Block 14 Pace 3 Prt 2
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Questions and Answers
- 1.
Dr. Odutola A 46-year-old man complained to his primary care physician of progressive difficulty with swallowing both solid and liquid foods, sometimes associated with choking episodes. He also experienced heaviness in the chest and weight loss. He is being treated for recurrent chest infection. The doctor requested a chest radiograph, barium swallow and meal. On review of the resulting images below, what is the most likely diagnosis?
- A.
Hodgkin’s lymphoma with metastases
- B.
Carcinoma of the lungs with metastases
- C.
Achalasia
- D.
Esophageal varices
- E.
Carcinoma of the esophagus with metastases
Correct Answer
C. AchalasiaExplanation
The most likely diagnosis based on the symptoms and the results of the imaging tests is achalasia. Achalasia is a condition characterized by the inability of the lower esophageal sphincter to relax properly, leading to difficulty in swallowing both solid and liquid foods. The symptoms of choking episodes, heaviness in the chest, and weight loss are consistent with achalasia. The barium swallow and meal would show a dilated esophagus with a narrowed lower esophageal sphincter, which is typical of achalasia. The other options, such as Hodgkin's lymphoma, carcinoma of the lungs or esophagus with metastases, and esophageal varices, are less likely based on the given information.Rate this question:
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- 2.
Dr. Goff The patient is an 18-year-old female, 65 inches/165 cm tall, who has lost 10 kg in the last six months and now weighs 41kg. Physical exam is unremarkable, with no indications for the cause of the weight loss. The patient states she is trying to look better and eating less. Because of cardiovascular complications, which eating disorder is of greatest immediate risk for the patient and thus requires treatment that emphasizes weight replacement?
- A.
Bulimia
- B.
Pica-type
- C.
Anorexia
- D.
Amnesia
- E.
Obsessive
Correct Answer
C. AnorexiaExplanation
The patient's significant weight loss, along with her desire to look better and eat less, suggests that she may be suffering from anorexia. Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight, distorted body image, and self-imposed starvation. It poses immediate risks to cardiovascular health and requires treatment that emphasizes weight replacement to restore the patient's health. Bulimia, pica-type, amnesia, and obsessive eating disorders do not align with the patient's symptoms and do not present the same level of cardiovascular risk.Rate this question:
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- 3.
Dr. Bergeron A 47-year-old diabetic man with chronic kidney disease requiring hemodialysis presents with fatigue. Physical examination reveals vague right upper quadrant discomfort, but is otherwise unremarkable. Relevant laboratory investigation shows the following: A 48-week course of ribavirin with pegylated interferon combination therapy fails to achieve a sustained virologic response (SVR); serum HCV RNA is measured to be at 104 IU/mL. Which HCV genotype and viral replication status is this patient most likely to have?
- A.
Genotype 1/RNAlow
- B.
Genotype 1/RNAhigh
- C.
Genotype 2/RNAlow
- D.
Genotype 2/RNAhigh
- E.
Genotype 3/RNAhigh
- F.
Genotype 4 /RNAlow (for discussion only)
Correct Answer
B. Genotype 1/RNAhighExplanation
This patient is most likely to have Genotype 1/RNAhigh. The fact that the patient is a diabetic man with chronic kidney disease requiring hemodialysis suggests a compromised immune system, which can make it more difficult to achieve a sustained virologic response (SVR) with treatment. Additionally, the high level of serum HCV RNA at 104 IU/mL indicates a high viral replication status. Genotype 1 is also the most common genotype in the United States, further supporting this answer.Rate this question:
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- 4.
A 23-year-old man presents with bloody diarrhea and weight loss. Colonoscopy shows patchy areas of ulceration involving the rectum, colon and terminal ileum. Biopsy of the rectum shows glandular disorder, crypt abscesses, paneth cell metaplasia, and granulomas. What is the most likely diagnosis?
- A.
Crohn disease
- B.
Irritable bowel disease
- C.
Cholera
- D.
E. coli infection
- E.
Ulcerative colitis
Correct Answer
A. Crohn diseaseExplanation
The most likely diagnosis for this patient is Crohn's disease. The presentation of bloody diarrhea, weight loss, and ulceration involving the rectum, colon, and terminal ileum are all consistent with Crohn's disease. The biopsy findings of glandular disorder, crypt abscesses, paneth cell metaplasia, and granulomas further support this diagnosis. Irritable bowel disease and ulcerative colitis are both types of inflammatory bowel disease, but the specific findings described in this case are more indicative of Crohn's disease. Cholera and E. coli infection are both infectious causes of diarrhea, but they do not typically present with the chronicity and specific findings seen in this case.Rate this question:
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- 5.
Dr. Butler A 44-year-old American traveling salesman presented with a 2-week history of epigastric pain occurring an hour after eating and waking him up at night. The pain was relieved by drinking milk and taking antacid tablets. After his physician obtained a blood test result showing antibodies against Helicobacter pylori, he was treated successfully with a proton pump inhibitor plus antibiotics. When he returned for an examination 2 years later, which of the following would you expect to be most likely present?
- A.
An episode of vomiting due to gastritis
- B.
High levels of antibodies against Helicobacter pylori
- C.
No symptoms
- D.
Recurrence of ulcer symptoms
- E.
Adenocarcinoma of the gastric cardia
Correct Answer
C. No symptomsExplanation
After successful treatment of Helicobacter pylori infection with a proton pump inhibitor plus antibiotics, it is expected that the patient would have no symptoms when he returns for an examination 2 years later. The resolution of epigastric pain and the absence of any symptoms indicate that the treatment was effective in eradicating the infection. The presence of high levels of antibodies against Helicobacter pylori is not expected because successful treatment would lead to a decrease in antibody levels. Recurrence of ulcer symptoms or the development of adenocarcinoma of the gastric cardia would indicate a failure of treatment or progression of the disease, which is not the case here.Rate this question:
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- 6.
A week after a young couple took a summer vacation, both developed diarrhea that was worsened by drinking milk and that caused them to lose weight. Their physician obtained stool specimens that showed cysts of Giardia lamblia. Which of the following exposures was most likely how the patients acquired this infection?
- A.
Drinking mountain stream water
- B.
Swimming in a pool that was adequately chlorinated
- C.
Eating ham and potato salad at a church picnic
- D.
Foreign travel to Panama
- E.
Bathing in a farm pond near cows and sheep
Correct Answer
A. Drinking mountain stream waterExplanation
The correct answer is drinking mountain stream water. Giardia lamblia is a parasite that commonly infects humans through contaminated water sources. Drinking water from a mountain stream, which may not be treated or purified, increases the risk of acquiring this infection. The symptoms of diarrhea and weight loss are consistent with a Giardia infection. The other options, such as swimming in a chlorinated pool or foreign travel, are less likely to be the source of the infection. Eating ham and potato salad or bathing in a farm pond near animals would not typically lead to a Giardia infection.Rate this question:
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- 7.
Dr. Kelly On Tuesday morning, a group of fraternity brothers presented to the student health clinic complaining of nausea, vomiting, abdominal cramping, and watery diarrhea for the past 36-48 hours. The fraternity had held a barbeque cookout for its members on the previous Saturday. The menu included chicken, deviled eggs, potato salad, and chocolate cake. A methylene blue-stained stool smear showed numerous leukocytes and red blood cells. A motile, hydrogen sulfide-producing, Gram-negative bacillus was isolated from the stool culture. What is the most likely causative agent?
- A.
Shigella sonnei
- B.
Listeria monocytogenes
- C.
Salmonella Typhimurium
- D.
Campylobacter jejuni
Correct Answer
C. Salmonella TypHimuriumExplanation
The most likely causative agent in this case is Salmonella Typhimurium. The symptoms described, including nausea, vomiting, abdominal cramping, and watery diarrhea, are consistent with a gastrointestinal infection. The fact that leukocytes and red blood cells were present in the stool smear suggests an inflammatory response, which is commonly seen in Salmonella infections. Additionally, the isolation of a motile, hydrogen sulfide-producing, Gram-negative bacillus from the stool culture is consistent with the characteristics of Salmonella Typhimurium.Rate this question:
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- 8.
A previously healthy 45-year-old woman was admitted to the hospital with a 2-day history of nausea, vomiting, fever, shaking chills, and right-sided low back pain. Physical examination was significant for right costoverterbral angle tenderness. Urine dipstick was leukocyte esterase-positive and nitrite-negative. Blood cultures obtained in the emergency department were positive in 18 hours. A Gram-stained smear of the blood is shown below Based on this information, what is the most likely causative agent?
- A.
Escherichia coli
- B.
Candida albicans
- C.
Enterococcus faecalis
- D.
Klebsiella pneumoniae
- E.
Staphylococcus saprophyticus
Correct Answer
C. Enterococcus faecalisExplanation
Based on the given information, the most likely causative agent is Enterococcus faecalis. This is supported by the symptoms of fever, shaking chills, and right-sided low back pain, which are consistent with a urinary tract infection. The positive leukocyte esterase on the urine dipstick suggests the presence of white blood cells, indicating an infection. Additionally, the positive blood cultures further support the presence of a bacterial infection. Enterococcus faecalis is a common cause of urinary tract infections and is known to cause symptoms such as those described.Rate this question:
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- 9.
Dr. Beevers A 27-year-old woman complains of increasingly worsening abdominal pain, excessive gas, bloating, and a continual feeling of fullness. The patient was recently diagnosed with bulimia nervosa, which she has been suffering with for the past several years. The patient admits that part of her disease process is the excessive ingestion of an over-the-counter medication several times each week, particularly after eating binges, in order to purge herself of excess calories. A barium enema radiographic examination is performed and it reveals that the patient is suffering with a cathartic colon (neuromuscular damage resulting in the loss of haustral folds). What is the mechanism of action of the drug that is most likely causing this adverse effect in this patient due to her misuse of the pharmacological agent?
- A.
Increasing GI luminal fluid osmolarity
- B.
Direct stimulation of the ENS
- C.
Increasing water and lipid content of fecal matter
- D.
Antagonism of u-opioid receptors in the intestines
- E.
Stimulation of ClC-2 activity
Correct Answer
B. Direct stimulation of the ENSExplanation
The drug that the patient is misusing is most likely directly stimulating the enteric nervous system (ENS). This stimulation is causing neuromuscular damage in the colon, leading to the loss of haustral folds and the development of a cathartic colon. This is consistent with the patient's symptoms of abdominal pain, excessive gas, bloating, and a continual feeling of fullness. The direct stimulation of the ENS is likely disrupting the normal functioning of the colon, resulting in these adverse effects.Rate this question:
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- 10.
A 45-year-old male physician conducting medical mission work in Western Africa begins displaying the signs and symptoms of lassa hemorrhagic fever. The man is evacuated to the nearest hospital, and after being placed in quarantine, the patient is started on IV administration of an appropriate drug. After several days of therapy, the patient’s symptoms dramatically improve and he eventually makes a full recovery. Which of the following drugs was most likely used to treat this patient’s viral infection?
- A.
Telbivudine
- B.
Ribavirin
- C.
Entecavir
- D.
Fosaprepitant
- E.
Natalizumab
Correct Answer
B. RibavirinExplanation
The correct answer is Ribavirin. Ribavirin is an antiviral drug that is commonly used to treat viral infections, including Lassa hemorrhagic fever. It has been shown to be effective in reducing the severity and duration of symptoms in patients with this viral infection. Therefore, it is likely that Ribavirin was used to treat the patient in this scenario, leading to his dramatic improvement and full recovery.Rate this question:
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- 11.
Dr. Mallik A 22-year-old man was advised to take ciprofloxacin for his lower respiratory tract infection. After 4 days he felt very weak and went to the doctor again. On examination, he looked anemic as well as jaundiced; lab values showed he had increased levels of unconjugated bilirubin and reticulocytes in the blood. What is the probable cause of the jaundice?
- A.
Glucose 6 phosphate deficiency
- B.
Congenital spherocytosis
- C.
Crigler Nagger syndrome
- D.
Sickle cell anemia
- E.
Gilbert syndrome
Correct Answer
A. Glucose 6 pHospHate deficiencyExplanation
The probable cause of the jaundice in this case is glucose 6 phosphate deficiency. Glucose 6 phosphate deficiency, also known as G6PD deficiency, is an inherited condition that affects the red blood cells. It leads to a decreased ability of the red blood cells to protect themselves against oxidative damage, resulting in the destruction of red blood cells and anemia. This can cause an increase in unconjugated bilirubin levels, leading to jaundice. The presence of increased reticulocytes in the blood also suggests the possibility of hemolysis, which is commonly seen in glucose 6 phosphate deficiency.Rate this question:
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- 12.
Dr. Kolli 12) A 42-year-old black asthmatic woman presents to the emergency department with the acute onset of shortness of breath and wheezing. She has a 5-year history of hypertension, well-controlled with 50 mg daily hydrochlorothiazide. Therapy with aerosolized albuterol in the emergency department improves her wheezing. However, she becomes progressively weaker and her deep tendon reflexes dramatically decrease. Physical examination is as above with BP 120/85 mmHg. Laboratory studies on admission show the following: Serum Electrolytes (mEq/L): Na: 141, Cl: 103, K: 3.1, HCO3: 32 Arterial Blood Gases: pCO2: 40mmHg, HCO3: 31 mEq/L, pH: 7.50 Laboratory studies two hours later show the following: Serum Electrolytes (mEq/L): Na: 140, Cl: 102, K: 2.1, HCO3: 29 Arterial Blood Gases: pCO2: 50mmHg, HCO3: 31 mEq/L, pH: 7.40 Which of the following is the most likely cause of her hypercapnia?
- A.
She is developing status asthmaticus.
- B.
Pneumonia is superimposed on her asthmatic attack
- C.
She has diffuse vasculitis affecting her lungs and muscles
- D.
Therapy with hydrochlorothiazide
- E.
The bronchodilator therapy
Correct Answer
E. The bronchodilator therapyExplanation
Explanation: Albuterol decreases [K+], causing metabolic alkalosis. CO2 increases to compensate.Rate this question:
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- 13.
A 76-year-old man presents to the emergency department. He had influenza about a week ago and now presents with diffuse muscle pain and weakness. His past medical history is remarkable for osteoarthritis, for which he takes ibuprofen, and hypercholesterolemia, for which he takes lovastatin. Physical examination reveals blood pressure of 130/90 with no orthostatic change. The only other finding is diffuse muscle tenderness. Laboratory data include: BUN: 30 mg/dL ,Creatinine: 6 mg/dL , K: 6.0 mEq/L , Uric acid: 18 mg/dL ,Ca: 6.5 mg/dL UA: 2+ blood, 2+ protein. Microscopic study shows muddy brown casts and 1 to 2 RBC/HPF (red blood cells/high power field). Which of the following is the most likely diagnosis?
- A.
Ibuprofen-induced allergic nephritis
- B.
Prerenal failure due to volume depletion
- C.
Rhabdomyolysis-induced acute renal failure
- D.
Urinary tract obstruction
- E.
Hypertensive nephrosclerosis
Correct Answer
C. Rhabdomyolysis-induced acute renal failureExplanation
The patient's presentation of diffuse muscle pain and weakness, along with laboratory findings of elevated BUN, creatinine, and potassium levels, as well as the presence of blood and protein in the urine, suggest acute renal failure. The presence of muddy brown casts and RBCs in the urine, along with the history of recent influenza, are indicative of rhabdomyolysis-induced acute renal failure. Rhabdomyolysis occurs when muscle breakdown releases myoglobin into the bloodstream, leading to renal damage. The combination of muscle symptoms, laboratory findings, and urine analysis supports this diagnosis.Rate this question:
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.JPG "Dr. Bergeron
A 47-year-old diabetic man with chronic kidney disease requiring hemodialysis presents with fatigue. Physical examination reveals vague right upper quadrant discomfort, but is otherwise unremarkable. Relevant laboratory investigation shows the following:
A 48-week course of ribavirin with pegylated interferon combination therapy fails to achieve a sustained virologic response (SVR); serum HCV RNA is measured to be at 104 IU/mL. Which HCV genotype and viral replication status is this patient most likely to have?")
.JPG "A previously healthy 45-year-old woman was admitted to the hospital with a 2-day history of nausea, vomiting, fever, shaking chills, and right-sided low back pain. Physical examination was significant for right costoverterbral angle tenderness. Urine dipstick was leukocyte esterase-positive and nitrite-negative. Blood cultures obtained in the emergency department were positive in 18 hours. A Gram-stained smear of the blood is shown below
Based on this information, what is the most likely causative agent?")
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Mar 17, 2023Quiz Edited by
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Oct 25, 2012Quiz Created by
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