Block 10 Pace 3 Part 1
.JPG "Block 10 Pace 3 Part 1 - Quiz")
- 1.A 34-year-old woman while recuperating from a cesarean delivery 2 days earlier, becomes rigid, appears confused at times, and has a body temperature of 102oF. She developed serious tachycardia and hypercapnea. Her clinical notes indicated that halothane was the choice of anesthesia used for the delivery, supplemented with a skeletal muscle relaxant, succinylcholine. Which of the following drugs should immediately be given IV to this patient?
- A.
Dantrolene
- B.
Atropine
- C.
Neostigmine
- D.
Baclofen
- E.
Prazosine
- 2.A 52-year-old man comes to his physician today, complaining of excruciating pain in his left toe. On examination of the patient’s foot, the doctor notes a swollen, red, first metatarsophalangeal joint which is warm to the touch, and also 0.5cm mobile nodules near the olecranon bilaterally. PMH reports that over a two year period he had twice presented with similar complaints about a painful joint; his doctor had treated the acute pain with ibuprofen. Today, the acute pain is treated with a three-day regimen of Drug A, which binds to tubulin, inhibiting neutrophil activation. Two weeks after the acute attack had resolved, the doctor prescribes another drug, Drug B, a long term prophylactic, to manage this patient’s chronic condition. Which of the following pairs of drugs fits the characteristics of drugs “A” and “B”?
- A.
Ibuprofen and cortisone
- B.
Probenecid and indomethacin
- C.
Indomethacin and cortisone
- D.
Allopurinol and colchicines
- E.
Colchicine and allopurinol
- 3.A 37-year-old woman is scheduled to have an impacted wisdom tooth removed. On the day of the surgery, the patient tells the dentist that she has been taking an analgesic agent for the past 3 days to relieve the pain resulting from a recent sprained ankle. The dentist promptly reschedules the surgery 8 days later and tells the patient to stop taking that particular agent. Which drug was the patient most likely taking?
- A.
Ibuprofen
- B.
Acetaminophen
- C.
Aspirin
- D.
Meloxicam
- E.
Naproxen
- 4.A 30 year old woman developed severe pain over the mid anterior aspect of the lower leg. An infection was suspected but, because she was on vacation in an isolated area, she treated with an inadequate course of antibiotics. She subsequently observed sinus tracts on the skin surface over the affected area exuding granular material, identified by her surgeon as sequestrum. The latter is best described as:
- A.
Healthy bone growing around an area of infection
- B.
An abscess associated with bone infection
- C.
Periosteal response to underlying infection
- D.
Dead bone resulting from infection
- E.
Squamous cell carcinoma formed in sinus tracts
- 5.A 19-year-old man has been observing increasing swelling of the right knee and then suddenly fractures the distal right femur while jogging. An x-ray suggests a mass arising from the femur and the radiologist thinks he sees a “Codman’s” triangle. Even before you know the results of the biopsy, you strongly suspect:
- A.
Chondrosarcoma
- B.
Osteosarcoma
- C.
Fibrous dysplasia
- D.
Paget disease
- E.
Non-ossifying fibroma
- 6.A 15 year old boy complains of pain that appears to be coming from the middle of his right thigh. X-ray studies confirm the presence of a lytic lesion measuring 0.8 cm. surrounded by a rim of denser bone. On further questioning, the boy says that the pain is relieved by aspirin. His mother is very anxious and fears that the lesion is malignant. However you assure her it is likely to be benign. You are thinking of:
- A.
Pott disease
- B.
Fibrous cortical defect
- C.
Ewings sarcoma
- D.
Osteoid osteoma
- E.
Chronic osteomylitis
- 7.A 69 year-old woman presents with complaints of chronic back pain and x-rays reveals a compression fracture of the vertebral body of T2. She also says that she appears to be getting shorter. She is 20 years post menopausal. Histologic examination of the vertebral bone would most likely reveal:
- A.
Malignant osteoid deposition
- B.
Periosteal new bone formation
- C.
Subperiosteal resorption
- D.
Widened osteoid seams
- E.
Thinned bony trabeculae
- 8.In an experiment Dr. Kirlin intends to silence VEGF genes associated with abnormal proliferation of blood vessels in mice with induced age-related macular degeneration (AMD). The synthetic siRNAs that he injected intravitreally into the mouse eye for this purpose are most likely:
- A.
75 nbp long double stranded RNA fragments
- B.
22 nbp long double stranded RNA fragments
- C.
120 nbp long cDNA strands
- D.
9 nbp long mRNA sequences
- E.
1000 nbp long DNA sequences
- 9.In which of the following conditions will electromyography likely show no denervation?
- A.
Poliomyelitis
- B.
Amyotrophic Lateral Sclerosis
- C.
Carpal Tunnel Syndrome
- D.
Primary Lateral Sclerosis
- E.
S1 radiculopathy
- 10.A 19 year old male develops a painful knee that is swollen and red on examination. His physician decides to perform an arthrocentesis. The results follow: White Cell Count: 150,000/mm3 Differential: 85% polys Gram Stain: gram positive cocci in clusters Crystals: None String test: No string formed Culture: pending Which of the following is most true about arthrocentesis?
- A.
If rheumatoid arthritis is a possibility, arthrocentesis should not be performed
- B.
Arthrocentesis may be used diagnostically and therapeutically
- C.
If inflammation is present, the glucose in synovial fluid decreases, interfering with string formation
- D.
An elevated white count occurs only in infected synovial fluid
- E.
If only one test can be performed on a synovial fluid sample, it should be a cell count
- 11.Your patient presents with what appears to be Marfan’s syndrome with ocular fragility and joint hypermobility. But upon closer examination you note that her skin is also hyperextensible. Based on this finding you suspect that she has a particular enzyme deficiency that is causing her condition. What is the enzyme that is most likely deficient in this individual?
- A.
Lysyl hydroxylase
- B.
Proline hydroxylase
- C.
Procollagen N-protease
- D.
Procollagen C-protease
- E.
Procollagen translocase
- 12.A 30 year old woman developed severe pain over the mid anterior aspect of the lower leg. X-rays demonstrated a lytic lesion in that area. An infection was suspected and she was treated with a course of antibiotics. She was not compliant with the treatment and 1 month later she observed sinus tracts on the skin surface over the affected area exuding granular material, identified by her surgeon as sequestrum. A further complication of inadequately treated osteomyelitis is:
- A.
Osteoarthritis
- B.
Osteosarcoma
- C.
Involucrum
- D.
Ewing sarcoma
- E.
Lymphoma
- 13.An 18 year old man has been observing increasing swelling of the right knee and then suddenly fractures the distal right femur while jogging. An x-ray suggests a mass arising from the femur and the radiologist thinks he sees a “Codman’s” triangle. Pathological changes within the mass are likely to include:
- A.
Malignant chondrocytes
- B.
Atypical fibrous tissue
- C.
Atypical histiocytic-looking cells
- D.
Osteoid
- E.
Atypical fat cells
- 14.A 69 year-old woman presents with complaints of chronic back pain and x-rays reveals a compression fracture of the vertebral body of T2. She also says that she appears to be getting shorter. She is 20 years post-menopausal. Her disease might have been prevented had she:
- A.
Decreased her daily exercise program
- B.
Become a strict vegetarian
- C.
Taken estrogen supplements
- D.
Slept on a harder bed
- 15.A 54 year old man is evaluated for difficulty in climbing stairs and rising from a sitting position. He also mentions recent problems with a dry mouth and constipation. His neurologic exam reveals normal cranial nerve function, proximal >distal motor weakness (legs>arms), that improve briefly with repeat testing, and minimal wasting. His reflexes are trace to absent but also seem to improve temporarily after exercise. An Edrophonium test is negative. Of the following listed examinations, which would be most helpful in the diagnosis and treatment of this man’s condition?
- A.
Lumbar puncture with CSF examination
- B.
MRI cervical spine
- C.
Somatosensory evoked potentials
- D.
Computed tomography chest
- E.
Muscle biopsy
- 16.A 26-year-old woman complains of bilateral pain and swelling in her wrists and fingers, waxing and waning for about 6 months. In the last 2 weeks, her left knee has become painful as well. Her mother has rheumatoid arthritis. Physical examination reveals tenderness of the MP joints in both hands and her left knee is warm to the touch and demonstrates a small effusion. Which of the following statements is most correct about her condition?
- A.
Lack of joint deformity on examination rules out a diagnosis of rheumatoid arthritis
- B.
A normal rheumatoid factor rules out a diagnosis of rheumatoid arthritis
- C.
Subchondral sclerosis is a radiographic hallmark of rheumatoid arthritis
- D.
No treatment will slow the progression of joint destruction in rheumatoid arthritis
- E.
Bony erosions around the joints are a radiographic finding in rheumatoid arthritis
- 17.A 52-year-old woman who has been taking glucocorticoids (GCs) for the past 15 years is having these agents removed from her drug regimen. Which of the following statements correctly identifies a guideline that should be followed by her physician during this undertaking?
- A.
Upon stoppage, patient should be considered to have pituitary-adrenal suppression for 3 months
- B.
Upon stoppage, GCs should not be administered to this patient during stressful or traumatic events
- C.
GCs should be removed from her drug regimen slowly
- D.
Upon stoppage, a single large dose of a GC will most likely be harmful to this patient
- E.
GCs can be abruptly removed from her drug regimen
- 18.A 52-year-old man comes to his physician today, complaining of excruciating pain in his left toe. On examination of the patient’s foot, the doctor notes a swollen, red, first metatarsophalangeal joint which is warm to the touch, and also 0.5cm mobile nodules near the olecranon bilaterally. PMH reports that over a two year period he had twice presented with similar complaints about a painful joint; his doctor had treated the acute pain with indomethacin. Today, the acute pain is treated with a three-day regimen of Drug A, which reduces the synthesis of the prostaglandin inflammatory mediators and inhibits crystal phagocytosis in the joint. Two weeks after the acute attack had resolved , the doctor prescribes another drug , drug B , a long term prophylactic which is a non-purine inhibitor of xanthine oxidase.. Which of the following pairs of drugs fits the characteristics of drugs “A” and “B”?
- A.
Colchicine and allopurinol
- B.
Probenecid and indomethacin
- C.
Ibuprofen and febustat
- D.
Indomethacin and cortisone
- E.
Allopurinol and colchicine
- 19.Which of the following is a typical pathologic feature of rheumatoid arthritis?
- A.
Osteophytes
- B.
Crystal deposits on cartilage
- C.
Herberden nodes
- D.
Osteonecrosis
- E.
Pannus
- 20.Which of the following is the typical histopathological pattern of a fibrosarcoma?
- A.
Storiform
- B.
Mosaic
- C.
Herring bone
- D.
Bi-phasic
- E.
Interlacing
- 21.A 67-year-old woman is brought to your office by her husband. She complains to you of continually tripping over the throw rug in her apartment with her left foot. Her husband adds that her speech seems slurred and now has a nasal quality. On exam she has weak hand grips bilaterally associated with interosseus atrophy, hyperactive deep tendon reflexes throughout with a right extensor plantar response and a left foot drop, bilaterally positive Hoffman signs, diffuse tongue fasiculations, and a positive jaw jerk. Which of the following investigations will most likely yield the diagnosis?
- A.
Electromyography
- B.
Nerve conduction velocities
- C.
Lumbar puncture with spinal fluid examination
- D.
Cranial imaging
- E.
Spinal imaging
- 22.
Three female patients of the same age are administered various doses of dexamethasone followed by measurement of their serum cortisol levels. The results are presented here: Based on these results, what would be the most likely diagnosis for each patient?- A.
1—Healthy; 2—Adrenocortical carcinoma; 3—Pituitary adenoma
- B.
1—Ectopic ACTH-producing small cell lung cancer; 2—Healthy; 3—Neuroblastoma (arising in adrenal medulla)
- C.
1—Pheochromocytoma; 2—Adrenocortical carcinoma; 3—Healthy
- D.
1—Healthy; 2—Pituitary adenoma; 3—Ectopic ACTH-producing medullary thyroid carcinoma
- E.
1—Adrenocortical carcinoma; 2—Neuroblastoma (arising in adrenal medulla); 3—Healthy
- 23.
VEGF (vascular endothelial growth factor) plays a critical role in physiological and pathological angiogenesis (formation of blood vessels). In patients with age related macular degeneration (AMD) VEGF induced abnormal proliferation of blood vessels occurs below the macula of the eye. In a recent study involving human patients, snippets of synthetic double stranded RNA (A), targeting VEGF receptor genes were injected into the eyes of patients in order to silence the VEGF receptors by blocking a particular process (B). Using the table below, what is the best designation for A and B?
- A.
1
- B.
2
- C.
3
- D.
4
- E.
5
- 24.
A 30-year-old woman complains of pain in her right hand and her left wrist for several months. She has morning stiffness lasting about 2 ½ hours which is interfering with her work as a medical transcriptionist. On examination, the fingers of her right hand are diffusely swollen. The right DIP joints are tender to palpation, as is the left wrist. She has no skin lesions, but she has the following nail appearance: Which of the following is her most likely diagnosis?
- A.
Rheumatoid arthritis
- B.
Osteoarthritis
- C.
Psoriatic arthritis
- D.
Polymyalgia rheumatic
- E.
Reactive arthritis
.JPG "VEGF (vascular endothelial growth factor) plays a critical role in physiological and pathological angiogenesis (formation of blood vessels). In patients with age related macular degeneration (AMD) VEGF induced abnormal proliferation of blood vessels occurs below the macula of the eye. In a recent study involving human patients, snippets of synthetic double stranded RNA (A), targeting VEGF receptor genes were injected into the eyes of patients in order to silence the VEGF receptors by blocking a particular process (B).
Using the table below, what is the best designation for A and B?")
.JPG "A 30-year-old woman complains of pain in her right hand and her left wrist for several months. She has morning stiffness lasting about 2 ½ hours which is interfering with her work as a medical transcriptionist. On examination, the fingers of her right hand are diffusely swollen. The right DIP joints are tender to palpation, as is the left wrist. She has no skin lesions, but she has the following nail appearance:
Which of the following is her most likely diagnosis?")
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