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Flashcards in Pre Midterm Deck (19)
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Which of the following statements accurately describes stable angina?
A. Precipitated by exertion, cold, or stress and lasts 15 minutes
B. Tearing or ripping pain
C. May radiate to the epigastric area
D. Relieved by intake of food or antacids
E. chest pain associated with dyspnea

C. May radiate to the epigastric area

Stable angina lasts only 2-10 minutes, relieved by rest and although uncommon, chest pain due to angina may radiate to the epigastric area; Tearing or ripping pain is acute aortic dissection; relieved by intake of food or antacids is peptic ulcer disease presenting as chest pain; if with associated dyspnea- it can be pneumonia, pulmonary embolism pneumothorax.


A 70 year old male complains of back pain since 3 months PTC. He also had fever and productive cough
starting one week prior to consult. 2 days PTA, patient had noticed a decreased urine output and decreasing sensorium. Radiographs were taken and shows diffuse osteopenia. An impression of multiple myeloma was made.
What diagnostic modality is needed to complete the criteria for diagnosis ?
A. Bone marrow aspirate
B. Serum M protein
C. Urine M protein
D. Both B and C
E. All are correct.

E. All are correct.

Diagnosis: Multiple Myeloma

Bone marrow aspirate, Serum M protein, Urine M protein


Laboratory results that will support multiple myeloma.

Elevated ESR
Normochromic normocytic anemia


Bone lesions in multiple myeloma is caused by what mechanism?
A. Proliferation of tumor cells
B. Activation of osteoblasts that destroy the bone
C. Suppression of osteoclasts that form the new bone.
D. Elevated PTH levels thus promoting bone reabsorption. E. Elevated calcitonin levels.

A. Proliferation of tumor cells

Bone lesions are due to proliferation of tumor cells, activation of osteoclasts and suppression of osteoblasts. Calcitonin in rare cases in other hypercalcemic states but is rarely required in multiple myeloma.


What condition causes euvolemic hyponatremia?
A. Acute renal failure
B. Chronic renal failure
C. Glucocorticoid deficiency
D. Hyperthyroidism
E. Cirrhosis

C. Glucocorticoid deficiency

*Hypervolemic hyponatremia (cirrhosis, nephrotic syndrome);
*Euvolemic hyponatremia (Hypothyroidism, Glucocorticoid deficiency, SIADH),
*Hypovolemic hyponatremia(diarrhea, burns, vomiting)


Form of respiratory failure aka perioperative respiratory failure:
A) Type 1 B) Type 2 C) Type 3
D) Type 4 E) Type 5

Type 3

Type 1: hypoxic
Type 2: hypercarbic
Type 3: perioperative respiratory failure
Type 4: hypoperfusion related


Systemic lupus erythematosus most often involve what organ system?



A patient has constellation of tumors involving different organ systems. What is the clinical syndrome wherein a patient has multiple osteomas, familial polyposis, and skin and soft tissue tumor?
A. Cowden's syndrome
B. Gardner's syndrome
C. Turcot syndrome
D. Neuro`bromatosis 1
E. Neuro`bromatosis 2

Gardner's syndrome

*Cowden's syndrome- trichilemmomas, thyroid cancer, endometrial cancer, breast cancer, cerebellar gangliocytoma;
*Turcot syndrome-gliomas, medulloblastomas, adenomatous colon polyps, adenoCA;
*NF1-schwannoma, astrocytoma, optic nerve glioma, neurofibroma;
*NF2- bilateral vestibular schwannoma, ependymoma, multiple meningioma


Joints commonly involved on osteoarthritis:
A. Ankle
B. wrist
C. elbow
D. 1st metatarsophalangeal joint
E. Humeroulnar joint

1st metatarsophalangeal joint

OA commonly involves cervical and lumbosacral spine, hip, knee and 1st MTP; often spares elbow, wrist, ankle.


Sources of pain in osteoarthritis can be multifactorial, which is the unlikely source of pain?
a. Cartilage loss
b. Synovium
c. Joint capsule
d. Subchondral bone
e. Muscles surrounding joint

Cartilage loss

*Remember that cartilage is aneural.


Which of the following conditions can cause high output heart failure?
a. Chronic anemia
b. Acute immune hemolytic anemia
c. Thiamine deficiency
d. Valvular heart disease

Chronic anemia
Thiamine deficiency

high output failure can be caused by: beriberi (B1 deficiency), chronic anemia, systemic arteriovenous shunting;

diastolic heart failure causes-fibrosis, aging, restrictive cardiomyopathy, HOCM


Which of the following is true regarding acute pericarditis?
A. 2nd to pericardial tumors as the most common pathologic proces involving the pericardium
B. The pain due to acute pericarditis is often severe ,retrosternal and left precordial
C. Acute pericardial pain is referred to the axilla,right shoulder and jaw.
D. A pericardial friction rub is rarely appreciated.
E. The typical ECG finding involves 5 evolving stages.

B. The pain due to acute pericarditis is often severe ,retrosternal and left precordial

*Acute pericarditis is the most common process that involves the pericardium, pain is referred to left shoulder,neck or arms; pericardial friction rub is appreciated upto 85% of patients with acute pericarditis;
*The ECG finding in acute has four stages.


The following conditions are associated with Calcium pyrophosphate crystal deposition disease, except?
A. Aging
B. Primary hyperparathyroidism C. Chronic gout
D. Epiphyseal dysplasias
E. Hypermagnesemia

E. Hypermagnesemia

Hypomagnesemia and not hypermagesemia is associated with CPPD.

Choices A to D are correct.


The following conditions are associated with health care- associated pneumonia due to pseudomonas aeruginosa?
A. Hospitalization > 24 hours
B. Hospitalization for >2 days in prior 6 months
C. Nursing home or extended care facility residence
D. Antibiotic use in the preceeding 6 months

C. Nursing home or extended care facility residence

Hospitalization > 48 hours, Hospitalization for >2 days in the prior 3 months, nursing home or extended-care-facility residence, antibiotic use in the preceeding 3 months


A 32 year old male with no comorbidities has a 5 day history of productive cough, with high grade fever Tmax of 39.0 degree celsius. Upon Chest Xray, a finding of right lower lung lobe consolidation was found. What is the likely etiology?
A. Staph epidermidis
B. Staph aureus
C. Streptococcus Pneumoniae D. Haemophilus influenza
E. Pseudomonas aeruginosa

C. Streptococcus Pneumoniae

*Most common cause of community acquired pneumonia is still Streptococcus pneumonia


If the patient with cystic fibrosis presented with the same set of symptoms, what is the likely etiology?
A. Staph epidermidis
B. Staph aureus
C. Streptococcus Pneumoniae D. Haemophilus influenza
E. Pseudomonas aeruginosa

E. Pseudomonas aeruginosa


A 56 year old woman, with BMI of 31, has complained of polyuria, polydipsia and easy fatiguability. She also has frequent superficial infections and suffers minor cuts which heals longer than expected. Her father and 2 sisters are diagnosed with T2DM. Which of the following laboratory criteria supports a diagnosis of DM?
A. FBS of >136 mg/dL
B. HbA1c >7%
C. 1 hour plasma glucose > 200 mg/dL post OGTT
D. RBS of >200 mg/dL
E. All of the above

D. Random plasma glucose of >200 mg/dL


A 56 year old male, presented at the emergency department with severe chest pain lasting about > 30 minutes, radiating to the the jaw and left arm. The patient is hyperlipidemic and hypertensive, maintained on statin and calcium antagonist therapy but is poorly compliant. A signi`cant family history of hypertension was also elicited. What is the likely diagnosis?
A. Pulmonary embolism
B. Aortic dissection
C. Acute myocardial infarction D. Acute pericarditis
E. Pneumonia

C. Acute myocardial infarction


A patient suffered acute myocardial infarction. Upon physical examination, the patient has a bp of 110/80, dyspneic and with mid-bibasal rales. Chest xray shows kerley lines and peribronchial cuf`ng. Classify the patient based on killip scoring.
A. Killip 1
B. Killip 2
C. Killip 3
D. Killip 4
E. Killip 5

C. Killip 3

*Hint:if the patient has hypotension, automatically it is class IV