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Visceral CLET > iRAT 5 > Flashcards

iRAT 5 Flashcards

1
Q

Which of the following is associated with leukemia?

  • slight increase in WBC
  • marked increase in WBC
  • decrease in WBC
  • increase in RBC
A

marked increase in WBC

Leukemia: cancer of WBC forming elements in bone marrow, malignant transformation at expense of RBC and platelets - causes thrombocytopenia

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2
Q

According to CDC, AIDS diagnosis is based on HIV positive status as well as a CD4 below:

  • 500/ml
  • 200/ml
  • 800/ml
  • 1000/ml
A

200/ml

CD4: T-cell count

norm WBC count is 1000-1500/ml
important to make lifestyle modifications with HIV

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3
Q

Presence of ketones in urine suggest what?

  • fasting or dieting
  • TB
  • high protein diet
  • high carbohydrate diet
A

fasting or dieting

ketones = burning fat and protein

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4
Q

26 yo constructor worker presents with LBP, central, does not radiate. Had condition since 17 yo, but increased in severity over past year. No neuro abnormalities, but decreased thoracolumbar ROM and chest expansion. Which lab procedure is most useful in confirming your initial impression?

  • ANA
  • alkaline phosphatase
  • HLA-B27
  • C-reactive protein
  • erythrocyte sedimentation rate
A

HLA-B27 (for AS)

ANA = SLE
alkaline phosphatase = liver and bone, Paget’s
HLA-B27 = AS, Reiter’s, Psoriatic, IBS, uveitis,
C-reactive protein = inflammation
ESR = inflammation from infection, inflammation, cancer

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5
Q

Pancytopenia entails all except?

  • anemia
  • polycythemia
  • leukopenia
  • thrombocytopenia
A

polycythemia

pancytopenia: blood cell (red, white, platelets) are decreased in number, depressed bone marrow

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6
Q

Direct bilirubin is increased in?

  • iron deficiency anemia
  • obstructive jaundice
  • hepatitis
  • hemolytic jaundice
A

obstructive jaundice

hemolytic jaundice = indirect

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7
Q

Which of the following STDs is implicated in cervical cancer?

  • syphilis
  • gonorrhea
  • chlamydia
  • HPV
A

HPV (human papilloma virus)

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8
Q

Chancre is what stage of syphilis?

  • 1
  • 2
  • 3
A

1

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9
Q

Which of the following is most common STD?

  • syphilis
  • gonorrhea
  • chlamydia
  • HPV
A

chlamydia

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10
Q

Most common cause for occasional blood in urine is?

  • malignancy
  • hypertension
  • diabetes
  • physical activity
A

physical activity

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11
Q
  • acute cholecystitis
  • acute cystitis
  • acute pyelonephritis
  • ureteral stone
A

ureteral stone

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12
Q

39 yo, headaches for 3 months that are slow progressive, dull, aching pain. Normal vitals. BP 130/85 mm/Hg. Physical exam is unrewarding. Neuro exam shows visual field abnormalities in confrontation test. Other cranial nerves are WNL. Leaning forward and coughing, sneezing, straining aggravates headache. No other neuro findings are detected. What is most likely clinical cause of visual abnormalities?

  • suffering from SOL
  • suffering from classic migraine
  • must be referred out for further investigation
  • most common visual field abnormalities with optic tract lesion is bitemporal hemianopia

a. all are true
b. 1 and 3 are true
c. 2 and 4 are true
d. only 4 is true

A

1 and 3 are true

suffering from SOL and must be referred out for further investigation

confrontation test: optic nerve

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13
Q

Which of the following is true with regard to precaution/contraindication for chiropractic management?

  • iron deficiency anemia
  • diabetes
  • grade 2 spondylolisthesis
  • cauda equina syndrome

a. all are true
b. 1 and 3 are true
c. 2 and 4 are true
d. only 4 is true

A

only 4 is true?

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14
Q

30 yo male, swelling at angle of mandible, slight fever, malaise for 3 days. Exam shows hotness, redness and tenderness with obvious swelling of right cheek and mandibular angle area. Which of the following lab findings is most likely to help in establishing clinical impression?

  • eosinophil count
  • lipase and amylase
  • reticulocytes
  • ANA
  • C-reactive protein
A

lipase and amylase

Mumps and pancreatitis

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15
Q

Spinal x-rays of 50 yo reveals generalized osteopenia. Her hematology exam shows mild ESR elevation. There are generalized small lytic lesions around pelvis, skull and sternum. Which are the 2 most relevant findings?

  • increased albumin
  • decreased albumin
  • increased acid phosphatase
  • increased globulin
  • bence jones proteinuria
A

D and E

bence jones proteinuria and increased globulin
multiple myeloma

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16
Q

24 yo female complaining of joint pain. Indicates history of kidney disorder that was investigated in last years. Presence of rosy butterfly erythema like discoloration on her cheeks. Which 2 are mostly associated with her condition?

  • anti-nucleic antibody
  • Reiter’s syndrome
  • osteoarthritis
  • systemic lupus
  • fungus infection
A

A and D

anti-nucleic antibody and systemic lupus

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17
Q

Which 2 are associated with systemic lupus?

  • infectious in nature
  • needs to be co-managed by chiropractor and MD
  • condition is immune disorder in nature
  • uric acid is common finding
  • need to refer to ER immediately
A

B and C

immune disorder in nature and co-managed by chiro and MD

18
Q

60 yo black male, persistent thoracic back pain, unrelieved by rest and seems worse at night. History of fatigue and weakness, confusion, nausea, vomiting, recurrent bacterial infections. Chiro exam shows cervical syndrome on right and loss of motion in thoracic spine. Motion in thoracic spine is difficult to assess due to patient pain. X-ray shows generalized osteopenia and widespread lytic lesions in spine, ribs and skull. Lab tests show anemia, normal erythrocyte morphology, bence jones proteinuria, elevated BUN and creatine. Bone marrow aspirate shows greater than 20% plasma cells. What is the underlying cause of fatigue/weakness?

  • normal sign of aging
  • drugs consumed to fight recurrent infections
  • pathologic fractures in spine and ribs
  • anemia secondary to overcrowded bone marrow
  • renal failure
A

anemia secondary to overcrowded bone marrow

multiple myeloma
elevated BUN = kidney involvement
bence jones proteins = toxic to kidneys causing failure

19
Q

What is most likely cause of recurrent bacterial infections in patient with multiple myeloma?

  • staph aureus
  • overuse of antibiotics
  • deficiency of normal immunoglobulins
  • nosocomial invasion
  • reinfection due to risky behavior
A

deficiency of normal immunoglobulins

20
Q

What is most appropriate recommendation for case management of multiple myeloma?

  • begin clinical research project with upper cervical adjustment
  • recommend bed rest and low protein diet
  • refer to specialist for further evaluation and treatment
  • clear spine of subluxation and refer to MD
  • send out for immediate bone marrow transplant
A

refer to specialist for further evaluation and treatment

21
Q

T/F

Common migraine patient will see aura before onset

A

FALSE

22
Q

23 yo student who plays football and complaining of episodes of LBP starting 2 years ago. He had experienced 4 episodes per year. Pain is usually non-traumatic bilateral at SI joint and buttock area. History shows 1 episode of hospitalization for severe eye problem that was controlled by antibiotic and steroid. He had 1 milder attack of eye infection 6 months ago. What questions should be asked?

  • how intense is his football training?
  • any pervious episodes of skin lesions?
  • any previous episodes of shingles?
  • any previous episodes of UTI?
A

previous episodes of UTI?

Reiter’s

23
Q

What muscle is implicated of cervicogenic headache?

  • rectus capitus inferior major
  • rectus capitus inferior minor
  • splenius capitus
  • levator scapula
  • trapezius
A

rectus capitus inferior minor

24
Q

Severely dehydrated patient could exhibit which of the following lab values?

  • increased hematocrit levels
  • increased plasma levels
  • decreased hematocrit levels
  • increased total blood volume
A

increased hematocrit levels

25
Q

28 yo male, periodic episodes of severe headache that have occurred nightly for past 2 weeks. Pain awakens him 2 or 3 hours after he has been asleep and lasts for about 1 hour. Pain is always around the right eye and makes affected eye water. Pain seems to be aggravated by alcohol intake. He had similar episode of headache about 2 years ago. What is clinical impression?

  • brain tumor
  • bell’s palsy
  • hypertension
  • cluster headache
  • migraine
A

cluster headache

26
Q

Which is associated with high altitude?

  • microcytic hypochromic anemia
  • erythrocytosis
  • pancytopenia
  • thrombocytopenia
  • decreased hematocrit value
A

erythrocytosis

27
Q

10 yo presents with 4 day history of pain in knees, hips, shoulders, and wrists. Joints are not swollen, red, or tender. Her temperature is 102. Her mother states that her daughters only recent illness was a sore throat 1 month ago. Auscultation of chest reveals apical systolic murmur. Which of the following statements are true?

  • rheumatic fever
  • rheumatic arthritis
  • aortic valve is most common valve involved in problem
  • GI manifestation is common complication of this problem
A

rheumatic fever

28
Q

62 yo male, history of alcoholism with multiple episodes of liver trouble in form of hepatitis B and few episodes of jaundice. He was recently diagnosed with compensated liver choruses. Which of the following lab findings are associated?

  • excessive albumin production
  • excessive globulin production
  • decreased albumin
  • decreased globulin
A

decreased albumin

29
Q

High reticulocyte count is associated with which?

  • iron deficiency anemia
  • purpura
  • B12 deficiency
  • hemolytic jaundice/anemia
A

hemolytic jaundice/anemia

hemophilia

30
Q

Hemophilia is blood disorder characterized by all of the following EXCEPT?

  • congenital in nature
  • absence of 1 coagulation factors
  • more common in males than in females
  • decreased platelet count
A

decreased platelet count

31
Q

Which is true regarding STD?

  • most common STD is gonorrhea
  • 2nd state of syphilis is neurosyphilis
  • Reiter’s syndrome is associated with total patient incapacitation
  • Chlamydia infection may trigger episode of Reiter’s syndrome
A

Chlamydia infection may trigger episode of Reiter’s syndrome

32
Q

30 yo male with LBP and stiffness of 3 month duration. Pain is of insidious onset with slow, progressive course, aggravated by walking or any form of exercise. Lately painkillers have been of some help. Pain is not radiating. Patient’s main complaint is low back stiffness. Patient looks fit, history revealed absence of any significant trauma or past history of similar conditions. Shiny corner sign is observed in x-ray. Which are true?

  • AS is a possibility and is usually associated with HLA-B27
  • HLA-B27 is found in 3% of the normal population
  • bilateral sacroilitis is typically first radiographic finding
  • this condition is mainly prevalent in age group above 60 yo

a. all are true
b. 1 and 3 are true
c. 2 and 4 are true
d. 4 is true

A

1 and 3

HLA-B27 is in 8-10%, younger aged males

33
Q

42 yo accountant, upper mid-back and flank pain started 1 week ago, associated with fever and malaise. Increased temperate of 101 and pulse of 96 BPM, which is normally 76 BPM. Tenderness over flank and positive Murphy’s punch. Exhibited signs of abdominal discomfort upon palpation. No recent history of change in bowel or bladder habits, although he stated slight change of urine color. No frequency or dysuria. Other system reviews unrewarding. What is the diagnosis?

  • upper UTI
  • MS
  • SOL
  • syringomyelia
A

upper UTI

  • lower pH in blood and lower acidity and kills bacteria
  • must alkalize urine
  • cranberry juice prevents body from being able to eradicate microbes from urinary tract
  • avoid citrus for 1 day per week and high protein
  • infection favors acidity
34
Q

45 yo male, foot pain for 2 days. Patient wakes up in morning with redness and tenderness of big toe. Can barely walk. Patient indicates he had several episodes of same condition in last 6 months. Aggravating factors are alcohol and high protein diet. What is the diagnosis?

  • gout
  • allergy
  • meningitis
  • cluster headaches
A

gout

35
Q

14 yo male, multiple episodes of asthma attacks. Developing form of skin rash on which MD prescribes possible allergy, What is diagnosis?

  • allergic reaction
  • thalassemia
  • gout
  • hepatitis
A

allergic reaction

36
Q

19 yo male, Italian descent, complaining of acute torticollis which happened yesterday. Passive gentile neck mobilization and resisted active neck muscle contraction, dramatic improvement. System review reveals episodes of yellowish discoloration (jaundice 1 to 2 times per year) brought on by stress of infection. Currently he has tinge of jaundice ins clear. Exam of liver and GB revealed no abnormalities or tenderness. What is diagnosis?

  • hepatitis
  • gout
  • allergic reaction
  • hemolytic anemia
A

hemolytic anemia

37
Q

18 yo male with dizziness, light headedness, neck pain and low back discomfort. Describes neck as pain, stiffness, and inability to look down. Generalized body weakness. He is slightly lethargic, these symptoms began suddenly about 2 days ago, although he cannot remember any specific trauma. Since onset, he has not felt well. He has had several episodes of fever and chills. Exam shows generalized neck stiffness. What is diagnosis?

  • meningitis
  • cluster headaches
  • syringomyelia
  • MS
A

meningitis

38
Q

Periodic attacks of vertigo occurs from series of attacks over period of 3 months, few periods of remission of variable duration. Attacks consist of dizziness or vertigo. Sensation of spinning produces nausea, committing, sweating, associated with extreme motion sickness. Onset of vertigo may be preceded by sensation of fullness or pressure in ear, hearing loss, and ringing of right ear. Sudden onset, reaches peak intensity within minutes lasting for hour or more. Unsteadiness may persist for hours or days. Vertigo is especially aggravated by movement. What is diagnosis?

  • syringomyelia
  • Brown Secured syndrome
  • Meniere’s disease
  • beningn positional vertigo
A

Meniere’s disease

39
Q

45 yo female, decreased temperature on left foot in June 2001, slowly progressed until 2004, when she experienced loss of temp sensation and numbness and tight feeling below L2 dermatome. In 2005, motor weakness in right lower extremity and burning sensation on left side from T10-L1 dermatomes. She denies any trauma or surgery. Euro exam shows right lower extremity was moderately weak. Right patellar and achilles tendon reflexes were slightly hyperactive and Babinski sign was present on right side. She complained of numbness, tightens, and loss of temperature sensation below T6 on left side. What is diagnosis?

  • syringomyelia
  • Brown Squared syndrome
  • Meniere’s disease
  • bening positional vertigo
A

Brown Squared syndrome

  • lesion on right side of cord - left side if in brain
  • slow growing lesions, either aneurysm or tumor
40
Q

35 yo male, history of periodic episodes of unilateral headaches that are made worse by ingestion of alcohol and associated with lacrimation and rhinorrhea. What is diagnosis?

  • cluster headaches
  • syringomyelia
  • MS
  • SOL
A

cluster headaches

41
Q

32 yo male says for past year has experiences intermittent episodes of staggering gait, dizziness, and double vision. Recently, he has developed blind spot in hist left visual field. Euro exam shows nystagmus on left lateral gaze intention tremor of left upper extremity and hyperactive reflexes in lower extremity. What is diagnosis?

  • cluster headaches
  • syringomyelia
  • MS
  • SOL
A

MS

test with MRI

42
Q

45 yo female presents with headaches, she is a librarian. Condition started 4 months ago with slow, progressive, dull aching pain. Vitals are normal. BP is 135/85. Physical exam is unrewarding. Neuro exam shows visual field abnormalities detected by confrontation test. Other cranial nerves are WNL. Not other near findings. What is diagnosis?

  • cluster headaches
  • syringomyelia
  • MS
  • SOL
A

SOL

at pituitary or sella turcica

Visceral CLET (3 decks)

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