Exam 2
Which of the following diagnostic tools is commonly used for assessing liver cirrhosis?
A) Liver biopsy
B) Magnetic resonance imaging (MRI)
C) Complete blood count (CBC)
D) Abdominal ultrasound
E) Electrocardiogram (ECG)
A. Liver biopsy
Liver biopsy is commonly used as a diagnostic tool for assessing liver cirrhosis. It involves the removal of a small sample of liver tissue for examination under a microscope to assess for fibrosis, inflammation, and other pathological changes characteristic of cirrhosis.
Which of the following types of hypernatremia occurs when sodium loss is accompanied by a relatively greater loss of water from the body?
A. Essential
B. Euvolemic
C. Hypervolemic
D. Hypovolemic
D: Hypovolemic. Hypernatremia associated with hypovolemia occurs with sodium loss accompanied by a relatively greater loss of water from the body
Which of the following cancers does not have any screening available until Stage III/IV?
A. Cervical Cancer
B. Kidney Cancer
C. Thyroid Cancer
D. Ovarian Cancer
D. Ovarian Cancer
No screening available until Stage II/IV
(from the slideshow she did not share with us on 4/18/24)
Which of the following is a major symptom of hypernatremia?
A. Agitation
B. Difficulty ambulating
C. Difficulty communicating
D. Thirst
D: Thirst. The major symptom of hypernatremia is thirst.
*BONUS: How many pack years or greater than is the number that allows a person to get a CT scan?*
(Number of cigarette per day/ 20) x # of years smoked.
If the pack years is greater than 20 then they are able to get CT scan
Which of the following is a common clinical manifestation of ulcerative colitis?
A) Constipation
B) Abdominal pain relieved by eating
C) Bloody diarrhea
D) Weight gain
E) Hypertension
C) Bloody diarrhea
Bloody diarrhea is a common clinical manifestation of ulcerative colitis. It is often accompanied by other symptoms such as abdominal pain, urgency to defecate, and tenesmus (the feeling of incomplete evacuation). Well done!
Which of the following are risk factors for retinal detachment? (Select all that apply)
A) High blood pressure
B) Age over 60
C) Severe myopia (nearsightedness)
D) History of cataract surgery
All of the options listed are indeed risk factors for retinal detachment. High blood pressure can contribute to retinal vascular changes that increase the risk of detachment. Age over 60 is associated with changes in the vitreous gel, making detachment more likely. Severe myopia (nearsightedness) can lead to structural changes in the eye that predispose individuals to retinal detachment. Additionally, history of cataract surgery increases the risk due to changes in the anatomy of the eye following the procedure.
What are the three P's of Diabetes and explain what each symptom is?
*HINT Poly___, Poly___, Poly___*
Polyphagia: increased hunger due to cells lacking glucose
Polydipsia: increased thirst due to cells lacking glucose
Polyuria: kidney's produce more urine to remove extra glucose
What is the normal, prediabetic and diabetic fasting blood glucose?
Normal: 70 to 99 mg/dL
Prediabetic: 100 to 125 mg/dL
Diabetic: 126 mg/dL or higher
Which of the following is the most common cause of hyperfunction of the endocrine glands?
A. Hyperplasia of the gland
B. Hormone production by other organs
C. Overstimulation by the pituitary
D. Exogenous hormone ingestion
A: Hyperplasia or neoplasia of the gland itself is the most common cause of hyperfunction of the endocrine glands.
Choices B and C occur occasionally. D: Patients sometimes take hormones without telling the physician
Which group of people are most likely to develop heart failure?
A) Young adults aged 20-30
B) Individuals with a history of hypertension
C) Professional athletes
D) Vegetarians
E) Individuals with low cholesterol levels
B. Individuals with a history of hypertension
Individuals with a history of hypertension are indeed at an increased risk of developing heart failure. Hypertension can lead to structural changes in the heart over time, such as left ventricular hypertrophy and impaired diastolic function, which can ultimately progress to heart failure.
In patients with diabetic retinopathy, which of the following disease manifestations is the most common cause of vision loss?
A. Clouding and thicking of the lens
B. Deterioration of the macula
C. Abnormal blood vessel growth in the retina
D. Swelling of the optic disc
C. Abnormal blood vessel growth in the retina as this blocks fluid from draining out of the eye causing a type of glaucoma that leads to vision loss & blindness
Choice A is Cataracts, Choice B is Age-Related Macular Degeneration and Choice D is Papilledema
A patient presents with fatigue, weight loss, hyperpigmentation, and hypotension. Laboratory investigations reveal low cortisol levels and elevated ACTH levels. Which of the following conditions is most likely to be the cause?
A) Addison's disease
B) Cushing's disease
C) Primary hyperaldosteronism
D) Hypopituitarism
A) Addison's disease
In Addison's disease, there is adrenal insufficiency resulting in low cortisol levels. This leads to symptoms such as fatigue, weight loss, hyperpigmentation, and hypotension. The elevated ACTH levels occur due to lack of negative feedback from cortisol. Cushing's disease, on the other hand, is characterized by excessive cortisol production often due to a pituitary adenoma, leading to symptoms opposite to those of Addison's disease.
A 45-year-old female presents to the emergency department with complaints of muscle weakness, fatigue, and tingling sensations in her extremities. She has a history of chronic kidney disease and hypertension. Laboratory investigations reveal a serum potassium level of 6.8 mEq/L (normal range: 3.5-5.0 mEq/L). Which of the following conditions is the patient most likely experiencing?
A) Hyponatremia
B) Hypernatremia
C) Hypokalemia
D) Hyperkalemia
Option D, Hyperkalemia, is the most likely condition the patient is experiencing.
Hyperkalemia is characterized by elevated levels of potassium in the blood, which can lead to muscle weakness, fatigue, and tingling sensations. Patients with chronic kidney disease are at increased risk of hyperkalemia due to impaired potassium excretion by the kidneys.
In addition to insulin replacement and volume expansion, the most urgent goal in treatment of DKA includes prevention of which of the following?
A. Hyponatremia
B. Hypokalemia
C. Hypoglycemia
D. Hypocalcemia
Answer: B: Prevention of hypokalemia. Levels of other electrolytes (A, C, and D) should be corrected as needed, but if serum K is not monitored and replaced as needed, life-threatening hypokalemia may develop.
*Remember Potassium => Muscle => Heart*
Client Z is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg, and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?
A. Metabolic Acidosis, Uncompensated
B. Respiratory Alkalosis, Partially Compensated
C. Respiratory Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
C. Respiratory Alkalosis, Uncompensated
The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3 which is within 22-26 mEq/L.
Mr. Davis, a 45-year-old male, was involved in a motor vehicle accident and sustained a severe head injury. He is brought to the emergency department unconscious. Upon examination, his vital signs are as follows: blood pressure 160/100 mmHg, pulse 50 bpm, and respirations 8 breaths per minute. His pupils are unequal, with the right pupil dilated and unresponsive to light. In addition, he exhibits decerebrate posturing. What is the most likely diagnosis based on these findings?
A. Subdural hematoma
B. Epidural hematoma
C. Traumatic brain injury with increased intracranial pressure
C. "Traumatic brain injury with increased intracranial pressure," is the most likely diagnosis based on the presented findings. The symptoms of unequal pupils, particularly with one dilated and unresponsive to light, along with bradycardia and abnormal respirations (Cushing's triad), suggest increased intracranial pressure.
In the pathophysiology of DKA, which of the following is the initial effect of insulin deficiency?
A. Serum levels of glycerol and free fatty acids (FFAs) increase.
B. Glucagon excess stimulates hepatic gluconeogenesis.
C.Triglycerides and amino acids are metabolized for energy instead of glucose.
D.Acetone accumulates in serum and is slowly disposed of by respiration.
Answer: C: Insulin deficiency causes the body to metabolize triglycerides and amino acids instead of glucose for energy.
Choice A does increase however is not the reason for DKA, it is because of the lipolysis.
Choice B is true but not the reason for DKA but due to the excess of flucagon that accompanies insulin deficiency
Choice D is a result of DKA
(Slide 29 on Endocrine Disorders)
A 42-year-old woman comes to the office because she has had episodes of vertigo accompanied by nausea and vomiting and sweating over the past year. She says she also has had bilateral hearing loss, tinnitus, and a sensation of fullness in the ears. Meniere disease is suspected. However, which of the following findings in this patient’s presentation suggests the possibility of an alternate diagnosis?
A. Bilateral symptoms
B. Severe vertigo
C. Tinnitus
D. Hearing Loss
Answer: A: Bilateral symptoms. Although bilateral Meniere disease can occur(rarely), bilateral symptoms may suggest an alternate diagnosis such as vestibular migraine.
Choice B, C, and D: These symptoms strongly suggest Meniere disease as the diagnosis.
A 60-year-old male presents with complaints of pencil-thin stools, abdominal pain, and unintended weight loss. He denies any significant changes in his diet or bowel habits. Which type of cancer is most likely to be causing these symptoms?
A) Colorectal cancer
B) Pancreatic cancer
C) Gastric cancer
D) Esophageal cancer
Option A, Colorectal cancer, is the most likely cause of these symptoms. Pencil-thin stools, also known as "ribbon stools," can be a sign of colorectal cancer due to the narrowing of the bowel lumen by the tumor. This symptom, along with abdominal pain and unintended weight loss, should raise suspicion for colorectal malignancy.
Which of the following laboratory tests is primarily used to monitor the effectiveness of warfarin therapy?
A) Prothrombin Time (PT)
B) Partial Thromboplastin Time (PTT)
C) International Normalized Ratio (INR)
D) Platelet count
C) International Normalized Ratio (INR)
INR is primarily used to monitor the effectiveness of warfarin therapy. While both PT and PTT can be affected by warfarin, INR is specifically calibrated to standardize the PT value across different laboratories, making it the preferred test for monitoring warfarin therapy.
A 35-year-old woman comes to the emergency department because she had sudden onset of vision loss in her left eye 1 hour ago. She says that she had blurred vision and a flashing-light sensation in the eye prior to onset. Medical history includes prior intraocular sugery. Based on this information, which of the following is the most likely suspected diagnosis?
A. Macroaneurysm
B. Migraine
C. Retinal detachment
D. Tumor
Answer: C: Retinal detachment. This patient presentation is classic for retinal detachment especially since the patient had prior intraocular surgey and is older than 30 years of age. Choices A, B, and D are incorrect.
Mrs. Johnson is a 65-year-old woman who presents to her primary care physician with complaints of back pain and height loss. She reports that she has noticed a gradual decrease in her height over the past few years and has recently experienced increased back pain, especially when bending or lifting. Upon further questioning, she admits to occasional falls but denies any recent trauma. She has a history of smoking and consumes minimal amounts of dairy. Physical examination reveals a loss of height and tenderness over the lumbar spine. What is Mrs.Johnson suffering from?
A. Osteoarthritis
B. Osteoporosis
C. Degenerative Disc Disease
B. Osteoporosis
- Postmenopausal female
- Low calcium
- Height loss
Three-year-old Adrian is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child reports to the nurse on duty that she has witnessed slight tremors and behavioral changes in her child over the past four days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg, and HCO3 38 mEq/L. What acid-base disorder is shown?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Fully Compensated
C. Respiratory Alkalosis, Fully Compensated
D. Metabolic Alkalosis, Partially Compensated
B. Respiratory Acidosis, Fully Compensated
The patient has respiratory acidosis (raised carbon dioxide) resulting from asthma and respiratory distress syndrome, with compensation having normal pH value within 7.35to 7.45, increased PaCO2 which is acidic and increased HCO3 which is basic.
Mr. Smith is a 55-year-old man who presents to his orthopedic surgeon with complaints of progressive knee pain and stiffness over the past year. He describes difficulty with activities such as climbing stairs, prolonged standing, and walking long distances. He denies any history of trauma to the knee. On examination, there is crepitus on knee movement, joint line tenderness, and a decreased range of motion. X-rays reveal joint space narrowing, osteophyte formation, and subchondral sclerosis consistent. What is Mr.Smith suffering from?
A. Osteoporosis
B. Osteoarthritis
C. Degenerative Disc Disease
B. Osteoarthritis
- Creptius with motion
- Joint pain
- X-ray used to confirm diagnosis