Nokea
A man with gout has developed large, hard nodules around his toes and elbows. The phase of gout he is in is:
- A. asymptomatic
- B. acute flare
- C. the intercritical period
- D. chronic gout
Correct Answer: D
Rationale: The correct answer is 'chronic gout.' Chronic gout is characterized by the presence of tophi, which are large, hard nodules that can develop around joints like toes and elbows. These tophi are a sign of longstanding, untreated gout. Choice A, 'asymptomatic,' is incorrect as the presence of tophi indicates a symptomatic phase. Choice B, 'acute flare,' is incorrect as acute flares are characterized by sudden and severe pain, inflammation, and redness in the joints, not the development of tophi. Choice C, 'the intercritical period,' is also incorrect as this phase occurs between acute attacks and is typically asymptomatic, without the presence of tophi.
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Which of the following correctly identifies the plasma protein inflammatory mediator systems?
- A. Phagocytic, interferon, and complement systems.
- B. Complement, fibrinolytic, and clotting systems.
- C. Complement, clotting, and kinin systems.
- D. Complement, clotting, and acute phase reactant systems.
Correct Answer: C
Rationale: The correct answer is C: Complement, clotting, and kinin systems. These are the three main plasma protein inflammatory mediator systems. The complement system helps in inflammation and immune responses, the clotting system is involved in blood coagulation, and the kinin system regulates inflammation and blood pressure. Choice A is incorrect because interferon is not part of the plasma protein inflammatory mediator systems. Choice B is incorrect because the fibrinolytic system is not a primary inflammatory mediator system. Choice D is incorrect because acute phase reactants are not part of the plasma protein inflammatory mediator systems.
Which of the following types of vitamin or mineral deficiency can cause megaloblastic anemia and is associated with lower extremity paresthesias?
- A. Vitamin B12
- B. Folate
- C. Iron
- D. Vitamin K
Correct Answer: A
Rationale: The correct answer is Vitamin B12. Vitamin B12 deficiency can lead to megaloblastic anemia, a condition characterized by the production of abnormally large and immature red blood cells. Lower extremity paresthesias, such as tingling or numbness, are common neurological symptoms associated with vitamin B12 deficiency. Folate deficiency can also cause megaloblastic anemia but is not typically linked to lower extremity paresthesias. Iron deficiency leads to microcytic anemia, not megaloblastic anemia. Vitamin K deficiency is associated with bleeding tendencies, not megaloblastic anemia or paresthesias.
Which of the following is a characteristic of osteosarcoma?
- A. Slow-growing tumor that begins in the bone marrow
- B. Solitary tumor that most often affects the metaphyseal region of the femur or tibia
- C. An aggressive tumor most often found in the bone marrow of long bones
- D. A tumor that infiltrates the trabeculae in spongy bone and implants in surrounding tissue
Correct Answer: C
Rationale: Osteosarcoma is an aggressive bone tumor that most commonly arises in the bone marrow of long bones, such as the femur or tibia. Choice A is incorrect as osteosarcoma is not a slow-growing tumor but rather a fast-growing one. Choice B is incorrect as osteosarcoma is not typically solitary but can involve multiple lesions. Choice D is incorrect as osteosarcoma primarily affects the medullary (marrow) cavity of bones, rather than infiltrating the trabeculae in spongy bone and surrounding tissue.
Which of the following characterizes ductal carcinoma in situ?
- A. It is less common than lobular carcinoma in situ.
- B. Malignant cells have not invaded the stroma.
- C. It is considered a cancer precursor.
- D. Malignant cells have not invaded the stroma; it is considered a cancer precursor and has a higher risk for invasive cancer compared to lobular carcinoma in situ.
Correct Answer: D
Rationale: The correct answer is that ductal carcinoma in situ is characterized by malignant cells that have not invaded the stroma, making it a cancer precursor with a higher risk for invasive cancer compared to lobular carcinoma in situ. Choice A is incorrect because ductal carcinoma in situ is more common than lobular carcinoma in situ. Choice B is incorrect as it only partially describes ductal carcinoma in situ without mentioning its potential for progression to invasive cancer. Choice C is incorrect because it does not capture the complete characteristics of ductal carcinoma in situ, which include the risk for invasive cancer.
The early stages of atheroma development are characterized by:
- A. macrophages full of oxidized low-density lipoprotein (LDL; i.e., foam cells) in the intima
- B. accumulation of lipids in the intima (i.e., fatty streak)
- C. accumulation of proteins such as collagen and elastin (i.e., fibrous cap)
- D. development of calcium and a necrotic lipid core
Correct Answer: A
Rationale: The correct answer is A. In the early stages of atheroma development, macrophages accumulate oxidized low-density lipoprotein (LDL) and transform into foam cells, leading to the formation of fatty streaks in the intima of blood vessels. This process is a hallmark of the initial stages of atherosclerosis. Choice B is incorrect as it describes the accumulation of lipids in the intima, which is a later event following foam cell formation. Choice C is also incorrect as it refers to the accumulation of proteins forming the fibrous cap, which occurs at a later stage to stabilize the atheroma. Choice D is incorrect as it describes the development of calcium and a necrotic lipid core, typically seen in advanced atherosclerosis rather than the early stages.