Nokea
In which patient is alpha-1 antitrypsin deficiency the likely cause of chronic obstructive pulmonary disease?
- A. A 30-year-old who has smoked for 3 years
- B. A 65-year-old man who drove a taxi most of his life
- C. A 70-year-old woman who smoked for 40 years
- D. A 50-year-old with exposure to secondhand smoke
Correct Answer: A
Rationale: Alpha-1 antitrypsin deficiency is a genetic cause of chronic obstructive pulmonary disease (COPD). It is more common in younger patients with a history of smoking at a younger age, like the 30-year-old who has smoked for 3 years. Choices B, C, and D are less likely to be associated with alpha-1 antitrypsin deficiency as COPD in these cases is more likely due to smoking and environmental exposures.
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What is the pathophysiologic process responsible for the decreased glomerular filtration rate in a patient with acute glomerulonephritis?
- A. Decreased renal-induced constriction of the renal arteries
- B. Immune complex deposition, increased capillary permeability, and cellular proliferation
- C. Necrosis of 70% or more of the nephrons secondary to increased kidney interstitial hydrostatic pressure
- D. Scar tissue formation throughout the proximal convoluted tubule secondary to toxin-induced collagen synthesis
Correct Answer: B
Rationale: The correct answer is B: Immune complex deposition, increased capillary permeability, and cellular proliferation. Acute glomerulonephritis is characterized by inflammation of the glomeruli in the kidneys. This inflammation leads to the deposition of immune complexes, increased capillary permeability, and cellular proliferation, which collectively contribute to a decreased glomerular filtration rate. Choice A is incorrect as decreased renal-induced constriction of the renal arteries would not directly result in decreased glomerular filtration rate. Choice C is incorrect as necrosis of nephrons due to increased kidney interstitial hydrostatic pressure would affect kidney function differently. Choice D is incorrect as scar tissue formation in the proximal convoluted tubule due to toxin-induced collagen synthesis is not a typical feature of acute glomerulonephritis.
In which patients would the manifestation of a headache be a sign of a serious underlying disorder?
- A. A 55-year-old man with new onset of headaches that are worse at night and reported mood swings according to his family
- B. A 30-year-old woman with a unilateral throbbing headache with photophobia and nausea
- C. A 60-year-old man with his head feeling full and throbbing and muscle aching around his neck and shoulders
- D. A 40-year-old woman who experiences food cravings, gets irritable, and then develops a pulsatile-like headache on the right side of her head
Correct Answer: A
Rationale: In this scenario, the correct answer is the 55-year-old man with new onset headaches that worsen at night and reported mood swings according to his family. These symptoms, especially when combined with nighttime worsening and mood changes, could indicate a serious underlying disorder such as a brain tumor or increased intracranial pressure. Choice B is incorrect as the unilateral throbbing headache with photophobia and nausea is suggestive of migraine headaches, which are usually not associated with serious underlying disorders. Choice C describes symptoms that are more indicative of tension-type headaches rather than a serious underlying disorder. Choice D presents symptoms that are more likely related to hormonal changes and migraines rather than a serious underlying disorder.
After a 27-year-old woman with epilepsy had a generalized seizure, she feels tired and falls asleep. This is:
- A. an ominous sign.
- B. normal and termed the postictal period.
- C. a reflection of an underlying brain tumor.
- D. only worrisome if there are focal neurologic deficits after.
Correct Answer: B
Rationale: The correct answer is B: normal and termed the postictal period. The postictal period is a common phase following a seizure where the individual may experience fatigue, confusion, or sleepiness. It is a normal part of the seizure event and does not necessarily indicate a serious issue. Choice A is incorrect because feeling tired and falling asleep after a seizure is not an ominous sign but rather a typical postictal symptom. Choice C is incorrect as there is no indication in the scenario provided that links the symptoms to an underlying brain tumor. Choice D is incorrect because the absence of focal neurologic deficits does not make the postictal period worrisome.
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 are manifestations of Cushing syndrome?
- A. Truncal obesity with thin extremities.
- B. Enlargement of face, hands, and feet.
- C. Cachexia.
- D. Thick scalp hair.
Correct Answer: A
Rationale: Truncal obesity with thin extremities is a classic manifestation of Cushing syndrome due to the redistribution of fat. Enlargement of face, hands, and feet is seen in conditions like acromegaly, not Cushing syndrome. Cachexia is a state of severe weight loss and muscle wasting, typically seen in conditions like cancer or advanced infections. Thick scalp hair is not typically associated with Cushing syndrome.