Medicine Third Long Exam 2009-2010
1) Dermographism is usually associated with:
a. Bullae
b. Nebule
c. Wheal
d. Macule
2) Pigmented macules of Peutz-Jeghers Syndrome are always present on:
a. External nares
b. Lips and oral mucous membranes
c. Fingers
d. Axillary folds
3) Ash, leaf-shaped hypopigmented macules on arms, legs, and trunk are seen in:
· Tuberous sclerosis
4) A person who scratches a pruritic lesion may develop:
a. Excoriations
b. Lichenification
c. Crusts
d. Any of the above
5) Which of the following is of utmost importance in the history of a patient diagnosed with allergic contact dermatitis?
a. Drug ingestion
b. Travel history
c. Hobbies or occupation
d. Sexual history
6) Forty-three year old saleslady complains of an ulcer on the right medial malleolus of five months’ duration. When you inspected her legs, it revealed varicosities. What is your diagnosis of the ulcer?
· Venous
7) Heliothrope rash is seen in:
· Dermatomyositis
8) A seven year old with fish-like scales on both shins of two years’ duration will have most likely which of the following?
a. Lichen simplex chronicus
b. Lichen planus
c. Allergic contact dermatitis
d. Atopic dermatitis
9) A 55-year old male scratches the dorsum of his foot with a comb whenever it itches. After a few months, which of the following lesions will most likely be seen?
a. Lichenification
b. Scar
c. Wheal
d. Nodule
10) In a lesion of a person with a family history of atopy, the major criteria for acute dermatitis is:
a. Typical morphology or distribution
b. Pruritis
c. Chronicity
d. All of the above
11) Pellagra appears to be caused by a deficiency of:
· Nicotinic acid (Vitamin B3)
12) A nineteen-year-old nursing student consults for recurrent deep-seated tapioca-like pruritic vesicles on the sides of her fingers affecting both hands. What will you prescribe as treatment?
· Clobetasone cream
13) Steroids are discouraged in the treatment of
a. (audio was unclear…sorry) dermatitis (based from our lecture, steroids should be avoided in the treatment of asteatotic eczema)
14) Pretibial myxedema is associated with
a. adrenal problem
b. hyperlipidemia
c. thyroid dysfunction
d. diabetes
15) Gardner’s syndrome presents with:
a. Polyposis coli
b. epidermatitis
c. skeletal abnormalities
d. all of the above
16) A positive ostrich sign is a pathopneumonic for which of the following scaling disorder?
a. Keriatis (audio was unclear…sorry) vulgaris
17) Herald patch is the usual lesion seen in:
b. Pityriasis rosea
18) Pemphigus vulgaris, an autoimmune blistering disease presents with flaccid bullae which easily ruptures on the level of split of which layer?
a. Subepidermal
b. Intradermal
c. Subterial
d. Subcutaneous
19) 35 year old female with Stevens Johnson syndrome secondary to anticonvulsants, what type of lesion do you look for?
c. Target lesion
20) 65 year old male who has an ulcer on the medial malleolar area: the diagnosis is
a. Arterial
b. Neurotropic
c. Venous
d. Decudeter
21) A scar which spreads beyond the initial injury is
b. keloid
22) Sand? allopecia may be one of the dermatologic presentation of
a. SLE
b. Syphilis
c. Both
d. Neither
23) Alopecia in SLE is caused by
C. an autoimmune damage to the hair follicle
24) A 35 year old male with multiple patches and fine scaling at the periphery on?? the trunk. The diagnosis is Pityriasis Rosea. PE revealed similar lesions on the palms and soles. You now suspect that the patient has:
a. Scabies
b. Folliculitis
c. Secondary Syphilis
d. Psoriasis
25.) Diagnosis for syphillis? C. VDRL
26.) The lesion/ cutaneous manifestation for lichen planus? D. Wickham’s striae
27.) Neurofibromatosis will present: A. Café au lait spots
28.) In meningococcemia, lesions are actually: E. Septic emboli
29.) Basal cell carcinoma presents with C. Diabetic ulcer
30.) Polycystic ovarian syndrome presents with B. Hirsutism
31.) 30-year old female, asthmatic, complains fish-like scales on the shin. Diagnosis? A. Ichthyriosis
32.) A common deformity of the wrist seen in patients with Rheumatoid Arthristis
a. ulnar deviation c. median deviation
b radial deviation d.Swan-like deformity
33.) Muscles form the rotator cuff except:
a.Infraspinatus c. Teres Minor
b. Suprapinatus d. Teres Major
34.) Full abduction of the shoulder has two components, one of which is:
a. movement of clavicle and scapula in relation to the thorax
b. movement includes extension and supination of the forearm
c. movement includes flexion and pronation of the forearm
d, rotation of the arm externally
35.) These are functions of talo-calcaneal and transverse tarsal joints:
a. dorsiflexion and plantar flexion
b. adduction and abduction of the ankle joint
c. medial and lateral deviation of the feet
d. inversion and eversion of the feet
36.) Which of the following does not form the knee joint?
a. fibula c. femur
b. tibia d. patella
37) When the patient is lying down, raise the leg…. (did not understand, sorry)…move laterally, what will happen?
a. the… (did not understand, sorry)… is abducted
b. the hips remain in their position
c. the hip is abducted
d. the femur rotates internally
38) In examining the patient from the side, one of these will be abnormal:
a. cervical convexity
b. thoracic concavity
c. lumbar concavity
d. sacral convexity
39) Which of the following statements is INCORRECT?
a. the most mobile portion of the spine is the neck
b. lateral bending involves the cervical spine from the second to the seventh vertebra
c. flexion and extension occurs freely between the head and the fourth cervical
d. rotation occurs primarily between the second and third vertebra
40) Asking the patient questions like if he/she has difficulty with walking, climbing stairs, getting up from bed is very important in assessing:
a. pain
b. functional status
c. inflammation
d. decreased activity
41) The focused and systematic 5-minute musculoskeletal exam is known as:
a. GIRLS
b. GOALS
c. GALS
d. GODS
42) Gait is assessed by the following EXCEPT:
a. free movement of shoulders
b….(did not understand, sorry)… and symmetry of the legs
c. spine curvature
d. shoulder and arm movement
43) Schouder’s test is said to be normal when:
a. the distance between two points is increased by at least 5 centimeters
44) (did not understand, sorry)… motion of the thumb and index finger is test for what?
c. fine precision grip
45) To determine the functional status of the hand, you may perform the following EXCEPT:
a. ask the patient to make a fist
b. do a power grip
c. do fine precision grip
d. squeeze the hand at the area of metacarpophalangeal joint
46) As you observe the patient while he walks, you noticed that he has a tilt to one side. This gait is called:
a. Gala gait
b. Arthralgic gait
c. Anthalgic gait
d. Arthritic gait
47) What is called the patients calling card?
a. head
b. (did not understand, sorry)…
c. hands
d. face
48) Which is not seen when examining the spine from behind?
a. spinal curvature
49. Asking the patient to put his hands at the back of his neck, it detects if the patient is (……)
ANS. B)Shoulders
50. All of the following are signs of general inflammation except.
ANS. D) Crepitation
51. The presence of this in the (….) is called what sign?
ANS. A. Bulb sign
52. Sings of osteoarthritis in the knee except
ANS. (Valvus??)
53. Which of the following lacks a bigger (….)
ANS. A) Thumb
54. Hyper (extension???) of the proximal IP (….) deflection at the distal IP (….) is known as what deformity?
ANS. B) Swan neck deformity
55. (….) of the cervical spine, you ask the patient to do what?
ANS. C) Chin to shoulder
56. Movement of the (elbow joints??) are all of the following except
ANS. A) Rotation
57. (computation for ANION GAP)
ANS. 18
58. A lobar(….) concentration may be seen in (….) simple acid base disorder
ANS. B) Metabolic acidosis and Respiratory Alkalosis
59. (Seizures??) of confrontation for primary acid base disturbance
ANS. B) Confrontation is not complete
61) The normal ratio of bicarbonate to CO2 is:
a. 1:1 c. 10:1
b. 2:1 d. 20:1
62) Pneumonia most likely results to which acid-base derangement?
a. metabolic acidosis c. respiratory acidosis
b. metabolic alkalosis d. respiratory alkalosis
63) What is the pCO2 if the plasma CO2 concentration is 1.144 mmol?
a. 38
64) What is the unit in mmHg to which pCO2 will fall in response to metabolic acidosis?
a. 4-6 c.12-14
b.16-18 d.8-10
65) Which of the following is a normal anion gap result?
a. 11 c.16
b. 18 d. 8
66) A cause of high anion gap acidosis is:
c. End stage renal disease
67) An effect of metabolic acidosis:
a. central venodilatation c. decreased myocardial contractility
b. peripheral vasoconstriction d. decreased tissue unloading
68) Metabolic alkalosis develops in..
a. hypokalemia
69) Hyperalbuminemia, low protein leads to (?)
a. increased anion gap
b. decreased anion gap
70) Which of the following results to a primary respiratory alkalosis?
b. hypoxemia
71) Supportive management of respiratory acidosis include:
a. c. bicarbonate infusion
b. rapid correction of hypercapnea d. severity of disorder influences management
72) pCO2 results of 34 mmHg may be seen in patients with:
a. metabolic acidosis c. acute respiratory acidosis
b. metabolic alkalosis d. chronic respiratory acidosis
73.) pH=7.38 pCO2=32 HCO3=18.4 Anion gap=14
b. Metabolic Acidosis
74.) ……….
a. ………..
75.) ……….
d. Respiratory Acidosis
76.) ………..
c. Metabolic Alkalosis
77.) A 40 y.o. male ….. fever, on and off cough ….. P. E revealed decreased fremitus and dullness to percussion ……
d. Pleural Effusion
78.) Patient complained of cough and dyspnea …..
b. Atelectasis
79.) …... prolonged expiratory time …..
b. …..
80.) ….. paralyzed hemidiaphragm….., deep expiration …..
b. as it moves upward into the thoracic cavity
81.) Stridor is present in what condition?
c. Laryngeal edema
82.) Which of the following is true of sound ….. by the normal lung?
a. whispered words are unintelligibly heard on auscultation
83.) Which of the following will characterize rhonchi?
c. they change in character after a strong productive cough
84.) ……….
d. prevent premature ….. of the distal airway
85. Kussmauls breathing most likely entails that patients have Metabolic acidosis
86. Where is tympany normally appreciated on the chest wall? Over the left lower anterior chest while the patient is supine
87. 51yr old female has cough 3 weeks, worries that her father has been diagnosed with lung CA a month ago and fears she might also develop the same disease Psychogenic cough
88. 27 male, reproductive cough over 3 weeks, TB suspected… Sputum exam
89. Which of the following is true of cough variant asthma Large airways are predominantly affected
90. Complications of chronic cough… except (not sure)? Rib fracture
91. 19 year old co-ed, cough 3 weeks, fever, nasal catarrhal, body malaise, had a flu, treated symptomatically, sent home to rest. Symptoms relieved but noted cough 3 days after starting medications Post infectious bronchopneumonia
92. Post-tussive syncope is due to Acute drop in cardiac output while coughing
93. 56 male, cough of 3 months, seen 3 doctors, symptomatic treatment alleviating cough but not to his satisfaction, HTN & IHD, smokes readily, has other current medications: aspirin, captopril, metoprolol, ranitidine, multivitamins. Which of the following medications will you suspect to be causing cough?
Captopril and Metoprolol
94. Cough that gets worse at night is characteristic of: GERD
95. Which of the following describes chronic bronchitis Productive cough for at least 2 years
96. Most common cause of cough is: Upper airway cough syndrome
Pathology 3rd Long Exam
1. The “global burden of disease” has reported a 50 fold increase in mortality of children under 5 years of age in underdeveloped countries. The major cause of death would be due to:
A. Congenital disease C. malnutrition and infections
B. Cardiovascular disease
D. malignant tumors
2. Recent increases in levels of greenhouse gases are strongly correlated with warming of the earth. The country with the largest emission of CO2 is:
A. United States C. Russia
B. China D. Saudi Arabia
3. An example of a phase 1 xenobiotic metabolizing enxyme that generates DNA- binding metabolic from benzo[a] pyrene from cigarette smoke causing cancer is:
A. Cytochrome P-450
B. Biomethylation
C. Glucouronidation
D. Conjugation to reduced glutathione
4. Mortality and morbidity caused by mercury contamination (Minimata disease) is:
A. Usage of hospital based equipment with mercury
B. Vaccination using thimesoral as vaccine preservative
C. Mercury vapors in dental amalgams
D. Ingestion of organism from contaminate rivers
5. The mechanism of toxicity in the contamination of Tokyo subways by the organophosphate pesticide SARIN is:
A. Acetylcholinesterase inhibition
B. Blocking the re-uptake of acetylcholine
C. CNS depression
D. Pulmonary edema causing respiratory failure
6. The substance in cigarette that makes it addictive is:
A. Tar
B. Nitrosamine
C. Nicotine
D. Polycyclic aromatic hydrocarbons
7. The flushing syndrome in an alcoholic drinker is due to genetic variant with inactivity of:
A. Alcohol dehydrogenase
B. Acetaldehyde dehydrogenase
C. Mirosomal ethanol – oxidizing system
D. Catalase
8. The use of anabolic steroids by athletes can lead to:
A. Inhibition of LH and FSH
B. Testicular hypertrophy
C. Decrease estrogen
D. All of the above
9. The mechanism of action of cocaine is/are:
A. Blocks re-uptake of Dopamine
B. Stimulate pre-synaptic norepinephrine release
C. Inhibits acetylcholinesterase
D. All of the above
E. A and B only
10. The unit of measurement of the dose of radiation that measures the relative biologic effect is/are:
A. Curie or roentgen
B. Gray or rads
C. Sievert or “rem”