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Patho final

Terms in this set (53)

The treatment of a 4 mm corneal abrasion typically includes which of the following?

A. antibiotic ointment
B. irrigation for 20 minutes
C. patching the eye
D. home topical anesthetic drops
A
The normal pH of the eye is
7
When would a dendritic lesion be present?

A Adenovirus
B. Bacterial conjunctivitis
C. Herpes simplex
D. Scleritis
c
The pathophysiology of primary open angle glaucoma involves which of the following?

A. Rapid onset
B. Central vision loss
C. Narrow angles
D. Optic nerve dysfunction
D
An episode of AACG would be incited by which of the following?

A. bright light
B. darkness
C. diabetes
D. trauma
B
Uveitis vs AACG:
Uveitis is characterized by

A. Increased intraocular pressure
B. hypopion
C. pain
D. redness
B

also w/ Uveitis: pressure is usually normal & usually no vision loss
Which of the following symptoms is indicative of dry macular degeneration?

A. acute vision loss
B. insidious vision loss
C. peripheral vision loss
D. painful vision loss
B
Papilledema is least likely to be seen in which of the following conditions?

A. Brain tumor
B. Meningitis
C. Central retinal vein occlusion
D. Stage IV hypertensive retinopathy
C
A 41-year-old music teacher presents with a 10-mo. history of prolonged morning stiffness accompanied by swelling of her wrists and the PIP joints of both hands. Now she feels that her knees are also swollen and painful.
PE reveals synovial tenderness and swelling of her knees, wrists, and PIP joints. She has subcutaneous nodules in the extensor area of her right forearm. The right knee has a positive bulge sign consistent with an effusion.

Q1. Which of the following is the most likely diagnosis

A. Osteoarthritis
B. RA
C. Septic Arthritis
D. Chondrocalcinosis
E. Scleroderma
B
Q2. In the course of the pathophysiology of Rheumatoid arthritis, which of the following is most characteristic of the disease?

A. Synovial proliferation with cartilage erosion stimulated by cytokines
B. Cartilage destruction stimulated by the proliferation of proteoglycans
C. Cartilage destruction stimulated by the enzymatic action of proteoglycans
D. Loss of synovial membrane
E. None of the above; the pathophysiology is not known with any certainty
A
Q3. What is the most characteristic symptom of rheumatoid arthritis?

A. Early morning stiffness
B. Progressive joint pain
C. Predilection for the small joints
D. Joint swelling
E. Normal cartilage despite joint pain
A
A 22-year-old man presents with complaints of low back pain for 3-4 months and stiffness of the lumbar area, which worsens with inactivity. He reports difficulty in getting out of bed
In the morning and may have to roll out sideways, trying not to flex or rotate the spine to minimize pain. The patient denies any previous history of eye or GU problems. PE reveals there is diminished chest expansion with inspiration. On cardiac exam there is a high-pitched grade 3/6 decrescendo murmur heard best at the 4th L ICS with the patient sitting up and leaning forward. Sacroiliac tenderness is present. Best Dx?

A. Ankylosing spondylitis
B. Rheumatoid arthritis
C. Gonococcal arthritis
D. Reactive arthritis(Reiter Syndrome)
E. System lupus erythematosus
A
Q2. An L-S spine x-ray film (in ankylosing spondylitis) would most likely show:

A. Degenerative joint disease with spur formation
B. Sacroiliitis with increased sclerosis around the SI joints
C. Vertebral body destruction with wedge fractures
D. Osteoporosis with compression fracture of L3-L5 E. No abnormalities
b
Q3. Which of the following cardiac conditions may be seen in patients with ankylosing spondylitis?

A. Aortic Stenosis
B. Aortic Regurgitation
C. Mitral Regurgitation
D. Tricuspid Regurgitation
E. Pulmonary Regurgitation
B
A 27 y/o man presents because of a painful, swollen knee and ankle of 2 weeks' duration. He has never had joint disease prior to this time. The patient also complains of low back pain and a recent history of clear penile discharge. On examination he has vesicles (some of which have crusted over) on the palms, soles, and glans penis; injected conjunctivae; a swollen right index finger; and arthritis of the right knee and left ankle.
Q1. The MOST likely diagnosis is

A. Septic arthritis (gram +/-)
B. Gonococcal arthritis
C. Crystalline arthritis
D. Psoriatic arthritis
E. Reactive Arthritis(Reiters Syndrome)
E
A 29 y/o male IV drug abuser shows up at your emergency facility transported by Miami Fire Rescue. He has had a 1-day history of fever, and a very swollen, and painful left knee.
The swelling started yesterday just before the chills and fever. PE shows limited passive and active motion in that knee and an otherwise unremarkable physical examination. 45 cc of purulent fluid. Gram stain shows gram-positive cocci in clusters.

Q1. The MOST likely diagnosis is

A. Septic arthritis (gram +/-)
B. Gonococcal arthritis
C. Crystalline arthritis
D. Psoriatic arthritis
E. Reactive Arthritis(Reiters Syndrome)
A

def wanna do the arthrocentesis here
A 21-year-old sexually active man presents with a 5-day history of fever, chills, and persistent left ankle pain and swelling. On PE, maculopapular and pustular skin lesions are noted on trunk and extremities. He denies any symptoms of GU tract infection. Examination of the synovial fluid revealed 190,000 WBC's/cu mm and 95% PMN's.
The MOST likely diagnosis is

A. Septic arthritis (gram +/-)
B. Gonococcal arthritis
C. Crystalline arthritis
D. Psoriatic arthritis
E. Reactive Arthritis(Reiter's Syndrome)
B
What is the max dose of acetaminophen? (from Langen)
3g/day
When does a patient with a rib fracture get admitted?
if 3 or more and/or displaced
if elderly
What is the tx for a single, non displaced rib fracture?
D/C home with NSAIDS, +/- binder
Pt presents with hand pain after falling while state boarding and reached his hand out to catch his fall. On exam you palpate tenderness in the anatomical snuff box, and order an X-ray, which is negative. Best next step?

a. Thumb spica splint, ortho referral and analgesics
b. D/C home with NSAIDS
c. Sugar tong splint and NSAIDS
d.. sugar tong splint, ortho referral, and analgesics
a. even if xray is negative- thumb spica, and should be followed by ortho

complication: avascular necrosis
Pain, edema, and crepitus 4 & 8 cm proximal to radial styloid is pathopneumonic for
Intersection syndrome
For unilateral pedal edema, ________ should be at the top of your ddx
DVT

she had a whole slide that just said this on it
A 12 year old twisted her ankle and is not walking. What areas must you palpate?
-Posterior portions of the medial and lateral malleolus
-Base of the fifth metatarsal
-Navicular bone

Ottawa ankle rules
A pt is presenting with pain that radiates down the back of the leg. After performing the straight leg test, the patient experiences the pain. This positive straight leg could be documented as

a. Jobe's sign
b. Lasegue's sign
c. Lisfranc sign
d. Homans sign
d. Mcmurrays signs
B
70 year old patient is presenting with vision changes that she has been noticing for months, which she attributed to old age. She tells you this has been going on for months now. PE reveals central field deficits, but preserved peripheral vision. A fundoscopic exam reveals drusen adjacent to the macula. What is the best treatment for this patient?

a. No approved treatment, recommend use of magnifying lens
b. intraorbital injection with antivascular endothelial growth factor
c. Latanoprost drops
d. LASER therapy is definitive tx
A.

"Dry" macular degeneration (peripheral vision is preserved, insidious onset, and drusen on fundoscopic are the keys)

no approved tx. :(
Which of the following is used to detect wet age related macular degeneration?

a. Fundoscopic exam, which may reveal hard drusen
b. increased optic disc ratio
c. Fluorescein angiogram
d. fundoscopic exam revealing optic nerve compression
C
How can a patient monitor the progression of their age related macular degeneration?
Amsler grid
What is the definitive treatment of an ectropion?

a. Artificial tears
b. Petroleum lubricant
c. Surgery
d. Taping the eye closed
C
Diabetic retinopathy due to poor blood glucose control causes microvascular and tissue damage to the retina, and neovascularization. Which of the following can be used to help stop the process of neovascularization?

a. yearly opthalmologist exams
b. pan retinal photocoagulation
c. Blood pressure control
d. Scleral Buckle surgical intervention
B
Intraocular injections such as bevacizumab and triamcinolone are helpful in which TWO conditions?

a. Diabetic retinopathy
b. Wet ARMD
c. Dry ARMD
d. Hypertensive retinopathy
A & B
Pt presents to the ER after a MVA complaining of "black spots" in his vision. a quick eye exam reveals visual fields defects. A fundoscopic exam reveals a retina that appears "blurry" What is the best next step? what is the most likely dx?
Retinal detachment

STAT ophthalmology consult
Which of the following physical exam findings are most indicative of central retinal artery occlusion?

a. Drusen spots
b. Cotton wool exudates
c. "Blurry" retina
d. White retina with a deep red macula
e. papillodema
D
Which type of Retinal vascular occlusion is associated with diffuse pan retinal hemorrhages on fundoscopic exam?
Retinal Vein occlusion
How does Retinal artery occlusion appear on fundoscopic exam?
White retina and deep red macula
What is the most common cause of blindness in the world?
Cataracts
Which is true regarding a hyphema?

a. should be given ASA to prevent clotting in the eye
b. it is a collection of blood in the sclera
c. A fox shield should be placed as definitive tx
d. No pressure dressing should be placed
D

Cover with fox shield until ophthalmology shows up to determine tx

NO ASA/NSAIDS
NO NOSE BLOWIN
NO PRESSURE DRESSING

refer to ophalmology
Which portion of the anatomy is usually affected in a "blow out" fracture?"

a. Inferior orbit
b. Nasal septum
c. Superior orbit
d. Zygomatic arch
A
A 60-year-old female complains of dry mouth and a gritty sensation in her eyes. She states it is sometimes difficult to speak for more than a few minutes.
There is no history of diabetes mellitus or neurologic disease. The patient is on no medications. On exam, the buccal mucosa appears dry and the salivary glands are enlarged bilaterally.

Q1. This patient probably has:

A. Sjogren's Syndrome
B. SS
C. SLE
D. Wegener's Granulomatosis
E. Mixed connective-tissue disease (MCTD)
A
Q2. The next step in evaluation of Sjogren syndrome is

A. Labial salivary gland biopsy
B. Schirmer test and measurement of autoantibodies
C. IgG antibody to mumps virus
D. Use of corticosteroids
A (definitive diagnosis)


This is confusing because he says something kinda different in the ppt but this is the answer he gave. Just in case:

Criteria: keratoconjunctivitis sicca (KCS) xerostomia, (+) serologic features of autoimmunity

If serology is negative, do labial salivary gland bx
An otherwise-healthy 75-year-old man who underwent a left total hip replacement 6 months ago develops slowly progressive left hip pain. He feels relatively well. Physical examination is unremarkable except for pain on internal rotation of the left hip. Routine laboratory studies are unremarkable except for an elevated ESR. Radiographs reveal loosening of the hip prosthesis. The next most appropriate action is

A. begin a 6-week course of IV vancomycin
B. administer a 6-month course of oral rifampin and ciprofloxacin
C. administer a 6-month course of ciprofloxacin
D. joint aspiration
E. begin a 6-week course of IV vancomycin; replace the joint after 3 weeks of therapy
D

If an infection in a prosthetic joint is documented after joint aspiration, cure usually requires a combination of organism-specific antibiotic plus joint replacement.
A 31-year-old man presents with fever and arthralgia's for 1 day. He complains of diffuse abdominal pain and inability to move his left foot due to weakness. He also states he has had hematuria for several hours.
On PE the patient has a T of 101.2 F. BP 150/95 mm Hg.
He has diffuse abdominal tenderness on palpation but has no rebound tenderness. Testicular exam revels marked tenderness of the testes but no urethral discharge. Neurologic exam reveals a left foot drop.
Laboratory studies reveal anemia of chronic disease, high ESR, and polymorphonuclear leukocytosis. CXR is clear.

Q1. The most likely diagnosis is
A. Giant cell arteritis
B. Allergic granulomatosis
C. Wegener's granulomatosis
D. Polyarteritis nodosa(PAN)
E. Hypersensitivity vasculitis
D

CXR being clear helps distinguish from Wegners
A 35-year-old female comes to your office with a 1-year history of "aching and hurting all over". In addition, she complains of a chronic headache, difficulty sleeping, and generalized fatigue.
When questioned carefully, she describes "muscle areas tender to touch." Although the pain is "worse in the back," there is really is no place where it doesn't exist. She also describes headaches, generalized abdominal pains, and some constipation
On examination, the most striking finding is the presence of 13 discrete "trigger points".
These include the treapezius muscle, the sternomastoid, the masseter muscle, the levator scapulae, the muscles inserting into the area of the greater trochanter, the muscles inserting into the upper border of the petellae, and six areas on the back that together cover almost the entire back areas

Dx?
Fibromyalgia
A 68-year-old previously healthy woman develops a lilac-colored rash in a butterfly distribution about the eyes, on the bridge of the nose, and on the cheeks. She has a similar rash on her knuckles. She has had an associated muscle weakness manifested by difficulty arising from a chair and climbing stairs. She takes no medicines. Other than the rash and proximal muscle weakness, the woman's examination is unremarkable.

Q1. The most likely diagnosis is

A. Lambert-Eaton Syndrome
B. Botulism
C. Myasthenia Gravis
D. Multiple Sclerosis
E. Dermatomyositis
E
A 50-year-old woman has had Raynaud's phenomenon of the hands for 15 years. The condition has become worse during the last year, and she has developed arthralgias and arthritis involving the hands and wrists as well as mild sclerodactyly and difficulty swallowing solid foods. Physical Exam of the face shows shiny, taut skin and no facial wrinkles Laboratory studies reveal a positive serum antinuclear antibody assay at a dilution of 1:160. Anticentromere antibodies are present in high titers; antiribonucleoprotein antibodies are not detectable

Q1. The most likely diagnosis of this woman's disorder is

A. Systemic sclerosis
B. MCT disease
C. Overlap syndrome
D. Dermatomyositis
E. SLE
A




the ribonucleoprotein not detectable makes MCT less likely
Q2. If this patient with diffuse cutaneous scleroderma (systemic sclerosis) develops severe hypertension she is at significant risk of dying from

A. Thrombotic stroke
B. Central nervous system hemorrhage
C. Renal failure
D. Pulmonary hypertension
E. Pulmonary fibrosis
C
A37-year-old woman with Raynaud's phenomenon complains of progressive weakness with inability to arise out of a sitting position without assistance.
On examination, the patient has swollen "sausage-like" fingers, alopecia, erythematous patches on the knuckles, facial telangiectasias, and proximal muscle weakness. Labs reveal a normal CBC and serum chemistries, except for creatine phosphokinase, 270 U/L, and aldolase, 30 U/L. serologic profile is found: rheumatoid factor is positive at 1: 1600; ANA is also positive at 1:1600 with a speckled pattern and very high titers of antibodies against the ribonuclease-sensitive ribonucleoprotein component of extractable nuclear antigen.

Q1. This patient probably has:

A. Early rheumatoid arthritis
B. Systemic sclerosis
C. Systemic lupus erythematosus
D. Dermatomyositis
E. Mixed connective-tissue disease (MCTD)
E
A 55-year-old male presents to clinic for "weakness." He looks "depressed." He complains of fatigue and difficulty lifting his arms and some leg weakness when he tries to go up to his upstairs bedroom at night. If he sits for long periods of time, he arises stiff. He states that he has felt feverish over the past few weeks, between 100-102 F orally when he has taken his temperature and admits to some "night sweats" when prompted. He has lost about 10 pounds over the past month and his pants are looking "big" for him. He's just not hungry. He continues to work as a lumber yard manager. Physical exam reveals no discernable weakness on objective neurological exam and an otherwise normal exam except his slow, paced movements indicating fatigue.
Lab studies show an elevated erythrocyte sedimentation rate, mild anemia, and an increased alkaline phosphatase

Dx?
PMR
Q2. In consideration of the Polymyalgia Rheumatica diagnosis, you order a muscle biopsy to be performed by the end of the week and immediately begin a course of which of the following?

A. Small dose prednisone, by mouth
B. High intensity physical therapy for strength, balance, and mobility
C. Broad spectrum antibiotic, by mouth, with revisit in 1 week.
D. Narcotic analgesic, and instructions to stay home from work
E. Muscle relaxant, like cyclobenzaprine, before bedtime
A
A 41-year-old music teacher presents with a 10-mo. history of prolonged morning stiffness accompanied by swelling of her wrists and the PIP joints of both hands. Now she feels that her knees are also swollen and painful.
PE reveals synovial tenderness and swelling of her knees, wrists, and PIP joints. She has subcutaneous nodules in the extensor area of her right forearm. The right knee has a positive bulge sign consistent with an effusion.

Q1. Which of the following is the most likely diagnosis

A. Osteoarthritis
B. RA
C. Septic Arthritis
D. Chondrocalcinosis
E. Scleroderma
B
Q2. In the course of the pathophysiology of Rheumatoid Arthritis, which of the following is most characteristic of the disease?

A. Synovial proliferation with cartilage erosion stimulated by cytokines
B. Cartilage destruction stimulated by the proliferation of proteoglycans
C. Cartilage destruction stimulated by the enzymatic action of proteoglycans
D. Loss of synovial membrane
E. None of the above; the pathophysiology is not known with any certainty
A
Polyarteritis nodosa, polymyalgia Rheumatica, polymyositis, temporal arteritis are all types of which disorder

a. Vasculitis
b. Rheumatic disorder
c. arthritis
Vasculitis
Endotracheal intubation should be performed with caution in patients with which of the following underlying conditions due to the propensity to cause subluxation of C1 on C2?

a. Rheumatoid arthritis
b. Osteoarthritis
c. Gout
d. Pseudogout
A
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