Block 11 Pace 6 Prt 1

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  • 1/21 Questions

    Dr Callender: IME   A 65 year old afro-Caribbean who migrated from Jamaica 20 years ago presents to his health care provider. He has a history of smoking 1 pack of 20 cigarettes per day for 30 years, and complains of cough, fatigue, and 10 pound weight loss for 4 months. On physical examination there is no lymphadenopathy. His chest X-ray shows bilateral hilar adenopathy. His tuberculin skin test is strongly positive. Biopsy of the nodes shows caseating granuloma. What is the most likely diagnosis?

    • Tuberculosis
    • Hodgkin’s disease
    • Sarcoidosis
    • Lung cancer
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Block 11 Pace 6 Prt 1 - Quiz
About This Quiz

This quiz titled 'Block 11 Pace 6 prt 1' assesses medical knowledge through diverse case studies, including cardiovascular and respiratory diseases, and rare conditions like angiosarcoma. It evaluates diagnostic skills and understanding of disease pathophysiology, crucial for medical professionals.

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  • 2. 

    A 9-year-old girl with known history of cystic fibrosis since birth now complains of increased difficulty breathing over the past week. Her vital signs include T 38.5ËšC, P 80/minute, RR 30/minute, and BP 110/60 mmHg. A chest radiograph shows prominent bronchial markings and some bronchi appear markedly distended. No other infiltrates or masses are present. Which of the following does she most likely have?

    • Hypersensitivity pneumonitis

    • Mycobacterium tuberculosis infection

    • Lobar pneumonia

    • Bronchiectasis

    • Aspiration pneumonitis

    Correct Answer
    A. Bronchiectasis
    Explanation
    The 9-year-old girl with cystic fibrosis presenting with increased difficulty breathing, prominent bronchial markings, and distended bronchi on chest radiograph is most likely to have bronchiectasis. Bronchiectasis is a chronic condition characterized by permanent dilation and destruction of the bronchi, leading to impaired clearance of mucus and recurrent infections. It is commonly seen in patients with cystic fibrosis, as the thickened mucus in their airways predisposes them to bronchial dilation. The other options, such as hypersensitivity pneumonitis, tuberculosis infection, lobar pneumonia, and aspiration pneumonitis, do not fit the clinical presentation and findings described.

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  • 3. 

    Dr Bateson A 34-year-old woman visits her family doctor to discuss the results of her recent blood test which showed cholesterol levels of 180 mg/dL and triglyceride levels of 426 mg/dL.  A diagnosis is made of Type IV hyperlipidemia for which an antihyperlipidemic drug is prescribed.  On initially taking the drug the woman experiences an intense flush.  What is the mechanism underlying the flushing symptoms?

    • Release of platelet-derived growth factor (PDGF)

    • Release of histamine

    • Release of nitric oxide (NO)

    • Blockade of calcium channels

    • Release of prostaglandin

    Correct Answer
    A. Release of prostaglandin
    Explanation
    The correct answer is the release of prostaglandin. Prostaglandins are lipid compounds that are involved in various physiological processes, including inflammation and vasodilation. In this case, the antihyperlipidemic drug is likely causing the release of prostaglandins, leading to the intense flush experienced by the woman.

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  • 4. 

    A 20-year-old male college student went to the clinic with a week-long history of fever, fatigue, and cough. After viewing the chest x-ray, his physician diagnosed atypical pneumonia. Which of the following clinical features would best characterize atypical pneumonia rather than typical pneumonia?

    • Shorter incubation period after exposure

    • Interstitial infiltrates on chest x-ray

    • Higher temperature and pulse rate

    • Chest x-ray showing cavities or abscesses

    • Extracellular bacteria visible in Gram stain of sputum

    Correct Answer
    A. Interstitial infiltrates on chest x-ray
    Explanation
    Atypical pneumonia is characterized by interstitial infiltrates on chest x-ray, which refers to inflammation and fluid accumulation in the spaces between the alveoli in the lungs. This is in contrast to typical pneumonia, which typically presents with lobar consolidation on chest x-ray. The other options listed do not specifically differentiate between atypical and typical pneumonia.

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  • 5. 

    ICM: Dr Selfridge A 23-year-old woman with known asthma on maintenance medication consisting of twice daily inhaled combined beta agonist and corticosteroid presents to your office with increasing dyspnea over the last 24 hours.  On physical examination she is afebrile, she is anxious, her respiratory rate is 22 breaths per minute, her heart rate is 110 beats per minute, she is using accessory muscles of respiration, and she has no breath sounds bilaterally.  Which of her physical findings, listed below, is most ominous?

    • Tachypnea

    • Tachycardia

    • Anxiety

    • Use of accessory respiratory muscles

    • Silent chest

    Correct Answer
    A. Silent chest
    Explanation
    Silent chest is the most ominous physical finding in this patient. It indicates severe airway obstruction and lack of air movement in the lungs. This can be a life-threatening situation and requires immediate intervention. Tachypnea, tachycardia, anxiety, and use of accessory respiratory muscles are all common findings in patients with asthma exacerbation, but the absence of breath sounds is a more concerning sign.

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  • 6. 

    A 12-year-old boy developed fever, painful stiffness of his fingers and knees, and a heart murmur 3 weeks after having a severe sore throat. His doctor made a diagnosis of acute rheumatic fever. Which of the following medical procedures is most responsible for the low incidence of acute rheumatic fever in the USA?

    • Use of the anti-streptolysin O antibody test

    • Early detection of heart murmurs in patients with fever

    • Antibiotic treatment of patients with acute pharyngitis

    • Culture of throat swabs on blood agar plates with bacitracin disks

    • Testing throat swabs with the rapid antigen detection test

    Correct Answer
    A. Antibiotic treatment of patients with acute pharyngitis
    Explanation
    Antibiotic treatment of patients with acute pharyngitis is the most responsible for the low incidence of acute rheumatic fever in the USA. Acute rheumatic fever is a complication of untreated or inadequately treated streptococcal pharyngitis. Antibiotic treatment helps to eradicate the streptococcal infection, preventing the development of acute rheumatic fever. The other options mentioned are important for diagnosing or detecting acute rheumatic fever, but they do not directly address the prevention of the disease.

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  • 7. 

    Dr Bellot A 68-year-old man who has been a 2-pack-a-day smoker for more than 40 years has been suffering from shortness of breath and a dry cough for the past year and both are getting worse. Examination reveals a barrel-chested man who is quite thin. He is not cyanosed but has an obviously increased respiratory rate and is using his accessory muscles of respiration. Which of the following pathologic descriptions best fits his disease?

    • Destroyed alveolar walls

    • Pulmonary consolidation

    • Irreversibly dilated bronchioles

    • Mucus gland hyperplasia

    • Asbestos bodies

    Correct Answer
    A. Destroyed alveolar walls
    Explanation
    The patient's symptoms of shortness of breath, dry cough, and increased respiratory rate suggest a chronic obstructive pulmonary disease (COPD) such as emphysema. Emphysema is characterized by the destruction of alveolar walls, leading to the loss of elastic recoil and decreased gas exchange. This results in difficulty breathing and decreased lung function. The patient's history of smoking for more than 40 years further supports the diagnosis of emphysema, as smoking is a major risk factor for developing this condition.

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  • 8. 

    A 45-year-old alcoholic man with signs of malnutrition presented to the clinic with pneumonia and pleural effusion. Sputum was collected for culture. The laboratory reported two days later that the patient was likely infected with Nocardia asteroides.   What were the likely laboratory findings?

    • Aerobic culture showing branching acid-fast rods

    • Anaerobic culture showing branching Gram-positive rods

    • Anaerobic culture showing branching Gram-negative rods

    • Aerobic culture showing Gram-positive cocci in pairs

    • Aerobic culture showing acid-fast beaded rods in palisades

    Correct Answer
    A. Aerobic culture showing branching acid-fast rods
    Explanation
    The likely laboratory findings in this case would be an aerobic culture showing branching acid-fast rods. Nocardia asteroides is a Gram-positive, aerobic, branching, filamentous bacterium that is partially acid-fast. It is commonly associated with infections in immunocompromised individuals, such as alcoholics, and can cause pneumonia and pleural effusion. The branching acid-fast rods seen on the culture are characteristic of Nocardia asteroides.

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  • 9. 

    An 18-year-old male student returning from the Argentine pampas, where he worked in the fields while taking a break from school, presents with fever, prostration, headache, dizziness, gastrointestinal disturbances, hypotension, and bleeding from the nose and gums. Pre-immune serum from the patient is negative for hemorrhagic fever viruses, but serum obtained from the patient 15 days after resolution of the illness is positive for an enveloped, segmented (-) ssRNA virus. What is the reservoir host of the virus responsible for this patient’s disease?

    • Ticks

    • Rats

    • Humans

    • Bats

    • Mosquitoes

    Correct Answer
    A. Rats
    Explanation
    The correct answer is Rats. The symptoms described in the patient are consistent with a viral hemorrhagic fever, and the positive result for an enveloped, segmented (-) ssRNA virus suggests an infection with an arenavirus. Arenaviruses are primarily transmitted to humans through contact with infected rodents, particularly rats. Therefore, rats are the reservoir host for the virus responsible for this patient's disease.

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  • 10. 

    Microbiology: Dr Butler A 32-year-old male immigrant from Bangladesh underwent screening for tuberculosis. His tuberculin skin test was read as positive because of 18 mm induration. He reported no current or past symptoms and did not receive BCG vaccine as a child. Which of the following can cause a tuberculin test to be positive?

    • Exposure to cross-reacting antigens of Mycobacterium kansasii

    • Multiplication of Mycobacterium tuberculosis in his alveoli after inhaling organisms

    • Presentation of antigen to T cells by macrophages and dendritic cells in a lymph node

    • Multiplication of Mycobacterium tuberculosis in macrophages in a lymph node

    • Formation of granulomatous inflammation and caseous necrosis in the lung

    Correct Answer
    A. Presentation of antigen to T cells by macrophages and dendritic cells in a lymph node
    Explanation
    The tuberculin skin test measures the immune response to the tuberculin antigen, which is derived from Mycobacterium tuberculosis. When the tuberculin is injected into the skin, it is taken up by macrophages and dendritic cells. These cells then migrate to the regional lymph nodes where they present the antigen to T cells. If the individual has been previously exposed to M. tuberculosis or other mycobacterial antigens, the T cells will be activated and release cytokines, leading to an inflammatory response and induration at the site of injection. Therefore, the correct answer is the presentation of antigen to T cells by macrophages and dendritic cells in a lymph node.

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  • 11. 

    A 40 year-old white female who smokes 2 packs of cigarettes a day awoke one morning with shaking chills, fever, a cough productive of rusty-colored sputum, and shortness of breath. She went to the ER where a chest x-ray revealed an infiltrate that extended throughout the right middle lobe. Gram stain of sputum  showed many PMNs and Gram-positive cocci in pairs. Which pertains best to this case?  

    • Mycoplasma pneumoniae is the leading cause of CAP

    • Streptococcus pneumoniae infection is preventable in most cases by giving the pneumococcal conjugate vaccine to adults over 65 years

    • The polysaccharide capsule of S. pneumoniae is antiphagocytic and essential for virulence

    • S. pneumoniae causes inflammation of alveolar septa giving an interstitial pattern on x-ray

    • S. pneumoniae gains access to alveolar spaces by inhaling airborne droplets from coughing patients

    Correct Answer
    A. The polysaccharide capsule of S. pneumoniae is antiphagocytic and essential for virulence
    Explanation
    the conjugated vaccine is for children.

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  • 12. 

    Dr Nine A 76-year-old woman is found to have a 4x3 cm area of slightly raised, red coalescent nodules on her left lateral chest wall.  Biopsy of the nodules shows poorly differentiated spindle-shaped cells, with multiple areas of positive staining by CD31 immunohistochemistry.  What is the diagnosis?

    • Angiosarcoma

    • Bacillary angiomatosis

    • Hemangiopericytoma

    • Glomus tumor

    • Kaposi sarcoma

    Correct Answer
    A. Angiosarcoma
    Explanation
    The correct diagnosis in this case is angiosarcoma. The patient's presentation of slightly raised, red coalescent nodules on the chest wall, along with the biopsy findings of poorly differentiated spindle-shaped cells and positive staining by CD31 immunohistochemistry, are consistent with angiosarcoma. Angiosarcoma is a malignant tumor derived from endothelial cells, and it commonly presents as a red or purple nodule on the skin. CD31 is a marker for endothelial cells, and its positive staining suggests the presence of endothelial cells in the biopsy sample, supporting the diagnosis of angiosarcoma.

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  • 13. 

    A 3-year-old boy is found to have Tetralogy of Fallot.  Which component of this complex heart disease was most likely responsible for the delay in his diagnosis?

    • Size of atrial septal defect

    • Severity of aortic coarctation

    • Size of ventricular septal defect

    • Severity of pulmonic stenosis

    • Degree of right ventricular hypertrophy

    Correct Answer
    A. Severity of pulmonic stenosis
    Explanation
    The severity of pulmonic stenosis is most likely responsible for the delay in the diagnosis of Tetralogy of Fallot in the 3-year-old boy. Pulmonic stenosis is a narrowing of the pulmonary valve, which obstructs blood flow from the right ventricle to the lungs. This obstruction leads to decreased oxygen levels in the blood, causing symptoms such as cyanosis (bluish discoloration of the skin). The severity of pulmonic stenosis can vary, and if it is mild, the symptoms may be less noticeable, leading to a delay in diagnosis.

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  • 14. 

    A 21-year-old girl in Pakistan lived in a house with a grandfather, who was diagnosed with pulmonary tuberculosis. Two years later she developed fever and cough and hemoptysis. In a clinic her chest x-ray was read as probable tuberculosis. What clinical form of disease did she most likely present with?

    • Latent tuberculosis

    • Primary disease

    • Extra-pulmonary disease

    • Reactivation tuberculosis

    • Ghon complex

    Correct Answer
    A. Reactivation tuberculosis
    Explanation
    The girl most likely presented with reactivation tuberculosis. Reactivation tuberculosis occurs when a person who has been infected with tuberculosis in the past becomes symptomatic again due to a weakened immune system. In this case, the girl lived with her grandfather who had pulmonary tuberculosis, which put her at risk for infection. Two years later, she developed symptoms such as fever, cough, and hemoptysis, which are characteristic of reactivation tuberculosis. The chest x-ray reading of "probable tuberculosis" further supports this diagnosis.

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  • 15. 

    Behavioral: Dr Sharma A 54 year old physician is seen by his patients and colleagues as an unemotional person. He keeps his feelings to himself and would not discuss his feelings with anyone even if he is faced with difficult situations such as having to manage a terminally ill patient. He has been diagnosed with a cardio vascular illness. Based on the psychosomatic theory to the causation of a physical illness as a reaction to psychological stressors, which illness would he likely be suffering from?

    • Ischemic heart disease

    • Exertional angina

    • Hypertension

    • Coronary artery disease

    • Cardiac arrhythmias

    Correct Answer
    A. Hypertension
    Explanation
    The physician's unemotional behavior and tendency to keep his feelings to himself suggest that he may be experiencing high levels of psychological stress. According to the psychosomatic theory, this psychological stress can manifest as physical illness. In this case, the physician's cardiovascular illness is likely to be hypertension, as it is commonly associated with stress and can be caused by the body's physiological response to chronic stress.

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  • 16. 

    A 65-year-old textile worker has had no major medical problems prior to the past year, when he noted increasing malaise along with a 12 kg weight loss. He is a non-smoker but enjoys at least 5 drinks a day.  On physical examination, he has non-tender supraclavicular lymphadenopathy. The lungs are clear to auscultation but chest x-ray shows multiple solid nodules ranging from 1 to 3 cm scattered throughout all lung fields. No infiltrates or areas of consolidation are noted. Laboratory studies show Hgb 10.6 g/dL, Hct 30.7%, MCV 79, and WBC count 6800. Which of the following pathologic processes in his lungs is most likely to account for these findings?

    • Metastatic carcinoma

    • Pulmonary infarctions

    • Foreign body aspiration

    • Sarcoidosis

    • Silicosis

    Correct Answer
    A. Metastatic carcinoma
    Explanation
    The patient's presentation of weight loss, malaise, supraclavicular lymphadenopathy, and multiple solid nodules on chest x-ray are consistent with metastatic carcinoma. Metastatic carcinoma refers to cancer that has spread from its primary site to other parts of the body, in this case, the lungs. The patient's history of heavy alcohol consumption is a risk factor for developing certain types of cancer. The laboratory findings of anemia and low white blood cell count can also be seen in patients with metastatic cancer. Therefore, metastatic carcinoma is the most likely explanation for the patient's findings.

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  • 17. 

    One drug used in the treatment of latent and active TB has probably more clinically significant interactions than any other drug in any hospital pharmacy.  This is mostly explained by its induction of several CYP450 enzymes especially 3A4.  In the light of the recommended treatment for HIV/AIDS –TB, the  interaction  between this drug and which  one of the following  agents is most likely to affect treatment strategies ?

    • 5HT3 antagonists

    • NRTI’s

    • Protease inhibitors

    • Contraceptive steroids

    Correct Answer
    A. Protease inhibitors
    Explanation
    The drug used in the treatment of latent and active TB induces several CYP450 enzymes, especially 3A4. This means that it can significantly affect the metabolism of other drugs that are also metabolized by these enzymes. Protease inhibitors, which are commonly used in the treatment of HIV/AIDS, are known to be metabolized by CYP450 enzymes, including 3A4. Therefore, the interaction between the TB drug and protease inhibitors is most likely to affect treatment strategies for HIV/AIDS-TB co-infected patients.

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  • 18. 

    Dr Turnbull A recent chilling report from S. Africa referred to clinical cases of extensively-drug-resistant -TB found in HIV-treated patients. Two major points were made concerning these patients: i) Some subjects in the report were under treatment for HIV when they contracted TB. They had not been treated for TB before. ii) Even patients who had been treated for TB before, most subsequent TB infections were caused by organisms resistant to second line TB medications, despite the patients having received only first line medications   Which of the following statements seems the most appropriate description of the drug resistance characteristics observed in these patients?  

    • Primary resistance-infection with a drug-resistant strain found in the local community

    • Acquired resistance due to inadequate therapy which then facilitates selection of drug-resistant organisms

    Correct Answer
    A. Primary resistance-infection with a drug-resistant strain found in the local community
    Explanation
    The most appropriate description of the drug resistance characteristics observed in these patients is primary resistance, meaning that they were infected with a drug-resistant strain of TB that is already present in the local community. This is supported by the fact that some patients had not been treated for TB before contracting it and even those who had been treated before still contracted infections caused by drug-resistant organisms. This suggests that the drug-resistant strains are circulating in the community and are not solely a result of inadequate therapy.

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  • 19. 

    Dr Bergeron   The antiviral oseltamivir (ethyl(3R,4R,5S)-4-acetomido-5-amino-3-(1-ethylpropoxy)-1-cyclohexene-1-carboxylate, or Tamiflu™) is a molecule that inhibits the activity of the influenzavirus neuraminidase. Which step of the viral replicative cycle is inhibited by this molecule?

    • Adsorbtion

    • Entry

    • Assembly

    • Exit

    • Maturation

    Correct Answer
    A. Maturation
    Explanation
    Oseltamivir, also known as Tamiflu, inhibits the activity of the influenzavirus neuraminidase. Neuraminidase is an enzyme involved in the maturation of the virus. Therefore, the correct answer is "Maturation."

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  • 20. 

    Dr Goff Based on the review of the video segment “the Last Heart Attack” what is the hardest step to make in reversing coronary disease in the United States?

    • Moving to a vegetarian diet

    • Getting adequate sleep

    • Having all patients spend more time running and lifting weights

    • Making proper prescription for statins

    • Avoiding too much trans-fat in the diet

    Correct Answer
    A. Moving to a vegetarian diet
    Explanation
    The hardest step to make in reversing coronary disease in the United States, based on the review of the video segment "the Last Heart Attack," is moving to a vegetarian diet.

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  • 21. 
    Dr Cannon Today a 55-year-old male with a long history of smoking presents to the emergency department with an acute onset of dyspnea at rest.  He is afebrile with the following vital signs:   Respiratory rate: 30 bpm, Pulse: 110, BP: 140/80, O2 saturation of 74%.   The chest x-ray shows: Which of the following is the most likely type of respiratory failure this patient would have? - ProProfs

    Dr Cannon Today a 55-year-old male with a long history of smoking presents to the emergency department with an acute onset of dyspnea at rest.  He is afebrile with the following vital signs:   Respiratory rate: 30 bpm, Pulse: 110, BP: 140/80, O2 saturation of 74%.   The chest x-ray shows: Which of the following is the most likely type of respiratory failure this patient would have?

    • Hypoxemic

    • Mixed hypoxemic and hypercapnic

    • Compensated

    • Hypercapnic

    Correct Answer
    A. Hypercapnic
    Explanation
    Based on the information provided, the patient is experiencing an acute onset of dyspnea at rest, which suggests a respiratory problem. The vital signs show an increased respiratory rate, indicating respiratory distress. The low oxygen saturation of 74% suggests hypoxemia, which is a low level of oxygen in the blood. Additionally, the patient has a history of smoking, which increases the risk of chronic obstructive pulmonary disease (COPD). Hypercapnic respiratory failure is characterized by elevated levels of carbon dioxide in the blood, which can occur in patients with COPD. Therefore, the most likely type of respiratory failure this patient would have is hypercapnic.

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