42-YEAR-OLD NATIVE AMERICAN WOMAN WITH KIDNEY FAILURE
A 42-year-old Native American woman with poorly controlled type 2 diabetes mellitus and a basal cell carcinoma of the face has advanced renal failure and is starting the process to get on dialysis. Her hemoglobin at 9 g/dl and her hematocrit at 28% were very low. The red blood cells were normal size and shape. Her white cell levels and platelet counts were normal.
1. Which of the following is the most likely to result from renal failure?
a. Hypernatremia
b. Hypokalemia
c. Hyponatremia
d. Hyperkalemia
Hyperkalemia
- What is the most likely cause of her anemia?
a. Hemolytic anemia
b. Iron deficiency
c. Erythropoietin deficiency
d. Acute bleeding
Erythropoietin deficiency
(As the kidneys progressively fail, they lose their endocrine functions as well as their filtration functions. Very important among these is a decline in erythropoietin production, which leads to a normocytic, normochronic anemia.)
- What enzyme in the kidneys handles the main step it carries out in vitamin D metabolism?
a. 24-Hydroxylase
b. Vitamin D monohydrase
c. 1-alpha-hydroxylase
d. 25-Hydroxylase
1- alpha-hydroxylase
(1-alpha-hydroxylase, located primarily in the proximal tubules of the kidneys, converts 25-OH-D3 to 1a,25-(OH)2-D3 (i.e. calcitriol). 25-Hydroxylase is found mainly in the liver and converts vitamin D to 25-OH-D. 24-Hydroxylase inactivates calcitriol. Note that all of these are cytochrome P450 enzymes.)
- Which of the following cells line the proximal convoluted tubules?
a. Complex cuboidal epithelium
b. Simple squamous epithelium
c. Simple cuboidal epithelium
d. Juxtaglomerular cells
Simple cuboidal epithelium
- What is the role of the kidneys in relationship to vitamin D?
a. Conversion of 25-hydroxyvitamin D3 to 1,25-dihydroxyvitamin D3
b. Conversion of 25-hydroxyvitamin D3 to vitamin D3
c. Conversion of 1,25-dihydroxyvitamin D3 to 25-hydroxyvitamin D3
d. Conversion of vitamin D3 to 25-hydroxyvitamin D3
Conversion of 25-hydroxyvitamin D3 to 1,25-dihydroxyvitamin D3
- Which of the following accurately describes an anatomical relationship?
a. The adrenal glands are superior to the kidneys.
b. The aorta is lateral to the kidneys.
c. The adrenal glands are superolateral to the kidneys.
d. The aorta is inferior to the kidneys.
The adrenal glands are superior to the kidneys
- Which of the following is the most likely cause of her kidney failure?
a. Basal cell carcinoma of the face
b. Diabetes mellitus type 2
c. None of these is a likely cause
d. Native American ethnicity
Diabetes mellitus type 2
18-YEAR-OLD AFRICAN-AMERICAN MAN WITH SORE THROAT
An 18-year-old African-American man came to the clinic complaining of a sore throat that he has had for 2 weeks. His ex-girlfriend, who he recently broke up with, also suffered from similar symptoms about one month ago. He mentions he has been more tired than usual and his cervical lymph nodes are tender on palpation. You perform an in-office test and diagnose him with infectious mononucleosis.
Which of the following viruses causes infectious mononucleosis?
a. Epstein-Barr virus
b. Herpes simplex virus
c. Respiratory syncytial virus
d. Cytomegalovirus
EBV
- A sore throat may also indicate tonsillitis. Which tonsils are located between the palatoglossal and palatopharyngeal arches?
a. Palatine tonsils
b. Lingual tonsils
c. Tubal tonsils
d. Adenoids
Palatine tonsils
(The adenoids are located at the root of the nasopharynx. The tubal tonsils are located posterior to the opening of the Eustachian tube on the lateral wall of the nasopharynx. The lingual tonsils are located at the root of the tongue.)
- Which of the following is true with regards to shingles and chickenpox?
a. Chickenpox and shingles are different viruses that infect the body in a similar manner.
b. If you haven�t had chickenpox, it is safe to come into contact with someone with shingles.
c. Chickenpox is more severe in children.
d. Shingles can only occur in patients who have already experienced chickenpox.
Shingles can only occur in patients who have already experienced chickenpox
(In order to develop shingles, you need to contract the virus first, which would lead to an outbreak of chickenpox. The reactivation at a later time is in the form of shingles. Chickenpox is more severe in adults. Both chickenpox and shingles are due to the varicella zoster virus.)
- Herpes simplex virus type 1 is latent in ________ and varicella zoster virus is latent in _______ .
a. the trigeminal ganglion; B lymphocytes
b. the trigeminal ganglion; the dorsal root ganglion
Explanation:
c. all lymphocytes; B lymphocytes
d. all lymphocytes; the dorsal root ganglion
HSV- Trigeminal ganglion
Varicella Zoster virus- Dorsal root ganglion
4-YEAR-OLD WHITE GIRL WITH LEUKEMIA
A 4-year-old girl of European descent is brought to the emergency room with multiple bruises on her body. She has recently been experiencing arthralgia, anemia, fatigue, and unintentional weight loss. After multiple tests, she is diagnosed with leukemia.
- Blood vessels are formed from which embryonic tissue?
a. Neuroectoderm
b. Endoderm
c. Paraxial mesoderm
d. Lateral mesoderm
Lateral mesoderm
- Excessive bruising can also be linked to deficiencies of clotting factors. Which of the following vitamins is the most important for normal clotting mechanisms?
a. Vitamin K
b. Vitamin E
c. Vitamin B6
d. Vitamin D
Vitamin K
(Vit-C is also important for this process)
- In a healthy patient, what percentage of white blood cells should be lymphocytes?
a. 0%
b. 60%
c. 8%
d. 2%
e. 30%
30%
(In a white blood cell count with differential, the ratio should be as follows: neutrophils 60%, lymphocytes 30%, monocytes 8%, eosinophils 2%, and basophils 0%.)
- Which type of leukemia would she most likely be suffering from?
a. Chronic lymphocytic leukemia (CLL)
b. Acute myelogenous leukemia (AML)
c. Chronic myelogenous leukemia (CML)
d. Acute lymphocytic leukemia (ALL)
Acute lymphocytic leukemia (ALL)
(ALL is the most common leukemia seen in children ages 2-5. A small number of elderly patients also develop ALL. Both children and adults can suffer from AML. CML affects mostly adults. CLL is most likely to affect patients over 55 years old.)
- Which of the following likely explains the bruising she is suffering?
a. Low levels of clotting factors
b. Improper clotting factor activity
c. Low platelet count
d. Impaired platelet adhesion
Low platelet count
(The leukemia cells crowd the bone marrow, suppressing platelet production along with all other types of blood cells. Platelet function is not significantly changed.)
5-YEAR-OLD WHITE GIRL WITH COUGH
A 5-year-old girl of European descent comes to the clinic complaining of a cough, which started 3 days ago. She is having trouble breathing and, when you hear her cough, it is harsh and resembles barking. She is diagnosed with croup.
- The opening in the diaphragm for the aorta, thoracic duct, and azygous vein to pass through is at the level of ______ .
a. L1
b. T10
c. T8
d. T12
T12
- Which of the following viruses is the most common cause of croup?
a. Parvovirus
b. Rhinovirus
c. Parainfluenza virus
d. Coxsackievirus
Parainfluenza virus
- Which of the following is an accurate reason for a shift to the right on the oxygen-hemoglobin dissociation curve?
a. Decreased 2,3 BPG
b. Decreased pCO2
c. Increased temperature
d. Increased pH
Increased temperature
(If more heat is produced in tissues, there is an increased need for oxygen. A shift to the right unloads oxygen into the tissues. A shift to the right is also due to increased 2,3 BPG, increased pCO2, and decreased pH.)
- Which of the following is true with respect to the lungs?
a. The right lung has 2 lobes, while the left lung has 3 lobes
b. Foreign objects usually travel into the right middle lobe
c. The oblique fissure separates the middle lobe and inferior lobe in the left lung and separates the superior and inferior lobe in the right lung
d. The right lung has a lingula on the upper lobe
Foreign objects usually travel into the R middle lobe
(The right bronchus is more vertical than the left bronchus, making it easier for objects to make their way into the right middle lobe, leading to aspiration pneumonia.)
14-YEAR-OLD HISPANIC BOY WITH A BROKEN ANKLE
A 14-year-old Hispanic boy arrives at the clinic with a broken ankle. He mentions he just got back from a camping trip. He spotted a bear entering their campsite and tripped over a log while running away.
- This patient has also been experiencing diarrhea since he got back. Which parasite is most commonly transmitted through ingestion of contaminated lake water?
a. Toxoplasma gondii
b. Entamoeba histolytica
c. Giardia lamblia
d. Cryptosporidium parvum
Giardia lamblia
- Which of the following mechanisms does not occur during the sympathetic fight-or-flight reaction?
a. Vasodilation occurs in the blood vessels of muscles and skin
b. The pupils dilate
c. The lungs and bronchi dilate
d. GI peristalsis and secretions decrease
Vasodilation in blood vessels of muscles BUT vasoconstriction in bv of skin to prevent potential blood loss
- An isokinetic contraction of the muscle means ______ .
a. The muscle lengthens while contracting
b. There is no length change as the muscle contracts
c. The muscle contracts under a constant load
d. The muscle contracts at a constant speed
The muscle contracts at a constant speed
- The spring ligament in the ankle connects which two bones?
a. Calcaneus and cuboid
b. Talus and Navicular
c. Calcaneus and navicular
d. Talus and calcaneus
Calcaneus and navicular
(The spring ligament runs from the sustentaculum tali of the calcaneus to the navicular bone.)
