcemia:
○ A: Trousseau's sign may be present
○ B: Is caused by hyperparathyroidism
○ C: Is caused by hyperthyroidism
○ D: Need not be corrected
○ A: Trousseau's sign may be present
| § Also Chvolstek
39
Torsion of the testicle:
○ A: should be treated immediately
○ B: should not be treated immediately
○ C: wait and watch policy should be followed
○ D: if there is any doubt about the diagnosis,
re-evaluation should be made w/in 48 hrs
○ A: should be treated immediately
○ Def: spermatic cord twists causing ischemia (cut testicular blood supply)
40
Risk factors for the cancer of the penis include:
○ A: undescended testicle
○ B: HPV infection
○ C: unclean personal hygiene
○ D: Tobacco use
○ C: unclean personal hygiene
○ Phimosis- adherence of prepuce to head of penis d/t smegma collection
§ Phimosis--> cancer of penis
41
The differential diagnosis of a scrotal mass include:
○ A: Inguinal hernia
○ B: Cancer of the testicle
○ C: Hydrocele
○ D: all of the above
○ D: all of the above
```
○ D/D Scrotal mass:
§ Inguinal hernia
§ Epidiymitis
§ Orchitis
§ Hydrocele
§ Hematoma
§ Torsion of the testicle
§ Testicular cancer (seminoma= most common)
```
42
Severe pain in the testicular area may be caused by:
○ A: hematoma of the testicle
○ B: torsion of the testicle
○ C: epididymitis
○ D: all of the above
○ D: all of the above
○ No pain w/ cancer until progressed
43
During a 3 day starvation, the body continues to produce glucose from:
○ A: Fat
○ B: Protein
○ C: Carbohydrate
○ D: none of the above
○ B: Protein
§ 2 days glycogen store
§ The break down muscles for usable proteins
44
Which of the following is not a sexually transmitted disease:
○ A: Gonorrhea
○ B: Syphilis
○ C: Pyelonephritis
○ D: HIV infection
○ C: Pyelonephritis
| § KD disease
45
In Klinefelter's Syndrome, which one of the following is present?
○ A: Cancer of the breast
○ B: Infertility
○ C: Testicular enlargement
○ D: increased levels testosterone
○ B: infertility
```
§ XXY
§ Male
§ Gynecomastia
§ Testicular atrophy
§ ↓Testosterone
§ ↑LH
```
46
Pre-renal kidney failure results from:
○ A: obstruction
○ B: dehydration
○ C: Renal parenchymal problem
○ D: none of the above=
○ B: dehydration
○ Post-renal= obstruction
47
What stimulates the Graafian (ovarian) follicle?
○ FSH (Follicle stimulating hormone)
| § From anterior pituitary
48
What causes ovulation?
○ LH surge
49
What is the name of the follicle after ovulation and the ova is gone?
○ Corpus luteum
50
When is maximum fertility?
○ 14-21
○ Ovulation = +/- day 14
51
What is measured when doing a pregnancy test?
○ HCG (Human chorionic gonadotropin)
§ Urine
§ Blood- more accurate & shows earlier
52
What is the test for menopause?
○ FSH↑
| § (b/c estrogen↓)
53
What are the hormones produced by the corpus luteum?
○ Progesterone
| ○ Estrogen
54
What stops sperm production and how does it work?
○ Inhibin
§ Hormone produced by the gonads that inhibit FSH production by the pituitary gland
§ Is a negative feedback system
55
Give some examples of common vaginal infections:
```
○ Gardnerella vaginalis (g. vaginalis)
○ Candida
○ Trichomonas vaginalis
○ Herpes simplex
○ Gonorrhea
○ Chlamydia
○ Syphilis
○ Human papiloma virus (HPV)
```
56
What test would you use for a suspected UTI?
○ Urine dip stick
○ UTI if nitrites +/or WBC present
○ If no, but burning/pain/discomfort- could be other infection (Chlamydia, etc.)
57
What joint disease is related to a bacterial infection such as Chlamydia? What are the signs and symptoms associated?
○ Reiter's Syndrome aka Reactive Arthritis
§ w/ Chlamydia infection
○ Category: spondyloarthropathy
```
○ S/S:
§ Urethritis
§ Conjunctivitis
§ Scaling skin heels & palms
§ Joint discomfort
```
58
On which day of the menstrual cycle is a woman most fertile?
○ Day 14-21
59
A 36 year old para 1 gravida 1 female comes in with a singular complaint of breast milk secretion. Her last menstruation was six months ago. What is your diagnosis and what tests will you order?
○ Prolactinoma
○ Tests:
§ HCG/Pregnancy
§ Prolactin
§ CT Scan (tumor of Ant. Pituitary)
○ Para= pregnancy
○ Gravida/grava= baby birthed
○ Gen presentation in men:
§ impotence
60
• What are the risk factors for:
```
○ A: Cancer of the cervix
○ B: Cancer of the uterus
○ C: Cancer of the testicle
○ D: Cancer of the penis
○ E: Cancer of the urinary bladder
```
```
○ A: Cervix:
§ Intercourse began @ early age
§ Multiple sexual partners
§ HPV infection
§ Other venereal diseases
```
○ B: uterus:
§ Unopposed estrogen
§ Nulliparity
○ C: testicle:
§ Undescended testicle
○ D: penis:
§ Poor hygiene
□ Smegma collection--> phimosis--> cancer
○ E: UB:
§ Smoking tobacco
61
What is genotype?
○ Genetic constitution or type
62
What are three different origins of ovarian neoplasm? From which one does a teratoma arise?
○ Types:
§ Primarily cystic
□ Ex: mucinous cystadenoma
§ primarily solid
□ Ex: fibroma
§ Mixed
□ Ex: dermoid (teratoma)
○ Surface epithelium affected
germ cell (ova)- teratoma arise from germ cell
63
What is placenta previa?
Placenta grown in front of baby b/c fertilized ovum doesn't attach to sticky surface of uterus
64
What are causes of hematuria?
```
○ Infection (KD/UB)
○ Stones (KD/UB)
○ Cancer (no pain)
○ Trauma
○ Menstrual contamination
```
65
What are causes of a scrotal mass?
```
○ Inguinal hernia
○ Epididymitis (pain)
○ Orchitis (↑WBC)
○ Hydrocele
○ Hematoma
○ Torsion of testcle
○ Testicular cancer (#1= seminoma, no pain)
```
66
What are the presenting features of toxemia of pregnancy?
○ Pre-eclampsia toxemia:
§ ↑Proteinuria
§ ↑BP
```
○ Eclampsia:
§ +Seizures/convulsions
§ +comatose
§ +very ill
§ +potential loss baby + mother
```
67
What is the peak for gestational diabetes?
2nd trimester (week 22-ish)
68
What are the presenting features of nephrotic syndrome?
○ Proteinuria (>3.5g/24hr)
○ Hypoproteinemia
○ Hyperlipidemia
○ Edema
69
A 22 y.o woman who has been pregnant for the last three months comes in w/ complaints of passage of grape like tissue from her vagina. What is your diagnosis?
○ Dx: Gestational trophoblastic disease
○ +Pregancy test (making HCG)
○ no period
○ Placental disease
○ Tx:
§ Remove placenta
§ D & C (dilation & curettage- dilate cervix remove
uterine contents)
70
What are the features of Benign Prostatic Hyperplasia?
○ Difficult urination
○ Frequent urination
○ ↓Power stream (urine)
71
What is the lab test for cancer of the prostate. At what age should screening for this start?
○ PSA (antiquated)
○ Rectal exam- w/ biopsy if mass/tumor
○ Begin +/- 40 y.o
§ 15 y.o. for testicles
72
What are the lab abnormalities in Klinefelter's syndrome?
○ ↓testosterone
○ FSH↑
○ LH↑
○ Karyotyping: XXY
○ S/S:
§ Impotence
§ Testicular atrophy
§ Gynecomatia
73
What is the name of a hernia in the groin for a man? For women?
○ Man: inguinal hernia
| ○ Female: femoral hernia
74
What are features of Turner's syndrome?
```
○ XO genotype
○ Female phenotype
○ No estrogen (no ovaries)
○ Webbing neck
○ No secondary sex characteristics @ puberty
```
○ Test: Karyotyping
○ Tx:
§ 6 month unopposed estrogen
§ Then: cycle estrogen/progesterone
75
Give 5 features of Rheumatoid arthritis:
```
○ Morning stiffness
○ Wrist pain
○ Ulnar deviation
○ Proximal phalangeal joint deformity
○ Anemia (of chronic illness)
```
76
Give 4 pathogenic features of osteoarthritis:
```
○ Pain
○ Deformity
○ Herberden (Buchard) nodules
○ Distal joint deformity
○ Crepitis
```
77
Classify spondyloarthropathy:
○ Ankylosing spondylitis
○ Reactive arthritis
○ Enteropathic arthrits (Crohn's/ulcerative colitis)
○ Psoriatic arthritis
78
Give 5 features of Ankylosing spondylitis:
```
○ Low back pain
○ Morning stiffness
○ Pain at night
○ Uveitis/eye problems
○ Aortic incompetence
```
○ Predom. Affect young men
○ Test: HLA B27
79
Give 4 causes of Carpal Tunnel Syndrome:
○ Repeat trauma (jack-hammer)
○ Pregnancy
○ Hypothyroidism
○ Rheumatoid arthritis
○ w/ hypothyroid- Test TSH, Free-T4- Tx & S/S resolve
80
What is pannus?
In Rheumatoid arthrits, is a thick covering of joint made by attacking and protecting cells
81
What are the differences in the hand of a patient w/ osteoarthritis & Rheumatoid arthritis?
○ Osteo- DISTAL jt deformity
(herberden/bouchards nodules)
○ R.A.- PROXIMAL jt deformity
82
Give 4 features of Gout. Make sure you include origin of uric acid & age of onset of gout.
○ 3 places deposit:
§ Joint (esp big toe)
§ Ear (tophi)
§ KD (uric acid stones)
○ Age: young male
○ KD failure ↑Uric acid
○ Gout- congenital
83
Give 4 features of reiter's syndrome:
```
○ S/S:
§ Joint pain
§ Urethritis
§ Conjunctivitis
§ Exfoliation- esp of palms & soles of feet
```
○ A reactive arthritis
○ Related to bacterial infection (ex: chlamydia)
84
What is Charcot foot?
○ Foot bones become fragmented
○ From tabes dorsalis causing repeated trauma to arch & foot bones
§ Rel. Diabetes M. & tertiary syphilis
85
Describe 4 different kinds of fracture of the bone:
○ Compound
§ Skin broken/complete fracture
○ Simple
§ Complete or incomplete
§ No break in skin
○ Comminuted
§ Shattered
○ Green stick
§ In children, bone still cartilaginous, therefore bends
86
What 3 bones commonly result in fracture secondary to osteoporosis? Which is worst? How can you help?
○ 3 bones:
§ Hip/femur neck
§ Wrist
§ Spine
○ Hip/femur neck= worst
§ If not Tx w/ surgery- lead to death (pneumonia, etc.)
○ Prevention:
§ Calcium & vit. D
§ Weight bearing exercise
○ Exacerbated by:
§ Steriods (>7 weeks- will cause)
§ Cusings Disease
§ Make worse- ↓bone density
○ Test: Dexa scan
○ Tx:
§ androgens- to reduce impact of just estrogen
§ Mix estrogen/testosterone short time
87
Charcot foot:
○ A: is a result of rheumatoid arthritis
○ B: is a destructive lesion d/t diabetic neuropathy
○ C: is a destructive lesion d/t Myasthenia gravis
○ D: is a destructive lesion d/t Osteoporosis
○ B: is a destructive lesion d/t diabetic neuropathy
○ Diabetes & tertiary syphilis> tabes dorsalis> charcot foot
88
```
The commonest site of ectopic pregnancy is:
○ A: the fallopian tube
○ B: the ovary
○ C: the cervix
○ D: the colon
```
○ A: the fallopian tube
```
○ No s/s
○ If persist> rupture & death
○ Test: ultrasound, ↑amylase
○ Tx: D&C (dilation & curettage- dilate cervix remove
uterine contents)
```
89
```
Which one of the following is not an STD?
○ A: Gonorrhea
○ B: Syphilis
○ C: Pyelonephritis
○ D: HIV infection
```
○ C: Pyelonephritis (KD infection)
```
○ STD D/D:
§ HPV
§ Infectious vaginitis:
□ Trichomonas vaginalis
□ Gardnerella vaginalis
□ Candida albicans
§ Chlamydia
§ Gonorrhea
§ Syphilis
```
90
```
In Klinefelter's Syndrome, which one of the folling is present:
○ A: cancer of the breast
○ B: Infertility
○ C: testicular enlargement
○ D: Increased levels of testosterone
```
○ B: infertility
○ S/S:
§ Gynecomastia
§ Testicular atrophy
§ Impotence
○ Test:
§ Karyotypling (XXY)
§ Testosterone↓
§ FSH↑
○ Tx:
§ Testosterone
§ Mamoplasty
91
Risk factors for the cancer of the urinary bladder include:
○ A: undescended testicle
○ B: Human Papiloma Virus (HPV) infection
○ C: Unclean personal hygiene
○ D: tobacco use
○ D: tobacco use
```
○ Cancers rel. Tobacco use:
§ UB
§ Esophagus
§ Lung
§ Mouth
```
92
In type 2 Diabetes mellitus:
○ A: there is no insulin
○ B: patients cannot utilize insulin properly
○ C: the insulin produced is biologically inactive
○ D: none of the above
○ B: patients cannot utilize insulin properly
93
Chronic complications of diabetes mellitus include all except:
○ A: Heart disease
○ B: Kidney disease
○ C: Liver disease
○ D: Blindness
C: Liver disease
```
○ HKBL²
§ HT disease
§ KD disease
§ Blindness
§ Non-traumatic peripheral LIMB LOSS
```
94
The initial lesion of primary Syphilis is a:
○ A: Chancre
○ B: cyst
○ C: Tumor
○ D: Abscess
○ A: Chancre
```
○ Primary: chancre
○ Secondary: systemic s/s
○ Tertiary:
§ Dementia
§ Tabes dorsalis
§ Aortic aneurysm
```
95
```
Osteoporosis is often seen in:
○ A: Menopause
○ B: Cushing's Syndrome
○ C: Hyperparathyroidism
○ D: All of the above
```
○ D: all of the above
§ Menopause- no estrogen
§ Cushings- deactivates osteoblasts
§ Hyperparathryoid- PTH stim osteoclasts PTH↑ Calcium↑
```
○ D/D Causes:
§ Menopause
§ Lack sex hormones
§ Steroid intake (>7wks)
§ Endocrine disease (Cushings, hyperparathyroid)
§ Vit. D or Ca xu
§ Immobility
```
96
The chromosomal pattern of Turners Syndrome is:
○ A: XXY
○ B: XX
○ C: XO
○ D: XY
○ C: XO
§ XXY= Klinefelter's
§ XX= female
§ XY= male
97
Herberden's nodules are seen in:
○ A: Rheumatoid arthritis
○ B: gout
○ C: osteoarthritis
○ D: osteomyelitis
○ C: osteoarthritis
§ Herberden= Bouchards
○ R.A= Rhumatoid nodules
○ Osteomyelitis
§ Myelo= marro
§ Inflammation of bone marrow
98
In hypocalcaemia:
○ A: Trousseau's sing may be present
○ B: is caused by hyperparathyroidism
○ C: is caused by hyperthyroidism
○ D: need not be corrected
○ A: Trousseau's sign may be present
§ Or Chvostek
○ Trousseau: Bp cuff maintain ↑ systolic for 3 min- hand form crane
○ Chvostek: tap @ masseter (facial nerve)- cringe response face
○ Hyperthyroidism- calcitonin from thyroid lowers calcium
○ Hypoparathyroid (ex: surgical removal)
○ Hypercalcemia:
§ Hyperparthyroid
§ Bone disease (ex: bone cancer- osteoma)
□ w/ low PTH
§ Excess vitamin D
□ Water based vitamins in excess can pee out
□ Oil based- body cannot excrete
99
```
Osteomyelitis is a bone disease caused by:
○ A: metabolic disease
○ B: tumor
○ C: infection
○ D: heredity
```
○ C: infection
§ Osteo=bone, myelo=marrow, -itis= inflammation
○ Def. osteomyelitis:
§ Infection & inflammation of bone or bone marrow
○ Test: ↑Sed rate, ↑WBC
§ If chronic, WBC may not be so elevated
100
Osteomalacia results from:
○ A: Vitamin D xu
○ B: Vitamin C xu
○ C: infection
○ D: trauma
○ A: Vitamin D xu
○ S/S:
§ Bowing of spine
§ Can't hold own weight
○ Test: 25D (it's always around)
○ =Rickets in children
101
In nephrotic syndrome, all are present except:
○ A: proteinuria
○ B: edema
○ C: hematuria
○ D: hyperlipidemia
○ C: hematuria
```
○ S/S:
§ Proteinuria (>3.5g/24hrs)
§ Hypoalbuminemia
§ Edema
§ Hyperlipidemia
```
102
During a 4 day starvation, the body continues to produce glucose from:
○ A: Fat
○ B: protein
○ C: Carbohydrate
○ D: none of the above
○ B: protein
○ Day 1-2: glucose from glycogen stores
§ Also energy from fat always (ketones in urine)
§ Brain needs glucose
○ Day 2+: breakdown glucogenic amino acids
§ (proteins from muscles)
103
The test for the diagnosis of Polymyalgia rheumatica is:
○ A: MRI
○ B: Sed rate
○ C: biopsy
○ D: skin test
○ B: Sed rate (ONLY TEST!!) ↑↑
```
○ S/S:
§ Transient unilateral blindness (early)
□ From temporal arteritis
§ Lingual gangrene (advanced)
□ Lingual arteritis> ischemia
```
104
Prolonged morning stiffness is seen in:
○ A: Ankylosing spondylitis
○ B: Osteoarthritis
○ C: Gout
○ D: Charcot foot
○ A: Ankylosing spondylitis
§ Also w/ Rheummatoid arthritis
○ Osteoarthrits S/S
§ Pain, deformity, Herberden nodules- distal jts
○ Gout S/S:
§ Big toe pain/uric acid KD stone/ tophi ear
§ Pain dv't overnight- acute
○ Charcot foot S/S:
§ Neurophatic/Stomping gate
§ foot=bag fragmented bones
§ rel. Tabes Dorsalis (Diabetes or tertiary Syphilis)
105
Risk factors for the cancer of the Cervix include:
○ A: Nulliparity
○ B: Human Papiloma Virus (HPV) infection
○ C: unclean personal hygiene
○ D: Tobacco use
○ B: Human Papiloma Virus (HPV) infection
```
○ Risk factors:
§ Sex @ early age
§ Multiple sex partners
§ HPV infection
§ Other venereal diseases
```
106
Problems encountered at the time of menopause include:
○ A: temperature intolerance
○ B: depression
○ C: dyspareunia (painful intercourse)
○ D: all of the above
○ D: all of the above
§ Can also lead to osteoporosis
§ Tx: dyspareunia-lubrication,estrogen/progesterone
107
At the time of menopause:
○ A: serum FSH is increased
○ B: serum FSH is decreased
○ C: only a small # of ova are left in the ovary
○ D: Conception, if happens, results in congenital birth defects
○ A: serum FSH is increased
§ b/c ↓estrogen, ↑FSH
§ Negative feedback b/c ovary not producing
estrogen b/c no more ova
§ Pituitary gland continues FSH to stimulate ovary
§ Menopause is not a point in time
§ Think perimenopause
§ Can last 1-3 years
§ If elderly woman & FSH↓- maybe pituitary tumor
108
Rheumatoid arthritis:
○ A: is characterized by pannus formation
○ B: affects the interphalangeal joints
○ C: is an autoimmune disease
○ D: all of the above
○ D: all of the above
```
○ S/S:
§ Morning stiffness
§ Wrist pain
§ Ulnar deviation
§ Proximal jts
§ Rheumatoid nodules
§ Pannus formation
```
```
○ Test:
§ Blood: Rheumatoid factor, ↑Sed rate
§ JT fluid: Rheumatoid factor, PMN
(polymorphonuclear leukocytes)
§ X-ray- shows deformity
```
109
Repeated vaginal yeast infection may be d/t:
○ A: congenital genital problem
○ B: Diabetes mellitus
○ C: herpes infection
○ D: chronic urine infection
○ B: Diabetes mellitus
```
○ S/S D.M.:
§ Polyuria
§ Polydypsia
§ Poor vision
§ Repeat vaginal yeast infections
```
○ Dx: Fasting blood sugar (> 126 g/dL)
110
A skin disease presenting with slightly elevated papules especially on the knees and elbows that are covered w/ silvery scales, is suggestive of:
○ A: Eczema
○ B: Psoriasis
○ C: Squamous cell carcinoma
○ D: Melanoma
○ B: Psoriasis
§ Biggest complaint is cosmetic, some itching, very little pain
§ If combo w/ joint pain= Psoriatic Arthritis
111
Charcot foot:
○ A: is a result of Rheumatoid arthritis
○ B: is a destructive lesion d/t diabetic neuropathy
○ C: is a destructive lesion d/t Myasthenia gravis
○ D: is a destructive lesion d/t osteoporosis
○ B: is a destructive lesion d/t diabetic neuropathy
§ & tertiatry syphilis
§ Both rel.- tabes dorsalis
§ S/S:
□ No sense of pain, temperature or touch
□ Loss of arch
□ Foot= bag of bones
112
The neurotransmitter used at the myoneural junction is:
○ A: Acetylcholine
○ B: Norepinephrine
○ C: Adrenaline
○ D: Dopamine
○ A: Acetylcholine
§ Absent/very low in Myasthenia Gravis d/t autoimmune destruction
○ Norepinephrine & adrenaline/epinephrine- from adrenal medulla
○ Dopamine- neurotransmitter in brain absent in Parkinson's
113
Functions of the skin include all except:
○ A: formation of vitamin D
○ B: protection from invasive organisms
○ C: temperature regulation
○ D: formation of immune mediators
○ D: formation of immune mediators
§ B-Cells - (b-lymphocyte)- make plasma cells- which produce antibodies
□ Formed in bone marrow by stem cells
114
In Myasthenia Gravis:
○ A: there is a malfunction at the myoneural junction
○ B: removal of the thymus may help
○ C: repetitive movements are effected
○ D: all of the above
○ D: all of the above
○ Myasthenia Gravis:
§ Autoimmune disease
§ Very little ACT b/c devpt antibodies against
vesicles that produce ACT
§ w/ repetitive movts- ACT runs out- therefore
movts peter out
```
§ S/S:
□ Tired all the time
□ Ptosis (drooping eyelids)
□ Diplopia (double vision)
□ All repetitive muscular mov'ts peter out
```
§ Physical exam:
□ Simple repetitive muscular mov't
□ Counting
§ Test: EMP (electromyogram)
□ Measure action potential
§ Lab: ACT antibodies
§ Tx: ACT-like substance + Choline esterase
inhibitors
115
Risk factors for cancer of the uterus include:
○ A: Sexually transmitted viral infection
○ B: smoking
○ C: hematuria
○ D: unopposed estrogen
○ D: unopposed estrogen
§ Also nulliparity
○ STI/STD- cervix risk factor
○ Smoking- UB risk factor
116
Causative factors of acne include:
○ A: puberty
○ B: androgenic hormones
○ C: hyperkeratosis & blockage of discharge of sebum
○ D: all of the above
○ D: all of the above
○ Tx: Retinine (caution: cause deformity to in-utero fetus)
117
The test for the diagnosis of Polymyalgia rheumatica is:
○ A: MRI
○ B: Sed. Rate
○ C: Biopsy
○ D: skin test
○ B: Sed. Rate ↑↑ (ONLY TEST)
118
Prolonged morning stiffness is seen in:
○ A: Ankylosing Spondylitis
○ B: Osteoarthritis
○ C: Gout
○ D: Charcot foot
○ A: Ankylosing Spondylitis
§ Also w/ Rheumatoid arthritis
119
Osteoarthritis usually affects the:
○ A: Proximal interphalangeal joints
○ B: Distal interphalangeal joints
○ C: the big toe
○ D: all of the above
○ B: distal interphalangeal joints
§ Herberden/Bouchard's nodules
○ R.A: proximal jts
○ Gout: big toe
120
In endometriosis, ectopic endometrial tissue may be present in:
○ A: the ovaries
○ B: the colon wall
○ C: anywhere in the pelvis
○ D: all of the above
○ D: all of the above
121
What is the most common pituitary tumor?
○ Prolactinoma
```
○ General Pit. Tumor S/S:
§ Headache
§ Loss of peripheral vision
§ Endocrine s/s
□ No period
□ Milk secretion
□ Not pregnant
```
□ Men= impotence
122
What is a disease spurred by a GH Pituitary tumor?
Acromegaly
123
What is Multiple Endocrine Neoplasia/Adinoma?
Many endocrine glands affected simultaneously
124
What are the 5 conditions related to Multiple Endocrine Adinomas (neoplasia)?
```
○ Hypothyroid
○ Addison's Disease
○ Diabetes Mellitus
○ Pernicious anemia
○ Premature menopause
```
125
Where is the visual cortex located in the brain?
○ Occipital lobe
126
What does the temporal lobe of the brain dominate?
○ Hearing
| ○ Smell
127
What does the frontal lobe of the brain dominate?
Psychiatric
128
What does the cerebellum dominate?
○ Coordination
○ Balance
○ Ex: Gate
129
Describe how an image meeting the eye gets translated in the brain.
Retina (eye)> optic nerve> optic chiasm> optic tract> visual cortex
130
What are the coverings of the brain, from outermost to innermost?
○ Dura mater
○ Arachnoid mater
○ Pia mater
131
What are the three components of the brainstem?
○ Midbrain
○ Pons
○ Medulla oblongata
132
Where does sensation connect in the brain?
All sensation connects @ Thalamus- then goes to sensory area- most anterior area of parietal lobe
133
Which part of the spinal cord does sensation come in?
○ Posterior horn cell
§ >thalmus
□ >sensory area brain
134
What is the difference between an upper motor neuron paralysis and a lower motor neuron paralysis? (Ex: the difference between a CVA vs. Polio)
○ Upper motor neuron paralysis:
§ Ex: CVA/stroke
§ Exacerbated long tendon jerks
○ Lower motor neuron paralysis
§ Ex: Polio
§ Complete paralysis/no response tendon jerks
135
Which horn of the spinal cord deals with sensory function?
○ Posterior horn cell
136
Which part of the spinal cord relates to motor function?
○ Anterior horn cell
137
What is hemiplegia?
○ One sided loss from stroke
138
What is paraplegia?
○ Two sided loss from stroke
139
What is a warning sign for a stroke or CVA?
○ TIA (Transient Ischemic Attack)
§ Temporary loss motor or sensory (depend area)
§ TIA= temporary blockage of blood supply
140
What are the two types of CVA's? Which is more prevelant?
○ Thrombo-embolic= 80%
| ○ Hemorrhagic =20%
141
What is DEXTER CARDIA?
○ Heart on opposite side of body
142
What is SITUS INVERTUS?
○ Reversal of body organization- complete system reversal
○ Not pathological
○ More common in men (RT testicle lower w/ this)
143
Generally, in men, which testicle hangs lower?
Left testicle
144
What disease is characterized by bleeding to the touch, swelling, & no sensation of the nipple & areola + visible areolar skin discoloration?
○ Pagets disease of the breast
| ○ Malignancy
145
What is the first sign of malignancy in the breast?
○ Stipple cell calcification
○ Dx: Biopsy
§ under mammography- insert needle- then send
for surgical biopsy
146
What is the best test for acute diverticulitis?
○ CT Scan
**colonoscopy is contraindicated b/c can lead to perforation**
147
What are the most common ovarian tumors?
○ Tumors of surface epithelium =70%
§ Overgrowth of surface tissue
○ Germ cell tumors= 20%
§ Ova becomes teeth, hair, etc.
§ =teratomas (dermoid cyst)
○ Sex cord-stromal tumors= 10/5%
§ Tumor making hormones (estrogen, androgen-
more rare)
148
• What are the three primary sites for metastic tumors?
○ 1: Endometrium
○ 2: Breast
○ 3: Stomach
○ Ovarian cancers/tumors- may be secondary site
149
What is tested in a pregnancy test?
HCG
150
What are the three layers of the eye?
○ Retina
○ Choroid
○ Sclera
151
What disease is characterized by increased intraocular pressure in the anterior chamber?
○ Glaucoma
| § Canal of Schlemm not draining
152
What disease is characterized by a clouding of the lens of the eye?
Cataracts
153
What disease is characterized by an inflammation of the conjunctiva?
Conjunctivitis
154
Give two examples of causes of increased retinal pressure:
○ High BP/ Hypertension
| ○ Diabetes Mellitus
155
What disease is characterized by weakness in a leg & visual blurriness intermittently?
○ Multiple sclerosis
§ Autoimmune attack of myelin sheath
§ CT Scan brain: plaque
156
What is the disease called when multiple sclerosis is only affecting the eye?
○ Devic's Disease
157
What is the commonest ear problem in childhood?
○ Otitis media (middle ear infection)
158
What is a common ear problem w/ adults in old age?
○ Otosclerosis
§ Scarification of stapes> deafness
§ Tx: laser stapedectomy
159
What disease is characterized by vertigo, hearing loss, and tinnitus?
Meniere's disease
160
What nerve does an acoustic neuroma affect?
8th Nerve
| Tumor
161
What are the features of Nephrotic Syndrome.
○ Proteinuria (>3.5g/24hrs)
○ Hypoproteinemia/hypoalbuminemia
○ Edema
○ Hyperlipidemia
