The Daily PANCE and PANRE "Second Midterm" Exam:Questions 30 through 60

Again, the wording is difficult in this question. Macular degeneration, retinal detachments and trauma are not preventable. Cataracts are "curable", but the cataract itself is probably not "preventable". Chronic glaucoma can be treated to prevent blindness this is a matter of semantics.

Amantadine (Symmetrel) is effective somewhat). It is used in treating Influenza A. Another choice is selegiline, and levodopa/carbidopa. The other antibiotics listed here are not useful in Parkinson's.

High T4 (hyperthyroid), with a low TSH indicates that the pituitary is working normally, and the thyroid is hyperactive, i.e. Grave's disease. Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.

Plummer-Vinson is something to know for those who want a 100% on the exam. There is no need to memorize this. More importantly, webbing in the distal esophagus with no other symptoms but dysphagia would be a Schatzki’s ring (much more common). Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa. Achalasia is a primary neurologic problem of the esophagus causing dysphagia.

Of these choices, prazosin is an alpha- blocker. Ritodrine and epinephrine cause beta sympathetic stimulation. Albuterol is a beta agonist. Propranolol is a beta blocker.

This is genu varum (bow legs). Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)

Clue cells means BV

Koebner's phenomenon is described - it suggests psoriasis. Auspitz sign is also present in psoriasis where the scales bleed when removed. Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. Gottron's papules are purple papules on the fingers seen in dermatomyositis. Gorlin's sign is seen in Ehlers-Danlos when a patient can touch the tip of the nose with his tongue (I learn something new every day!!) These last two are not important to know.

OE is described here. OM would not cause periauricular nodes and tragal tenderness. Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). Ramsey- Hunt is herpes zoster of the ear canal and would be visible. A perforated TM would cause middle ear, not external ear pain (typically).

This is a potassium sparing diuretic and should be avoided in anyone with renal disease. ACEI should be avoided as well (but none of these are ACEI's).

This is a typical scenario for MAOI induced malignant hypertension from eating the "wrong" foods, which are frequently found on a Christmas buffet, (cheese, sausages, red wine, etc.).

Statin + fibrate = suspicion for rhabdomyolysis in a patient with myalgias, ALWAYS order a CPK. (statin alone, or fibrate alone may cause it too, but the combination is most likely)

This is the genotype for Turner's syndrome. XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). Trisomy 21 is Down's. The other two are not common genotypes.

Any patient presenting with mediastinal nodes should have a CT. This patient may have sarcoid or Hodgkin's or another type of cancer - CT is indicated.

Empyema (lung abscess) is almost always staph aureus. While strep pneumo is the most common CAP, when a complication like empyema occurs, it is almost always staph.

This is the typical clinical presentation of tamponade (hypotension, JVD). He was stabbed and probably has a mediastinal bleed (so, I think the mediastinum would be widened on his chest film — but the "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.

It is obvious this patient is having an AMI. The ECG lead abnormalities suggest occlusion of the high lateral and low lateral walls of the LV - typically supplied by the circumflex - there are no Q waves - so subendocardial. Inferior AMI is leads II, III, avF. Anterior wall AMI is leads +- VI, with V2-V4, and maybe V5& V6.

This is a typical presentation of varicella (chicken pox)

This patient struck a nail (think metal splinter), pain was immediate (as the splinter entered his eye). His pupil is elliptical, indicating penetration of the globe. He needs X-ray of the globe to look for the metal splinter. Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetrated

Dilantin (phenytoin) causes these typical symptoms

When the infant has meconium in the amniotic fluid, he has been in distress, and the meconium is frequently aspirated prior to delivery and can cause pneumonitis and respiratory distress syndrome in the neonate.

Diabetes insipidus (ADH deficiency) can occur after acute head trauma. ADH is secreted by the posterior pituitary gland and causes the body to retain fluid (to increase volume). In a patient who has damaged the posterior pituitary, ADH is not secreted, so the body urinates "water". There is frequent large volume urination with a very low specific gravity, and will cause hypernatremia unless the patient is given large quantities of water to drink.

Most polyps are, in fact, quite small. All the rest of these statements are true.

WPW & LGL both have short PR intervals. WPW also has a "delta wave" and predisposes the patient to supraventricular tachyarrhythmias.

The fifth finger is ALWAYS innervated by the ulnar nerve, and would not be affected in a true carpal tunnel syndrome.

Any patient with an IUD, or with a tubal ligation, or known obstruction of a tube, who has a positive HCG needs an ultrasound to r/o ectopic pregnancy.

This is a description of varicocele (varicose veins of the scrotum). Hydrocele is just a water collection in the scrotum. Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).

Sialo(salivary gland) lithiasis (stone) is described in this question. Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.

Tiny amounts of albumin (microalbumin) show up first - but need a special test ordered to detect it. Intervention at this point with an ACEI prolongs the length of time before the patient progresses to albuminuria (noted on a typical urine "dip")

A grossly purulent tap would suggest staph (empyema). Loculated effusion does not describe either a trans or exudative effusion. Chylo and hydro thorax suggest a transudative effusion (not purulent). And hemothorax is blood.