Carmen's Fcm Post-Exam Questions

Front 1

1. 24 year old comatose pt from a car accident with eye movements that are non-purposeful.

Back 1

ANS: The patient is in a neurovegetative state and although his reticular activity is in tact, connections are compromised.

Front 2

1. Which is NOT a measurement of neurological function

Back 2

ANS: IQ

Front 3

1. A previously healthy 38 year old male is unresponsive. His BP is 210/90. He attends parties where there is cocaine. Which would you NOT do in assessing this patient?

Back 3

ANS: a lumbar puncture to r/o subdural bleed (subarachnoid doesn’t communicate with subdural bleed)

Front 4

1. 68 year old male with hx of using tobacco has shortness of breath over 6 mo. Can’t do manual tasks. Suspect COPD- O2 stats @ room air is 80%. All are true EXCEPT:

Back 4

ANS: His hypoxia is likely caused by a true pulmonary shunt

Front 5

1. 78 year old male with CHF. Heart displaced to the left. Vocal and tactile frematis on the right with decreased breath sounds.

Back 5

ANS: right pleural effusion

Front 6

1. An example of hypoxia due to a pure Right to Left shunt is:

Back 6

ANS: A 4 year old with a VSD

Front 7

1. Increased leukocytes are NOT found in

Back 7

ANS: Migraine

Front 8

T or F: Lymphocytes are increased in a left shift

Back 8

False: 1. ANS: Lymphocytes are NOT increased in a Left shift

Front 9

1. 72 year old female with metastatic breast cancer presents with weakness. HR is 110, BP 88/45. Mucous membranes are dry. Na is 133, BUN is 28, and normal creatinine of 1.8. All are true EXCEPT:

Back 9

ANS: patient is dehydrated and would benefit from administration of free H2O.

Front 10

1. Which is least likely to increase eosinophils

Back 10

ANS: pneumococcal pneumonia (remember, think NAACP)

Front 11

1. All of the following can increase body temperature. Which is NOT an exogenous pyrogen?

Back 11

ANS: cytokines

Front 12

1. Which of the following statements is TRUE regarding hyperthermia?

Back 12

ANS: Hyperthermia is an increase in temperature with a NORMAL hypothalamic set point

Front 13

1. Which of the following scenarios is mechanical lowering of body temperature NOT indicated?

Back 13

ANS: a case of west nile virus in an elderly male with a temp of 38 degrees C.

Front 14

1. A 69 year old male with 2 week history of retrosternal chest pain, increased dyspnea and dizziness after exercise. BP is 125/95 (narrow pulse pressure) and pulse of 76. Patient is NOT a smoker. On auscultaion of the heart he is noted to have a harsh, late peaking, crescendo-decrescendo systolic ejection murmur. What is his likely diagnosis?

Back 14

ANS: critical aortic stenosis

Front 15

1. What is the mechanism of aortic stenosis?

Back 15

ANS: supply/demand mismatch with sub endocardial ischemia secondary to increased left ventricular pressure in face of significant thickening of the left ventricular myocardium.

Front 16

1. A 48 year old female with Graves disease has pedal edema, orthopnea, dyspnea, and a myxomatous mitral valve. She has a loud holosystolic murmur that radiates to the left axillae. What is the best course of action for her?

Back 16

ANS: she should undergo a valve replacement with a MECHANICAL valve (because she is young) and be on anticoagulation for life

Front 17

1. All are true of aortic insufficiency EXCEPT:

Back 17

ANS: murmur of aortic insufficiency is loud, low pitch, and best heard at the beginning of systole over the Left precordium (false b/c AI is in DIASTOLE)

Front 18

1. A 42 year old female plays tennis. She has jaw pain, mild nausea, and shortness of breat. Crushing substernal chest pain. She smokes. Her glucose is 125. EKG shows ST elevation, ST impressions, Reciprocal changes across the anterolateral wall of heart. She most likely has:

Back 18

ANS: Rupture of a vulnerable plaque in a major coronary with subsequent formation of an occlusive thrombus eliminating anterograde blood flow to a portion of the myocardium.

Back 19

1. ANS: Beta blockers

Front 20

1. A 55 year old male with history of diabetes, smoking, etc… which risk factor affects him the most?

Back 20

ANS: cigarette smoking

Front 21

1. Which scenario is NOT an absolute indication for CAB?

Back 21

ANS: severe (>90%) stenosis in mid portion of the LAD with patent collateral circulation.

Front 22

1. A young Japanese medical student presents with crushing substernal chest pain. His condition:

Back 22

ANS: often requires stenting and or thrombolytic therapy

Front 23

1. A 59 year old post menopausal woman who is overweight and has diabetes. Her triglycerides are 400. Which is NOT immediately recommended?

Back 23

ANS: pharmacotherapy to decrease patient’s weight

Front 24

1. What influences what and EKG does?

Back 24

1. To determine heart rate from EKG (300/# of big boxes).

Front 25

1. Which interval in the EKG represents the delay between SA and AV node in the heart?

Back 25

ANS: the PR interval

Front 26

1. Which of the following is correct about Deep Venous Throbosis and PE?

Back 26

ANS: A normal V/Q scan excludes the diagnosis of PE with 75 % accuracy

Front 27

1. A patient with orthopnea, dyspnea and an enlarged heart:

Back 27

ANS: he is likely to have adaptive mechanisms for his heart failure which would include ventricular remodeling and neurohormone activity.

Front 28

If a patient has a HR of 150

Back 28

1. (It is a 2:1 atrial flutter until proven otherwise!)

Front 29

1. With systolic heart failure, which of the following is NOT true?

Back 29

ANS: plasma levels of NE will be decreased (false because everything neuroendocrine will be increased)

Front 30

1. Treatment for dilated cardiomyopathy includes:

Back 30

ANS: DECREASE in Na intake

Front 31

1. A 23 year old blacked out:

Back 31

ANS: ECG is diagnostic test of choice and should be done ASAP

Front 32

1. Which is NOT a dilated cardiomyopathy?

Back 32

ANS: Amyloid cardiomyopathy

Front 33

1. Dimentia of Alzheimers disease (DAT) is best correlated with neuropathologial findings. Severity depends on:

Back 33

ANS: degree of neuronal synaptic loss

Front 34

1. An 86 year old male develops flu like symptoms followed by a bacterial lower pneumonia. His Serum Na is 115 and Urine Na is 35. Serum Os is 240 and Urine Os is 600. He has:

Back 34

ANS: SIADH (if urine Os is greater than serum, then you are inappropriately secreting ADH)

Front 35

1. Which of the following is NOT a cardinal sign of Parkinsons:

Back 35

ANS: Flacid paresis

Front 36

1. A 60 year old male with advanced colon cancer presents with 4+ Edema, large protein in urine w/o casts. (Nephrotic syndrome picture). All are true EXCEPT:

Back 36

ANS: the presence of RBC casts or dysmorphic RBCs in the urine are commonly found in Nephrotic syndrome. (this is false b/c this is descriptive of NEPHRITIC syndrome)

Front 37

1. Emphysema is characterized by:

Back 37

ANS: FEV1/FVC decreased

Front 38

1. All are examples of acute renal failure EXCEPT:

Back 38

ANS: Ureteral obstruction

Front 39

1. Not likely to occur in dehydration and volume depletion:

Back 39

ANS: an increase in UNa via aldosterone stimulation

Front 40

1. 38 year old male is tachypnic with a BP of 105/64. May have O.D. He has low serum Na, a low pH, PCO2… In determining the cause of his hyponatremia the 1st step is to:

Back 40

ANS: compare a calculated to a measured serum osmolality

Front 41

1. From the patient in the previous question… how can you tell he is volume depleted?

Back 41

ANS: by the BUN and Creatnine ratio

Front 42

1. A seven year old child with cocacola colored urine and periorbital edema. He has low complement. He is most likely to have:

Back 42

ANS: Acute post infectious glomerulonephritis.

Front 43

1. The best way to distinguish chronic from acute renal failure?

Back 43

ANS: In chronic renal failure, small echogenic kidneys on ultrasound

Front 44

1. What is the best description of epilepsy?

Back 44

ANS: Recurrent, unprovoked seizures of unexplained or unknown etiology.

Front 45

1. A compensatory response to metabolic alkylosis is characterized by:

Back 45

ANS: increased arterial blood pCO2

Front 46

1. A 67 year old male with history of smoking and progressive shortness of breath. Arterial blood gases: 7.32/58/65/33 (pH/pCO2/PO2/HCO3). What is the primary acid-base disorder?