Final

Question 1

The Glasgow-Blatchford scoring system notes a different score between men and women in which of the following parameters?

Answer 1

Hemoglobin

Question 2

What is the most common cause for death due to an acute myocardial infarction.

Answer 2

arrhythmia

Question 3

Of the following causes for a lower GI bleed, which is most commonly diagnosed in patients who are 65 years of age and older?

Answer 3

Ischemic Colitis

Question 4

Superior Vena Cava syndrome is most commonly found as a consequence of what type of cancer?

Answer 4

Bronchogenic

“SVCS” occurs when a person’s superior vena cava is partially blocked or compressed. It carries blood from the head, neck, upper chest, and arms to the heart. Cancer is usually the main cause of SVCS

Question 5

A sense of “Glare” due to refraction of light when looking at a light source, particularly at dusk, is more likely due to which of the following conditions?

Answer 5

Cataract

Question 6

Mallory-Weiss tears are full thickness tears to the:
A. Upper third of esophagus C.Lower 1/3 of esophagus
B. Middle third of esophagus D.Gastro-esophagus Jxn
E. None of the above

Answer 6

None of the above (It’s not a full thickness tear, Boerhaave’s syndrome is!)

• Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from a laceration in the mucosa at the junction of the stomach and esophagus. This is usually caused by severe vomiting because of alcoholism or bulimia, but can be caused by any conditions which causes violent vomiting and retching such as food poisoning.
• Boerhaave’s syndrome-Spontaneous perforation of the esophagus most commonly results from a full-thickness tear in the esophageal wall due to a sudden increase in intraesophageal pressure combined with relatively negative intrathoracic pressure caused by straining or vomiting

Question 7

Displacement of the trachea is most likely to be found in which of the following conditions?

Answer 7

pneumothorax

Question 8

Which of the following findings is most characteristic of the syndrome (SIADH)?

“Syndrome of inappropriate antidiuretic hormone secretion”

Answer 8

Hyponatremia

*“Sodium level is low, but SIADH is brought about by an excess of water rather than a deficit of sodium.”

Question 9

Which of the following is least likely to be noted in a patient with cardiac Tamponade?

Answer 9

Hypertension

Question 10

Which of the following conditions represent a strict contraindication to the use of epinephrine presenting with anaphylactic shock?
A. Atrial Fibrillation C. Ventricular tachycardia
B. Ventricular Fibrillation D. All of the above
E. none of the above

Answer 10

E. none of the above, (they are all indicative)

*All 3 are indicated for epinephrine w/anaphylactic shock:
A. Atrial Fibrillation
B. Ventricular Fibrillation
C. Ventricular tachycardia

Question 11

Which of the following is not part of Samter’s triad?
A.Sinus polyps C. Nasal polyps
B. Hives D. aspirin allergy
E. Asthma

Answer 11

Hives

Question 12

Painless loss of vision with pale retina and a markedly red macula is most common consistent with which of the following conditions?

Answer 12

Central retinal artery occlusion

Question 13

Which of the following lab findings is not generally noted in a patient with tumor lysis syndrome?

Answer 13

Hyperglycemia (Not noted)

These would all be found:
*High blood potassium (hyperkalemia), 
*High blood phosphorus (hyperphosphatemia), 
*High blood uric acid (hyperuricemia), 
*High blood urea nitrogen (BUN)
& the only "Low"
***Low blood calcium (hypocalcemia),

Question 14

Which of the following conditions is the most highly associated with signs of distress that includes patient sitting forward, drooling and dysphagia.

Answer 14

Epiglottis

Question 15

The EKG of a patient with an acute myocardium infarction reveals ST elevation and Q Wave in leads V4, consistent with an MI in which of the following locations?

Answer 15

Lt. ventricular anterior wall

Question 16

Which of the following conditions is most likely to present with chest pain that radiates to the upper back between the scapulae?

Answer 16

Aortic dissection

Question 17

The acute onset of visual “floaters” and a loss of vision as if curtain is being lowered or raised over the visual field is most consistent with which of the following conditions?

Answer 17

Retinal detachment

Question 18

Which of the following is least consistent with cancer that has metastasized to a ventral body.

Answer 18

Pain improves with rest

Pain should worsen

Question 19

The development of sustained bradycardia in the setting of an acute myocardial Infarction suggests that the infarction involved which of the following parts of the heart?

Answer 19

Inferior Left ventricle

Question 20

Whereas pneumothorax is notable for breath sounds that are ______ with ______ to
percussion, a lobar pneumonia is notable for breath sounds that are ______ with ______ to Percussion.

Answer 20

Decreased with hyper-resonance
&
Decreased with Dullness

Question 21

Which of the following is most closely associated with an extending thoracic aortic dissection when the ____murmur develops acutely or the pre-existing murmur acutely worsens?

Answer 21

Aortic Regurgitation

Question 22

Painless loss of vision with a markedly hemorrhagic retina extending outward from the optic disk occasionally referred to as a “blood and thunder” retina, is most consistent with which of the following conditions?

Answer 22

Central retina venous occlusion

Question 23

Which of the following characteristics is most consistent with a greater likelihood that a patient pain represents acute coronary syndrome?

Answer 23

Dyspnea accompanies pain

*Acute Coronary S/d:
“Sudden reduction or blockage of blood flow to the heart.”

Question 24

Which of the following is not suggestive of the presence of a pulmonary embolism according to the Well’s PE scoring criteria for a PE?

Answer 24

BradyCardia

Question 25

Which of the following conditions is associated with the EKG pattern known as (electrical alternans) change in the QRS pattern from one heart beat to the next?

Answer 25

Cardiac tamponade

Question 26

What does the acronym MONA stand for? List at least one reason why each is used.

Answer 26

* Morphine->to decrease pain when pain is not resolved with nitroglycerin. * Oxygen->improves oxygenation of the ischemic heart tissue. * Nitrogen (Nitroglycerin)-venous dilatation (Dec. heart workload & reduces myocardial oxygen demand. Also, decrease chest pain) * Aspirin-prevent further clot formation by decreasing platelet aggregation.

Question 27

List 4 symptoms of temporal arteritis | Aka=“Giant cell arteritis”-most common form of vasculitis that occurs in adults

Answer 27

1. Headache - early symptom in ≈33% of cases, present in ≈72% of cases 2. Neck, torso, shoulder, and pelvic girdle pain (consistent with polymyalgia) 3. Jaw claudication – early symptom in ≈4%, present in ≈40% of cases 4. Fatigue 5. Malaise - early symptom in ≈20% of cases, present in ≈56% of cases 6. Fever – early symptom in ≈11% of cases, present in ≈35% of cases 7. Visual blurring or vision loss (Unilateral), often painless, or occasionally diplopia ≈50% of patients with GCA experience visual symptoms over the course of the disease. 8. Complete blindness-Alternatively, a partial field defect may progress to complete blindness over days. 9. Rheumatica are early symptoms in ≈ 25% of cases, present in ≈ 58% of cases

Question 28

List 4 signs or symptoms of superior vena cava syndrome.

Answer 28

- Shortness of breath is the most common symptom, - Cough - Dyspnea (difficulty breathing) - Headache - Lightheadedness - "JVD"Venous distention (In the neck, upper arms & chest) - Facial edema - Upper limb edema - Edema of the neck - Facial swelling - Arm swelling.

Question 29

List 4 signs or symptoms of acute angle closure glaucoma.

Answer 29

Sx’s = - “halos around lights”, - Ocular (eye) pain (Severe & Sudden onset,) - HA, - Nausea, - Vomiting, - Blurred vision - Loss of vision Signs = - Conjunctival injection, - Corneal edema (light reflex irregular or steamy appearance), - Mid-dilated pupil, - Nonreactive pupil, - Evidence of shallow anterior chamber, - IOP much greater than 21 mm Hg. - Corneal cloudiness

Question 30

Compare and contrast the signs and symptoms of Stable, unstable and atypical angina.

Answer 30

*Stable Angina: Occurs w/the same degree of exertion & resolves w/the same decree of rest (Also, Same dosage & strength of nitroglycerine.) * Unstable Angina: More frequent episodes, - ----Longer lived ones, - ----Not relieved by nitroglycerine * Atypical/Prientz Metal: Angina at rest - ----Not relieved by Nitroglycerine *Angina Pectoris: -----Discomfort induced by exertion & Relieved with rest or nitroglycerin. (Due to ischemia of the heart or obstruction of coronary arteries.)

Question 31

Anginal symptomatology that occurs with the same degree of exertion and resolves with the same decree of rest and same dosage and strength of nitroglycerine.

Answer 31

*Stable Angina:

Question 32

Angina that occurs with more frequent occurrence of angina episodes, longer lived ones, or more easily proved not relieved by nitroglycerine

Answer 32

*Unstable Angina:

Question 33

Angina at rest not relieved by Nitroglycerine

Answer 33

*Prientz Metal/ Atypical:

Question 34

Discomfort induced by exertion and relieved with rest or nitroglycerin. Due to ischemia of the heart or obstruction of coronary arteries.

Answer 34

*Angina Pectoris:

Question 35

What is the definition of pulsus paradoxes?

Answer 35

Drop of systolic blood pressure with inspiration > 10mm.

Question 36

What does the Glasgow-Blatchford attempt to predict?

Answer 36

(GBS) is a screening tool to assess the likelihood that a patient with an acute upper gastrointestinal bleeding (UGIB) will need to have urgent medical intervention such as a blood transfusion or endoscopic examination.

Question 37

What does the Rockall scale attempt to predict?

Answer 37

The severity of an upper GI bleed

Question 38

Although uncommon, a patient with severe COPD who is felt to rely on CO2 retention for respiratory drive should utilize which of the following methods of oxygen delivery when supplemental O2 is needed? A. Nasal Cannula C. Venturi Mask B. Rebreather Mask D. non-rebreather mask E. Any supplemental oxygen us is contraindicated

Answer 38

Venturi Mask

Question 39

Which of the following signs or symptoms is least consistent w/severe asthma?

Answer 39

Wheezes more audible

Question 40

Which of the following is not part of the criteria that make up the Glasgow-Blatford scoring system?

Answer 40

Hemoptysis

Question 41

A 50-year-old woman presents with right eye pain and blurred vision with the perception of "halos forming around objects." Examination reveals conjunctival injection with corneal clouding and a mid-dilated pupil. What is the most likely diagnosis?

Answer 41

B. Acute angle-closure glaucoma

Question 42

61 year old male with complaints of headache, scalp tenderness, jaw claudication and reduced visual acuity in right eye.

Answer 42

``` Temporal arteritis (often assoc. w/polymyalgia rheumatica= Onset= Giant cell arteritis (GCA) ```

Question 43

A 35-year-old man presents with sudden onset of pain and decreased vision of the right eye after he was in an altercation. The patient's exam includes visual acuity of 20/200 (OD), an afferent pupillary defect, proptosis, decreased extraocular movements, hemorrhagic chemosis, and IOP of 40 mm Hg. The left eye exam is normal. What is the most likely diagnosis?

Answer 43

Retrobulbar hematoma

Question 44

A 55-year-old woman presents with loss of vision in her right eye that occurred suddenly and without pain. Examination reveals a pale, edematous retina with a visible "cherry-red spot" & red macula. What is the diagnosis?

Answer 44

Central retinal artery occlusion