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PACKRAT 4 – Questions And Correct A+ Solutions
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PACKRAT 4 – Questions And Correct A+ Solutions**(C) Denotes - Right Ans **
Which of the following is a major contraindication to curative surgical
resection of a lung tumor?
A. Liver metastases
B. Vagus nerve involvement
C. Non-malignant pleural effusion
D. Chest wall invasion of the tumor (c) A. Distant metastases,
except for solitary brain and adrenal metastases are an absolute
contraindication for pulmonary resection. Other absolute contraindications
include MI within past 3 months, superior vena cava syndrome due to
metastatic tumor, bilateral endobronchial tumor, contralateral lymph node
metastases and malignant pleural effusion.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
A 23 year-old female complains of fever and genital pain. Examination reveals
the presence of lymphadenopathy in the groin and the presence of vulvar
vesicles surrounded by erythematous skin. The diagnosis may be confirmed
by
A. A culture of a vesicle using blood agar medium.
B. The presence of similar lesions on the fingers and hands.
C. A Gram stain of a scraping from the base of the lesion.
D. The presence of giant multinucleated cells on Tzanck smear. (u)
A. Herpes virus will not grow on blood agar medium.
(u) B. Herpes genitalis occurs in skin that comes into contact with the herpes
virus. Usually the infection is localized.
(u) C. A Gram stain will not identify the herpes virus.
(c) D. A Tzanck smear is the standard laboratory test to confirm the herpes
virus as an etiologic agent of a vesicular lesion on an erythematous base.
A 28 year-old woman is complaining of heavy uterine bleeding and pelvic
pressure that has progressively worsened over the past year. Evaluation
,reveals multiple moderate-sized uterine fibroids. The patient desires to have
more children. The most appropriate definitive treatment is
A. Myomectomy.
B. Hysterectomy.
C. GnRH agonists.
D. Oral progesterone. (c) A. Myomectomy is the definitive
treatment of choice for moderate-sized uterine fibroids in young women who
desire to maintain reproductive capability.
(u) B. Hysterectomy is indicated as definitive treatment in a patient who does
not desire to maintain reproductive capability.
(u) C. GnRH agonists are used as an adjunct to surgery for treatment of uterine
fibroids. Used alone, they would not be considered definitive treatment.
(u) D. Oral progesterone may be used to suppress menorrhagia
preoperatively. Used alone, it would not be considered definitive treatment.
A 59 year-old otherwise healthy female develops acute dyspnea and chest
pain one week post total abdominal hysterectomy. Echocardiogram
demonstrates normal heart size with normal right and left ventricular
function. Lung scan demonstrates two segmental perfusion defects. Which of
the following is the next step in the management of this patient?
A. Anticoagulation
B. Embolectomy
C. Thrombolysis
D. Inferior vena cava filter (c) A. Anticoagulation is the treatment of
choice in patients with pulmonary embolism with normal ventricular function
and no absolute contraindications.
(u) B. Embolectomy is not indicated as initial treatment of a pulmonary
embolism in patients with normal ventricular function.
(h) C. Thrombolysis is contraindicated in patients within 10 days of having
major surgery.
(u) D. An inferior vena cava filter is considered in patients with
contraindications to anticoagulation therapy or failed anticoagulation therapy.
Long term use of which of the following drugs may cause a drug-induced
lupus-type eruption?
A. prednisone
B. tetracycline
C. procainamide
,D. oral contraceptives (u) A. Prednisone is not implicated in drug-
induced skin reactions.
(u) B. Tetracycline and sulfonamides are known to cause a photosensitive
rash on sun exposed areas of the skin.
(c) C. Procainamide and hydralazine are the most common drugs that may
cause a lupus-like eruption.
(u) D. Oral contraceptives may induce erythema nodosum.
Which of the following clinical manifestations is most commonly seen in viral
croup?
A. drooling
B. wheezing
C. sputum production
D. inspiratory stridor (u) A. Drooling is common in epiglottitis not
viral croup.
(u) B. Wheezing is noted in asthma.
(u) C. Sputum production is noted in bacterial infections.
(c) D. Viral croup typically presents with a barking cough and stridor.
Whispered voice test on a patient reveals decreased hearing in the left ear.
Which of the following would be most consistent with conductive hearing loss
in the left ear?
A. Sounds best heard in the left ear on Weber test.
B. Air conduction longer than bone conduction in the left ear on Rinne test.
C. Sound best heard in the right ear on Weber test.
D. Bone conduction longer than air conduction in the right ear. (c)
A. Sound best heard in the ear with decreased hearing on Weber test (in this
case, the left ear) is indicative of conductive hearing loss.
(u) B. With conductive hearing loss, bone conduction should be heard as long
as or longer than air conduction of sound in the effected ear. Air conduction
lasting longer than bone conduction of sound would indicate sensorineural
hearing loss.
(u) C. Sound best heard in the ear with unaffected hearing on Weber test (in
this case, the right ear) is indicative of sensorineural hearing loss.
(u) D. With conductive hearing loss, bone conduction should be heard as long
as or longer than air conduction of sound in the effected ear. The right ear
showed normal hearing on physical exam.
, A 65 year-old male presents with multiple lesions on his back. He denies any
pruritis. Physical examination reveals the presence of multiple scattered
brown plaques with a raised, warty surface that appear to be stuck onto the
skin and feel greasy. Which of the following is the most likely diagnosis?
A. lentigines
B. actinic keratosis
C. keratoacanthomas
D. seborrheic keratosis (u) A. Lentigines most commonly are seen
on the dorsum of the hand and appear as flat brown spots, often with sharp
borders.
(u) B. Actinic keratosis usually present as small patches of flesh-colored, pink
or yellow-brown lesions often with an erythematous component. The lesions
are better felt than seen, having a rough, sandpaper feel and are often tender
to palpation.
(u) C. Keratoacanthomas usually occur as an isolated lesion on the face
appearing as an erythematous, dome-shaped nodule with a central
keratinaceous plug.
(c) D. Seborrheic keratosis is a common benign plaque in the elderly that
characteristically has a velvety or warty surface associated with a stuck on
appearance and greasy feel.
You are called to the nursery to see a male infant, born by uncomplicated
vaginal delivery. He weighs 2,600 grams and has one deep crease on the
anterior third of each foot. Respirations are 88 breaths/minute with
expiratory grunting and intercostals retractions. He is cyanotic on room air
and becomes pink when placed on 60% oxygen. Chest x-ray shows atelectasis
with air bronchograms. Which of the following is the most likely diagnosis?
A. neonatal pneumonia
B. congenital heart disease
C. hyaline membrane disease
D. chronic lung disease of prematurity (u) A. While tachypnea,
grunting, retractions and cyanosis may be signs of neonatal pneumonia, they
are primarily late findings of progressive respiratory distress and would not
be seen immediately at the time of delivery. A chest x-ray in pneumonia would
also most commonly reveal an infiltrate or effusion.
(u) B. While congenital heart disease may present with cyanosis, the chest x-
ray will reveal a cardiac abnormality, such as cardiomegaly.
(c) C. Hyaline membrane disease is the most common cause of respiratory
distress in the premature infant. The infant typically presents with tachypnea,
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