Pathophysiology Exam 2 Student Questions

A 65-year-old man with a 110-pack-year history of smoking presents to his primary care physician because of shortness of breath, dyspnea on exertion, and cough for three months. X-ray of the chest reveals flattened diaphragms bilaterally. The doctor orders pulmonary function tests to evaluate the patient. Which of the following pulmonary function test results would most likely be found in this patient? (A) Decreased FEV1:FVC (B) Decreased functional residual capacity (C) Decreased total lung capacity (D) Increased FEV1 (E) Increased FEV1:FVC

(A) Decreased FEV1:FVC

Which of the following best describes the pathology of Lymphedema? A) Lymphatic vessels become blocked or damaged, causing a buildup of lymph fluid in the affected area B) Excessive production of lymph fluid by the lymphatic system, leading to swelling C) Inflammation and damage to blood vessels, resulting in fluid buildup in the tissues D) Overgrowth of adipose tissue in the affected area, causing compression of lymphatic vessels

A) Lymphatic vessels become blocked or damaged, causing a buildup of lymph fluid in the affected area

A 20-year-old male presents to the office for a sports physical. He has no health problems except for prior surgery for lens subluxation. He is 6'4" with long, thin extremities and digits. His chest has an unusual inward slope, and he has very flexible joints. Upon cardiac auscultation, an early, soft, diastolic decrescendo murmur is heard at the apical area. Which of the following is this patient at the greatest risk for? A. Aortic dissection B. Cardiac tamponade C. Mitral stenosis D. Myocardial infarction E. Pulmonary artery hypertension

A. Aortic dissection

Which one of the following below is a common cause of wheezing? Select all that apply: A. COPD B. Obstructive lung disease C. Anemia

A. COPD B. Obstructive lung disease

A 55-year-old patient comes to the emergency department with difficulty breathing. He has a productive cough and yellow mucus. His dyspnea worsens with minimal exertion. He denies fever or chest pain. He is otherwise generally but he does experience a morning cough that brings up white sputum, which he has had for many years. He has been smoking one pack of cigarettes for the last 30 years. On examination he has an oxygen saturation of 88% on room air, no cyanosis, a prolonged expiratory phase, and auscultation elicits expiratory wheezes bilaterally. What is the most likely diagnosis? A. Chronic obstructive pulmonary disease B. Bronchial pneumonia C. Congestive heart failure D. Viral pneumonia

A. Chronic obstructive pulmonary disease

A 6-year-old female child presents to the emergency room in early May after playing in her first soccer game of the season at Deer Lakes Park with shortness of breath, chest tightness, and wheezing. This is the first time this child has experienced these symptoms. What is the likely cause of this asthmatic episode and what type of diagnostic testing would lead you to this diagnosis? (select all that apply) A. Exercise-induced; SpO2 B. Hypoxemia; D-dimer C. Chronic bronchitis; BMP D. Allergen-induced; Capnography

A. Exercise-induced; SpO2 D. Allergen-induced; Capnography

Your patient, is a 54 year old black woman with a PMH lung cancer. She recently recived a lung transplant, and is doing very well. As apart of her recovery, you ordered use of the incentive spirometer 3 times a day. you are most concerned with increasing her inspirative capacity, what is formula for this value ? A. Tidal volume + Inspiratory reserve volume B .Inspiratory reserve volume - tidal volume C. Total lung capacity - expiratory reserve volume D. Tidal volume + inspiratory reserve volume + expiratory reserve volume

A. Tidal volume + Inspiratory reserve volume

A patient comes into the ED and is having severe pain. They point to their chest and states they are having an increased heart rate. Along with an EKG you order ____ to help see any cardiac injury. A. Troponin B. BUN C. Creatinine level D. AST

A. Troponin

What is the most common cause of cholecystitis? A) A bacterial infection B) A gallstone blocking the bile duct C) A tumor in the gallbladder D) A ruptured gallbladder

B) A gallstone blocking the bile duct

A 56 y/o patient presents to the clinic with complaints of nausea, vomiting, and severe abdominal pain that radiates directly into the back. The patient reports increased alcohol intake of up to 10 beers a day after he lost his job two weeks ago. Upon physical examination, the patient was noted to have bruising and discoloration on his bilateral flanks and tenderness in the epigastric area. What is the most likely diagnosis? A) Cholecystitis B) Acute Pancreatitis C) Gastritis D) Hepatitis E) Diverticulosis

B) Acute Pancreatitis

A 64 year old woman comes to your clinic for chest pain. The patient states that she has been feeling difficulty catching her breath and swelling to her left ankle. PMH includes smoking, hypertension, and mitral valve replacement. Vitals are 120 bmp, 144/100 bp, 89% O2. What diagnostic test would you obtain to properly diagnose this patient? A) EKG and CBC B) CT and EKG C) D-Dimer and PT/INR D) BMP and ABG

B) CT and EKG

62-year-old male patient with a history of smoking and high blood pressure presents with symptoms of a painful ulcer at the base of his heel. His nails seem to be brittle, hypertrophic, and ridged. A Doppler Ultrasound reveals decreased blood flow. What is the likely diagnosis? A) Coronary Artery Disease B) Peripheral Artery Disease C) Chronic Venous Insufficiency D) Aortic Dissection

B) Peripheral Artery Disease

The diaphragm has three resisting factors that it has to overcome during inhalation. Two of them are elastic recoil and inertia of respiratory system. What is the third as well as its definition? A) Mechanoreceptors. Afferent receptors that affect breathing control B) Resistance to airflow. Proportional to length of airway and gas viscosity and inversely proportional to radius of airways C) Surfactant surface tension. Surface tension in alveoli allowing them to stay inflated D) Resistance to airflow. Proportional to radius of airways and inversely proportional to length of airway and gas viscosity

B) Resistance to airflow. Proportional to length of airway and gas viscosity and inversely proportional to radius of airways

which of the following is the most likely sign or symptom of Ulcerative Colitis? A) Hypercholesterolemia B) Tenesmus C) Febrile Pharyngitis D) Menorrhagia E) Seizure

B) Tenesmus

1. When the lower sphincter is closed too often or closed too tight, food cannot go to the stomach. Which of the following is this describing? A. Irritable bowel syndrome B. Achalasia C. GERD D. Heartburn

B- Achalasia

Conrad, a 46 year old, biracial man presents to your outpatient clinic with some Jaundice of the skin. As he is trying to describe his symptoms, he starts slurring his words and all of sudden vomits blood all over you! You decide to run a PT/INR on this patient and want to calculate a MELD score. What is the most likely diagnosis? A. Diverticulitis B. Cirrhosis C. Acute Hepatitis D. H. Pylori gastritis

B- Cirrhosis

A 72 year old female presents to the clinic with abdominal pain, constipation, nausea, and urinary urgency. She tells you she had a hamburger for lunch about a hour ago and mentions hamburgers are her her favorite food so she has one a day. What diagnostic testing would you use to determine the most likely diagnosis in this case? A. Ultrasound of the abdomen B. CT of the abdomen with IV contract C. Fecal occult blood testing D. Colonoscopy

B. CT of the abdomen with IV contract

A 62-year old woman with a 40-year history of cigarette smoking recently returned from an international trip to Africa. She was relatively immobile for 16 hours on her flight. She presents to the ER with symptoms of acute onset chest pain, shortness of breath, tachycardia, unilateral leg edema and hemoptysis. You suspect a pulmonary embolism. What diagnostic testing should be ordered to confirm your diagnosis? A. Transthoracic echocardiogram B. Contrast enhanced CT PE of chest and d-dimer C. EKG and troponin D. Spirometry

B. Contrast enhanced CT PE of chest and d-dimer

A 55 year old male patient with history of alcohol use disorder presents with fatigue, dyspnea, and chest pain on exertion. On exam you hear a S3 heart sound and his ECG shows ventricular dilation and reduced ejection fraction. What is his possible diagnosis? A. Hypertrophic cardiomyopathy B. Dilated cardiomyopathy C. Pericarditis D. Restrictive cardiomyopathy

B. Dilated cardiomyopathy

A 47 year old man comes into the office he is severely short of breath after climbing a flight of stairs. He says he has had a productive cough for about 3-4 months now but has been going on for years. The patient admits smoking a pack of cigarettes a week for the past ten years. Which is most likely to be observed on physical examination? A. Decreased respiratory rate B. Expiration time much longer than inspiration time C. Normal chest appearance

B. Expiration time much longer than inspiration time

All of the following are risk factors for atherosclerosis except: A. Increasing age B. Premenopausal women C. Males D. Family history

B. Premenopausal women

The "bundle of His" splits into right and left bundle branches - these break off into specific fibers that have a major role in electrical conduction and propagation of impulse to the ventricular muscle, these are called ________ Fibers A. Wenckebach B. Purkinje C. Bachmann D. AV node

B. Purkinje

A 23 year-old female reports to the clinic with complaints of abdominal pain, fatigue, increased urgency with bowel movements, and occasional blood and pus in the stool. You decide to send the patient out for a colonoscopy. What would you expect to see based on the patients symptoms? A. Transdermal inflammation B. Superficial inflammation C. Skip lesions D. Diverticular bleed

B. Superficial inflammation

A 6 year old male presents to the emergency room with abdominal breathing, decreased lung sounds/ minimal wheezing, and intermittent coughing. After speaking with his mother, it is revealed that her son just played his first little league baseball game and had been running around all afternoon. All things considered, you suspect an asthma attack - which has happened one time previously to the boy. After treatment of his asthma, how would you expect his lung sounds to change at first? A. Wheezing will subside immediately B. Wheezing will increase on both inspiration/expiration C. The lung sounds would not change - will remain decreased

B. Wheezing will increase on both inspiration/expiration

Which of the following are NOT accessory organ associated with the small intestine? A. gall bladder B. duodenum C. liver D. pancreas

B. duodenum

A 70 year old female with type II diabetes presents to the ED with leg pain and confusion. Her blood pressure is 139/87 and her pulse sounds are weakened. A biopsy of the patient's kidney would most likely show: A. cholesterol clefts B. hyaline material C. Reed-sternberg cells D. Cystine crystals

B. hyaline material

If the hepatopancreatic ampulla is blocked, what is an alternative route for pancreatic juices to reach the duodenum? A.) Common Bile Duct B.) Duct of Santorini C.) Cystic Duct D.) Sphincter of Oddi

B.) Duct of Santorini

What is the main sensor for ACUTE blood pressure management? A: Increase in heart rate B: Arterial Baroreceptor Reflex C: Cushing Reflex D: Cardiopulmonary receptors

B: Arterial Baroreceptor Reflex

Mike Wheezy is a 56-year-old AMAB with past medical history that includes type 2 diabetes mellitus, hypertension, and COPD who presents to the clinic with persistent productive cough for the past 6 months. Patient reports that he reluctantly came in today because his last coughing spell caused him to spit out blood, and his wife rachet strapped him to the car seat and drove him in. Patient has a 30-pack year smoking history and has been taking metformin and losartan "as prescribed" for the past 7 years. Patient denies any fever or N/V/D, as well as any recent trauma or traveling. Rhonchi can be heard during physical exam. Patient is sent for ABG, PFT, BMP, and CBC + diff. Which of the follow results DOES NOT FIT with his clinical presentation and diagnoses. A: decreased FEV1/FVC B: decreased H+ C: increased hemoglobin D: increased PaCO2 E: all of these findings are correct

B: decreased H+

Acute Liver Failure is progression of acute hepatitis with the notable addition of which two features? Choose 2 A: marked leukocytosis on CBC B: encephalopathy C: irreversible structural changes D: elevated INR

B: encephalopathy D: elevated INR

A 42 year old man comes into the health clinic with LLQ pain, nausea, vomiting and fever. The patient cannot think of any recent significant events or exposure to illness that may have caused this. Upon interviewing the patient, we find that he works long hours from his home office and is a recently single man who can't cook. He therefore relies heavily on the same menu every day: Breakfast: Yogurt and an Energy Drink Lunch: Smooth Peanut Butter and Jelly Sandwich with diet coke Dinner: Cheeseburger with beer The patient also states he is a smoker and can't remember the last time he had a bowel movement. Without obtaining lab results, which of the following is the most likely diagnosis for this patient? A) Diverticulosis B) H. Pylori gastritis C) Diverticulitis D)Ulcerative Colitis

C) Diverticulitis

Which of the following is listed in the correct pathological order? A) Cholesterol plague grows —> Excess cholesterol deposits in the artery wall — > plaque narrows artery/ruptures —> Plaque damages artery wall B) Excess cholesterol deposits in artery wall —> cholesterol plaque grows —> plaque narrows artery —> Plaque damages artery wall C) Excess cholesterol deposits in artery wall —> cholesterol plaque grows —> Plaque damages artery wall —> plaque narrows artery D) Plaque narrows artery —> Plaque damages artery wall —> cholesterol plaque grows —> excess cholesterol deposits in artery wall

C) Excess cholesterol deposits in artery wall —> cholesterol plaque grows —> Plaque damages artery wall —> plaque narrows artery

A 60-year-old male presents to your emergency department with complaints of fatigue x a few months, dyspnea, occasional chest pain/pressure, and reports having had a few 'near syncopal" episodes in the last few months. During your physical examination, you find his pulse to be 40 bpm. You complete an EKG to assess the patient's heart rhythm and find his EKG to have a normal PR Interval with nonconductive P-Waves occurring in a regular pattern, at a bradycardic rate of 40 bpm. What is most likely your diagnosis? a. A. 3rd Degree Heart Block B. 1st Degree Heart Block C. 2nd Degree Heart Block Type 2 D. 2nd Degree Heart Block Type 1

C. 2nd Degree Heart Block Type 2

A 60-year-old male presents to your clinic because he isn't able to be as active as he used to be. He has not been to see a doctor in a couple years, but figured he should come in after noticing chest pain on exertion over the last 8 months. He has a smoking history of 40 pack years, a total cholesterol of 240 mg/dL and an HDL cholesterol that is 20 mg/dL. His blood pressure was 160/95. Which of the following is most likely to be his most serious health risk? A. Deep Vein Thrombosis B. Pneumonia C. Atherosclerosis D. Acute Pancreatitis

C. Atherosclerosis

A 64-year-old male presents to the clinic with complaints of SOB, palpitations, and more frequent lightheadedness. He has a PMHx of smoking, HTN and a more recent diagnosis of CHF. During his physical exam, you note an irregular heart rate. An EKG is ordered for this patient and it's clear that there is an irregular rhythm and pattern with no discernible P waves. There are several short and long pauses between the QRS complexes. What is the likely diagnosis? A. Sinus Tachycardia B. Atrial Flutter C. Atrial Fibrillation D. None of the above

C. Atrial Fibrillation

A 68-year-old male presents to the clinic with complaints of fatigue and occasional dizziness. On examination, his heart rate is 45 beats per minute, and his blood pressure is 130/80 mmHg. An EKG confirms sinus bradycardia. Which of the following is correct? A. The EKG shows a shortened PRI interval B. The EKG shows nonconductive P waves C. Bradycardia is occurring due to an SA node dysfunction D. Bradycardia is occurring due to an AV node dysfunction

C. Bradycardia is occurring due to an SA node dysfunction

A 38 year female with a known hx of alcohol abuse presents to the ED with complaints of worsening epigastric pain, nausea, and vomiting x 2 days. PE demonstrates upper abdominal tenderness on palpation, mild abdominal distention, and decreased bowel sounds in the ileum. Suspicious of acute pancreatitis you order lipase serum levels and an ultrasound. You know inflammation of the pancreas can cause an imbalance of which electrolyte? a. Sodium b. Potassium c. Calcium d. Magnesium

C. Calcium

A 36-year-old female arrives at the ED complaining of nausea and severe RUQ abdominal pain after eating a cheeseburger and french fries for dinner. The PA immediately notices that the patient's skin appears yellow and is concerned that her symptoms could be caused by an obstructed gallstone, so he decides to palpate the gallbladder while asking the patient to take a deep breath. The patient shows signs of pain and stops breathing suddenly. Lab results show elevated T. bili and elevated LFTs, but her lipase and calcium are within normal range. Based on these findings, where do you think the gallstone obstruction could occur? A. Ampulla of Vader B. Duct of Wirsung C. Common bile duct D. Gallbladder

C. Common Bile Duct

A patient presents to the ED with a recent onset of chest pain, SOB, swelling in the left lower leg and hemoptysis. Which of the following lab findings would be most consistent with your suspected diagnosis? A. Elevated CBC B. Lowered CBC C. Elevated D dimer D. Elevated CMP

C. Elevated D dimer

A 37 year old female presents with RUQ pain, nausea, tachycardia, jaundice and scleral icterus. She states she was at her best friend's wedding rehearsal dinner party when her pain started. Your CBC comes back normal. However, the CMP reads increased total bilirubin and high LFT. What do you suspect is most likely going on? A. buildup of fluid in abdomen from portal hypertension B. presence of gallstone in gallbladder C. gallstone impacting common bile duct D. erosion of diverticular wall

C. Gallstone impacting common bile duct

A PA student went to a yoga session and was asked to take a full breathe in and a full breathe out. Suddenly they think about their pulmonary physiology and realized they "actively" just used the following lung capacities? Pick the answer that is most correct (ala PANCE style). A. TV + IRV B. RV C. IRV + ERV+TV D. TV + IRV

C. IRV + ERV+TV

Which of the following is an example of a pseudoaneurysm? A. Symmetrical dilation of blood vessels B. Asymmetrical ballooning of blood vessels due to increased blood pressure on one side of the vessel wall C. Leaking of blood from a small hole in the blood vessel wall D. None of the above

C. Leaking of blood from a small hole in the blood vessel wall

A patient presents to the clinic with right lower quadrant abdominal pain that has persisted for several days. They admit to a diet full of fatty acids and lacking fiber intake. They also explain that they haven't had much energy to exercise. You have a diagnosis in mind based on the symptoms and decide to order a CBC and BMP for this patient. What indicator on the CBC or BMP would help the most to confirm your suspicion? A. Anemia B. Thrombocytopenia C. Nutritional deficiencies D. Leukocytosis

C. Nutritional deficiencies

A patient presents to the emergency department complaining of stomach pain that feels like "something is gnawing or eating her stomach." She also states that she has been nauseous and vomiting for 2 days. After further evaluation of the patient, you determine that she has H. pylori. What is the pathophysiology that has caused this burning sensation? A. production of CO2 and ammonia that increases somatostatin and decreases gastrin B. production of CO2 and ammonia that decreases somatostatin and decreases gastrin C. production of CO2 and ammonia that decreases somatostatin and increases gastrin D. production of CO2 and ammonia that increases somatostatin and increases gastrin

C. Production of CO2 and ammonia that decreases somatostatin and increases gastrin

You are concerned that your patient maybe experiencing an acidosis episode in the blood. Upon further review and observation of the oxygen-hemoglobin dissociation curve you would see the curve shift in which way? A. Stay the same B. Shift to the left C. Shift to the right D. Plato with more Hg%

C. Shift to the right

A 73 y/o female with a PMHx of cholelithiasis presents to the ER with severe epigastric abdominal pain. She has no signs of jaundice, but upon PE we find bruising around the belly-button. What patho is most likely the cause of what we are seeing? A. Increase in both bile stasis and bile concentration that leads to the promotion of coagulation B. Lecithin in bile coverts to lysolecithin to cause inflammation C. Unintentional activation of pancreatic enzymes causing auto digestion of pancreas D. Unintentional activation of pancreatic enzymes causing ischemia and necrosis of gallbladder wall

C. Unintentional activation of pancreatic enzymes causing auto digestion of pancreas

A deficiency in alpha-1 antitrypsin would result in which of the following patterns of emphysema? A. paraseptal B. centrilobular C. paracinar D. a deficiency in alpha-1 antitrypsin does not result in emphysema

C. paracinar

A 15-year-old female presents with acute onset of right upper quadrant abdominal pain. Abdominal ultrasound reveals a dilated gallbladder with thickened wall and filled with calculi. A laparoscopic cholecystectomy is performed and reveals dark, greenish-black gallstones. Which of the following underlying conditions does this female most likely have? A.) Crohns disease B.) Hypercholesterolemia C.) Sickle cell anemia D.) Hyperparathyroidism

C.) Sickle cell anemia

A patient presents to your clinic complaining of acute onset chest pain, shortness of breath, and hemoptysis. Their records indicate a past history of DVTs. What is the most ideal diagnostic testing for this patient given their symptoms and history? A - D-dimer B - EKG C - CBC D - Chest CT with IV contrast

D - Chest CT with IV contrast

Tim is a 68-year-old male presenting to the primary care office. He has not been consistent with his annual physicals but decided to make an appointment with his PCP due to worsening symptoms. He reports increasing levels of fatigue and dizziness that are hindering his ability to perform activities of daily living. A new heart murmur is discovered on physical exam. His CBC reveals a hemoglobin of 9, and the subsequent peripheral smear shows schistocytes. Tim now presents to the cardiology clinic as referred by his PCP. As the cardiology PA seeing Tim in the clinic, you correctly identify a crescendo-decrescendo murmur with an ejection click. Based on your current findings, what do you diagnose Tim with? A). Mitral stenosis B). Aortic regurgitation C)Tricuspid regurgitation D). Aortic stenosis

D). Aortic stenosis

Which of the following can cause hepatitis? A. Alcohol B. Drugs C. Viruses D. All of the above

D. All of the above

A patient presents to the ED with vomiting, severe abdominal pain, and jaundice. Murphy's sign is positive after examining the patient's abdomen. Their CMP result reveals elevated T. Bili and LFTs. What is your specific diagnosis for this patient? A. Acute pancreatitis with stone in Ampulla of Vater B. Cholecystitis with stone in cystic duct C. Acute Hepatitis with lipid accumulation D. Cholecystitis with stone in common bile duct

D. Cholecystitis with stone in common bile duct

A 25 y/o female with a family history of IBD presents to your clinic complaining of ongoing bloody diarrhea, RLQ abdominal pain, tenesmus, and fatigue. Which of the following results would you expect to find in her bloodwork? A. Increased albumin B. Decreased platelet count C. Increased WBC count D. Decreased hemoglobin

D. Decreased hemoglobin

Which of the following is an INITIAL result of H. pylori colonization in the stomach? A. Increased somatostatin B. Decreased acid production C. Decreased gastrin D. Increased acid production

D. Increased acid production

Which of the following appropriately describes achalasia? A. Salivary glands do not release amylase which is important for complex carbohydrate digestion B. Lower sphincter of esophagus does not properly close, allows for acid to travel up and cause heartburn C. Pyloric sphincter of stomach does not close, prevents food from entering small intestine D. Lower sphincter of esophagus does not properly relax, prevents food from entering stomach

D. Lower sphincter of esophagus does not properly relax, prevents food from entering stomach

Which is not a potential complication of h. Pylori infections? A. Gastritis B. Duodenal ulcers C. Predisposition to cancers such as lymphoma D. Macrocytic anemia

D. Macrocytic anemia

A patient presents to you with classic Cushing's reflex secondary to a suspected intracranial hemorrhage. What relationship below is most accurate regarding this reflex? A.) Decreased intracranial pressure, increased blood pressure, vasoconstriction B.) Decreased intracranial pressure, decreased blood pressure, bradycardia C.) Increased intracranial pressure, increased blood pressure, vasodilation D.) Increased intracranial pressure, increased blood pressure, vasoconstriction

D.) Increased intracranial pressure, increased blood pressure, vasoconstriction

You are working at a pulmonology office and a new patient presents after their second hospital stay in a calendar year. You notice the patient has digital clubbing, barrel chest, and is slightly tachypneic. After a full workup you get the PFT (pulmonary function test) results which show: FEV1 - decreased, FVC - decreased, RV - increased, and FRC - increased. Which of the following would you begin maintenance of? A: Asthma B: Pulmonary Fibrosis C: Bronchiectasis D: COPD

D: COPD

A 28y old male presents to the emergency department with a complaint of palpitations and chest discomfort. He reports that the symptoms started suddenly while he was at rest and have been ongoing for the past hour. He has no significant past medical history and takes no medications. His vital signs are stable. An ECG is performed and shows sinus tachycardia with a broad QRS complex and a delta wave. Which of the following is the most likely diagnosis? A) Acute coronary syndrome B) Atrial fibrillation C) Supraventricular tachycardia D) Ventricular tachycardia E) Wolf-Parkinson-White syndrome

E) Wolf-Parkinson-White syndrome

Which of the following systems are affected by hypertension? a) cardiovascular, kidneys, eyes, brain b) cardiovascular, kidney, reproductive c) kidneys, reproductive, respiratory d) lymphatic, digestive, cardiovascular

a) cardiovascular, kidneys, eyes, brain

A 55 year old male comes into the clinic complaining of stomach pain in his lower left quadrant. He states his diet consists of mostly red meats and not a whole lot of veggies. He has had some nausea and vomiting and urinary urgency. You order a CBC and see mild leukocytosis. What do you think is causing this? a. Diverticulitis b. Diverticulosis c. Bowel obstruction d. Constipation

a. Diverticulitis

Which of the following would cause a decrease in cardiac output? a. Increased arterial resistance b. Anemia c.Epinephrine d. Exercise

a. Increased arterial resistance

A patient presents to you saying he has the amazing ability to see inside his stomach and decipher exactly what cells compose it. He says he noticed he no longer has G cells in his pyloric antrum and is scared. What is the likely result of this? a. Low levels of HCl b. Low levels of calcium c. Low levels of pepsin d. Low levels of trypsinogen

a. Low levels of HCl

A 34 yo female presents to your clinic with right sided chest pain, palpitations, and SOB for the past three days. She mentions that she recently fell and broke her left ankle, and subsequently underwent a reduction and internal fixation procedure two weeks ago, and now her leg is swollen. She takes birth control, drinks occasionally, but denies any other prescription medication, smoking, or illicit drug use. Otherwise, she is in good health, and denies fever, nausea, vomiting, diarrhea, or abdominal pain. Which factor would NOT be considered a positive PERC item for this patient when ruling out a PE? a. Patient's age b. Recent ankle fracture c. Birth control d. Unilateral leg swelling

a. Patient's age

Which of the following would be expected in an individual with liver failure? (select all that apply) a. Reduced ammonia metabolism b. Increased levels of clotting factors c. Reduced bile production d. Increased levels of albumin

a. Reduced ammonia metabolism c. Reduced bile production

What would be the effect of significant blood loss on the hydrostatic pressure at the arteriole end of a capillary bed? a. Reduced hydrostatic pressure b. Increased hydrostatic pressure c. No change

a. Reduced hydrostatic pressure

A 23 year old patient presents to their PCP with chronic diarrhea and bloating. They do not appear jaundiced and the liver is not enlarged upon palpitation. The patient states that their pain always seems worse after eating a loaf of bread. Their fecal occult blood is negative and H&H is normal. An anti-TTG IgA test is ordered and this comes back elevated. What do you suppose is causing these symptoms? a. Hepatitis A b. Gliadin c. H. pylori d. Cholelithiasis

b. Gliadin

A 45 year old female returns from her trip to China. She presents to the ED with her suitcase in one hand and the other over her left lower quadrant in severe pain. She notes bouts of nausea on the duration of flight. Her labs return with mildly increased white blood cell count, a slightly elevated CRP, and a CT Abd/pelvis w/ IV contrast as seen below (CAN't INSERT PHOTO-SORRY) What is your diagnosis? a) Cirrhosis b) Diverticulitis c) Acute Liver Failure d) Acute Pancreatitis

b) Diverticulitis

A patient has a HR of 52, and their EKG confirms they're bradycardic. While looking closer at the EKG, you notice there are P waves and QRS complexes with normal PR intervals. As they continue, there are slightly longer and longer PR intervals with normal QRS complexes, until you spot a lone P wave and no QRS complex at all. What type of heart block is this? a) Type 2 2nd degree b) Type 1 (wenckebach) 2nd degree c) 1st degree d) complete heart block

b) Type 1 (wenckebach) 2nd degree

A 67-year old male patient presents to the ED from home complaining of chest pain starting 20 minutes after eating dinner. He believed it to be his GERD flaring up, so he took a TUMS tablet immediately. He has had no relief. PMH includes GERD, hypertension, and hyperlipidemia. FMH includes his father having cardiac issues, but the patient cannot recall what exactly. He denies palpitations. He started feeling fatigued in the past few hours as well. His vitals are: temperature 37 C, HR 55 BPM, and BP 136/90 mmHg. An EKG is ordered and reveals bradycardia with normal PR intervals and a patterned non conductive P waves. What is this arrhythmia? a. 1st degree AV block b. 2nd degree type II AV block c. Atrial Fibrillation d. Sinus Bradycardia e. 3rd degree AV block

b. 2nd degree type II AV block

You are a PA student shadowing in a local hospital. A 72-year-old male is complaining of fatigue, dizziness, and a near syncope event. He also notes of having chest pain as well. The PA on the floor orders an EKG that shows that all P waves are non-conducting P waves with ventricular escape complexes. Based on what you recently learned in your pathophysiology class, what type of AV block is this? a. 2nd degree type II b. 3rd degree c. 2nd degree type I d. 1st degree

b. 3rd degree

Which of the following patients does NOT have one or more risk factors for cholelithiasis? a. A 33-year old female who is pregnant with her first child b. A 29-year old male who drinks 2 black coffees a day c. A 70-year old female with an elevated BMI d. A 51-year old male with diabetes mellitus

b. A 29-year old male who drinks 2 black coffees a day

A 62 year old male presents with complaints of claudication and elevation pallor with dependent rubor. Pt also has small non healing ulcer on his left foot. Pt's history is significant for smoking and hypertension. What would be the appropriate work up for diagnosis? a. Angiogram b. ABI with doppler ultrasound c. Labs with troponin levels d. Percutaneous coronary intervention

b. ABI with doppler ultrasound

Which is NOT part of Virchow's Triad? a. Venous stasis b. Decreased levels of von Willebrand Factor c. Vascular wall endothelial injury d. Increased activation of coagulation

b. Decreased levels of von Willebrand Factor

A 60 year-old male patient presents for his yearly check-up appointment with his PCP. When asked about his GI health he stated he only has about one bowel movement every 5 days and feels like he may be constipated, but it does not bother him. Patient also mentioned he has frequent GI bleeds but they are painless. Patient eats a keto diet, mainly consisting of fats and red meat. Patient denies abdominal pain, nausea and vomiting, urinary symptoms, weight loss, and fatigue. Before further testing, what do you think could be the top differential diagnosis for the patient's symptoms? a. Crohn's disease b. Diverticulosis c. H. pylori gastritis d. Cholecystitis

b. Diverticulosis

A 43-year-old female presents to your clinic with a chief complaint of "my lower tummy hurts". She states that for the past 2 months, she has been having bloody (bright red) diarrhea with some occasional pus. She states that there is a history of IBD in her family and she admits that her poor diet of Cheetos and Mountain Dew might not be good for her. Because the wait to get a colonoscopy is so long, you decide to run some labs to figure out what might be going on with your patient. Which of the following lab values would you suspect to see that best correlate to this patient's specific type of IBD? SELECT ALL THAT APPLY a. Increased albumin levels b. Electrolyte abnormalities c. Pancytopenia d. Leukocytosis e. CBC values associated with anemia

b. Electrolyte abnormalities d. Leukocytosis e. CBC values associated with anemia

What would you expect to see on lab work for a patient with a hepatocyte injury with cell death, inflammation, and regeneration without any structural changes to the liver? a. Elevated ammonia b. Elevated T. bili c. Decreased LFTs d. Decreased albumin

b. Elevated T. bili

A 9 year old child with a history of eczema and allergies presents to the clinic with coughing, wheezing, and tachypnea. You can tell the child is working hard to breath as you witness retractions that coincide with the child's attempts to inhale. Which cells listed below are the main mediators for the condition this child is currently experiencing? a. Macrophages b. Mast cells and eosinophils c. Neutrophils and basophils d. Dendritic cells

b. Mast cells and eosinophils

You are treating a 45 year old, African American female patient that presents with faintness, shortness of breath, and slight edema in her legs. She tells you she has a family history of amyloidosis. Upon reading her EKG, you notice a low-amplitude QRS complex. Which cardiomyopathy do you suspect? a. Dilated cardiomyopathy b. Restrictive cardiomyopathy c. Hypertrophic cardiomyopathy d. Tricuspid cardiomyopathy

b. Restrictive cardiomyopathy

67 y/o M w/PMH of MI X2 yrs ago, presents to the clinic with c/o rapid heartbeat and dizziness X 3 days. Pt denies passing out. You perform an EKG and his rhythm is normal, but fast. What else may be an expected finding? a. Sinus bradycardia b. Sawtooth P waves c. Prolonged PRI d. Dissociated P waves from the QRS

b. Sawtooth P waves

A 30 y/o F with no significant PMH presents to her PCP with increased epigastric discomfort for the past month. After some testing, it is determined that she has an H. pylori infection. The patient has many questions about H. pylori and wants to know how it is able to survive in her stomach. Her PCP explains to her that H. pylori can survive in the stomach because: a. Stomach acid is decreased secondary to the infection b. The bacteria produce ammonia which neutralizes stomach acid c. The bacteria damage the gastric epithelium and cause it to weaken d. H. Pylori does not need oxygen to survive and the gastric epithelium lacks oxygen

b. The bacteria produce ammonia which neutralizes stomach acid

A 45 year old patient presents complaining of unresolved heartburn and nausea. The patient states that these symptoms occur on daily basis. As a provider, you suspect that the patient may have GERD. Which of the following may cause this condition? a. Elevated levels of vitamin A b. Weakness of the lower esophageal sphincter c. Blocked salivary glands/stones d. Portal vein thrombosis

b. Weakness of the lower esophageal sphincter

A 63 y/o male who is a smoker presents with severe left flank pain and a pulsating mass. He has a history of chronic hypertension and chronic obstructive pulmonary disease. He has a normal urinalysis. What is the most likely diagnosis? a. renal artery stenosis b. abdominal aortic aneurysm c. obstructive shock d. lymphedema

b. abdominal aortic aneurysm

What are the nerves cells in the carotid bodies that monitor CO2 levels and oxygen concentration in the blood? a. spinal nerve cells b. chemoreceptors c. mechanoreceptors d. phrenic nerve cells

b. chemoreceptors

What is a manifestation of a 1st degree heart block? a. Slowing of conduction in SA node b. prolonged PR interval c. tachycardia d. ST elevation

b. prolonged PR interval

Acetylcholine is an awesome and busy neruotransmitter. It fires off and it's released by the brain when eating starts, it triggers acid production and protection. It also stimulates all the cells except? a) Parietal Cells b) Chief Cells c) Kupffer Cells d) Mucin

c) Kupffer Cells

Ozzy O., a famous rockstar was out on tour and took a few too many opiates for his bad knee pain. After taking this high dose of medication with known respiratory suppression, what would be the likely result? a) Increase in blood oxygen percentage b) decrease in CO2 concentration c) increase in CO2 concentration d) increased tidal volume

c) increase in CO2 concentration

An 82 year old male is seen in the ER for chest pain. He explains that it feels like a tearing chest pain that radiates to his back. His blood pressure is 220/115 mm Hg in the left arm, and 160/95 mm Hg in the right arm. He has a past medical history notable for a long history of poorly controlled hypertension. He also smokes and drinks alcohol regularly. A chest X-ray shows a widened mediastinum. ECG and cardiac enzymes are negative. What is the likely diagnosis in this patient? a. Myocardial Infarction b. Hypertension c. Aortic Dissection d. Shock

c. Aortic Dissection

7 year old Charlie and his mom come into your office because Charlie has been complaining of chest tightness and coughing directly after his soccer practices. You notice that Charlie wipes his nose by rubbing his hand straight up his face. What would you most likely diagnose Charlie with? a. COVID b. Pneumonia c. Asthma d. Common cold

c. Asthma

A 65 yo male presents to your primary care office to establish care as a new patient. He has not seen a primary care provider in over 20 years due to living in a rural area with limited transportation. He complains of gradual onset of generalized lightheadedness, dizziness, and fatigue. He has never experienced these symptoms before. He has no past medical history of cardiac issues. His physical exam results in mild bradycardia. You decided to perform an EKG, Professor Tolomeo's favorite diagnostic testing! The EKG resulted in prolonged P wave intervals and then to your surprise, a P wave with no QRS complex. Following the patient's EKG, you recall that his family history mentioned that his mother had Lupus. In addition to the EKG, you ordered generic lab work. You added a Lyme panel due to the fact that the patient lives in a rural area. His lab work was negative although had a positive Lyme panel. You return to the patient and state that you are concerned for Wenckebach Phenomenon based off his EKG. What cardiac arrythmia are you concerned for specifically? a. Tachycardia, Wolf-Parkinson-White b. Bradycardia, AV node block, 1st degree c. Bradycardia, AV node block, 2nd degree, Type 1 d. Tachycardia, AV node block, 3rd degree

c. Bradycardia, AV node block, 2nd degree, Type 1

A 37 year old female presents with RLQ abdominal pain. She reports that she has also had bloody diarrhea. She has also had recent weight loss that was unintentional. She denies pus-like substances in her diarrhea. She denies changes in diet and appetite. She also denies any lifestyle changes. Her CBC is positive for nutritional deficiencies and her colonoscopy shows skip lesions. What is her primary diagnosis based on the information given? a. Ulcerative Colitis b. H. pylori gastritis c. Crohn's Disease d. Diverticulitis

c. Crohn's Disease

The basic pathophysiology of myocardial infarction can be described as: a. Vasospasms in the coronary artery causing ischemia in the heart layers b. Irregular heart rate causing decreased blood supply to the coronary arteries c. Death of the heart muscle cells due to lack of oxygen-rich blood flow d. Insufficient cardiac output for sufficient blood circulation in the body

c. Death of the heart muscle cells due to lack of oxygen-rich blood flow

A 64 y/o male patient presents with a CC of a worsening non-healing foot wound x 4 weeks. On PE you note an ulcer at the base of the heel with a punched-out appearance. What additional findings suggest peripheral arterial disease? a. Normal pulses b. Warm skin c. Diminished or absent pulses d. Brisk capillary refill

c. Diminished or absent pulses

A 57 y/o male with a BMI greater than 30 has acute onset confusion, chest pain, and breathlessness. He is found to have a systolic pressure of 220 mmHg. What type of hypertension is causing this patients symptoms? a. Primary hypertension due to lifestyle b. Secondary hypertension due to atherosclerosis c. Emergency hypertensive crisis with potential for end organ damage d. Emergency hypertensive crisis with no damage to end organs

c. Emergency hypertensive crisis with potential for end organ damage

Your 20 year old patient comes in for his yearly physical and to review his bloodwork that he did last week. He has a past medical history of asthma and chronic kidney disease. His blood work comes back and one of his labs showing elevated troponin levels. He is not complaining of anything in his visit with you. What is the most likely cause of his elevated troponin level? a. Patient was suffering a heart attack and was unaware. Pt should be transferred to ER b. Elevated troponin is idiopathic and there's no treatment necessary at this time. c. Patient has chronic kidney disease causing elevated troponin due to the kidneys being unable to clear out the troponin. d. Patient is a bodybuilder, which causes the myocytes to break down quickly releasing a large amount of troponin which can be detected in his labs.

c. Patient has chronic kidney disease causing elevated troponin due to the kidneys being unable to clear out the troponin.

Which of the following is the correct pathway of electrical conduction? a. SA node, intra-arterial and internodal pathways, purkinje fiber s, AV node, and bundle of His. b. Bundle of His, AV node, intra-arterial and internodal pathways, purkinje fibers, and AV node. c. SA node, intra-arterial and internodal pathways, AV node, bundle of His, and purkinje fibers. d. Bundle of His, SA node, intra-arterial and internodal pathways, purkinje fibers, and AV node.

c. SA node, intra-arterial and internodal pathways, AV node, bundle of His, and purkinje fibers.

60-year-old man is brought to the ED because of crushing substernal chest pain for the past 45 minutes. He received 325 mg of aspirin en route. Nitroglycerin does not relieve his pain. He has a history of diabetes and hypertension. Medications include carvedilol and sildenafil. His temperature is 36.8°C (98°F), pulse is 99/min, respirations are 18/min, and blood pressure is 192/88 mm Hg. He appears diaphoretic. ECG shows ST-segment elevation. What is the diagnosis? a. NSEMI b. Unstable Angina c. STEMI d. Stable Angina

c. STEMI

. A 60 year old patient presents with acute chest pain and hemoptysis. Given that they received a 2 on the PERC test and a 3 on the Wells test, what is the next diagnostic step? a. A PE can be ruled out b. The patient should receive a CT c. The patient should have their D-dimer levels tested d. A PE has been diagnosed

c. The patient should have their D-dimer levels tested

You suspect that your 60-year old patient with abdominal pain has diverticulitis, the following symptoms and examination findings all support your diagnosis except; a) Pain and tenderness in the lower left quadrant of the abdomen b) Patient has a history of recurrent episodes of constipation c) Slight elevation of C-reactive protein (CRP) d) Positive Murphy's sign e) Positive fecal occult blood test

d) Positive Murphy's sign

The myocardial muscle can be affected in two different ways during an MI. What difference would you see on an ECG between an NSTEMI and a STEMI? a. An elevated ST segment in an NSTEMI b. A decreased QRS complex in a STEMI c. An elevated P wave in an NSTEMI d. An elevated ST segment in a STEMI

d. An elevated ST segment in a STEMI

Your new admit presents with irregular tachycardia and fatigue and states that they have a history of a previous MI. You recognize upon a read through of the patient's medical Hx that your patient also has a BMI > 40 and hypertension. You believe that your patient is presenting with atrial fibrillation. Which of the following is the pathophysiology behind this diagnosis? a. The patient's myocytes, found near pulmonary veins, are exhibiting pacemaker cell qualities and are therefore depolarizing sporadically b. An accessory pathways has formed and therefore a Bundle of Kent has allowed for a second gate for electricity to travel through the heart c. Increased parasympathetic stimulation caused by a heart abnormality which can cause more sporadic and rapid depolarization d. Both A and C are correct

d. Both A and C are correct

Elastic recoil is: a. The main driving factor in inhalation b. The main driving factor in exhalation c. The main resisting factor in inhalation d. Both b and c are correct choices

d. Both b and c are correct choice

You have a 29 year old patient present to your ED complaining of a sudden throbbing, cramping pain in her left lower leg. Pt noted this has never happened to her before. When asked if she had any recent immobilizations or surgery, pt noted she was a driver in a 6 hour road trip 6 weeks ago. On physical exam-- there is mild swelling, no redness at the site, and the dorsalis pedis pulse is palpable. Lung sounds are present and clear bilaterally. Vital signs are as follows: HR 95, BP 106/81, SPO2 94% on room air, 20 breaths/min, temperature 98.9F. What would be your next step? a. Continue DVT physical assessment only, signs for a PE are negligible b. Chest CT scan c. Chest POCUS d. D-dimer test

d. D-dimer test

What result in diagnostic testing can you expect to see in the case of a Cholecystitis Common Bile Duct Blockage? a. Decreased Albumin b. Increased CRP c. Decreased LFTs d. Increased T. bili

d. Increased T. bili

You ask your patient to breathe normally. Then you say, "At the end of your next normal breath in I want you to keep breathing in as much as you can". What are you measuring? a. Tidal volume b. Expiratory reserve volume c. Vital capacity d. Inspiratory reserve volume

d. Inspiratory reserve volume

Which of the following is NOT a vasoconstricting hormone? a. catecholamines b. Vasopressin c. Angiotensin II d. Kinins

d. Kinins

A 28-year-old male comes to the physician because of worsening shortness of breath and productive cough for the past year. The patient has not seen a physician in several years. Despite being a respiratory therapist, he has smoked 2 packs of cigarettes daily for the past 10 years. Vital signs are within normal limits. Physical examination shows a thin man who breathes through pursed-lips. Lung auscultation reveals diffuse wheezing bilaterally. Which of the following parameters is most likely to be increased in this patient? a. Forced vital capacity b. Forced expiratory volume in one sec c. Diffusing capacity for carbon monoxide d. Lung compliance e. Lung elastic recoil

d. Lung compliance

A 67 y/o/f walks into your ER complaining of difficulty breathing. The patient is coughing, has a barrel shaped chest, and wheezing can be heard during auscultations of the lungs. You ask the patient if she has a history of asthma, which she replies "nope" to. Patient doesn't present any other past medical history... but then asks if she can run outside quickly to smoke. The patient states this has been going on for a while, but insists that being stung by a bee two weeks ago probably caused it, and just wants to be "pumped with air." After obtaining vitals you note: RR = 21 BP = 145/90 O2 = 95 HR = 80 What do you suspect is going on with the patient, and what key course of action do you want to make sure you don't forget? a. Patient is experiencing prolonged anaphylaxis after living unknowingly with a bee sting allergy. Epinephrine should be administered asap into the upper thigh to induce dilation of the bronchioles b. Patient likely has COPD. Due to this probable cause, the patient should be placed on a CPAP to increase oxygen saturation to 100 in order to subside the patient's present air hunger c. Patient is experiencing an anxiety attack due to the traumatic bee sting incident; psych should be consulted. d. Patient likely has COPD. To avoid eliminating the patient's respiratory drive, you want to avoid providing supplemental O2 at this time given the patient's current vitals.

d. Patient likely has COPD. To avoid eliminating the patient's respiratory drive, you want to avoid providing supplemental O2 at this time given the patient's current vitals.

What is the thickest layer of venous anatomy that contains connective tissue and nerves? a. Tunica Media b. Tunica Externa c. Capillaries d. Tunica Externa

d. Tunica Externa (This one has two of the same answers?)

Which statement is true about the tricuspid valve? a. it transmits oxygenated blood b. it is opened by the pull of the chordae tendinae c. it is open during ventricular systyle d. it is open during ventricular diastole

d. it is open during ventricular diastole

Which of the following describes a true aneurysm? a. All layers of the blood vessel walls dilate symmetrically b. Asymmetrical ballooning of all layers of blood vessel walls due to an increased pressure on one side c. A small hole in the blood vessel wall causes blood to leak out and pool d. all of the above e. a & b

e. a & b