PANCE PANRE Fast Track Exam 2 - Questions 30-60

Questions 90-120 Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Start Congratulations - you have completed Questions 90-120. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% %%FORM%% Have Your Exam Results Emailed to You Enter your name and email address below to have your results as well as the test questions, your answers and the correct answers delivered to your inbox. Name First Last Email mTouch Quiz Populated FieldsmTouch Quiz will automatically populate the fields below. Feel Free to add additional fields for the Quiz Taker to complete using the "Add Fields" options to the right.Quiz NameThe name of the quizResults SummaryScoreThe number of correct answers. This has the same value as the %%SCORE%% Variable on the Final Screen.Total QuestionsThe total number of questions. This has the same value as the %%TOTAL%% Variable on the Final Screen.PercentageCorrect answer percentage. This has the same value as the %%PERCENTAGE%% Variable on the Final Screen.Wrong AnswersNumber of wrong answers. This has the same value as the %%WRONG_ANSWERS%% Variable on the Final Screen.Time Allowed (Seconds)Time allowed (Requires timer add on). This has the same value as the %%TIME_ALLOWED%% Variable on the Final Screen.Time Used (Seconds)Time used (Requires timer add on). This has the same value as the %%TIME_USED%% Variable on the Final Screen. This iframe contains the logic required to handle Ajax powered Gravity Forms. jQuery(document).ready(function($){gformInitSpinner( 7, 'https://www.thepalife.com/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery('#gform_ajax_frame_7').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_7');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_7').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_7').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_7').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_7').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_7').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_7').val();gformInitSpinner( 7, 'https://www.thepalife.com/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery(document).trigger('gform_page_loaded', [7, current_page]);window['gf_submitting_7'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_7').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_7').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [7]);window['gf_submitting_7'] = false;}, 50);}else{jQuery('#gform_7').append(contents);if(window['gformRedirect']) {gform Redirect();}}jQuery(document).trigger('gform_post_render', [7, current_page]);} );} ); jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 7) {} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){} ); jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [7, 1]) } ); Your answers are highlighted below. Question 1A patient complains of marked weakness, nausea, vomiting and weight loss. His skin appears well-tanned, although he denies any sun exposure. The laboratory studies demonstrate an elevated potassium, a low sodium and eosinophilia. What is the most likely diagnosis?ACushing's syndromeBCushing's diseaseCAddison's diseaseDacromegalyEscarlet feverQuestion 1 Explanation: This is Addison's disease, autoimmune destruction of the entire adrenal gland. No Cortisol, increased ACTH (pigmentation), high K Incarcerated means "not reducible", strangulated means "ischemic", or no flow.Question 3A 46 year-old patient with chronic hypertension, suddenly discontinues the use of his antihypertensive agent. This patient presents to your office with a blood pressure of 198/116 in the left arm. The patient denies chest pain and shortness of breath. You note no evidence of acute end-organ changes on physical examination. His laboratory studies and EKG are normal. What diagnosis will you place on this patient's chart?Ahypertensive emergencyHint: Hypertensive emergencies are severe elevations in blood pressure (BP) that are complicated by evidence of progressive target organ dysfunction, and will require immediate BP reduction (not necessarily to normal ranges) to prevent or limit target organ damage. Examples include: hypertensive encephalopathy, intracranial hemorrhage, unstable angina pectoris, or acute myocardial infarction, acute left ventricular failure with pulmonary edema, dissecting aneurysm, or eclampsia. While the level of BP at the time of presentation is usually very high (greater than 180/120 mm Hg), keep in mind that it is not the degree of BP elevation, but rather the clinical status ofthe patient that defines a hypertensive emergency. For example, a BP of 160/100 mm Hg in a 60-year-old patient who presents with acute pulmonary edema represents a true hypertensive emergency.Bhypertensive urgencyCmalignant hypertensionDidiopathic hypertensionEhypertension of un determined etiologyQuestion 3 Explanation: Traditionally, hypertensive crises have been divided into emergencies and urgencies. Hypertensive emergencies are severe elevations in blood pressure (BP) that are complicated by evidence of progressive target organ dysfunction, and will require immediate BP reduction (not necessarily to normal ranges) to prevent or limit target organ damage. Examples include: hypertensive encephalopathy, intracranial hemorrhage, unstable angina pectoris, or acute myocardial infarction, acute left ventricular failure with pulmonary edema, dissecting aneurysm, or eclampsia. While the level of BP at the time of presentation is usually very high (greater than 180/120 mm Hg), keep in mind that it is not the degree of BP elevation, but rather the clinical status of the patient that defines a hypertensive emergency. For example, a BP of 160/100 mm Hg in a 60-year-old patient who presents with acute pulmonary edema represents a true hypertensive emergency. Hypertensive urgencies are severe elevations of BP but without evidence of progressive target organ dysfunction and would be better defined as severe elevations in BP without acute, progressive target organ damage. Most of these patients are, in fact, nonadherent to drug therapy or are inadequately treated hypertensive patients and often present to the ED for other reasons. Patients with severe elevations of BP can be managed in the ED with oral agents and appropriate follow-up within 24 hours to several days depending upon the individual characteristics of the patient. It is the correct differentiation of these two forms of hypertensive crises, however, that presents the greatest challenge to the physician.Question 4A patient returns from a Caribbean cruise. He admits to spending "a lot of time sitting at the bar." He presents today, complaining of atraumatic swelling of his right elbow. On examination, he is afebrile, and has a soft, well circumscribed mass over the olecranon. The rest of the examination is unremarkable. The diagnosis is:Alateral epicondylitis.Bmedial epicondylitis.Colecranon bursitis.Dnursemaid's elbow.Ea dislocated elbow.Question 4 Explanation: Olecranon bursitis from leaning on a hard surface.Question 5Which of the following is most likely the cause of galactorrhea and amenorrhea?ASheehan's syndromeHint: I would choose Sheehan's syndrome if the question stated that the patient had a postpartum hemorrhageBprolactin - secreting adenomaCFrohlich's syndromeDCushing's diseaseEa basophilic adenoma of the pituitaryQuestion 5 Explanation: Prolactin-secreting adenoma is the most common cause of galactorrhea/amenorrhea (after exclusion of pregnancy). I would choose Sheehan's syndrome if the question stated that the patient had a postpartum hemorrhage. The others do not cause this.Question 6A young female presents with several "target-like lesions" on her arms, legs and thorax. She takes birth control pills and recently completed a ten-day course of penicillin. What is the most likely diagnosis?Aerythema multiformeBerythem nodosumHint: erythema nodosum causes PAINFUL purple nodules on the anterior shins.CerysipelasDpleurodyniaEerythema chronicum migransQuestion 6 Explanation: Target lesions are erythema multiforme - commonly caused by drugs (many drugs) and some illnesses, like mycoplasma Another common problem with OCP's is erythema nodosum which causes PAINFUL purple nodules on the anterior shins.Question 7Which of the following statements regarding infectious mononucleosis is FALSE?AInfectious mononucleosis is caused by the Epstein-Barr virus.BMost adults (>90%) have been infected with the Epstein-Barr virusCSplenic rupture is a dreaded complication of infectious mononucleosis.DStreptococcal pharyngitis and infectious mononucleosis never coexist.EThe usual mode of transmission of the viral etiology of infectious mononucleosis is through infected saliva.Question 7 Explanation: Strep commonly co-exists with mono.Question 8Whic h of the following increases the likelihood that a patient will precipitate calcium-containing kidney stones?Aan increase in daily water intakeBan increase in daily sodium chloride intakeCa reduction in daily sugar consumptionDa reduction in daily protein consumptionE"normal" daily dairy product consumptionQuestion 8 Explanation: The combination of high sodium intake and high animal protein intake will raise urinary calcium more than high calcium intake will. The reason is that only a net of 100 to 300 mg of calcium is absorbed from the intestine/day. In contrast, 10,000 mg of calcium is filtered and 9,700 to 9,900 mg is reabsorbed by the kidney. Since sodium and animal protein inhibit calcium reabsorption by the kidney, it is not surprising that they affect urinary calcium substantially.Question 9A 54 year-old female enters your practice. She has a history of poor interpersonal relationships, chronic headaches and previous suicide attempts. After a few visits, you appreciate that s he has an extremely demanding attitude and often directs anger toward you. Which of the following is the most likely diagnosis?Adysthymic disorderBnarcissistic disorderCborderline personality disorderDsomatization disorderEanxietyQuestion 9 Explanation: This is a typical "borderline personality disorder" presentation.Question 10Which of the following is most likely to present with dysphagia?Arheumatoid arthritisBankylosing spondylitisCsystemic lupus erythematosusDsclerodermaEperiarteritis nodosaQuestion 10 Explanation: Dysphagia is the most common presenting symptom in a patient with scleroderma.Question 11Which of the following etiologies of acute hepatitis would most likely be followed by the development of chronic hepatitis? Ahepatitis A virusBhepatitis B virusChepatitis C virusDhepatitis D virusEhepatitis E virusQuestion 11 Explanation: Hepatitis C is the most common blood borne infection in the US, causes chronic hepatitis in almost all persons infected, is the most common reason for liver failure in the US, and the most common reason for liver transplant.Question 12Which of the following diagnostic studies should be performed on all patients with acute exacerbations of asthma that present for evaluation?Achest x-rayHint: CXR is not necessary unless you suspect the patient has pneumonia. Bwhite blood cell countCserum theophylline levelDpeak expiratory flow rateEarterial blood gas analysisHint: ABG's may be indicated in a severe asthma attack, but not typically.Question 12 Explanation: Peak flows should be done in ALL asthma patients with an acute exacerbation. It gives you a baseline, and allows you to decide how effective nebulizer treatments are. CXR is not necessary unless you suspect the patient has pneumonia. ABG's may be indicated in a severe asthma attack, but not typically.Question 13A mother brings her four year-old son to your clinic. She noted several "blisters" on his check and around his nose. On examination, you note several large flaccid, thin-roofed bullae on both cheeks and extensive involvement around the nose, as well as the extremities. Which treatment is the most appropriate?Abacitracin ointmentBmupirocin ointmentCerythromycin orallyHint: Erythromycin is not a bad choice, but choose diclox for staph aureus.Damoxicillin orallyEdicloxacillin orallyQuestion 13 Explanation: This is impetigo (staph skin infection) For the Boards, use Dicloxacillin for staph. Mupirocin cream would be indicated if there was only a small area infected, although there now is an indication for Mupirocin (Bactroban) for staph in the nose. Erythromycin is not a bad choice, but choose diclox for staph aureus.Question 14A mother brings her adult son to your office, relating a history of two weeks of dif ficulty sleeping, irritability, and problems with relationships with others. He has also been very talkative, expressed a multitude of "great ideas" and just seems to "talk constantly." Several weeks ago, he seemed depressed. Which of the following diagnostic studies would be the most helpful in his evaluation?Acomplete blood countBrandom blood sugar Cfree T4 levelDliver function studiesEhead CT scanQuestion 14 Explanation: This Q suggests bipolar disorder - thyroid function should be checked in all patients with a psych diagnosis.Question 15A 47 year-old male presents with "crushing chest pain." He is a diabetic and smoker, with a history of hyperlipidemia and angina. Which of the following physical findings is most suggestive of acute myocardial ischemia?Aphysiologic split second heart sound (split S2)Bcrackles in both lungs that do not change with coughingCchest tenderness with palpation of the costosternal junctionsDan S4 gallop that is not present when the patient is asymptomat icEsinus bradycardiaQuestion 15 Explanation: S4 is almost always present in an acute MI.Question 16During a newborn's first feeding attempt, choking, coughing and cyanosis occur. Historically, the mother had polyhydramnios during the pregnancy. Which diagnosis is most likely the explanation for the newborn's distress?Achoanal atresiaBrespiratory distress syndromeCpolycystic kidney diseaseDcongenital heart diseaseEtracheoesophageal fistulaQuestion 16 Explanation: This is the classic presentation of TE fistula - when the patient drinks he aspirates because there is a connection between the trachea and the esophagus.Question 17You diagnose a patient with shingles involving the trigeminal nerve. Since there is involvement of the tip of the nose, you examine her thoroughly to exclude concurrent involvement of the:Atympanic membraneBcorneaCnasal septumDcontralateral pinnaEipsilateral epitrochlear nodeQuestion 17 Explanation: This is Hutchinson's sign and suggests an involvement of the cor nea with herpes. An ophthalmologic referral is indicated. (Fluorescein staining would show a dendritic lesion on the cornea).Question 18A 65 year-old female is referred to your office by her rheumatologist, complaining of a severe, unilateral headache of a piercing quality. You examine the patient and cannot appreciate any pulsation of the temporal artery on the side of her head, ipsilateral to her cephalgia. While awaiting consultation of the appropriate specialist, you prescribe prednisone. Why has the prednisone been prescribed in this case?Ato reduce the stenosis of the contralateral temporal arteryBto reduce the swelling of the patient's berry aneurysmCbecause the patient is at risk for developing blindnessDbecause the patient most likely has pseudotumor cerebriEbecause of the associated risk of angioedema developing in her oropharynxQuestion 18 Explanation: This is temporal arteritis (or giant cell arteritis). It is a vasculitis and can cause blindness if not treated aggressiv ely with steroids.Question 19A 59 year-old, heavy smoker, presents for the evaluation of facial swelling. Upon examination, you note swelling, not only of the face, but also of the neck and upper extremities. You appreciate diminished breath sounds and tactile fremitus in the right upper lobe. Which of the following diagnosis is most likely?APancoast tumorBTuberculosisCpneumothoraxDsuperior vena cava syndromeEpneumoniaQuestion 19 Explanation: This is superior vena cava syndrome suggestive of bronchogenic carcinoma causing lymphadenopathy in the mediastinum which can impinge on the SVC.Question 20Which type of breathing pattern is classically observed at the bedside during acute diabetic ketoacidosis?ABiot'sBCheyne-StokesHint: may be caused by damage to respiratory centers, or by physiological abnormalities in chronic heart failure, and is also seen in newborns with immature respiratory systems and in visitors new to high altitudes.CKussmaul'sDApneusticEAtaxicQuestion 20 Explanation: Kussmaul's is the pulmonary compensation for the metabolic acidosis of DKA. The lungs blow off C02(an acid) to normalize the pH. Remember "K" for Ketoacidosis Question 21A 57 year-old female with a history of pancreatitis presents for the third time in three weeks complaining of midepigastric pain. At this visit, you perform a CT scan, which reveals a mass in the pancreas. Which of the following is the most likely diagnosis?Aepithelial cell carcinomaBgastrinomaCadenocarcinomaDteratomaEinsulinomaQuestion 21 Explanation: This patient has chronic pancreatitis which predisposes this patient to cancer. The head of the pancreas is sometimes palpable.Question 22A patient's blood pressure is 172/96 mm Hg. Which of the following is the LEAST likely the etiology?Apericardial effusionHint: Pericardial effusion would cause diastolic pressures. Baortic regurgitationCarteriovenous fistulaHint: AV fistula would cause increased systolic pressures with decreased diastolic pressures as well. DthyrotoxicosisHint: Thyrotoxicosis would cause high systolic, but low diastolic pressures (increased HR reduces filling time, so less EDV ). Epatent ductus arteriosusHint: PDA would cause increased systolic pressures with reduced diastolic pressures.Question 22 Explanation: Pericardial effusion would cause diastolic pressures. AV fistula would cause increased systolic pressures with decreased diastolic pressures as well. Thyrotoxicosis would cause high systolic, but low diastolic pressures (increased HR reduces filling time, so less EDV). PDA would cause increased systolic pressures with reduced diastolic pressures.Question 23A patient presents after falling down some stairs. The chief complaint is pain to the right thumb. During the examination, you note gross laxity in the first metacarpophalangeal joint when moving the right thumb into abduction. An x- ray reveals no fracture. Which of the following structures is injured?Aradial collateral ligament of the thumbBulnar collateral ligament of the thumbCflexor tendons of the thumbDextensor tendons of the thumbEmedian nerve, causing thenar musculature hypotonicityQuestion 23 Explanation: This is the ulnar collateral ligament - must be referred. Look at the anatomy of the thumb!Question 24A 24 year-old female presents complaining of recurrent bilateral breast pain, worst during the last few days of her menstrual cycle. She states that she does have "lumpy" breasts. On examination, you note several small nodular lesions in both breasts that are freely movable. The axilla are bilateral unremarkable. You suspect:A a fibroadenoma.Bcarcinoma of the breast.Cfibrocystic breast changes.DBowen's disease.Eher mammogram to be normal.Question 24 Explanation: Fibrocystic breast disease is most likely in this patient.Question 25A 24 year-old female presents complaining of recurrent bilateral breast pain, worst during the last few days of her menstrual cycle. She states that she does have â€Å"lumpy† breasts. On examination, you note several small nodular lesions in both breasts that are freely movable. The axilla are bilateral unremarkable. You suspect:A a fibroadenoma.Bcarcinoma of the breastCfibrocystic breast changes.DBowen’s disease.Eher mammogram to be normal.Question 25 Explanation: Fibrocystic breast disease is most likely in this patientQuestion 26Which of the following is the most effective prophylaxis for traveler’s diarrhea?AMetronidazoleBCiprofloxacinCTetracyclineDAmpicillinQuestion 26 Explanation: Options for prophylaxis of tra veler’s diarrhea include norfloxacin, ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole.Question 27A patient is started on a new antipsychotic medication for his disorder. Three days later he develops altered consciousness, lead-pipe rigidity, diaphoresis and catatonia. Vital signs reveal respiratory rate of 20, temperature of 105.6 degrees F, and pulse oximetry of 95% room air. Which of the following would be the most appropriate initial intervention in this patient?AImmediate oral SSRI’s and BenadrylB Supportive care with fluids and antipyreticsC IV antibiotics and naloxoneDIntubation and mechanical ventilationQuestion 27 Explanation: Neuroleptic malignant syndrome is characterized by extrapyramidal signs, blood pressure changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, cardiovascular instability, fever, pulmonary congestion and diaphoresis. Controlling fever and fluid support are the best initial management. With a normal pulse oxim etry mechanical ventilation is not indicated.Question 28Which of the following is most frequently associated with renal cell carcinoma?AHematuriaBInguinal painCHypocalcemiaDFeverQuestion 28 Explanation: Gross or microscopic hematuria, flank pain, or mass is common in renal cell carcinoma.Question 29What is the mechanism of action for aspirin?AInhibits platelet aggregation by blocking cyclooxygenase-1 activityBExerts antiplatelet effects by blocking the platelet membrane adenosine diphosphate receptorsCInhibits the platelet membrane glycoprotein IIb/IIIa receptorDConverts plasminogen to the natural fibrinolytic agent plasminQuestion 29 Explanation: Aspirin inhibits platelet aggregation by blocking cyclooxygenase-1 activity.Question 30A 28 year-old man presents to the emergency department complaining of sudden onset of shortness of breath associated with sharp right-sided chest pain increased with breathing. On physical examination, respirations are 20 per minute and blood pressure is 120/76 mm Hg. Auscultation of the chest reveals absent breath sounds over the right apex with normal heart sounds. Percussion of the right apex is noted to be hyperresonant. Which of the following is the most likely diagnosis?AHemothoraxB PneumothoraxCPulmonary embolusDForeign body aspirationQuestion 30 Explanation: This patient most likely has a spontaneous pneumothorax which is supported by the presenting symptoms of sudden onset of dyspnea and pleuritic chest pain as well as the physical exam findings of absent breath sounds and hyperresonance to percussion. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 30 questions to complete. List Return Shaded items are complete. 123456789101112131415161718192021222324252627282930End Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All doneNeed more practice!Keep trying!Not bad!Good work!Perfect!