Cardiology and Hematology Review
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Questions and Answers

A patient presents with end-stage renal disease and severely elevated potassium levels unresponsive to conventional treatments. What is the most appropriate next step in management?

  • Loop diuretic administration
  • Dietary potassium restriction
  • Sodium bicarbonate administration
  • Dialysis (correct)

Which of the following represents the best initial treatment strategy for a patient diagnosed with stage 1 chronic kidney disease accompanied by proteinuria?

  • Angiotensin-converting enzyme (ACE) inhibitor therapy (correct)
  • High-dose steroid therapy
  • Calcium channel blocker therapy
  • Aggressive diuretic therapy

Analysis of a patient's kidney stone reveals that it is primarily composed of which of the following, representing the most common cause of nephrolithiasis?

  • Cystine stones
  • Uric acid crystals
  • Struvite stones
  • Calcium oxalate crystals (correct)

A 45-year-old woman with a history of systemic lupus erythematosus develops new onset proteinuria and hematuria. Which of the following renal conditions is most likely?

<p>Lupus nephritis (B)</p> Signup and view all the answers

In a patient with chronic kidney disease, which of the following clinical findings is the clearest indication for initiating dialysis?

<p>Fluid overload unresponsive to diuretics (B)</p> Signup and view all the answers

Which of the following etiologies is the most common culprit behind nephrogenic diabetes insipidus?

<p>Lithium toxicity (D)</p> Signup and view all the answers

A 25-year-old female with recurrent UTIs presents with hematuria. Urinalysis reveals RBC casts. What is the most likely underlying cause?

<p>Glomerulonephritis (B)</p> Signup and view all the answers

Which of the following metabolic derangements is a well-recognized complication of nephrotic syndrome?

<p>Hyperlipidemia (B)</p> Signup and view all the answers

A patient's lab results indicate elevated levels of homocysteine and methylmalonic acid. Which condition does this most likely suggest?

<p>Vitamin B12 deficiency (B)</p> Signup and view all the answers

A hematologist is reviewing a patient's bone marrow sample and identifies the Philadelphia chromosome. Which hematologic malignancy is most closely associated with this genetic abnormality?

<p>Chronic Myelogenous Leukemia (CML) (D)</p> Signup and view all the answers

A doctor notices a sharp drop in a hospitalized patient's platelet count after the administration of heparin. What condition should the doctor suspect?

<p>Heparin-Induced Thrombocytopenia (HIT) (A)</p> Signup and view all the answers

A patient presents with bone pain, elevated calcium levels, and impaired kidney function. Further testing reveals an M-protein spike. Which condition is most likely?

<p>Multiple Myeloma (A)</p> Signup and view all the answers

Genetic testing confirms a mutation leading to excessive iron absorption in a patient. What is the most probable primary cause of their iron overload?

<p>Hemochromatosis (C)</p> Signup and view all the answers

A 55-year-old male with a history of excessive alcohol consumption exhibits bleeding gums and a low platelet count. How does cirrhosis contribute to thrombocytopenia in this patient?

<p>Reduced thrombopoietin production due to liver damage (B)</p> Signup and view all the answers

A patient is diagnosed with myelodysplastic syndrome (MDS). Which of the following is a key characteristic that differentiates MDS from other bone marrow disorders?

<p>Hypercellular bone marrow with cytopenias and dysplastic cells (D)</p> Signup and view all the answers

Which of the following factors associated with increased deep vein thrombosis (DVT) risk is most directly linked to impaired venous return?

<p>Obesity (B)</p> Signup and view all the answers

A patient presents with a chronic cough and sputum production for at least three months of the year for two consecutive years. Which condition is the most likely diagnosis?

<p>Chronic Bronchitis (B)</p> Signup and view all the answers

Which pulmonary function test finding is most indicative of asthma?

<p>Reversible decrease in FEV1 (C)</p> Signup and view all the answers

A 60-year-old patient with a history of heavy smoking presents with new onset hemoptysis, unexplained weight loss and a persistent cough. Which of the following is the most likely diagnosis?

<p>Lung cancer (D)</p> Signup and view all the answers

What is the most common causative organism in community-acquired pneumonia?

<p>Streptococcus pneumoniae (B)</p> Signup and view all the answers

A patient with known asthma experiences acute shortness of breath, wheezing, and chest tightness following exposure to cat dander. What is the MOST appropriate initial treatment?

<p>Administer an inhaled short-acting beta-2 agonist (C)</p> Signup and view all the answers

Which of the following is the strongest risk factor for the development of pulmonary embolism?

<p>Deep vein thrombosis (D)</p> Signup and view all the answers

A 65-year-old patient with a 45-pack-year smoking history presents with progressive dyspnea on exertion. Examination reveals a barrel chest and decreased breath sounds bilaterally. Which of the following is the most likely diagnosis?

<p>Chronic Obstructive Pulmonary Disease (C)</p> Signup and view all the answers

For acute exacerbations of COPD, which intervention is most important to improve airflow and oxygenation?

<p>Oxygen therapy and bronchodilators (D)</p> Signup and view all the answers

A patient's chest X-ray reveals a mass located in the apex of the lung. While other conditions are possible, what primary diagnosis should be considered?

<p>Primary lung cancer (D)</p> Signup and view all the answers

Which histological type of lung cancer is most frequently observed in individuals who have never smoked?

<p>Adenocarcinoma (D)</p> Signup and view all the answers

A 50-year-old woman with a history of asthma reports increased difficulty breathing and wheezing. Which action is the most appropriate initial step in her management?

<p>Measure peak expiratory flow (A)</p> Signup and view all the answers

A patient experiences a sudden onset of sharp chest pain that intensifies with inspiration. Physical examination reveals tenderness over the rib cage. Which condition is the most likely cause?

<p>Costochondritis (D)</p> Signup and view all the answers

A 40-year-old male with chronic asthma experiences progressively worsening dyspnea, cough, and wheezing. What is the most probable underlying cause?

<p>Acute asthma exacerbation (C)</p> Signup and view all the answers

A 25-year-old woman presents with a persistent dry cough and malaise after a recent visit to a farm. Which condition should be prioritized in the differential diagnosis?

<p>Hypersensitivity pneumonitis (C)</p> Signup and view all the answers

A 65-year-old male with a history of smoking and COPD presents with a new productive cough, fever, and pleuritic chest pain. A chest X-ray shows consolidation in the lower lobe. What is the most likely diagnosis?

<p>Pneumonia (D)</p> Signup and view all the answers

What pulmonary function test finding is typically observed in a patient with restrictive lung disease, reflecting the reduced lung volume?

<p>Increased FEV1/FVC ratio (A)</p> Signup and view all the answers

A patient's chest X-ray reveals a cavitary lesion in the upper lobe. While tuberculosis is a primary concern, what other condition can present with similar radiographic findings and should be considered in the differential diagnosis?

<p>Lung abscess (B)</p> Signup and view all the answers

A patient develops pneumonia 48 hours after being admitted to the hospital. Pseudomonas aeruginosa is a common cause; however, what patient-related risk factor most significantly increases the likelihood of this specific infection over other hospital-acquired pneumonias?

<p>Prolonged mechanical ventilation (B)</p> Signup and view all the answers

Polysomnography is the primary diagnostic test for obstructive sleep apnea. Beyond identifying apneas, what crucial information does polysomnography provide that is essential for determining the severity and guiding treatment?

<p>Blood oxygen saturation levels during sleep (A)</p> Signup and view all the answers

A 35-year-old woman presents with a non-productive cough, fatigue, and shortness of breath, with a history of exposure to bird droppings, suggesting hypersensitivity pneumonitis (HP). What is the most important next step in management after suspecting HP?

<p>Identifying and eliminating the source of antigen exposure (C)</p> Signup and view all the answers

A patient with emphysema shows a flattened diaphragm on a chest X-ray. What physiological change directly leads to this radiographic finding?

<p>Alveolar wall destruction and air trapping (A)</p> Signup and view all the answers

A patient with COPD presents with worsening dyspnea, increased sputum production, and purulent sputum, indicating a respiratory infection as the likely cause of acute exacerbation. Besides antibiotics, what is another crucial component in managing this acute exacerbation of COPD?

<p>Optimization of bronchodilator therapy and, potentially, corticosteroids (C)</p> Signup and view all the answers

Digital clubbing is a common finding in patients with chronic pulmonary fibrosis. What pathophysiological mechanism is thought to be the primary cause of digital clubbing in this condition?

<p>Chronic hypoxemia leading to increased blood flow to the digits (B)</p> Signup and view all the answers

Rifampin and isoniazid are first-line treatments for active tuberculosis. What is a critical counseling point to emphasize to patients starting this regimen to minimize adverse effects?

<p>Monitor for signs of liver damage and avoid alcohol consumption. (C)</p> Signup and view all the answers

A 35-year-old man presents with a high fever, night sweats, and a productive cough with blood-streaked sputum for the past month. A chest X-ray shows upper lobe cavitary lesions. Which of the following is the most appropriate initial test for diagnosis?

<p>Sputum acid-fast bacilli (AFB) smear and culture (D)</p> Signup and view all the answers

A 27-year-old woman presents with fever, headache, and a stiff neck. Lumbar puncture reveals an elevated white blood cell count, increased protein, and decreased glucose in cerebrospinal fluid. Which of the following is the most common cause of her condition in adults?

<p>Streptococcus pneumoniae (C)</p> Signup and view all the answers

A 40-year-old man with poorly controlled diabetes presents with a rapidly spreading infection of the soft tissue in his leg, associated with crepitus and foul-smelling discharge. What is the most likely causative organism?

<p>Clostridium perfringens (C)</p> Signup and view all the answers

A patient with HIV presents with progressive confusion, focal neurological deficits, and seizures. MRI reveals multiple ring-enhancing lesions in the brain. Which of the following is the most likely diagnosis?

<p>Toxoplasmosis (B)</p> Signup and view all the answers

A 28-year-old woman presents with fever, malaise, pharyngitis, and posterior cervical lymphadenopathy. Monospot test is positive. Which of the following complications is most concerning in this patient?

<p>Splenic rupture (A)</p> Signup and view all the answers

A 55-year-old male presents with sudden-onset high fever, hypotension, and purpura. He recently had a splenectomy after a motor vehicle accident. Blood cultures grow an encapsulated Gram-negative diplococcus. Which of the following pathogens is most likely responsible?

<p>Neisseria meningitidis (D)</p> Signup and view all the answers

A patient presents with severe watery diarrhea after returning from a trip to South America. Which of the following is the most likely cause?

<p>Vibrio cholerae (B)</p> Signup and view all the answers

An elderly patient in a nursing home develops a cough, fever, and pleuritic chest pain. A chest X-ray shows a right lower lobe consolidation. Sputum Gram stain reveals Gram-positive cocci in pairs. What is the most likely causative organism?

<p>Streptococcus pneumoniae (C)</p> Signup and view all the answers

Flashcards

Vitamin B12 deficiency

Elevated homocysteine and methylmalonic acid levels are indicative.

Chronic myelogenous leukemia (CML)

Characterized by the presence of the Philadelphia chromosome (BCR-ABL fusion gene).

Thrombocytopenia in hospitals

Heparin-induced thrombocytopenia is a common cause.

Multiple myeloma hallmark

Hypercalcemia and renal failure are common findings.

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Iron overload cause

Hemochromatosis is the most common cause of iron overload.

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Thrombocytopenia causes

Cirrhosis is a likely cause in patients with bleeding and bruising.

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Myelodysplastic syndromes feature

Cytopenias with dysplastic cells are characteristic of this condition.

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Deep vein thrombosis (DVT) risk

Obesity is associated with an increased risk of DVT.

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Dialysis

A medical procedure to remove waste from the blood in kidney failure.

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ACE inhibitor

A medication used as an initial treatment for chronic kidney disease with proteinuria.

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Calcium oxalate crystals

The most common type of kidney stones causing nephrolithiasis.

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Lupus nephritis

A renal manifestation of systemic lupus erythematosus, causing proteinuria and hematuria.

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Fluid overload unresponsive to diuretics

An indication for dialysis in chronic kidney disease patients.

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Lithium toxicity

The most common cause of nephrogenic diabetes insipidus, affecting kidney function.

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Glomerulonephritis

A condition characterized by inflammation of the kidney's filtering units.

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Hyperlipidemia

A common complication of nephrotic syndrome, leading to high lipid levels.

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Chronic Bronchitis

A long-term inflammation of the bronchial tubes often due to smoking.

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Hallmark of Asthma

Decreased forced expiratory volume in 1 second (FEV1) during attacks.

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Lung Cancer Symptoms

Weight loss, hemoptysis, and a persistent cough in smokers.

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Common Cause of Pneumonia

Streptococcus pneumoniae is the most frequent cause in adults.

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Acute Asthma Treatment

Inhaled short-acting beta-agonists are used during exacerbations.

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Pulmonary Embolism Risk Factor

Deep vein thrombosis (DVT) is a major risk factor for pulmonary embolism.

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COPD Symptoms

Characterized by worsening dyspnea, productive cough, and frequent infections.

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COPD Exacerbation Treatment

Oxygen therapy and bronchodilators are primary treatments during exacerbations.

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Lung mass diagnosis

A mass in the lung apex is most likely primary lung cancer.

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Most common lung cancer in nonsmokers

Adenocarcinoma is the most common type of lung cancer in nonsmokers.

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Asthma management step

The best next step for asthma is peak flow measurement.

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Costochondritis symptoms

Sharp chest pain worsening with inspiration indicates costochondritis.

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Acute asthma exacerbation

Worsening dyspnea, cough, and wheezing in chronic asthma indicates acute exacerbation.

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Hypersensitivity pneumonitis

Persistent dry cough after farm visit indicates hypersensitivity pneumonitis.

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Pneumonia characteristics

Productive cough and fever with X-ray consolidation in chronic smokers indicates pneumonia.

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Restrictive lung disease finding

Increased FEV1/FVC ratio is characteristic of restrictive lung disease.

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Cavitary lesion in lung

Most likely indicative of tuberculosis based on chest X-ray presentation.

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Common cause of hospital-acquired pneumonia

Pseudomonas aeruginosa is the most frequent pathogen for hospital-acquired pneumonia.

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Primary test for obstructive sleep apnea

Polysomnography (sleep study) is the standard diagnostic test for obstructive sleep apnea.

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Symptoms from bird droppings exposure

Hypersensitivity pneumonitis is likely with non-productive cough and fatigue after exposure to bird droppings.

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Emphysema hallmark X-ray finding

Flattened diaphragm on chest X-ray is a key feature of emphysema.

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Acute COPD exacerbation cause

Most often caused by respiratory infection in patients with COPD.

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Finding in chronic pulmonary fibrosis

Digital clubbing is a common physical finding in patients with chronic pulmonary fibrosis.

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First-line treatment for active tuberculosis

Rifampin and isoniazid are the primary medications used to treat active tuberculosis.

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Osteoarthritis

A degenerative joint disease characterized by cartilage breakdown.

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Initial test for TB

Sputum acid-fast bacilli (AFB) smear and culture is the initial diagnostic test for suspected tuberculosis.

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Common cause of meningitis in adults

Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults.

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Causative organism for necrotizing fasciitis

Clostridium perfringens is often responsible for rapidly spreading infections in diabetic patients.

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Diagnosis in HIV with brain lesions

Toxoplasmosis is often diagnosed when HIV patients show ring-enhancing brain lesions.

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Complication of mononucleosis

Splenic rupture is a serious complication associated with infectious mononucleosis.

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Pathogen post-splenectomy

Streptococcus pneumoniae is often responsible for infections after splenectomy.

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Traveler's diarrhea

Severe watery diarrhea after travel often suggests an infectious cause.

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Study Notes

Cardiology

  • Left-sided heart failure: Chronic hypertension is the most common cause.
  • Chest pain, dyspnea, new murmur: Aortic stenosis is the likely diagnosis. Echocardiogram reveals left ventricular hypertrophy and aortic valve thickening.
  • Fatigue, dyspnea, orthopnea, bilateral crackles, pitting edema: Congestive heart failure is the likely diagnosis.
  • Untreated atrial fibrillation: A common complication is stroke.
  • Rate control in atrial fibrillation: Metoprolol is commonly used.
  • Acute coronary syndrome: Beta-blockers and aspirin are the first-line treatment.
  • Sudden cardiac death: The most common cause is ventricular arrhythmias.

Hematology

  • Iron deficiency anemia: Microcytic hypochromic cells are a characteristic finding in the peripheral blood smear.
  • Inherited bleeding disorder: Von Willebrand disease is the most common.
  • Microangiopathic hemolytic anemia: Hemolytic uremic syndrome is a common cause.
  • Acute myeloid leukemia: Increased number of blasts in blood smear is typical.
  • Polycythemia vera: Phlebotomy is the first-line treatment.
  • Vitamin B12 deficiency: Elevated homocysteine and methylmalonic acid are common laboratory findings.
  • Chronic myelogenous leukemia (CML): Philadelphia chromosome (BCR-ABL fusion gene) is a characteristic feature.
  • Hospitalized patients with thrombocytopenia: Heparin-induced thrombocytopenia is common.
  • Iron overload: Hemochromatosis is the most common cause.

Nephrology

  • Chronic kidney disease (CKD) in adults: Diabetic nephropathy is the most common cause.
  • Hypertensive nephrosclerosis: Elevated serum creatinine and proteinuria are common findings.
  • Nephritic syndrome: Hematuria and hypertension are characteristics.
  • Nephrotic syndrome: Proteinuria > 3.5 g/day, hypoalbuminemia and edema.
  • Minimal change disease: A common cause of nephrotic syndrome in children.
  • Acute kidney injury (AKI): Hyperkalemia is a common electrolyte disturbance.
  • Chronic kidney disease (CKD) cause: Hypertensive nephrosclerosis is the most common cause of renal impairment with proteinuria and hematuria.

Pulmonary

  • Chronic bronchitis: A common diagnosis in smokers, characterized by chronic cough and sputum production.
  • Asthma: Decreased FEV1 is a hallmark feature.
  • COPD: A common diagnosis in smokers, marked by persistent cough, dyspnea, and decreased breath sounds.
  • Community-acquired pneumonia (CAP): Streptococcus pneumoniae is the most common cause in adults.
  • Hospital-acquired pneumonia: Pseudomonas aeruginosa is the most common cause.
  • Obstructive sleep apnea: Polysomnography is the primary test.
  • Hypersensitivity pneumonitis: A common cause of cough, fatigue, and shortness of breath in patients with a history of exposure to bird droppings.

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Description

Review questions covering cardiology and hematology. Topics include heart failure, chest pain, atrial fibrillation, anemia, and bleeding disorders. Designed to test knowledge of common diagnoses, treatments, and complications in these medical specialties.

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