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34.) All of the following are associated with being pregnant EXCEPT A. Breast tenderness B. Increased urinary frequency C. Quickening D. Vaginal erythema E. Softening of the cervix
Answer Explained Breast tenderness is often the first sign of pregnancy for many women. Quickening is defined as the first time you feel your baby move. Since your uterus puts pressure on your bladder most heavily in the third trimester, this means you'll probably have to go to the bathroom more than you ever did before. www.babyzone.com; www.webmd.com.
3.) Which of the following would be most helpful in establishing the diagnosis of iron deficiency anemia? A. Increased reticulocyte count B. Decreased serum iron and decreased TIBC C. Normochromic macrocytic anemia D. Decreased serum iron and increased TIBC E. Decreased reticulocyte count
Answer Explained Serum iron is a test that measures how much iron is in your blood. Low serum iron suggests iron deficiency anemia. TIBC is usually higher-than-normal when the body's iron stores are low. Higher-than-normal TIBC may mean: iron deficiency anemia.
28.) A 60 year old female smoker complains of weight loss and progressive dysphagia. Which of the following diagnosis is the most consistent with the history? A. Achalasia B. Esophageal varices C. Esophageal cancer D. Mallory-Weiss tear E. Zenker's diverticulumt
Answer Explained Signs and symptoms of esophageal cancer include: difficulty swallowing (dysphagia),weight loss without trying, chest pain/pressure/burning, fatigue, frequent choking while eating, indigestion, heartburn, coughing or hoarseness. http://www.mayoclinic.com/health/esophagealcancer/DS00500/DSECTION=symptoms.
33.) A college student with suspected meningitis undergoes a lumbar puncture. The CSF reveals an elevated white blood cell count of 5,000/mcl with > 90% neutrophils, decreased glucose level of 30 mg/d, and elevated protein level of 150 mg/dL. What is the most likely diagnosis? A. Bacterial meningitis B. Viral meningitis C. Fungal meningitis D. Tuberculosis meningitis E. Aspetic meningitis
Answer Explained A suspected case of Bacterial Meningitis when CSF examination shows at least one of the following: turbid appearance; leukocytosis (> 100 cells/mm3); leukocytosis (10-100 cells/ mm3) AND either an elevated protein (> 100 mg/dl) or decreased glucose (< 40 mg/dl) World Health Organization: http://www.who.int/en/.
14.) A postmenopausal woman reports vaginal soreness and painful intercourse. Pelvic examination reveals thin, pale vaginal walls. No malodorous discharge, cervical motion tenderness or vulvar lesions are noted. Wet prep is negative. Which of the following is the most likely diagnosis? A. Atrophic vaginitis B. Bacterial vaginosis C. Cervicitis D. Endometrial carcinoma E. Uterine prolapse
Answer Explained A woman may experience one or several of these symptoms of atrophic vaginitis, to varying degrees: vaginal dryness, pain during sex (dyspareunia), changes in appearance of the labia and vagina (it looks paler and thinner), irritation when wearing certain clothes such as tight jeans or when doing certain activities, an increase in urinary tract infections. MediLexicon, Intl., 20 May. 2010. Web.
17.) Which of the following causes of pneumonia is most likely to be complicated by diarrhea? A. Pneumococcal B. Mycoplasma C. Fungal D. Legionella E. Tuberculosis
Answer Explained Although the pneumonia affects the lungs, Legionnaires' disease is accompanied by symptoms that affect other areas of the body. About half the victims experience diarrhea and a quarter have nausea and vomiting and abdominal pain. World of Microbiology and Immunology, ©2003 Gale Cengage.
39.) All of the following are sign or symptoms of aortic stenosis EXCEPT A. Angina B. Syncope C. Systolic murmur D. Hemoptysis E. Dyspnea
Answer Explained Aortic valve stenosis signs and symptoms typically develop when narrowing of the valve is severe and can include: Chest pain (angina) or tightness; Feeling faint or fainting with exertion; Shortness of breath, especially with exertion; Fatigue, especially during times of increased activity; Heart palpitations and heart murmur. http://www.mayoclinic.com/health/aortic-valve-stenosis/DS00418/DSECTION=symptoms.
27.) A 42 year-old female comes to the Urgent Care because of increasing shortness of breath. Vital signs reveal she is afebrile with respirations of 22, blood pressure 130/90 and heart rate 100 and regular. Physical exam of the chest reveals decreased fremitus with a prolonged expiration phase and low diaphragms. Which of the following is the most likely diagnosis? A. Pneumothorax B. Acute asthma attack C. Pleural effusion D. Atelectasis E. Lobar pneumonia
Answer Explained Asthma is predominantly a disease of inflammation with superimposed bronchospasm, leading to air trapping. As such, the normally resonant thorax becomes hyperresonant, reflecting the less dense quality of the air- filled thoracic tissue, and tactile fremitus is diminished. Additional asthma findings include prolonged expiration phase and hyperinflation reported on the chest x-ray. Prolonged inspiration phase of respiration is usually found in upper airway obstruction such as epiglottis or tonsillar abscess. Tactile fremitus is typically increased when there is increased lung tissue density in conditions including pneumonia with consolidation.
21.) A 60 year old patient complains of significant right eye pain with decreased vision in that eye for 4 hours. She also notes a mild headache and nausea. Which of the following will you most likely see on exam? A. Hyphema B. Conjunctivitis C. Moderately dilated, nonreactive pupil D. Cotton wool spots E. Normal eye exam
Answer Explained Closed-angle glaucoma accounts for less than 10% of glaucoma cases in the United States, but as many as half of glaucoma cases in other nations (particularly Asian countries). About 10% of patients with closed angles present with acute angle closure crises characterized by sudden ocular pain, seeing halos around lights, red eye, very high intraocular pressure (>30 mmHg), nausea and vomiting, suddenly decreased vision, and a fixed, mid-dilated pupil. It is also associated with an oval pupil in some cases. Acute angle closure is an emergency. Merck.com. Retrieved 2011-01-24 .
35.) An 8 day post op CABG patient has lower extremity edema, elevated JVD that does not fall with inspiration, a positive Kussmaul sign and reduced mitral inflow velocities with inspiration. What do you think he has? A. Kawasaki disease B. Pulmonary hypertension C. Constrictive pericarditis D.Hypertrophic cardiomyopathy E. Pleural effusion
Answer Explained Constrictive pericarditis is most commonly caused by conditions or events that cause inflammation to develop around the heart, including heart surgery, radiation therapy and tuberculosis. A physical exam may show that your neck veins stick out, suggesting increased blood pressure in the area. This is called Kussmaul's sign. The doctor may note weak or distant heart sounds when listening to your chest with a stethoscope. The physical exam may also reveal liver swelling and fluid in the belly area. Lower extremity edema is common. Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap75.
30.) A 39 year old female corporate secretary is evaluated for a 2-months history of proximal interphalangeal and wrist joint swelling and pain There is some stiffness in this joints in the morning. Her grandma had something similar. Exam show symmetrical synovitis of the MCP, wrist and knee joints. Lab results show : Hemoglobin 10.9 g/dL, Rheumatoid Factor negative, ANA negative. What is your diagnosis? A.Osteoarthritis B. Psoriatic arthritis C. Calcium pyrophosphate deposition disease D. Rheumatoid Arthritis E. Systemic Lupus Erythematosus
Answer Explained Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease. There is no one test or physical finding to confirm the diagnosis. Mayo Clinic; Ferri's Clinical Advisor 2011.
18.) A patient complains of burning retrosternal pain after eating a large meal. Bending over aggravates his symptoms. The history is consistent with which of the following diagnosis? A. Acute cholecystitis B. Angina pectoris C. Esophageal spasm D. Peptic ulcer E. Reflux esophagitis
Answer Explained Factors that contribute to the development of reflux esophagitis include the caustic nature of the refluxate, the inability to clear the refluxate from the esophagus, the volume of gastric contents, and local mucosal protective functions. The main symptom of reflux esophagitis is heartburn, with or without regurgitation of gastric contents into the mouth, which worsens on bending over. Health Encyclopedia - Diseases and Conditions.
15.) A patient with type 2 diabetes and hypertension should be treated with which agent?? A. Alpha blocker B. Beta blocker C. Calcium channel blocker D. ACE Inhibitor E. Hydrochlorothiazide
Answer Explained Hypertension is a common comorbidity in patients with diabetes, and adequate control of blood pressure significantly reduces the risk of macrovascular and microvascular complications. Patients with diabetes should achieve a target blood pressure of less than 130/80 mm Hg. The use of angiotensin-converting enzyme inhibitors may slow progression to kidney failure and cardiovascular mortality; these agents are the preferred therapy for managing coexisting diabetes and hypertension. Am Fam Physician. 2008 Dec 1; 78(11):1277-1282.
24.) Which one of the following SSRIs used to treat PMS and PMDD should be avoided in women of childbearing age without reliable contraception? A. Citalopram (Celexa) B. Fluoxetine (Prozac) C. Sertraline (Zoloft) D. Paroxetine (Paxil) E. None of the above
Answer Explained In 2005, the US FDA listed paroxetine (Paxil) as pregnancy category D based on studies demonstrating increased risk of major congenital heart defects from first-trimester exposure. US Food and Drug Administration.. MedWatch safety alerts. Paroxetine HCl-Paxil and generic paroxetine. December 2005. http://www.fda.gov/Safety/MedWatch/ucm152062.htm. Accessed May 14, 2011.
5.) A 30 year old female has a 1 week history of dyspnea and bilateral ankle edema. BP is 170/68, pulse is 122/min, and respirations 28/min.. Exam shows warm skin, lid lag, bounding pulses, bibasilar rales, and fine tremor. Which of the following is the most likely diagnosis? A. Myasthenia gravis B. Essential tremor C. Mercury poisoning D. Hyperthyroidism E. Decreased reticulocyte count
Answer Explained Individuals suffering from hyperthyroidism exhibit different common symptoms like hair loss, heat intolerance and anxiety. Although patients can experience significant increase in appetite, the loss of weight is evident. Additional signs include fatigue, weakness and muscle aches that affect the entire body. Furthermore, patients can also experience apathy, irritability and hyperactivity. It is also quite common for patients to have polydipsia, polyuria as well as depression. Aside from sweating, they can also experience pretibial myxedema, tremor and delirium. Patients are more likely to have dyspnea or shortness of breath, arrhythmias and palpitations. These signs are also accompanied by diarrhea, vomiting, nausea and loss of libido. When left untreated, this condition can even lead to more health problems, one of which is osteoporosis. Patients with hyperthyroidism may also show some minor ocular symptoms. These include the lid-lag, extra-ocular muscle weakness and eyelid retraction, the last symptom of which is often referred to as the hypothyroid stare.
8.) A patient complains of abdominal pain, low-grade fever, weight loss, nausea, vomiting and diarrhea. Abdominal radiograph shows a string sign. Colonoscopy reveals skip lesions, a cobblestone appearance and deep and longitudinal fissures. Which of the following diagnosis do you suspect? A. Crohn's disease B. Diverticulitis C. Irritable bowel syndrome D. Ischemic colitis E. Ulcerative colitis
Answer Explained Low-grade fever, prolonged diarrhea with abdominal pain, weight loss, and generalized fatigability are usually reported in Crohn's disease. The ulcerations of Crohn's disease may appear aphthoid, but they could also be deep and serpiginous. Skip areas, a cobblestone appearance, pseudopolyps, and rectal sparing are characteristic findings. http://www.clevelandclinicmeded.com.
19.) A 55 year old male comes in for a physical and his urinalysis reveals hematuria. He denies any symptoms but has smoked a pack of cigarettes daily for the past 32 years. What is the next most appropriate step? A. CBC and chemistry profile B. Pelvic and abdominal CT scan C. Retrograde pyelography D. Cystoscopy and biopsy E. Intravenous urogram
Answer Explained Most patients present with unexplained hematuria (gross or microscopic). Some patients present with anemia, and hematuria is detected during evaluation. Bladder cancer is suspected clinically. Urine cytology, which may detect malignant cells, may be done. Cystoscopy and biopsy of abnormal areas are usually also done initially because these tests are needed even if urine cytology is negative. The Merck Manual.
29.) A cardinal manifestation of the nephrotic syndrome is A. Granular casts B. Proteinuria C. Pyuria D. Hematuria E. Anuria
Answer Explained Nephrotic syndrome is characterized by high protein excretion, peripheral edema, and metabolic abnormalities. Proteinuria in nephrotic syndrome is due to increased permeability of the glomerular basement membrane to albumin and arises in response to alterations in both the size and charge barriers of the glomerular filtration apparatus. Albumin is the predominant protein excreted. Am Fam Physician - 15-NOV-2009; 80(10): 1129-34.
10.) The most common bone malignancy that typically occurs in adolescents and presents with pain or swelling in the bone or joint and commonly affects the knee is A. Osteoid osteoma B. Ewing's sarcoma C. Osgood-Schlatter D. Osteosarcoma E. Chondroblastoma
Answer Explained Osteosarcoma is the most common cancerous (malignant) bone tumor in kids. Osteosarcoma tends to occur in the bones of the Knee, Shin (near the knee) or Thigh (near the knee). Lerner A, Antman KH. Primary and metastatic malignant bone lesions. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 208.
11.) A child comes to the clinic with left ear pain and itching. On exam you see edema and erythema in the left ear canal with purulent exudate. Pushing on the tragus causes increased pain. You cannot visualize the tympanic membrane very well. What is the treatment of choice? A. Amoxicillin B. Augmentin C. Irrigation of ear canal D. Polymyxin B sulfate E. ENT consult
Answer Explained Otitis externa is usually treated empirically with topical neomycin/polymyxin B/hydrocortisone. The predominant pathogens associated with this infection are Pseudomonas aeruginosa and Staphylococcus aureus. South Med J. 2004 May;97(5):465-71.
1.) A 23 year old female complains of a worsening sore throat for 3 weeks. She now complains of fever, difficulty swallowing, and difficulty opening her mouth. Her voice is muffled. On exam, her right tonsil is bulging. Which of the following is the most appropriate management? A. Steroid administration B. Duoneb therapy C. Nasotracheal intubation D. Needle aspiration E. Antifungal therapy
Answer Explained Peritonsillar abscess, the most common deep infection of the head and neck that occurs in adults, is typically formed by a combination of aerobic and anaerobic bacteria. The presenting symptoms include fever, throat pain, and trismus. Ultrasonography and computed tomographic scanning are useful in confirming a diagnosis. Needle aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess. After performing aspiration, appropriate antibiotic therapy (including penicillin, clindamycin, cephalosporins, or metronidazole) must be initiated. Am Fam Physician. 2002 Jan 1;65(1):93-97
32.) A 27 year-old female comes to the Urgent Care with complaints of palpitations. She feels that her heart rate has been speeding up and then slowing down for approximately the past 6 hours. She denies any caffeine intake or significant stress. On ECG you find a variable heart rate with normal P, QRS and T waves. The PR interval is 0.12 seconds and the P to QRS ratio is 1:1. The R to R interval does appear to accelerate and then decelerate during the normal respiratory cycle. Which of the following is the most likely diagnosis? A. Sinus arrhythmia B. Atrial fibrillation C. Atrial flutter D. First degree heart block E. Premature junctional contractions
Answer Explained Respiratory sinus arrhythmia (RSA) is a naturally occurring variation in heart rate that occurs during a breathing cycle. Heart rate increases during inhalation and decreases during exhalation. A term frequently used to describe a normal heart rhythm in which the heart rate varies by more than 10 beats in a minute. equimedcorp.com/patient-resources/information/glossary/.
36.) A 6 year old boy is brought in by his mom with a very pruritic rash for the past week. There are excoriations on the boy's lower abdomen, buttocks, and hands with red papules. A few small burrows are noted. What is the most likely diagnosis and treatment plan? A. Seborrheic dermatitis, steroid cream B. Dyshidrotic eczema, antiparasitics C. Seborrheic dermatitis, antihistamines D. Pityriasis rosea, antihistamines E. Scabies, antiparasitics
Answer Explained Scabies produces a skin rash composed of small red bumps and blisters and affects specific areas of the body. Scabies may involve the webs between the fingers, the wrists and the backs of the elbows, the knees, around the waist and umbilicus, the axillary folds, the areas around the nipples, the sides and backs of the feet, the genital area, and the buttocks. Textbook descriptions of scabies always mention "burrows" or "tunnels." Medicine Net.Com 5% permethrin cream: This is the most common treatment for scabies. http://www.aad.org/skin-conditions/dermatology-a-to-z/scabies/diagnosis-treatment.
26.) Schizoid personality is characterized by all the following EXCEPT A. Avoidance of close relationship with others B. Inability to express aggression C. Autistic thinking D. Double personality E. Shy, obedient childhood
Answer Explained Schizoid personality disorder (SPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness and apathy. Affected individuals may simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world. Ball, Jeff. "Schizoid Personality Disorder". Psychological Care & Healing Treatment Center. 12/18/2010.
16.) Which of the following statements about depression and cardiovascular disease is NOT correct?? A. SSRIs generally should be avoided in older patients with cardiac conditions B. SSRIs generally should be avoided in older patients with cardiac conditions C. Depression after an acute coronary event increases the risk of future cardiovascular events and death D. About 20 percent of patients with myocardial infarction develop major depression E. All the above are correct
Answer Explained Selective serotonin reuptake inhibitors (SSRIs) and venlafaxine are preferred to other antidepressants because of their positive profile as regards side effects. More specifically, the action of SSRIs involves: a) an increase in serotonin in the receptors; b) a reduction in platelet activation; and c) a restoration of heart rate variability. These drugs show a low anticholinergic effect and almost zero arrhythmogenesis. Hellenic J Cardiol 2010; 51: 142-152.
40.) A 30 year old female presents with thickened skin, telangiectasias, loss of normal skin folds and fingertip ulcerations. She denies any constitutional symptoms, fever, arthritis, muscle weakness, or other symptoms. Which of the following is the most likely diagnosis? A. Rheumatoid arthritis B. Polymyalgia rheumatica C. Wegener granulomatosis D. Scleroderma (systemic sclerosis) E. Reactive arthritis (reiter syndrome)
Answer Explained Skin involvement in systemic sclerosis can include hair loss, calcium deposits, open sores, swelling, gangrene, changes in skin color, itching, small mouth, swollen or hardened skin on fingers or elsewhere, loss of skin folds and dry skin. Telangiectasias may appear on the hands or face. Systemic scleroderma and Raynaud's can cause painful ulcers on the fingers or toes, which are known as digital ulcers. Sclero.org.
25.) A 25 year old type 1 diabetic on insulin TID presents with the following blood sugars : bedtime = 94 mg/dL 3:00 am = 50 mg/dL 7:00am = 220 mg/dL Which of the following is the most likely cause? A. Dawn phenomenon B. Insulin resistance C. Somogyi effect D. Primary hypoglycemia E. Insulin allergy
Answer Explained Somogyi effect is a rebound phenomenon occurring in diabetes: overtreatment with insulin induces hypoglycemia, which initiates the release of epinephrine, ACTH, glucagon, and growth hormone, which stimulate lipolysis, gluconeogenesis, and glycogenolysis, which, in turn, result in a rebound hyperglycemia. Farlex Medical Dictionary.
13.) A 23 year old college student presents to the urgent care complaining of a sore throat for 2 weeks. He also notes significant fatigue for the same amount of time. On exam there is exudative pharyngitis and tender enlarged posterior cervical lymphadenopathy. His spleen is also enlarged. Rapid strep screen is negative. Which of the following is the most appropriate next step in diagnosis? A. Throat culture B. Repeat strep screen in 24 hours C. Mono spot D. Serology for anti-EBV antibodies E. Trial of amoxicillin
Answer Explained Symptoms of mono include fatigue, sore throat, swollen lymph nodes, and fever. Enlargement of the spleen and inflammation of the liver may also occur. More specific blood tests, such as the monospot and heterophile antibody tests, can confirm the diagnosis of mono. AM J Med 109.7(2000): 531.
4.) A 30 year old pregnant female presents at 34 weeks gestation complains of bright red vaginal bleeding without pain for fever. The most likely etiology is A. Abruptio placentae B. Placenta previa TIBC C. This is normal for 34 weeks gestation D. Pre-eclampsia E. Eclampsia
Answer Explained The classic presentation of placenta previa is painless vaginal bleeding. This hemorrhage often stops spontaneously and then recurs with labor. Placenta previa often leads to preterm delivery, with 44% of pregnancies with placenta previa delivered before 37 weeks. Am J Perinatol.
20.) Most long bones show a fine white line located near the end of the bone on X-rays. What does this correspond to? A. Haversian canal B. Intramembranous bone C. Medullary cavity D. Epiphyseal disc scar E. Periosteal membrane
Answer Explained The epiphyses is the end of a long bone that is originally separated from the main bone by a layer of cartilage but later becomes united to the main bone through ossification. This process results in an epiphyseal scar. Farlex Medical Dictionary.
9.) Increased potassium concentrations may be found in which of the following conditions? A. Prolonged vomiting B. Metabolic alkalosis C. Primary aldosteronism D. Renal Insufficiency E. None of the above Answer Explained The kidneys normally remove excess potassium from the body. Renal insufficiency can have high potassium levels when the kidneys are not working properly and are less able to get rid of potassium. Seifter JL. Potassium disorders. In: Goldman L, Schafer, AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 119..
Answer Explained The kidneys normally remove excess potassium from the body. Renal insufficiency can have high potassium levels when the kidneys are not working properly and are less able to get rid of potassium. Seifter JL. Potassium disorders. In: Goldman L, Schafer, AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 119..
6.) Which of the following is the preferred urgent treatment for an episode of panic disorder with terror and chest pressure? A. Sublingual nitroglycerin B. Oral temazepam (Restoril) C. Oral hydroxyzine (Vistaril) D. Oral phenobarbital E. Sublingual lorazepam (Ativan)
Answer Explained The most commonly-prescribed class of drugs for panic disorders are the benzodiazepines (such as clonazepam, lorazepam, alprazolam). Copyright 2012 Mental Health Disorders.
12.) National guidelines state blood pressure targets should be lower for patients with diabetes and A. History of stroke B. Liver disease C. Renal disease D. Thyroid disease E. Hyperlipidemia
Answer Explained The most recent scientific guideline statements from foundations and societies dealing with diabetes and kidney disease (renal disease) argue for blood pressure goals lower than 130/80 mm/HG. Curr Hypertens Rep. 2011 Dec;13(6):452-455.
23.) Which laboratory finding is the hallmark for acute myelogenous leukemia? A. Auer rods B. Heinz bodies C. Hirano bodies D. Howell-Jolly bodies E. Philadelphia chromosome
Answer Explained The presence of Auer rods in myeloid blasts is considered a hallmark of acute myeloid leukemia. Low Blast Count Myeloid Disorders With Auer Rods, A Clinicopathologic Analysis of 9 CasesMonte S. Willis, MD, PhD,1 Robert W. McKenna, MD,1 LoAnn C. Peterson, MD,2James E. Coad, MD,3 and Steven H. Kroft, MD1 .
31.) A 25-yo man presents with nasal obstruction, mild facial pain, and a low grade fever lasting more than one week. He has no drug allergies. Which of the following antibiotics is considered first-line therapy? A.Cefuroxime (Ceftin) B. Azithromycin (Zithromax) C. Amoxicillin D. Levofloxacin (Levaquin) E. Amoxicillin/clavulanate (Augmentin)
Answer Explained The standard first-line antibiotic treatment for acute uncomplicated bacterial sinusitis is a 10 - 14 day course of amoxicillin. http://www.umm.edu/patiented/articles/how_acute_sinusitis_treated_000062_8.htm#ixzz2DkIfrVoa.
7.) What is the test of choice to diagnose cystic fibrosis? A. Physical exam B. Genetic testing C. Serum potassium and chloride levels D. Chest radiograph E. Sweat chloride concentration testing
Answer Explained The sweat test has been the gold standard diagnostic test for CF for many years. The sweat test is a quick, non-invasive, painless test that measures the levels of sodium and chloride excreted in sweat. Bilton, D (2008).Cystic fibrosis. Medicine. 36, 273-278.
38.) Excruciating abdominal pain, profound shock, abdominal distention, and some abdominal rigidity and agonizing back pain are most characteristic of A. Acute appendicitis B. Aortic aneurysm C. Ruptured corpus luteum D. Biliary colic E. Renal colic
Answer Explained The symptoms of aortic aneurysm include: pain in the abdomen or back — severe, sudden, persistent, or constant. The pain may spread to the groin, buttocks, or legs. Symptoms include clammy skin, dizziness, nausea/vomiting, rapid heart rate and shock. Ann Intern Med. 2007; 146:735-741.
22.) Which of the following is not a diagnostic criteria of metabolic syndrome? A. High Triglycerides B. Low HDL C. High LDL D. Fasting Hyperglycemia E. Hypertension
Answer Explained This constellation of metabolic risk factors is strongly associated with type 2 diabetes mellitus or the risk for this condition. The metabolic risk factors consist of atherogenic dyslipidemia (elevated triglycerides and apolipoprotein B, numerous small LDL particles, and low HDL cholesterol [HDL-C] concentrations), elevated blood pressure, elevated plasma glucose, a prothrombotic state, and a proinflammatory state. December 2005 issue of Critical Pathways in Cardiology . How is metabolic syndrome diagnosed? To diagnose metabolic syndrome, most doctors look for the presence of three or more of these components: Central or abdominal obesity (measured by waist circumference): Men - 40 inches or above Women - 35 inches or above Triglycerides greater than or equal to 150 milligrams per deciliter of blood (mg/dL) HDL cholesterol: Men - Less than 40 mg/dL Women - Less than 50 mg/dL Blood pressure greater than or equal to 130/85 millimeters of mercury (mmHg) Fasting glucose greater than or equal to 100 mg/dL
2.) A 35 year old woman complains of episodic chest pain that usually lasts for 5-10 minutes, is sometimes related to exercise but sometimes occurs at rest. The pain does not radiate. She is a nonsmoker and has no history of HTN. Two other family members have died of heart disease, one at age 50, the other at 56. On physical examination, her BP is 120/70, pulse is 70, and cardiac exam shows a II/VI systolic ejection murmur heard along the left sternal border that increases in intensity when she stands up. Her point of maximum impulse is forceful. ECG shows nonspecific ST segment and T wave abnormalities. Which of the following tools would be best to use to confirm your diagnosis? A. Chest radiograph B. Cardiac Catheterization C. Echocardiography D. Chest CT scan E. Exercise Stress Test
Answer Explained Two-dimensional and Doppler echocardiography is the imaging modality of choice to diagnose and determine the severity of aortic stenosis. http://emedicine.medscape.com/article/150638-workup.
37.) A 60 year old man with history of chronic bronchitis presents with 3 days of increased dyspnea and cough with purulent sputum production. Which medication is NOT warranted for treatment at this time? A. Systemic corticosteroids B. Albuterol C. Mucomyst D. Antibiotic E. Theophylline
Answer Explained While therapy with short bursts of high-dose parenteral steroids is a mainstay of hospital management of acute exacerbations, rapid dosage reduction to the lowest oral dosage possible for long-term management is necessary to minimize long-term side effects. Inhaled ipratropium bromide (Atrovent) and sympathomimetic agents are for most patients the mainstays of therapy to provide relief of bronchospasm. Sympathomimetic agents such as albuterol (Proventil, Ventolin) provide more rapid bronchodilation. Antibiotics are probably helpful only in acute exacerbations of chronic bronchitis. http://www.aafp.org/afp/1998/0515/p2365.html. Mucomyst is used to treat chronic bronchitis. Mucomyst contains the medicine N-acetylcysteine which thins or loosens mucus in the airways or breathing tubes, making it easier to cough up. http://www.patienthealthinternational.com/content/product/mucomyst
