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PACKRAT PRACTICE EXAM QUESTIONS
Which of the following factors in patients with chronic venous insufficiency predisposes them to development of skin ulcers? A. Increased intravascular oncotic pressure B. Leakage of fibrinogen and growth factors into the interstitial space C. Decreased capillary leakage D. Inherited deficiency of protein C - Answers - B. Leakage of fibrinogen and growth factors into the interstitial space, leukocyte aggregation and activation, and obliteration of the cutaneous lymphatic network can predispose a patient to skin ulcers A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis? A. Ovarian cancer B. Endometriosis C. Functional ovarian cyst D. Pelvic inflammatory disease - Answers - B. With endometriosis, the uterus is often fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or "chocolate cyst". The patient with endometriosis also often has dysmenorrhea, dyspareunia, and dyschezia. At what age does the first tooth usually erupt in an infant? A. 2-4 months B. 6-8 months C. 10-12 months D. 14-16 months - Answers - B. The first tooth in an infant to erupt is the central incisor at the average age of 6-8 months. A 7 year-old boy wets the bed on most nights. Which of the following is the preferred pharmacological agent to decrease the incidence of bed wetting episodes? A. Imipramine (Tofranil) B. Phenytoin (Dilantin) C. Pramipexole (Mirapex) D. Hyoscyamine (Urised) - Answers - A. Imipramine is an anti-cholinergic and when given before bedtime has been shown to decrease the incidence of bed wetting. A newborn is being evaluated for perioral cyanosis while feeding associated with sweating. Vital signs are rectal temperature, 37.8 degrees C (100 degrees F), blood pressure 80/45 mmHg, pulse 180/min, and respirations 40/min. A grade 3/6 harsh systolic ejection murmur with a single loud S2 is heard at the left upper sternal border. Electrocardiogram (ECG) shows right ventricular hypertrophy with right axis deviation. Chest x-ray shows a bootshaped heart and decreased pulmonary vascular markings. Which of the following is the most likely diagnosis?
A. Atrial septal defect B. Total anomalous pulmonary venous return C. Coarctation of the aorta D. Tetralogy of Fallot - Answers - D. This is a common presentation for tetralogy of fallot. Which of the following is considered to be the modality of choice for the identification of a pituitary macroadenoma that is suspected on the basis of a visual field deficit? A. Skull x-ray B. PET scan C. CT of the brain D. MRI of the brain - Answers - D. MRI of the brain provides the best visualization of pituitary tumors. A 2 year-old male presents with a four day history of fever and general malaise. On examination the vitals reveal an oral temperature of 102 degrees F. The child appears to have rubor on the trunk which started one day prior to this visit. Physical examination reveals a maculopapular rash with defervescence. Which of the following is the most appropriate management at this time? A. Ibuprofen (Motrin) B. Aspirin C. Amoxicillin D. Valacyclovir (Valtrex) - Answers - A. Motrin is indicated for management of the fever in Roseola infantum caused by the herpesvirus. A 42 year-old female experiences pain on the plantar surface of her left foot in the area of the third metatarsal head. The pain is associated with wearing tight shoes and is relieved by removing shoes. Examination reveals a palpable mass and reproduction of pain with deep palpation of the third intermetatarsal space. The patient has tried wearing wider shoes with metatarsal cushions and taking NSAIDS but her symptoms persist. What is the best therapeutic option at this point? A. Casting of the involved foot B. Physical therapy C. Steroid injection D. Surgical excision - Answers - C. Steroid injection is the treatment of choice for Morton's neuroma when conservative measures fail. Which of the following is the most likely to develop into a persistent cough in the adult patient? A. Pertussis B. Allergic rhinitis C. Pharyngitis D. Heart failure - Answers - A. Pertussis is suspected in patients with persistent cough that lasts longer than 2-3 weeks. Allergic rhinitis, pharyngitis and heart failure are all potential causes of acute cough.
C. Intestinal obstruction D. Acute respiratory failure - Answers - B. This patient has cystic fibrosis. The most common causes of death include pulmonary complications, such as infections, and terminal chronic respiratory failure associated with cor pulmonale. In addition to tremor, which of the following are cardinal symptoms of Parkinson disease? A. Cognitive decline and rigidity B. Personality change and bradycardia C. Eye movement abnormalities and hyperkinesias D. Rigidity and bradykinesia - Answers - D. Tremor, rigidity, bradykinesia and postural instability are the cardinal features of Parkinsonism and may be present in any combination. Normal hemoglobin A is made of what combination of heme and globin chains? A. 2-alphas and 2-betas B. 4-gammas C. 2-alphas and 2-gammas D. 4-betas - Answers - A. Hemoglobin A1 is composed of two alpha and two beta chains. Which of the following is the most important intervention in acute pancreatitis? A. IV fluid administration B. Antibiotic administration C. Calcium replacement D. Antiemetics - Answers - A. The mainstay of management in acute pancreatitis is fluid resuscitation. Isotonic solutions are best to maintain renal perfusion and urine output > 100 ml/hour. An electrocardiogram (ECG) shows a sinus rhythm with varying T wave heights, axis changes every other beat and a wandering baseline. Which of the following is most likely the diagnosis? A. Artifact B. Digoxin toxicity C. Pericardial effusion D. Poor lead placement - Answers - C. This ECG pattern best represents pericardial effusion due to a swinging heart in fluid and is known as electrical alternans. Which of the following is the first-line treatment for a patient with mild syndrome of inappropriate secretion of ADH (SIADH)? A. Sodium supplementation to correct the hyponatremia B. Restriction of free water C. High volume hypertonic saline infusion D. Pituitary ablation via transsphenoidal approach - Answers - B. Restriction of free water intake is the first-line therapy for patients with euvolemic hyponatremia that is
caused by SIADH. Water intake should be restricted to 0.5 to 1 liter per day. A gradual increase in serum sodium will occur over days with this treatment. A 62 year-old homeless patient presents complaining of fever, weight loss, anorexia, night sweats and a chronic cough that recently became productive of purulent sputum that is blood streaked. On physical examination, the patient appears chronically ill and malnourished. Which of the following chest x-ray findings supports your suspected diagnosis? A. Hyperinflation and flat diaphragms B. Interstitial fibrosis and pleural thickening C. Cavitary lesions involving the upper lobes D. "Eggshell" calcification of hilar lymph nodes - Answers - C. This patient most likely has tuberculosis. A chest x-ray finding of cavitary lesions involving the upper lobes would support this suspected diagnosis. Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle? A. Supraspinatus B. Infraspinatus C. Teres minor D. Subscapularis - Answers - A. Abduction against resistance tests the supraspinatus. What is the recommended method for screening pregnant women for gestational diabetes? A. Fasting blood sugar and 2 hour post prandial B. 50 gram glucose load followed by a blood sugar in 1 hour C. 75 gram glucose load followed by a blood sugar in 2 hours D. 100 gram glucose load followed by a blood sugar at 1 hour, 2 hours, and 3 hours - Answers - B. One hour Glucola is the screening test for gestational diabetes. It is a 50 gram glucose load, with a serum glucose obtained 1 hour after the dose. Normal value is less than 140 mg/dL. A 45 year-old smoker presents with a sore mouth and increasing difficulty eating for two weeks. Physical examination reveals a 1 cm white lesion on the buccal mucosa that cannot be rubbed off. Which of the following is the most likely diagnosis? A. Oral cancer B. Oral candidiasis C. Aphthous ulcer D. Necrotizing ulcerative gingivitis - Answers - A. The presence of leukoplakia in a smoker over the age of 40 should be biopsied to rule out the presence of oral cancer. A 25 year-old female presents to the emergency department after an episode of substernal chest pain with radiation to the middle of her back that came on suddenly
fields. Blood pressure is 108/68 mmHg, pulse 70 bpm. Which of the following would be the definitive clinical intervention? A. Intra-aortic balloon counterpulsation B. Mitral valve replacement C. Coronary artery bypass surgery D. Immediate fluid bolus - Answers - B. MVR is the definitive intervention to correct MR caused by papillary muscle rupture. During an influenza epidemic, a 6 year-old male is seen with fever and a severe sore throat. The parents report that his symptoms have not improved despite administration of aspirin. The next day, the parent calls to report that the child has persistent vomiting and increased lethargy. On examination, he is found to be delirious and disoriented with hyperactive reflexes. The liver edge is 3 cm below the right costal margin in the midclavicular line. Which of the following is the most likely diagnosis? A. Reye's syndrome B. Measles encephalitis C. Guillain-Barre syndrome D. Acute bacterial meningitis - Answers - A. The suspected influenza associated with development of vomiting, progressive mental status changes, hyperreflexia, and hepatomegaly are consistent with a diagnosis of Reye's syndrome What is the treatment of magnesium sulfate toxicity? A. Nifedipine B. Terbutaline C. Potassium carbonate D. Calcium gluconate - Answers - D. 10% calcium gluconate is used to treat magnesium sulfate toxicity. A 26 year-old male who is an avid swimmer has been experiencing right shoulder pain for the past month. On examination, pain is elicited with palpation below the anterior acromion. Anterior shoulder pain is also reported when the patient flexes and extends his arm. Which of the following diagnostic tests is most appropriate at this time? A. Shoulder x-ray B. Shoulder arthroscopy C. Shoulder MRI D. Subacromial lidocaine injection - Answers - D. Subacromial injection of lidocaine leading to a transient but dramatic improvement in pain with shoulder extension makes the diagnosis of impingement highly likely. Which of the following is the major pathogenetic mechanism that causes asthma? A. Airway inflammation B. Increased pulmonary secretions C. Presence of Ghon complexes D. Irreversible fibrosis - Answers - A. Airway inflammation is the major pathogenetic mechanism that leads to the development of asthma.
When performing a Weber test on a patient with impacted cerumen in the right canal, the sound should be A. referred to the right ear. B. referred to the left ear. C. equal in both ears. D. louder with air conduction. - Answers - A. In unilateral conductive hearing loss, the sound is referred to the impaired ear. Which of the following is used to monitor possible recurrence of prostate cancer? A. Prostate specific antigen B. Acid phosphatase C. Transrectal ultrasound D. Bone scan - Answers - A. Increasing levels of prostate specific antigen are consistent with progression of disease A patient presents with profound itching. Examination reveals short, reddish lesions on the wrists, elbows, and finger webs. Papules are also noted in these areas. There appears to be burrow marks emanating proximal to the finger webs. Which of the following is the most likely diagnosis? A. Scabies B. Body lice C. Rocky Mountain Spotted Fever D. Lyme Disease - Answers - A. Scabies is an infestation of a mite that is usually spread by skin to skin contact. Patients present with intractable pruritus, often with minimal cutaneous findings. There may be an associated inflammatory papule or nodule along with a burrow that is sometimes seen early in the course of the infestation. Which of the following is the most accurate method to differentiate benign from malignant thyroid nodules? A. Fine needle aspiration biopsy B. Ultrasound of the thyroid gland C. Measurement of thyroid antibodies D. Radionuclide iodine uptake - Answers - A. Fine needle aspiration biopsy is the best method used in the evaluation of thyroid cancer. Fine needle aspiration biopsy can be done on an outpatient basis and can be done under ultrasound guidance for patients who have small thyroid nodules. A 16 year-old male with a history of tetralogy of Fallot presents to clinic for a follow-up visit status post replacement of his right ventricle to pulmonary artery conduit. He has complaints of chest pain with inspiration, fever and general
he repeatedly replies, "I don't know," without really trying. He states his wife thinks he just sits around the house all day since he retired. His neurological exam is unremarkable, except for some mild psychomotor retardation. Which of the following is the most likely diagnosis? A. Dementia B. Delirium C. Depression D. Dissociative disorder - Answers - C. Depression often presents with difficulty thinking and concentrating, lessened sleep, and withdrawal from activities. Which of the following is an established risk factor for osteoporosis? A. Parity status B. Carbohydrate intake C. Lactation history D. Low body weight - Answers - D. Established risk factors for osteoporosis include low body weight, female sex, advanced age, Caucasian race, and bilateral oophorectomy before menopause without estrogen replacement. A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient? A. Total abdominal hysterectomy B. Observation and endometrial biopsy in 3 months C. Endometrial curettage followed by progesterone daily D. Oral progesterone days 16-25 of the month for 6 months and repeat biopsy - Answers - A. Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in addition to glandular crowding and complexity. This has a 20-30% risk of progression to endometrial cancer and the recommendation is hysterectomy. A 72 year-old male presents to the emergency department with crushing chest pain, dyspnea and palpitations for 2 hours in duration. Enzymes are pending and he has been given aspirin and sublingual nitroglycerin. He is rushed to the catheterization lab where they find a totally occluded distal right coronary artery. Which of the following electrocardiogram (ECG) findings supports the diagnosis? A. Q waves in leads I, aVL, V5-V B. ST segment elevation in leads II, III, aVF C. Hyperacute T waves in leads I, aVL D. Flipped T waves with repolarization changes in leads V1-V4 - Answers - B. ST segment elevation in leads II, III, aVF, represents an acute process in the right coronary artery.
A patient presents with occasional wheezing and chest tightness that occurs approximately once a week and at night only about once a month. Peak expiratory flow is 85% of predicted. Which of the following is the most appropriate initial treatment? A. Albuterol (Proventil) inhaler B. Montelukast (Singular) C. Salmeterol (Serevent) inhaler D. Sustained release theophylline - Answers - A. This patient has mild intermittent asthma which is initially treated with inhaled beta 2-agonists as needed. No long-term control medications are indicated Which of the following signs and symptoms is typically noted in patients with acute cystitis? A. Fever and chills B. CVA tenderness C. Flank pain D. Frequency and dysuria - Answers - D. Irritative voiding symptoms, such as frequency and dysuria, are common in acute cystitis. A 54 year-old female presents to the office for radiographic and laboratory results. The radioactive iodine uptake is elevated while the thyroid hormone levels are increased with TSH levels being suppressed. Which of the following is the most likely diagnosis? A. Graves' disease B. Hashimoto's thyroiditis C. Subacute thyroiditis D. Pituitary failure - Answers - A. Graves' disease is associated with an elevated uptake on the radioactive thyroid scan due to an increase in the activity for the thyroid gland. Because the gland is actually making thyroid hormone, the free T4 level will be increased and the TSH will be suppressed as a result of negative feedback to the hypothalamus and pituitary gland. The source of pain experienced during a migraine headache is a result of activation of which nerve? A. Trigeminal B. Vagus C. Optic D. Occulomotor - Answers - A. Headache may result in release of neuropeptides acting as neurotransmitters at trigeminal nerve branches. A 17 year-old male is accidentally struck in the right eye while playing football and is immediately transported to the hospital. In the emergency room, he complains of severe pain behind the eye as well as double vision. On examination, he has exophthalmos,
A 23 year-old female is in active labor and has progressed from 3 cm to 6 cm in the last six hours. Fetal monitoring demonstrates mild repetitive late decelerations. Which of the following is the most likely cause of this finding? A. Fetal hypoxia B. Head compression C. Cord compression D. Uteroplacental insufficiency - Answers - D. Late decelerations are from uteroplacental insufficiency. The decelerations have a smooth, gradual symmetrical decrease in FHR beginning at or after the peak of the contraction. A 60 year-old female injured her right wrist when she slipped and fell onto her outstretched hand. Radiographs show a fracture through the metaphysis of the distal radius with dorsal displacement and angulation. Which of the following splints is the best method of temporary immobilization? A. Dorsal forearm B. Ulnar gutter C. Volar forearm D. Volar with thumb spica - Answers - C. The volar forearm splint is best for temporary immobilization of forearm, wrist and hand fractures and is the splint of choice for Colles' fracture. A 36 year-old patient presents requesting something to help him sleep. He reports that he has always had a problem sleeping, admits to feeling nervous most days for the last 2 years, and that he has always been "uptight" and a "worry wart." During the previous eight months he has frequently felt tense, shaky, sweaty, with palpitations and frequent headaches. He reports being irritable with his 5 year-old son. Which of the following is the best treatment option for this patient? A. Alprazolam (Xanax) B. Haloperidol (Haldol) C. Paroxetine (Paxil) D. Diphenhydramine (Benadryl) - Answers - C. SSRI's, specifically Paxil, are the mainstay for treatment of generalized anxiety disorder. A 60 year-old male with hypertension is brought to the emergency department 30 minutes after the sudden onset of severe chest pain that radiates to his back and arms. His blood pressure is 180/ mmHg in his left arm; no blood pressure reading can be obtained from the right arm. ECG shows sinus tachycardia with left ventricular hypertrophy. A high pitched decrescendo diastolic murmur is heard along the left mid-sternal border. Which of the following is the most likely diagnosis? A. Acute myocardial infarction B. Aortic dissection C. Pulmonary embolism
D. Right subclavian arterial embolus - Answers - B. This is a classic presentation for aortic dissection. Which of the following patients is at highest risk for the development of the skin disorder known as erythrasma? A. Lactating women B. Postmenopausal women C. Seniors living in cold northern climate D. People living in tropical climate - Answers - D. People living in warm, tropical climate, people wearing occlusive clothing or shoes, obese patients, and those with hyperhidrosis are at increased risk for erythrasma. The diagnosis of this condition is made by demonstration of a coral red fluorescence. What is the term for blue discoloration about the umbilicus? A. Cullen's sign B. Murphy's sign C. Rovsing's sign D. Turner sign - Answers - A. Cullen's sign is a blue discoloration about the umbilicus and can occur in hemorrhagic pancreatitis and results from hemoperitoneum. A 22 year-old woman presents with sneezing, runny nose, postnasal drip, and nasal congestion for the last week. She says this happens every spring. She is not allergic to any medications. Which of the following is the most appropriate pharmacologic treatment for this patient? A. Azithromycin (Zithromax) B. Phenylephrine (Neo-synephrine) C. Nedocromil D. Pseudoephedrine - Answers - C. Nedocromil inhibits mast cell degranulation and is an effective treatment for allergic rhinitis. It may take 2-6 weeks for full therapeutic effect. A 60 year-old patient presents with elevated blood pressure and peripheral edema. Laboratory testing reveals a BUN of 58 mg/dl and a creatinine of 4.5 mg/dl, these results are unchanged from six months ago. Urinalysis today is negative except for the following, specific gravity of 1.002, 2+ protein, and trace glucose. Which of the following laboratory findings would be most consistent for this patient? A. Hypercalcemia B. Metabolic alkalosis C. Hypokalemia D. Anemia - Answers - D. Anemia, due to low erythropoietin, is common in patients with chronic renal failure. Which of the following types of pleural effusion result from increased production of fluid due to underlying inflammatory conditions?
A 32 year-old male presents with an acute onset of pain and swelling to his left ankle. On physical examination the ankle is warm, swollen and erythematous. Evaluation of the synovial fluid reveals only leukocytosis with a low glucose. Which of the following is the most likely diagnosis? A. Gout B. Pseudogout C. Acute rheumatic fever D. Septic arthritis - Answers - D. Leukocytosis and a low synovial glucose are indicative of septic arthritis. Which of the following clinical signs or symptoms is most likely to be present following iatrogenic injury during subtotal thyroidectomy? A. Inability to shrug the shoulders B. Hoarseness C. Impaired gag reflex D. Impaired taste sensation anterior two-thirds of tongue - Answers - B. The recurrent laryngeal nerve is most commonly injured during subtotal thyroidectomy. If injured, hoarseness is the most common presentation for this nerve impairment. A patient states that he has been camping in the mountains of North Carolina for the past two weeks. He presents to the clinic complaining of "flu-like" symptoms for the past 10 - 14 days however he notes that he started to develop a slight rash on his wrist and ankles about seven days ago. Which of the following tests would provide a confirmatory diagnosis? A. Immunofluorescent assay B. C-reactive protein C. Heterophile agglutination D. Anti-streptolysin O titer - Answers - A. The immunofluorescent assay will confirm antibodies to Rickettsia. Who is most likely to require subacute bacterial endocarditis (SBE) prophylaxis prior to a dental procedure? A. 22 year-old female with mitral valve prolapse B. 36 year-old male with a bio-prosthesic mitral valve C. 45 year-old female with an ASD closure 8 months ago with no residual defect D. 15 year-old male with a bicuspid aortic valve - Answers - B. The AHA recommends that patients with prosthetic heart valves receive antibiotic prophylaxis. As should cardiac transplant recipients with valve disease, unrepaired cyanotic CHD, repaired CHD with prosthetic material or device during the first six months of the procedure and repaired CHD with residual defects at site of patch or prosthetic device. A 3 month-old male presents with two days of worsening hoarse cough and thick purulent rhinorrhea associated with
increasing problems breathing and trouble feeding. Examination reveals a temperature of 100.2 degrees F and respiratory rate of 80/minute with nasal flaring and retractions. Lung examination reveals a prolonged expiratory phase with inspiratory rales. He is tachycardic. Pulse oximetry reveals oxygen saturation of 89%. Chest x-ray reveals hyperinflation with diffuse interstitial infiltrates. Which of the following is the most appropriate intervention? A. Antibiotics B. Hospitalization C. Inhaled corticosteroids D. Racemic epinephrine - Answers - B. This infant most likely has bronchiolitis. While most cases are mild and can be treated at home, hospitalization is recommended for infants with hypoxia on room air, moderate tachypnea with feeding difficulties and marked respiratory distress with retractions. Additionally hospitalization is recommended for infants less than 2-3 months of age, a history of apnea or an underlying chronic cardiopulmonary disease. A patient with preterm labor may be given corticosteroids to A. decrease uterine activity. B. prevent chorioamnionitis. C. enhance fetal lung maturity. D. prevent the development of gestational diabetes. - Answers - C. Corticosteroids may be given from 24-34 weeks in patients with preterm labor or who have pregnancy complications which may cause premature birth. The corticosteroids enhance pulmonary maturity. Which of the following would indicate an optic nerve lesion? A. Excessive conjunctival edema B. Ptosis C. Inability to gaze laterally D. Afferent pupillary defect - Answers - D. Pupil size, controlled centrally by the Edinger-Westphal nucleus in the midbrain, is primarily based on the afferent light stimulus transmitted via the optic nerve. When evaluating jugular venous pulsations a prominent a wave represents which of the following? A. Atrial contraction against a closed tricuspid valve B. Rapid filling of the right atrium C. Tricuspid regurgitation D. Poor left ventricle compliance - Answers - A. The a wave corresponds to right atrial contraction. A patient presents with an episode of an expansive, elevated mood during which she cleaned excessively without sleeping. Which of the following is the most likely diagnosis? A. Major depressive disorder
C. Potassium hydroxide test D. Wood's light fluoroscopy - Answers - A. Acetowhitening is used to facilitate the diagnosis of condyloma acuminata lesions. A 3 to 5% acetic acid solution is applied to these suspected genital warts for five to ten minutes. Condyloma lesions will whiten and appear as circumscribed macular or papular lesions with a granular surface. Which of the following is an indication for a pediatric patient to receive the 23-valent polysaccharide vaccine (Pneumovax)? A. Children at any age with a history of asthma B. All children at 2,4,6 and 12-18 months of age C. All children at 12-23 months of age in a two dose series D. Children age 24-59 months at high risk for invasive pneumococcal disease - Answers - D. Pneumovax is licensed for use in children over the age of 23 months and is indicated for all pediatric patients at increased risk for pneumococcal disease. A patient presents to the office with worsening fatigue, weight loss, and weakness. She notes that she is having recurrent bouts of abdominal pain and has been losing her pubic hair. Patient is found to have orthostatic hypotension. Which of the following conditions is most likely? A. Cushing's syndrome B. Pheochromocytoma C. Primary hyperparathyroidism D. Addison's disease - Answers - D. Patients with Addison's disease have primary adrenal failure from an autoimmune problem in the adrenal gland or due to hemorrhage into the adrenal gland. These patients are not able to make glucocorticoids, mineralocorticoids, or sex hormones which result in hypotension, hyperpigmentation (from an increase in the ACTH and MSH hormones) and are hyponatremic. A patient presents to the emergency department with right upper quadrant pain over eight hours, nausea, and vomiting. On exam there is a fever of 101.2 degrees F. Ultrasound shows a distended gallbladder. What is the most appropriate management of this patient? A. Oral analgesics B. Diagnostic peritoneal lavage C. Proton pump inhibitors D. Laparoscopic cholecystectomy - Answers - D. The proper treatment for acute cholecystitis is IV fluids, antibiotics, pain control, and surgery. Cholecystectomy is the definitive treatment for acute cholecystitis and laparoscopic cholecystectomy is the procedure of choice. A 56 year-old male is noted to have a recent diagnosis of polycythemia vera. His current hemoglobin is 21 gms/dl. What treatment should be instituted for this patient at this time?
A. Phlebotomy B. Iron chelation therapy C. Bone marrow radiation therapy D. Normal saline IV hydration - Answers - A. This patient has a diagnosis of polycythemia vera treatment begins with phlebotomy instituted on a weekly basis until the hematocrit is less than 45%. Maintainance of the hematocrit at 45% is achieved with repeated phlebotomy as necessary. An 18 year-old female comes to the clinic with the complaint of increased vaginal discharge and vaginal odor. She also complains of urinary frequency. On physical examination there is evidence of thin, gray, frothy discharge in the vagina. The cervix appears erythematous and the vaginal pH is 6. Which of the following is the most likely diagnosis? A. Candida vaginitis B. Bacterial vaginosis C. Trichomonas vaginitis D. Chlamydia trachomatis - Answers - C. Signs of trichomonas include: thin frothy or bubbly, pale yellow-green to gray adherent vaginal discharge, can have erythema of vulva and vagina, may have petechiae on the cervix, amine odor may be present, may also complain of dysuria and dyspareunia, pH 5 to 6.5 (basic). An obese 15 year-old male presents with complaint of a limp and right knee pain for two weeks. He denies recent trauma or history of previous injury. Physical examination of the right knee is unremarkable. Examination of the right hip reveals pain with passive range of motion and limited internal rotation and abduction. Flexion of the hip results in external rotation of the thigh. Gait is antalgic with the right hip externally rotated. Which of the following radiographic findings supports the most likely diagnosis? A. Displacement of the femoral epiphysis B. Irregularity and fragmentation of the joint space C. Capsular swelling of the joint D. Dislocation of the hip - Answers - A. This patient has slipped capital femoral epiphysis (SCFE) and the classic x-ray findings will demonstrate displacement of the femoral head rotation of the femoral neck anteriorly. Which of the following is the most likely initial effect on the left ventricle from aortic stenosis? A. Dilitation of the ventricle with diastolic dysfunction B. Wall stiffness due to ischemia from decreased coronary blood flow C. Paradoxical wall motion abnormalities due to increased preload D. Concentric hypertrophy with preserved function - Answers - D. Hypertrophy would be the initial changes of the left ventricle as a response to the increased pressure. A 56 year-old female presents complaining of intense left eye pain associated with unilateral headache, nausea, and colored rings around lights. On examination you note decreased visual acuity, a pupil that is fixed and mid-dilated, and ciliary flushing. Which of the following is the most likely diagnosis?
