Questions and Answers
What is the most likely diagnosis for a 58 year-old male presenting with weakness of grip, hyperactivity of DTRs, extensor plantar reflexes, and dysarthria?
Which of the following is NOT a risk factor for the development of osteoporosis?
Which of the following diagnostic modalities will identify the source of a pale, cool extremity with severe pain and 'burning' sensation in approximately 95% of cases?
What is the most likely diagnosis for a patient experiencing rectal pain described as 'severe tightness' that interrupts sleep?
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Which condition is best described for a 38 year-old chronic smoker with recurrent wheezing and a chronic cough producing mucus?
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What is the most likely agent causing central scotomata and loss of green-red color perception in a patient treated for Tuberculosis?
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What kind of fracture is most likely for a child with a fracture line through the metaphysis of the proximal middle phalanx ending at the epiphyseal plate?
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Which test would be most compatible with a suspected diagnosis of pericarditis in a patient with chest pain worsened by swallowing?
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What is the most important diagnostic study for a 2-month-old febrile male with a petechial rash?
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What condition is most likely being treated if a sister requests refills of dexamethasone and homatropine ophthalmic drops?
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What is the best initial test to establish the diagnosis for a small pulsating mass at the level of the umbilicus?
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What is the most likely diagnosis for a patient complaining of right lower extremity swelling after cardiac catheterization with a bruit heard over the right groin?
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What is the treatment of choice for a patient with chronic venous insufficiency presenting with nonpitting edema and dermatitis?
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What is the most likely diagnosis for a 78-year-old woman who develops severe diffuse abdominal pain four days after MI?
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From which of the following is a cyanotic and cold right lower extremity likely to originate in a patient with atrial fibrillation?
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Which is the most common site at which an arterial embolus lodges?
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Stenosis of which vessel is associated with the highest patency rates following angioplasty or stenting?
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What further impairs wound healing after a midline abdominal incision and bowel resection performed on a retired surgeon?
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For a 60-year-old male with an inguinal hernia of recent onset, which statement is TRUE?
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What is the likely diagnosis for a 70-year-old male cigarette smoker with a right inguinal mass that reduces when resting?
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What is correct regarding a strangulated inguinal hernia?
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What is the most likely diagnosis for a 25-year-old man with recurrent fistula in ano, weight loss, and diarrhea with blood in the stool?
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In a patient with known ulcerative colitis, which of the following indicates a need for total proctocolectomy?
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Colectomy should be advised in patients with ulcerative colitis who have symptoms that persist for more than which of the following?
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What is the most likely cause of increased abdominal pain, vomiting, and fever in a patient with a long history of bloody diarrhea?
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The most likely diagnosis for a large amount of seroanguinous drainage from the abdominal wound that occurs 5 to 7 days post-op is:
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Which cardiac disease is most likely to cause exertional dyspnea and angina in a 49-year-old man?
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The hypertensive emergency that is most easily reversible with pharmaceutical management is:
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Which statement regarding posterior wall infarction is correct?
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Regarding treatment of heart failure in patients with diastolic rather than systolic dysfunction:
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Which statement regarding the use of continuous positive airway pressure therapy in pulmonary edema is correct?
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The most specific diagnostic test that can be obtained for an emergency department patient to make the initial diagnosis of aortic dissection is:
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Which of the following is the most common ECG abnormality associated with mitral valve prolapse?
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The next most appropriate management step for a 46-year-old woman with abdominal pain and elevated liver enzymes is:
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Which of the following statements regarding ingested foreign bodies is correct?
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What is the appropriate next management step for a patient with Boerhaave syndrome?
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The most appropriate management for a 53-year-old man with cirrhosis who presents with abdominal pain and elevated WBCs is:
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After assessing a 54-year-old man with a history of 'alcoholic liver disease' presenting with hematemesis, what is most likely to provide definitive treatment?
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What is the Glasgow Coma Scale score for a patient who is moaning, will not open his eyes to pain but withdraws to pain?
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What would be the best diagnostic test to definitively diagnose the etiology of the patient's abdominal pain after trauma?
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Which patient could be safely managed in a community emergency department, avoiding transfer to a burn unit?
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Which statement is correct regarding the treatment of a patient with lacerations to the hand?
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What is the most appropriate emergency department management for uncomplicated diverticulitis in a middle-aged patient?
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What is the next appropriate intervention for a 27-year-old woman with rapid narrow-complex regular tachycardia?
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What is the next best step in management for a patient with blunt force trauma to the chest who developed severe shortness of breath?
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Which of the following is most likely true about a 26-year-old female with multiple bruises and anxiety?
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What is the most likely diagnosis for a young male with erratic atrial activity showing irregular ventricular response after heavy alcohol consumption?
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What is the best initial treatment for a 13-year-old girl with acute, heavy vaginal bleeding?
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What would be most helpful to differentiate androgen insensitivity syndrome from mullerian agenesis?
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Which vitamin is most commonly deficient in vegetarian diets?
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Which birth control method has the highest failure rate?
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What is the most appropriate next step for managing a 39-year-old female with vaginal bleeding and a negative pregnancy test?
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What is the most appropriate next step in managing a 64-year-old female with light vaginal bleeding and no abdominal pain?
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What type of placentation is the most common in monozygotic twins?
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Patients with the gene for hereditary non-polyposis colorectal cancer have an increased risk for which gynecologic cancer?
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What risk factor confers the highest risk for an ectopic pregnancy?
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What is the appropriate treatment for vulvar pruritis revealed by colposcopy?
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Study Notes
Neurological Disorders
- A 58-year-old male with bilateral grip weakness and hyperactive deep tendon reflexes likely suffers from ALS (Amyotrophic Lateral Sclerosis).
- Multiple sclerosis (MS) may present with dysarthria but would typically have sensory impairment and bladder dysfunction, differentiating it from ALS.
Osteoporosis Risk Factors
- Risk factors for osteoporosis include low testosterone, low physical activity, smoking, and chronic corticosteroid use.
- Inadequate dietary protein is not a risk factor; low dietary calcium is the concern for osteoporosis.
Pain and Diagnostic Procedures
- Severe extremity pain, pale and cool limb with absent pulsation suggests arterial occlusion; an aortic angiogram is the gold standard for diagnosis.
- Proctalgia fugax is indicated for recurring rectal pain that interrupts sleep without other symptoms like bleeding.
- Chronic bronchitis is presented by a chronic smoker with cough and wheezing, often exacerbated by respiratory infections.
Tuberculosis Treatment Side Effects
- Ethambutol causes eye symptoms including scotomata and altered color perception in tuberculosis treatment.
Pediatric Conditions
- In a child with abdominal pain and fever where the appendix appears normal, consider mesenteric adenitis or similar diagnoses.
Beta-Blockers and Airways
- Metoprolol is the most cardioselective beta-blocker and could theoretically be used in patients with reactive airway disease despite general contraindications.
Abdominal Aortic Aneurysm (AAA) Management
- Acceptable indications for surgery in AAA include a 5.5 cm asymptomatic aneurysm and presence of an associated iliac aneurysm.
- Ultrasound is the preferred initial diagnostic test for abdominal aortic aneurysms due to its non-invasive nature.
Venous Issues and Treatments
- Chronic venous insufficiency treatment of choice is pressure-gradient stockings, not surgical options unless indicated.
Embolism Sources
- The heart accounts for approximately 90% of lower extremity emboli; common sites for emboli to lodge include the common femoral artery.
Hernias
- Direct inguinal hernias typically occur in adults and are less prone to strangulation due to wider necks, differing from indirect hernias.
Inflammatory Bowel Disease
- Crohn's colitis is characterized by recurrent anus fistulas, diarrhea with blood, and weight loss, differing from ulcerative colitis which affects the rectum.
Surgical Complications
- Wound dehiscence can occur 5 to 7 days post-op and is characterized by serosanguinous drainage, indicating an issue with surgical closure.
Cardiac Conditions
- Aortic stenosis is characterized by exertional dyspnea, angina, and syncope, especially in younger patients engaged in physical activities.### Tricuspid Incompetence
- Tricuspid incompetence involves the improper closure of the tricuspid valve, leading to backward flow of blood into the right atrium during ventricular contraction.
- Symptoms include fatigue, peripheral edema, ascites, and jugular venous distension.
Hypertensive Emergency
- The most easily reversible hypertensive emergency is encephalopathy.
- Other emergencies include acute coronary syndrome, aortic dissection, eclampsia/preeclampsia, and intracranial hemorrhage.
Posterior Wall Infarction
- Linked with ST-segment depression in V1 on ECG.
- It is characterized by inverted T waves and large S waves in V1; affects about 5% of acute myocardial infarctions (MIs).
Heart Failure Management
- In diastolic heart failure, β-blocking agents may enhance cardiac output.
- Diuretics are not as effective compared to therapies for systolic dysfunction; both types may present challenges in cardiac contractility.
Continuous Positive Airway Pressure Therapy
- CPAP in pulmonary edema reduces the work of breathing.
- It is effective in decreasing left ventricular preload and increasing thoracic pressure but does lower intrathoracic pressure.
Aortic Dissection Diagnosis
- The most specific and rapid test is a helical CT chest scan.
- Other possible diagnostic methods include 12-lead ECG, aortic angiography, portable chest x-ray, and transesophageal echocardiography.
Mitral Valve Prolapse
- The most common ECG abnormality associated with mitral valve prolapse is paroxysmal supraventricular tachycardia.
- It can also lead to QT prolongation and ST-segment changes.
Management of Abdominal Pain
- For suspected gallbladder pathology, RUQ ultrasonography is the most appropriate initial diagnostic step for a woman with abdominal pain and elevated liver enzymes.
Management of Ingested Foreign Bodies
- Objects longer than 5 cm and wider than 2 cm should be removed before passing through the stomach to prevent complications.
Boerhaave Syndrome
- Initial management includes administering broad-spectrum antibiotics following perforation of the esophagus due to severe vomiting.
Spontaneous Bacterial Peritonitis
- In a patient with cirrhosis and abdominal pain, starting cefotaxime and admitting the patient is the most appropriate management.
Treatment for Hematemesis
- Definitive treatment for a patient with hematemesis from liver disease is emergent endoscopy with sclerotherapy.
Glasgow Coma Scale
- A 23-year-old man with a score of 7 on the Glasgow Coma Scale demonstrates a medically altered state following trauma.
Abdominal Pain Evaluation
- An abdominal CT scan is the preferred diagnostic test for a stable patient with suspected abdominal injury after trauma.
Burn Management
- A 75-year-old man with a 5% BSA superficial partial-thickness burn can often be managed in a community emergency department, avoiding transfer to specialized burn units.
Wound Care Post-Fistfight
- Delayed primary closure or healing by secondary intention is appropriate for lacerations following a fistfight.
Diverticulitis Management
- The most appropriate management for uncomplicated diverticulitis in a suitable patient involves prescribing oral antibiotics.
Tachycardia Intervention
- In cases of persistent rapid narrow-complex tachycardia, the next step following initial treatment is administering adenosine 12 mg IV.
Chest Trauma Management
- In cases of blunt chest trauma leading to respiratory distress, immediate needle decompression is critical.
Intimate Partner Violence
- Pregnancy increases the risk of abuse in situations of domestic violence.
Alcohol-Induced Cardiac Problems
- Atrial fibrillation can occur in intoxicated individuals, characterized by erratic atrial activity and associated symptoms.
Heavy Vaginal Bleeding in Adolescents
- IV estrogen is the best initial treatment for severe vaginal bleeding in a young female with heavy menstrual issues.
Endocrine Disorders
- A distinguishing factor for androgen insensitivity syndrome is elevated serum testosterone compared to mullerian agenesis.
Nutritional Deficiencies
- Vegetarian diets often lead to vitamin B12 deficiency, necessitating supplementation during preconception counseling.
Birth Control Efficacy
- The lowest efficacy in preventing pregnancy is seen with oral contraceptive pills (OCPs), while surgical methods like sterilization have the highest effectiveness.
Management of Vaginal Bleeding
- In cases of prolonged vaginal bleeding in a middle-aged female, a referral to a gynecologist for endometrial biopsy is warranted.
Placental Types in Twins
- The most common placentation type in monozygotic twins is monochorionic/diamniotic.
Cancer Risks in Hereditary Syndromes
- Patients with hereditary non-polyposis colorectal cancer have a heightened risk for endometrial cancer.
Ectopic Pregnancy Risk Factors
- A history of previous ectopic pregnancy is a significant risk factor for future ectopic pregnancies.
Laser Treatment for Vulvar Issues
- Laser vaporization is a potential treatment option for multifocal conditions like vulvar pruritis.
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Description
Test your knowledge with these PANCE practice questions. This quiz focuses on neurological symptoms and diagnoses, featuring a case study on a patient presenting with grip weakness and hyperactive reflexes. Challenge yourself to identify the correct diagnosis based on the given information.
