Scotts Flashcards
Food allergy is present in ⅓ of children with:
a. Asthma b. Allergic Rhinitis c. Atopic Dermatitis d. Chronic Urticaria
C. Atopic Dermatitis.
From Adverse Food Reaction trans/Immuno exam 2 dignity: There is a 35% prevalence of children with adverse food reaction who also have atopic dermatitis. Extra info: Atopic March, sometime called Allergic March, refers to the natural history or typical progression of allergic diseases that often begin early in life. These include food allergy, atopic dermatitis (eczema), asthma, and allergic rhinitis (hay fever).
A 50 year old female complained of itchy generalized raised, erythematous well-circumscribed blanching lesions of four weeks duration. She is most likely suffering from
a. intermittent angioedema b. acute urticaria c. chronic angioedema d. persistent urticaria
B
Acute: recurrent episodes
A 45/F was seen at the dentist office for a tooth extraction. 15 minutes after administration of Lidocaine to the affected tooth and gum, the patient complained of itching around the neck and feeling lightheaded. She develops an itchy rash, facial and lip swelling and is immediately rushed to the ER. She is able to give her history but notices her voice is different. What is the initial pharmacologic intervention of choice?
a. Epinephrine IM b. Epinephrine IV c. Diphenhydramine IM d. Hydrocotisone IV e. Cetirizine PO
: A. Epinephrine IM
Trans on Adrenergic Agents in Allergy: Best route is through IV when the patient already has IV attached. If none available, IM is the best route since blood supply to the muscles are still high, while for the skin it’s variable. Since initial intervention ang tanong, and no mention of IV inserted, I think the best answer is A
In a patient who developed wheezing after being given several medicines for acute coronary syndrome, the initial step in assessing this patient is
a. Do serum IgE for all meds given
b. Do a skin test to all meds given
c. Do a drug chart of all meds given
d. Do rechallenge to all meds given
C. Make a drug chart.
From Scotts/trans on Adverse Drug Reactions: Part of the algorithm of the approach to ADR is making a drug chart, listing down all the drugs the patient has and is taking.
Which of the following is an organ specific autoimmune disease?
a. Dermatomyositis
b. Myasthenia gravis
c. Rheumatoid arthritis
d. Scleroderma
B. Myasthenia gravis
A lady with multiple sexual partners tested positive for HIV-1. If she becomes pregnant, the probability that her infant is going to test positive for HIV-1 using the antibody-based assay is:
a. 0%
b. 8%
c. 25%
d. close to 100%
D. Close to 100%.
From Scotts: Remember that the presence of antigen (meaning infection) is different from presence of anti-HIV Ab (which is the one tested for HIV screening). In screening for the newborn, there is almost 100% positive result for HIV because of maternal IgG against HIV that were able to pass through the placenta, not because of an actual infection in the newborn. If the question was the probability of the infant actually being infected, then it would be another matter. In the absence of prophylactic antiretroviral therapy to the mother during pregnancy, labor, and delivery, and to the fetus following birth, the probability of transmission of HIV from mother to infant/fetus ranges from 15 to 25% (Harrison’s, 18th ed- paragraph on HIV Maternal-fetal transmission)
This type of virus infection predisposes to Dengue Hemorrhagic Fever (DHF) rather than just Dengue Fever (DF)?
a. Homologous b. Heterologous c. Persistent d. Subclinical
B. Heterologous Dengue viruses (DENV) circulate as four serotypes with significant immunologic cross-reactivity that does not provide protection from secondary infection with heterologous serotypes. The strong association of severe dengue illness, dengue hemorrhagic fever (DHF), with heterologous secondary infection and high cytokine levels has led to a prevailing view that DHF is immunologically mediated
Chronic ingestion of non-steroidal anti-inflammatory medication can cause iron deficiency anemia by
a. interfering with iron transport
b. reducing amount of total iron binding capacity
c. inducing occult GI bleeding
d. preventing iron incorporation in the red cells
C.
Long-term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can irritate the stomach lining and cause bleeding that produces anemia
Choice of blood for exchange transfusion in ABO incompatibility:
a. Type O Rh positive Fresh Whole Blood
b. Type-specific Rh positive Fresh Whole Blood
c. Type O Rh positive packed RBC
d. Type-specific Rh positive packed RBC
A. Type O Rh+ FWB
Choice of blood for exchange blood transfusion
The following screening tests are done in blood donors, EXCEPT
a. Hgb determination
b. Hepatitis A
c. Hepatitis B
d. Hepatitis C
B. Hepatitis A.
Hepatitis A is transmitted via Oral-Fecal route.
a 60 yo male presenting with fever, dysuria, hematuria, pallor, gum bleeding, and multiple ecchymoses was admitted with impression of urosepsis and DIC. An expected laboratory finding is:
a. normal platelet count
b. presence of fragmented red cells in the peripheral blood smear
c. elevated fibrinogen
d. low fibrin degradation products
B. (+) fragmented RBC in peripheral blood smear
This is thrombotic thrombocytopenic purpura (TTP).
● CBC usually reveals a normal or slightly elevated total white blood cell count.
● Hemoglobin is moderately depressed at 8-9 g/dL.
● Platelet count generally ranges from 20,000-50,000 per microliter.
● Review of peripheral smears reveals moderate-to-severe schistocytosis (fragmented RBCs–helmet cells.)
The primary problem in thrombotic thrombocytopenic purpura is:
a. neurologic deficits
b. circulating large multimers of von Willebrand Factors
c. immunemediated
d. platelet dysfunction
B.
Patients with TTP have unusually large multimers of von Willebrand factor (vWF) in their plasma
Which of the following categories of disease affecting the nervous system is most likely to have a gradual onset and focal localization?
a. Infectious
b. Neoplastic
c. Metabolic
d. Vascular
e. Degenerative
B. Neoplastic.
The best way to conduct history taking with patients complaining of dizziness
a. ask if the dizziness is vertiginous in nature
b. ask if they feel unsteady
c. ask if they are feeling uneasy
d. ask them what they mean by dizzy
D.
From Approach to a Dizzy Patient trans: Ask the patient to describe what he means by “dizzy”. You must ask the right questions to determine what is the cause of the patient’s dizziness. Don’t ask leading questions and put any words in the patient’s mouth as this may lead to mismanagement, e.g., “Does the room spin?”, “Do you feel unsteady?”, or “Are you feeling lightheaded?”
A patient is rushed to the emergency room for loss of consciousness. A bottle of silver jewelry cleaning solution was found beside him. On the way to the hospital he had a seizure. He was intubated upon admission and he remained stuporous. The cause for decreased sensorium is most likely due to:
a. decreased oxygen carrying capacity of the blood
b. reduction in the delivery of oxygen to the blood
c. hypovolemia leading to decreased cerebral perfusion
d. impaired utilization of oxygen by the tissues
D
Silver jewelry cleaning solution contains cyanide among others (thiourea, isopropanol, sulfuric and nitric acids and ammonia). Cyanide can be rapidly absorbed in the human body and blocks utilization of oxygen in all organs. Cyanide affects virtually all body tissues, attaching itself to ubiquitous metalloenzymes and rendering them inactive. Its principal toxicity results from inactivation of cytochrome oxidase (at cytochrome a3), thus uncoupling mitochondrial oxidative phosphorylation and inhibiting cellular respiration, even in the presence of adequate oxygen stores. Cellular metabolism shifts from aerobic to anaerobic, with the consequent production of lactic acid. Consequently, the tissues with the highest oxygen requirements (brain and heart) are the most profoundly affected by acute cyanide poisoning.
A 9 month old child consulted at the ER for fever of 5 days duration. At the ER she had generalized tonic clonic movements of the extremities. Lumbar puncture was performed which showed the following findings: opening pressure of 25 cm H2O, clear colorless CSF, RBC 10(?), WBC 4 all lymphocytes, sugar 3.2 mmol, protein 0.70 gms%. What is the likely diagnosis?
a. viral meningitis
b. bacterial meningitis
c. tuberculous meningitis
d. febrile seizure
A NORMAL CSF findings: ● color should be clear as water ● normal glucose (CSF:blood ratio) is >= 0.6 or 2.5 mmol/L ● normal protein:
Suspect stroke mimickers in the ff. situations EXCEPT:
a. 55 yo female, diabetic with isolated hemifacial weakness
b. 40 yo female with vertigo with changes in head position
c. 60 yo male with sudden onset of monocular blindness and left hemiparesis
d. 29 yo male with progressive headache, fever, and R hemiparesis
e. All are correct (no exceptions)
C
A female neonate who was born to a consanguineous couple presented on the 3rd day of life with poor suck, lethargy, and spastic lower extremities. The mother had unremarkable history and investigations for sepsis were negative. What is the best thing to do to further evaluate this baby?
a. get a detailed family history
b. get a cranial CT scan
c. get an EEG and lumbar tap
d. get electrolytes and blood gas
A. Get a detailed family history.
Which of the following patients has/have epilepsy
a. A 13 y.o. girl who has episodes of loss of consciousness in school after standing up for prolonged periods of time
b. A 6 m.o. baby who developed cyanosis and some flickering of the fingers during vaccination
c. A 7 y.o. boy with clonic movements associated with fever
d. A 9 y.o. boy with left facial twitching during sleep
e. AOTA
D
The following are aims of a clinical genetic evaluation:
a. Make accurate diagnosis and provide prognosis and natural history information
b. Discuss management and provide recurrence risks
c. Provide anticipatory guidance and education
d. All of the above
D
Which is a red flag for developmental problems?
a. No 2-word phrases by age of 2 years
b. No pointing by 6 months
c. No sitting alone by 4 months
d. Cannot read by age of 4 years
e. Temper tantrums at age 2 years
A
A 2-year old should be able to form 2-3 word sentences. All other choices are normal for the age.
A 17-year old male is brought to the hospital because he is talking even when alone. Observation of him shows that he seems to be answering someone and at some point arguing to that person. This symptom is:
a. Hallucination b. Depersonalization c. Delusion d. Psychosis e. Neurosis
A. Hallucination
Hallucinations are perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space.
A score of 0 in Axis V means
a. poorest level of functioning
b. most psychotic
c. unable to work and socialize
d. uncommunicative
e. inadequate information
E. Inadequate information.
The different axis levels were not discussed in class. But just so you know,
Axis I - clinical psychiatric disorders (ex. depression, schizophrenia)
Axis II - Personality disorders (ex. bipolar, conduct disorder, borderline) and Mental retardation
Axis III - General medical conditions (ex. Diabetes, Hypertension, Stroke)
Axis IV - Psychosocial and environmental problems (ex. Death of loved one, Divorce, Job-loss, Bankruptcy)
Axis V - Global assessment function (ex. scale of 1-100) 1 is low level of function and 100 being superior function. The scale is compiled by a physician.
In 2008, the most common Axis I diagnosis made by the PGH C-L psychiatrist
a. Delirium
b. Adjustment disorder
c. Anxiety disorder
d. Schizophrenia
B. Adjustment disorder.
A TRUE statement regarding patients referred for psychiatric consultation at UP-PGH from 1999-2008:
a. percentage referrals reached 2.0%
b. there were more males than females
c. most of the patients were single
d. most belonged to the 21-40 age group
D. Most belonged to the 21-40 age group.
. The BPS model in health and disease
a. the state of illness is in a dynamic state
b. illness is caused by interaction of several factors
c. A person is best understood as composed on separate entities: body and mind
d. A, B, and C are true
e. Only A and B are true
E
Bio + Psycho + Social
Mid-shaft clavicular fracture causes:
a. The distal fragment to displace superiorly due to the pull of the trapezius muscle
b. The proximal fragment to displace inferiorly due to the action of the subclavius muscle
c. The proximal fragment to displace superiorly due to the pull of the sternocleidomastoid muscle
d. The distal muscle to displace inferiorly due to the pull of the deltoid muscle
C. Most class A fractures occur medial to the coracoclavicular ligament, at the junction of the middle and outer thirds of the clavicle. The proximal fragment is typically displaced upward because of the pull of the sternocleidomastoid muscle.
The immediate concern in acute pelvic fracture after severe trauma is:
a. the displacement of fracture fragments
b. leg length discrepancy
c. vascular injury (hemorrhage)
d. fracture reduction and fixation technique
C. vascular injury (hemorrhage)
Management of pelvic fractures in the immediate setting is centered on controlling life-threatening injuries, particularly severe hemorrhage.
Loss of ability to extend the DIP joint of a finger after being hit head-on by a ball is called a “Mallet” finger, and is due to the rupture of:
a. terminal extensor mechanism
b. FDP insertion
c. distal phalanx tip
d. collateral ligaments
A. terminal extensor mechanism
The terminal portion of the extensor mechanism that crosses the distal interphalangeal joint (DIPJ) in the midline dorsally is responsible for active extension of the distal joint…[in Mallet finger,] the active extension power of the DIP joint is lost.
Choose the correct statement about metastatic cancers.
a. secondary to metastatic bone deposits are less common than primary bone malignancies
b. metastatic bone cancers are more common in the young than in the older population
c. cancers that more commonly metastasize to bone include breast cancer, prostate cancer, thyroid cancer, renal cancer and lung cancer
d. there is little need to treat patients with metastatic bone cancer since they will not survive more than a few months
C
From the Bone Malignancies trans: the cancers that more commonly metastasize to bone are, in order, (1) breast ca, (2) lung ca, (3) kidney ca, (4) prostate ca, (5) thyroid ca, and (6) GI ca. (mnemonic: BLacK PuTi G)
Which is NOT a clinical feature of Deep Vein Thrombosis?
a. it does not occur once a patient is remobilized
b. its usual site of formation is in the veins of the calf muscles
c. it frequently develops during the first week of immobilization
d. it is frequently associated with obesity and hip and spine surgeries
A
The following statements are true about warm ups EXCEPT:
a. increases deep muscle temperature
b. increases speed of nerve impulses
c. increases cardiovascular response to sudden exercise
d. increase in muscle viscosity
D. Increase in muscle viscosity.
Which of the following patients with back pain would be LEAST likely to need further evaluation to rule out a more serious cause of back pain?
a. a 25 yo labandera with localized lumbar pain associated with low grade fever after washing all day
b. a 10 yo boy complaining of vague midback pain, usually occurring at night or when lying down
c. a 33 yo bank manager who complains of localized lumbosacral pain after he lifted a 44 inch television
d. a 64 yo lola who complains of low back pain after riding a tricycle with difficulty in urinating afterwards
A or C
Gait characteristic that is increased in the elderly
a. walking base
b. pelvic rotation
c. arm swing
d. cadence
A. Walking base
From 2014 trans on Normal and Abnormal Gait: Walking base is the distance between weight-bearing limbs. When increased, there is greater stability and balance. Sumo wrestlers (LOL), elephants, and the elderly have increased walking base
An anxious mother brings her 9 yo child to you for evaluation. She is warned that her child has a hearing problem, as he has been observed to want the television on at its loudest volume for the past several weeks. Which of the following would be the most appropriate test?
a. behavioral observation audiometry
b. visual reinforcement audiometry
c. play audiometry
d. adult audiometry
D. Adult audiometry
Since the child is 9 years old the standard test to be done is standard or adult pure tone audiometry (for >5 y.o.).
The following statements regarding nystagmus are true EXCEPT:
a. it involves involuntary rapid movement of the eyes
b. its direction is usually horizontal torsional if peripheral vestibular in origin
c. it may have a fast phase and a slow corrective phase
d. it can be caused by peripheral or central disturbances of the vestibular pathways
C. It may have a fast phase and a slow corrective phase.
A 30 yo complains of progressive unilateral hearing loss. Audiometric exam reveals a unilateral sensorineural hearing loss. Which of the ff examinations is MOST appropriate for assessing his condition?
a. CT scan of the temporal lobe
b. MRI of the cerebellopontine angle
c. auditory brainstem evoked responses (ABER)
d. electronystagmography (ENG)
C.
A patient who complains of a recurrent headache, and points to the forehead as the location of the pain. This is most likely to be a symptom of disease in which sinus? A. Maxillary B. Frontal C. Ethmoid D. Sphenoid
B. Frontal
The following are characteristics of Bell Palsy except
a. Most patients have bilateral involvement
b. May be associated with hearing loss
c. Most patients experience a full recovery of facial function
d. May be associated with altered taste
A. Most patients have bilateral involvement
A 16 yo high school senior was brought to the ER because of breathing difficulty and appearance of multiple wheals and hives on the face and body. These occurred less than an hour after scouting activities in Mt. Makiling. Of the various mechanisms causing urticaria, you would think that this is:
a. immune complex-induced
b. IgE-dependent
c. non-immunological
d. immunoglobulin/complement deposition
B. IgE-dependent
This is most likely an IgE-mediated anaphylaxis presenting with bronchospasm and/or laryngeal edema (breathing difficulty) and urticaria. Other SSx of anaphylaxis include flushing; angioedema; pruritus; abdominal cramping with nausea, vomiting, and diarrhea; and feeling of impending doom. Typical examples of IgE-mediated anaphylaxis include the reactions to many foods, drugs, and insect stings (the most common being Hymenoptera/wasp stings). He most likely got stung by a bee or a wasp while traipsing around the mountain.
The most important inflammatory cell in acute wound healing is:
a. eosinophil
b. monocyte
c. lymphocyte
d. neutrophil
D. Neutrophil
Neutrophil granulocytes are the most abundant type of white blood cells in mammals and form an essential part of the innate immune system. In general, they are referred to as either neutrophils or polymorphonuclear neutrophils (or PMNs), and are subdivided into segmented neutrophils (or segs) and banded neutrophils (or bands). They form part of the polymorphonuclear cell family (PMNs) together with basophils and eosinophils.
Gina, a 14 yo student developed painful groups vesicles on her left forehead, extending to the left side of the scalp and a few more vesicles on the top of her eyelid. Her left eye was erythematous and painful. What is your initial impression?
a. contact dermatitis
b. herpes simplex
c. herpes zoster
d. multiple folliculitis
C. Specifically, herpes zoster ophthalmicus.
A patient was diagnosed to have Hansen’s disease, indeterminate type. The doctor said he would just observe the lesion and patient does not take any anti-hansen’s medication. If his immunity is good, the lesion would disappear without medications. What would you most probably see on physical examination?
a. A hypoesthetic erythematous dry plaque with distinct borders
b. An erythematous hypoesthetic infiltrated nodule
c. A hypopigmented hypoesthetic patch
d. tender subcutaneous nodules
C. A hypopigmented hypoesthetic patch
A 24/F consults at the outpatient department for shortness of breath. On physical examination, you appreciated regular sinus rhythm with Grade 4/6 diastolic rumble at the apex radiating to the back. Which of the following drugs is most important for this case?
a. beta blocker to slow down the heart rate
b. ace inhibitor to decrease the afterload
c. digoxin to increase myocardial contractility
d. statins to decrease cholesterol levels
C
