Pharm
A patient presents with self-reported back pain after a truck driver tapped the back of her license plate. She states the pain shoots down the back of her legs and wraps around the front of her foot. You decide to complete some orthopedic tests to confirm what you believe to be happening. Which of the following must be positive for your decision to hold true?
C. Axial Compression Test and Hoover Test
When doing Liver Articulation, the goal is to:
A) Follow the liver inferiorly into inhalation and hold it there
B) Follow the liver inferiorly into exhalation and hold it there
C) Follow the liver superiorly into inhalation and hold it there
D) Follow the liver superiorly into exhalation and hold it there
D) Follow the liver superiorly into exhalation and hold it there
A 66-year-old man comes to the office because of new-onset weight gain, excessive sweating, and increased fatigue for 3 weeks. He has a history of uncomplicated pneumonia several years ago. He has smoked two packs of cigarettes per day for the last 25 years. He has a round appearing face and a highly elevated waist circumference, with purple markings on the abdomen. A dexamethasone suppression test is abnormal; however, a bilateral adrenal CT scan shows no abnormalities. Chest X-ray shows a left lung mass adjacent to the hilum. Which of the following is the most likely prognosis?
Poor prognosis due to likely metastatic spread to different sites
A 40 year-old female presents to your clinic today complaining of genital pruritis and dysuria. Urinalysis reveals + leukocyte esterase and nitrites, and WBCs. Upon thorough history, the patient relays that she has had numerous urinary tract infections and more recently suffered from kidney stones and intermittent flank pain. The patient relays her mother experienced similar symptoms prior to passing away suddenly. Being the astute physician you are, you obtain a renal ultrasound which reveals bilateral renal cysts. You tell the patient her symptoms are most likely from the following:
A- autosomal dominant mutation on chromosome 4
B- autosomal dominant mutation on chromosome 16
C- x-linked recessive mutation
D- autosomal recessive mutation on chromosome 4
E- autosomal recessive mutation on chromosome 16
Autosomal dominant mutation on chromosome 16
This vignette describes a patient presenting with symptoms of Autosomal Dominant Polycystic Kidney Disease (ADPKD). ADPKD often stems from one of two gene mutations - PKD1 on chromosome 16, or PKD2 on chromosome 4. Of the two, PKD1 mutations are more common (~85%) and typically present later in life with the disease, but are associated with more severe cases. (Info straight from Dr. Mengesha's material in conjunction with BAB).
A 24-year-old female presents with malaise over the last two weeks. She has a history of systemic lupus erythematosus complicated by lupus nephritis (diffuse proliferative glomerulonephritis). Laboratory testing reveals a creatinine of 5.5 mg/dL, increased from 1.5 mg/dL six weeks ago. A kidney biopsy is performed with the pathology shown below. Areas of the glomeruli stain positively for fibrin.
A. Diffuse Proliferative Glomerulonephritis
B. Rapidly Progressive Glomerulonephritis
C. Membranous nephropathy
D. Focal Segmental Glomerulosclerosis
E. Minimal Change Disease
Rapidly Progressive Glomerulonephritis
A 66-year-old woman with a long history of heavy smoking presents to her doctor with complaints of shortness of breath and chronic coughing that has been present for about 2 years and has been worsening in frequency. The doctor decides to prescribe a bronchodilator agent that has minimal cardiac side effects, since the patient also has an extensive cardiac history. Which medication did the doctor likely prescribe?
When performing a Mesenteric Lift, the physician:
A) Stands on the patients left side and gently pushes the border of the mesentery to the right
B) Stands at the patient's left side and places hands at the right border of the mesenteric region and pulls gently to the left
C) Sits on the patient's right side and places hands at left border of mesentery and pulls gently to the right
D) Performs soft & deep tissue palpation and declares the patient healed
C) Sits on the patient's right side and places hands at left border of mesentery and pulls gently to the right
A 58-year-old man comes to the office because of polyuria and constipation for 2 weeks. He says that he has never had these symptoms before and that he has lost 6-kg (13-lb) over the last 5 months and developed a chronic, non-productive cough. He has a history of hypertension for which he takes atenolol. He is also a long-time cigarette smoker. Laboratory studies show an electrolyte abnormality. A chest X-ray is obtained and is shown below. Subsequent histology shows keratinized cells and necrosis. Which of the following is the most likely diagnosis?
Squamous cell carcinoma
A 39 year-old male presents to your clinic for dark-colored urine, a swollen face and flank pain. Urinalysis is positive for protein and hemoglobin, and BUN and creatinine are elevated. Immunofluorescence study reveals a linear-type pattern. You have a strong suspicion type IV collagen is involved, but your attending asks you how. Your strongest response will include…
A- type I hypersensitivity reaction
B- type II hypersensitivity reaction
C- type III hypersensitivity reaction
D- type IV hypersensitivity reaction
E- How you will refer to your local immunologist, Dr. Benencia
Type II hypersensitivity reaction
Although a strong argument can be made for E, it is incorrect according to my NBOME informants. It is important to realize that many of the diseases we have been presented with can also be categorized in terms of hypersensitivity reactions. This question points to a patient with progressing renal disease associated with Goodpasture syndrome as indicated by the linear-type pattern found on immunofluorescence studies and the mention of type IV collagen. This disease is associated with antibodies against type IV collagen of the basement membrane, following type II hypersensitivity classification. Many of the diseases we have been presented follow type II and type III hypersensitivity reactions and it is important to keep this in mind. (iRAT Objective 7800 and iLAB objective 7870 class presentation from Dr. Benecia).
A 17-year-old girl is seen in the nephrology clinic for chronic renal disease. The patient has had progressively worsening renal function over the last two years, with her most recent creatinine level being 4.2 mg/dL (normal 0.8-1.1). She has no other significant medical history. She is not sexually active and does not use alcohol, nicotine products, or other substances. On light microscopy, renal biopsy shows thickened glomerular basement membranes. Electron microscopy demonstrates dense glomerular basement membrane deposits. Which of the following is most likely involved in the development of this patient’s condition?
A. Amyloid deposition
B. Antibodies against podocyte proteins
C. Complement overactivation
D. Glomerular basement membrane antibodies
E. Immune complex deposition
Complement overactivation
A 7-year-old boy is brought to the clinic by his mother. He complains of sharp pain in his flanks, as well as dysuria and frequency. The doctor orders a 24-hour urine calcium test, and the results come back abnormal. After additional work-up, the child is diagnosed with idiopathic hypercalciuria. What is a common type of medication used for this aliment?
C. Chlorthalidone
When doing the Linea Alba release, it is important to
A) evenly distribute your finger pressure
B) stab your fingers into the patient's abdomen
C) continuously alternate which fingers have more pressure so as to target each of the mesenteric ganglia
A) evenly distribute your finger pressure
45-year-old African-American woman comes to the physician after an episode of hemoptysis. Over the past 8 months, she has had a nonproductive cough, fatigue, and a 9-kg (20-lb) weight loss. She drinks a glass of wine every night and does not smoke cigarettes. She has a history of hypertension and osteoarthritis. She does not take any medications. She has never traveled out of the country. She works as an accountant. Her temperature is 37.0°C (98.6°F), pulse is 94/min, and blood pressure is 130/90 mm Hg. Lungs are clear to auscultation. An x-ray of the chest shows a 2.5-cm nodule with irregular borders at the apex of the left lung with no mediastinal or hilar enlargement. Which of the following is the most likely diagnosis?
Adenocarcinoma
A 32 year-old male presents with intermittent flank pain, nausea and dark-colored urine. Family history is positive for "kidney issues" in his aunt and grandfather. Urinalysis shows hematuria and renal ultrasound reveals the following image bilaterally (see image). Vitals include BP 168/92, Temp 98.8F, HR 72, RR 14.
You prescribe an ACE inhibitor in order to prevent which of the following in this patient:
A- aneurism
B- nephritic syndrome
C- arteriosclerosis
D- nephrotic syndrome
E- kidney stones
Aneurism
This patient has Autosomal dominant polycystic kidney disease (ADPKD). ADPKD often presents during adulthood as cysts tend to be microscopic during childhood and progressively enlarge. Familial history and imaging revealing bilateral renal cysts (bilateral is important!) and point towards ADPKD. ADPKD is associated with cerebral (Berry) aneurisms. First line treatment will include an ACE/ARB and may include many more HTN medications, and although you would want to slow the progression of chronic kidney disease and nephritic/nephrotic type symptoms, the most catastrophic consequence of uncontrolled high blood pressure would be potential cerebral aneurism. (Info straight from Dr. Mengesha's material in conjunction with BAB - image from radiopaedia.org).
A 32-year-old man presents for worsening cough over the last year. He reports a dry cough throughout the day that is associated with dyspnea. He ahs never had this before and has no history of asthma. Past medical history is unremarkable, and he takes no medications. He smokes one pack per day for the last 9 years. Vitals include Bp 132/78, HR 82, RR 16, and PO2 95% on room air. Examination shows normal heart sounds with physiologic splitting of the S2. Lung sounds are quiet throughout with no wheezes, rhonchi, or rales. Laboratory testing shows elevated AST and ALT levels. PFTs are performed which show an GEV1 at 60% of predicted and an FVC at 85% predicted. There is minimal improvement with bronchodilator administration. Which of the following most likely characterized the location of this patient’s pulmonary process.
Panacinar, Lower Lobes
A 54-year-old woman is diagnosed with congestive heart failure (CHF). You prescribe captopril, a medication proven to reduce her mortality. This agent delivers several benefits to patients with CHF. Which of the following effects is caused by this drug?
D. It causes venodilation and induces natriuresis
A patient presents with complaints of paresthesia and sciatica. You decide to do Homer's assessment to determine if more urgent imaging is needed. You complete the proper course of treatment including checking achilles reflxes on both legs prior to and after testing. Diminished achilles reflexes are noted bilaterally post testing. You become concerned for:
B. LMN lesion (spinal stenosis). Urgent imaging required
A 75-year-old man is referred for pulmonary function testing to evaluate new-onset exertional dyspnea. He has not seen a physician in 10 years and has not been treated for any pulmonary conditions previously. He has a 30 pack year smoking history and drinks three beers daily. A flow-volume curve is generated and displayed in red below, compared to a normal curve in black. Which of the following best explains the shape of the expiratory flow curve in this patient?
Loss of alveolar elasticity
A 10-year-old boy presents to his primary care doctor complaining of hematuria. Three weeks ago he had a sore throat which has since resolved. Urinalysis demonstrates hematuria, proteinuria, and red blood cell casts. Which of the following additional laboratory findings would be expected?
A. Auto-antibodies to collagen
B. Auto-antibodies to DNA
C. Low complement levels
D. Auto-antibodies to phospholipase A2 receptor
E. Auto-antibodies to neutrophils
Low complement levels
A 75-year-old man with a past medical history of HTN, DM, COPD, and gout presents for a health maintenance visit. He has been stable over the last year without hospitalizations. His most recent PFT shows an FEV1 of 45%. Vital include blood pressure 142/68, HR 82, RR 14, PO2 92% on room air. On exam, the patient breathes slowly with prolonged expiration. Which of the following is a potential complication of this patient’s underlying pulmonary disease?
Polycythemia
A 47-year-old woman is admitted for treatment of acute myocardial ischemia. Her prior medication included digoxin for atrial fibrillation. She also suffers from hypertension, for which she is currently not taking anything. Before you discharge her home, you decide to add a medication that works well for hypertension. While she is still on the floor she develops a dangerous arrhythmia, which you are fortunately able to treat promptly. Which medication you added likely increased the effects of digoxin that this patient was already taking?
b. Hydrochlorothiazide
A 65 year old patient presents with radiating low back pain of a sudden onset. After completing the straight leg raise, Siccard, and Bonnet's test all with negative results, you decide to do the single legged hyperextension test (modified micheli's?)? A positive result will give you a high clinical suspicion for what?
B. Pars fracture
Adenocarcinoma
A 45-year-old man is seen in the nephrology clinic for workup of nephrotic syndrome. He had been in good health until he was discovered to have abnormal kidney function by his primary care physician. A 24-hour urine collection revealed over 4 grams of protein. Renal biopsy showed diffuse thickening of the glomerular basement membrane and subepithelial dense deposits on electron microscopy consistent with membranous nephropathy. Workup for secondary causes of his condition, including syphilis, hepatitis, systemic lupus erythematosus, and malignancy, was negative. Which of the following laboratory test results is most likely to be found in this patient?
A. Anti-glomerular basement membrane antibodies
B. Positive HIV ELISA
C. Low complement levels
D. Auto-antibodies to phospholipase A2 receptors
E. Elevated hemoglobin A1C
Auto-antibodies to phospholipase A2 receptors
A 14-year-old male presents to the emergency department for blood-streaked sputum for the last week, he has had fever, fatigue, and cough productive of cupfuls of purulent sputum. He has a history of recurrent bacterial pulmonary and sinus infections that require antibiotic therapy. These episodes have become more frequent and severe over the last few years. Vitals include BP 106/60, HR 96, RR 22, and temp. 102.6. pulmonary exam demonstrates rales and wheezing throughout the upper and middle lung fields. Mild clubbing is present. Chest x-rays shows prominent bronchovascular markings. Which of the following is the most likely cause of this patient’s presentation?
Bronchiectasis