quick review questions

11.       Which imaging method is most often indicated for cases of generalized trauma?

a.       MRI

b.      US

c.       CT

d.      Xray

22.       What is the mechanism of Albuterol?

a.       Alpha 1-adren agonist

b.      SSRI

c.       B2 agonist

d.      Dopamine agonist

33.       26 year old male presents with a 3 week history of several swollen and painful toes and knees. He has a PMH of conjunctivitis. He also describes some low back pain that is worse in the AM. What is the most likely Dx?

a.       Lyme dz

b.      RA

c.       Septic arthritis

d.      Reiter’s syndrome

44.       27 year old man develops bilateral parotid gland swelling and orchitis, and is generally ill with fever of 102F. What is most likely elevated in this pt?

a.       ALT

b.      Amylase

c.       Ceruloplasmin

d.      Creatine phosphokinase MB isoenzyme

55.       11 year old female develops a gastrointestinal infection with cramping and watery stools. After several day she begins to pass blood in her stool and is suffering from signs of dehydration. She has decreasing urine output and rising blood urea nitrogen. Total blood count reveals anemia, thrombocytopenia and schistocytes. What is the most likely bacterial infection?

a.       Shigella

b.      Campylobacter

c.       Vibrio

d.      Salmonella

66.       Which of the following tests is considered positive when low back pain radiates into the lower extremity, indicating facet syndrome, fracture or disc involvement?

a.       Soto-hall

b.      Wrights

c.       Kemps

d.      McMurray

77.       Which of the following is NOT a side effect of Yohimbe?

a.       Anxiety or panic attacks

b.      HA

c.       Nausea

d.      Hypotensive crisis

88.       Which antiviral drug is also prescribed for Parkinson`s disease?

a.       Amantiadine

b.      Amiodarone

c.       Terbinafine

d.      Tolterodine

99.       A blood sample from a patient with polycythemia vera is sent for complete blood count. Which of the following blood components is most likely to be reported within normal limits?

a.       Platelets

b.      RBC

c.       Lymphocytes

d.      Neutrophils

110.   Which of the following is a radiographic contrast study for evaluation of the vascular system and chambers of the heart?

a.       Angiography

b.      Angiocardiography

c.       Echocardiography

d.      Encephalography

111.   Which of the following homeopathic remedies is most appropriate for a patient with anal prolapse and diarrhea?

a.       Aurum and baptisia

b.      Tabacum and ignatia amara

c.       Ledum and drosera

d.      Suphur and pulsatilla

112.   Psychosocial and environmental problems fall under which of the following DSM-IV axes?

a.       I

b.      II

c.       III

d.      IV

113.   Most of the testosterone secreted by the testes exists in the plasma in which of the following forms?

a.       Testosterone bound to sex-steroid binding globulin

b.      Testosterone bound to albumin

c.       Free testosterone

d.      Free dihydrotestosterone

114.   In Erikson's developmental model, autonomy vs shame and doubt occurs at approximately which of the following ages?

a.       0-18months

b.      18months-3years

c.       13-18 years

d.      25-40years

115.   Evaluation the bile ducts and gallbladder is accomplished by which of the following?

a.       Cystography

b.      Antegrade urethrogram

c.       Cholecystography

d.      Lower gastrointestinal study

116.   Homan`s test (in which dorsiflexion of foot elicits pain in posterior calf):

a.       Is a safe but largely unreliable way to diagnose a DVT

b.      Is a potentially unsafe but reliable way to diagnoses a DVT

c.       Safe and reliable

d.      Potentially unsafe and largely unreliable

117.   Which of the following organisms is the most common cause of community-acquired pneumonia?

a.       Chlamydia pneumonia

b.      Streptococcus pneumonia

c.       Haemophilus influenza

d.      Mycoplasma pneumonia

118.   Which of the following homeopathic remedies is appropriate for a patient who has chills that travel up the spine and headache that travels from the occiput, over the vertex to the frontal region?

a.       Gelsemium

b.      Eupatorium perfoliatum

c.       Pulsatilla

d.      Magnesium phosphoricum

119.   Which of the following is the method of choice for staging cervical, uterine, vulvar, and vaginal cancers?

a.       US

b.      MRI

c.       CT

d.      Radionuclide scans

220.   In which trimester of pregnancy is an MRI contraindicated?

a.       First

b.      Second

c.       Third

d.      Not safe during any stage of pregnancy

221.   Which of the following is a calcium channel blocker?

a.       Verapamil

b.      Atenolol

c.       Benazepril

d.      Etoposide

222.   The usual concentration of a continuous, peripheral IV infusion of potassium chloride is ______ and the maximum rate is _______.

a.       20-40mEq/L; 10mEq/hour

b.      2-4 mEq/L; 100 mEq/hour

c.       20-40 mEq/L; 100 mEq/hour

d.      40-60 mEq/; 100 mEq/hour

223.   Which of the following, if insufficient in the diet, most strongly influences the conversion of T4 to T3?

a.       Selenium

b.      Iodine

c.       Zinc

d.      Tyrosine

224.   Which of the following is true regarding cantharis vesicatora?

a.       Cantharis is > with hear but < with cold water

b.      Cantharis is > with urination

c.       Cantharis is > with cold bur < with cold water

d.      Cantharis is > with tobacco

225.   Fundoscopy reveals optic nerve atropy and cupping. Which of the following is most likely?

a.       Cataracts

b.      Diabetic neuropathy

c.       Amblyopia

d.      Glaucoma

226.   Downward pressure on a patient`s arm while  he is asked to extend his neck and hold a deep breath causes an obliteration of his radial pulse. A ________ should be charted, which is supports a diagnosis of ___________.

a.       Negative Adson’s test; Rotator cuff syndrome

b.      Positive Lipmans; Rotator cuff

c.       Positive Adsons; TOS

d.      Neg Lipmans; TOS

227.   Chvostek`s sign is elicited by ____________if the serum calcium is __________ ?

a.       Tapping on the face at a point below the zygomatic bone; low hypocalcemia

b.      Tapping on the face at a point below the zygomatic bone; high hypercalcemia

c.       Inflating a sphygmomanometer  above systolic BP for several min; low

d.      Inflating a sphygmomanometer  above systolic BP for several min; high

228.   A lumbar flexion exercise is contraindicated in which of the following?

a.       Spondyloysthesis of the lumbar spine

b.      Lateral posterior herniation

c.       Degenerative disk disease of the spine

d.      Lateral spinal stenosis of the spine

229.   _________ lung carcinoma has a __________ association with smoking and is generally associated with a poorer prognosis.

a.       Small cell; weaker

b.      Small cell; stronger

c.       Non-small cell; stronger

d.      Non-small cell; weaker

 

Answers

1) c. CT

2) c. B2 agonist

3) d. Reiter’s

This is a case of Reiter`s syndrome. Patients typically present with the acute onset of arthritis (usually asymmetric and additive), with involvement of new joints occurring over a period of a few days to two weeks. Joints of the lower extremities are the most commonly involved, but wrists and fingers can also be affected.  Up to 75% of patients are HLA-B27 positive.

4) b. Amylase

Amylase is the correct answer. The disease is mumps, caused by a paramyxovirus. In children, mumps causes a  transient inflammation of the parotid glands, and less commonly, the testes, pancreas, or central nervous system. Mumps tends to be a more severe disease in adults, involving the testes (orchitis) and pancreas (elevation of serum amylase).  

Ceruloplasmin is a copper-carrying protein that is decreased in Wilson`s disease. ALT is a markers for hepatocellular damage. CPK-MB is the isoenzyme of CPK that is relatively specific for the myocardium, increased in the early stages of a myocardial infarction.

5) a. Shigella

The correct answer is Shigella. This patient has developed hemolytic-uremic syndrome. HUS in children usually develops after a gastrointestinal or flu-like illness, and is characterized by bleeding, oliguria, hematuria and microangiopathic hemolytic anemia.

Long-term consequence of Campylobacter infection is a reactive arthritis or full-blown Reiter`s syndrome. Salmonella infections are almost all non-typhoid inflammatory diarrhea, producing a simple enterocolitis that may proceed to sepsis in some cases. Typhoid fever (produced by Salmonella typhi and S. paratyphi) produces a protracted illness that progresses over several weeks and includes rash and very high fevers, but not HUS.  Vibrio infections produce copious amounts of watery diarrhea, and the major risk of cholera and other Vibrio enteritides is shock due to hypovolemia or electrolyte loss.

6) c. Kemps

The correct answer is Kemp`s test.

The Soto-Hall test is used classically to screen for spinal meningitis. Wright`s test is used to evaluate thoracic outlet syndrome and more specifically, hyperabduction syndrome. McMurray`s test evaluates a lateral meniscal tear in the knee.

7) d. hypotensive

Yohimbe tends to produce hypertension, (not hypotension) in overdose. Other symptoms include: anxiety, panic attacks, high blood pressure, increased heart rate, irritability, headache, nausea, skin flushing, sweating, dizziness, frequent urination, water retention, rise in body temperature, and hyperactivity, weakness, paralysis, gastrointestinal problems, hallucinations, and psychosis.

8) a. amantadine

The correct answer is amantadine. Abrupt discontinuation of this drug can provoke Parkinsonian crisis.

Amiodarone is an antiarrhythmic agent used for various types of tachyarrhythmias. Tolterodine is a muscarinic antagonist used to decrease detrusor muscle pressure and increase residual urine volume. It is used to treat an overactive bladder and urge incontinence. Terbinafine (Lamisil) is an allylamine antifungal.

9) c. Lymphocytes

The only hematologic cell line which is not increased in polycythemia vera is the lymphocytic line, and the lymphocyte count is generally normal. Polycythemia vera is an example of a myeloproliferative disorder, a neoplastic disease of multipotent myeloid stem cells with the capacity to differentiate into erythrocytes, megakaryocytes, or granulocytes. The complications of polycythemia vera are generally due to increased blood viscosity and a tendency toward thrombosis. Without regular phlebotomy, death usually occurs within months of diagnosis.

10) b. angiocardiography

Angiography is an intravenous radiographic contrast study evaluating the vascular system, not the chambers of the heart.

11) b. tabacum and ignatia

Both tabacum and ignatia may present with anal prolapse that is associated with diarrhea.

12) d. IV

13) a. test bound to sex hormond binding globulin

The majority of circulating testosterone is bound to plasma protein (around 98%), rather than existing in free form. Of this, a majority is bound to a specific sex (or gonadal) steroid-binding protein, and a minority is bound to albumin.

14) b. 18months-3years

15) c. cholesystography

16) d. unsage and unreliable

Homan`s test is of little diagnostic value and is theoretically dangerous because of the possibility of dislodgement of loose clot.

17) b. strep pneumonia

The most common bacteria implicated in community-acquired pneumonia is the pneumococcus, Streptococcus pneumoniae.

Other organisms frequently implicated in patients less than age 60 without comorbidity include Mycoplasma pneumoniae, respiratory viruses, Chlamydia pneumoniae, and Haemophilus influenzae.

Chlamydia pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae are important causes of community-acquired pneumonia, but are not the most frequent causes.

Staphylococcus aureus is not a detractor and is an important cause of community-acquired pneumonia (particularly in the elderly and in patients with comorbidity), but is not the most frequent.

18) a. gelsemium

A typical gelsemium headache begins in the cervical spine and radiates to the forehead, causing a bursting sensation in the forehead and eyeballs. It is worse mental exertion, smoking, heat of sun, and lying with the head low.

19) b. MRI

20) a. first tri

MRI is avoided during first trimester due to rapid organogenesis.

21) a. verapamil

Verapamil is a calcium channel blocker. Atenolol is β-adrenergic receptor blocker. Benazepril is an angiotensin converting enzyme inhibitor. Etoposide is an inhibitor of the enzyme topoisomerase II, used as a form of chemotherapy.

22) a. 20-40mEq/L; 10mEq/hour

The usual concentration of a continuous, peripheral IV infusion of potassium chloride is  20-40 mEq/L and the maximum rate is 10 mEq/hour. The maximum safe daily dose is 40-200 mEq potassium/day.

23) a. selenium

Deiodinases are unusual in that the enzyme contains selenium, in the form of an otherwise rare amino acid selenocysteine.

24) c. >cold but <cold water

Cantharis is better with cold but worse with cold water. Cantharis is also worse around tobacco smoke and the pain with urination is aggravated with voiding.

25) d. glaucoma

Cupping is the hallmark physical finding with glaucoma.

26) c. + adson; TOS

The correct answer is positive Adson`s test and thoracic outlet syndrome. The two groups of people most likely to develop TOS are those suffering neck injuries in motor vehicle accidents and those who use computers in non-ergonomic postures for extended periods of time. The syndrome can involve the compresssion of any of the thoracic outlet components including the brachial plexus, the subclavian artery, or the subclavian vein. Adson's test is considered positive if it produces a diminution of the pulse or if it produces other symptoms (pain, paraesthesia etc).

Lipman`s test checks for bicipital tendinitis by directly palpating the proximal bicipital tendon. Rotator cuff syndrome may be evaluated with the impingment test (aka Neer`s test, aka Hawkins-Kennedy test).

27) a. tapping the face; low

Tapping on the face at a point just anterior to the ear and just below the zygomatic bone, low (hypocalcemia) is the correct answer. A positive finding is twitching of the ipsilateral facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia.

This should not be confused with Trousseau`s sign, elicited by inflating a sphygmomanometer cuff above systolic blood pressure for several minutes. Postitive response is muscular contraction including flexion of the wrist and metacarpophalangeal joints, hyperextension of the fingers and flexion of the thumb on the palm, suggestive of neuromuscular excitability caused by hypocalcemia.

28) b. later post herniation

29) b. small cell; stronger

Small cell lung carcinoma (SCLC, also called `oat cell carcinoma`) is less common, has a strong association with smoking and ultimately carries a worse prognosis than non-small cell carcinoma.

The non-small cell lung carcinomas (NSCLC) are grouped together because their prognosis and management are similar. There are three main sub-types: squamous cell lung carcinoma, adenocarcinoma, and large cell lung carcinoma. NSCLCs are more common, not as strongly associated with smoking and generally carry a more favorable prognosis.

For the purposes of the NPLEX, SCLC is more likely to require chemotherapy and radiation and NSCLC is more likely to be treated and cured with surgery alone.