Multiple choice: Please help me to answer the ffollowing questions.
Items 1-5:
A 42 year-old man enters the emergency department complaining of
dyspnea and severe chest pain. The physical findings suggest
pericardial tamponade. An ECG showing total electrical alternans and
an echocardiogram showing pericardial effusion confirm the diagnosis.
1. All of the following physical findings are commonly
encountered in cases of pericardial tamponade EXCEPT:
(A) shift of the right border of cardiac dullness to the right
(B) sinus tachycardia
(C) bilateral distension of the jugular veins
(D) increased intensity of S1 and S2
(E) decrease of the systolic blood pressure
2. Which jugular vein is commonly the best barometer of central
venous pressure?
(A) Right anterior jugular vein
(B) Right external jugular vein
(C) Right internal jugular vein
(D) Left external jugular vein
(E) Left internal jugular vein
3. All of the following statements concerning the jugular,
subclavian and brachiocephalic veins are correct EXCEPT:
(A) The anterior jugular vein ends via union with either the external
jugular or subclavian vein.
(B) The internal jugular vein ends at its union with the subclavian
vein.
(C) The union of the external jugular vein with the subclavian vein
forms the brachiocephalic vein.
(D) The union of the left and right brachiocephalic veins forms the
superior vena cava.
(E) In the mediastinum, the right brachiocephalic vein is more
vertical than the left brachiocephalic vein.
4.If the head, neck, and trunk of a supine adult are elevated
30-45 degrees from the horizontal, what is the normal vertical
distance above the level of the sternal angle that pulsatile activity
will be observed in the jugular veins?
(A) 0-1 cm
(B) 2-3 cm
(C) 4-5 cm
(D) 6-7 cm
(E) 8-9 cm
5. In a normal, healthy adult, the right border of the heart lies
to the right of the right border of the sternum by
(A) 0-1 cm
(B) 2-3 cm
(C) 4-5 cm
(D) 6-7 cm
(E) 8-9 cm
Items 6-8:
A 63 year-old woman enters the emergency department complaining of
exertional chest pain and exertional syncope. An ejection murmur and
other findings suggest severe aortic stenosis. An ECG showing left
ventricular hypertrophy and an echocardiogram showing a thickened,
calcified aortic valve confirm the diagnosis,
6. All of the following physical findings are commonly
encountered in cases of severe aortic stenosis EXCEPT:
(A) diminished intensity of S2
(B) slow-rising carotid arterial upstrokes
(C) radiation of the ejection murmur to the carotid arteries
(D) shift of the apical thrust upward and laterally
(E) marked precordial apical thrust
7. The second heart sound has two components because it is
produced by the near-simultaneous closure of two valves. These two
valves are the
(A) aortic and pulmonary valves
(B) tricuspid and mitral valves
(C) aortic and mitral valves
(D) pulmonary and mitral valves
(E) aortic and tricuspid valves
8.The apex beat [apical thrust, or PMI (Point of maximum
impulse) is normally found
(A) 3-5 cm to the left of the midsternal line in the 5th intercostal
space
(B) 5-7 cm to the left of the midsternal line in the 5th intercostal
space
(C) 7-9 cm to the left of the midsternal line in the 5th intercostal
space
(D) 5-7 cm to the left of the midsternal line in the 6th intercostal
space
(E) 7-9 cm to the left of the midsternal line in the 6th intercostal
space
9. S.F. is a 57-year-old female diagnosed with stage-3 breast
cancer. She is later treated with an extended radical mastectomy,
which involves extensive axillary dissection. Examination revealed
partial loss of the ability to depress the shoulder and extend and
adduct the arm. Which muscle is most probably be involved?
a. the pectoralis major
b. the latissimus dorsi
c. the trapezius
d. the biceps
10. Later examination revealed winging of the scapula when
pushing against the wall which was most probably due to damage to the
innervation of the serratus anterior. At which point of the brachial
plexus does this nerve exit?
a. from the roots
b. from the trunk
c. from the branches
d. from the cords
11.a villager complained of pain in his shoulder after taking a
heavy object on his shoulder over a long distance. Examination of the
patient revealed winging of the scapula on pushing against the wall.
Which structure may be involved?
a. long thoracic nerve
b. ulnar nerve
c. radial nerve
d. flexor pollicis longus
12.On postoperative day three after thyroidectomy the patient
voice sounds hoarse . Indirect laryngoscopy reveals paralysis of one
of the laryngeal cord. Which structure was likely injured during this
surgery?
a. Internal laryngeal nerve
b. External branch of the superior laryngeal nerve
c. The thyroideus nerve
d. the recurrent laryngeal nerve
13.A Wimbledon tennis champion complains of pain and tenderness
in the proximal portion of the anterior forearm that often occurs
after prolonged practice. The sports medicine specialist claims that
this is due to the trapping of the median nerve near the elbow . Where
does this "entrapment" occur ?
a. at the medial epicondyle of the elbow
b. by the palmaris longus
c. between the heads of the pronator teres
d. due to compression by the flexor retinaculum
14.The fimbriae (pili) provide what function to Neisseria
gonorrhoeae?
A. Protect against phagocytosis
B. Provide adherence to various surfaces
C. Motility
D. Resistance to detergents
E. Provide a means of genetic exchange
15.What nutrient transport system alters the nutrient upon its
transfer into the cell?
A. Proton symport
B. Uniport
C. Group translocation
D. Facilitated diffusion
E. Shock sensitive transport
16.A beta-lactamase inhibitor that can be co-administered with
penicillin to render a penicillin resistant Staphylococcus species
susceptible to the antibiotic is
A. lysozyme.
B. clavulanic acid.
C. cephalosporinase.
D. penicillin binding protein.
17. What is the basis of the specific toxicity of ketoconazole?
A. Bacteria lack sterols in their membranes
B . The primary sterol in fungal membranes is ergosterol
C . The presence of the endoplasmic reticulum in mammalian cells
D. Humans require folic acid preformed
18. N-acetyl glucosamine and N-acetylmurarnic acid are fundamental
building blocks for
A. outer membrane.
B. inner membrane.
C. lipopolysaccharide.
D. peptidoglycan.
E. capsule.
19. Most disinfectants eliminate infectious organisms by
A. bacteristatic mechanisms.
B. reducing the microbial flora to a federally accepted level.
C. killing the vegetative cells.
D.killing vegetative cells and spores.
20.Tetracyclines are useful drugs which
A. prevent RNA synthesis.
B. are bactericidal.
C . prevent binding of aminoacyl tRNA to the 30S ribosome.
D. bind to the L12 subunit of the 50S ribosome.
E. inhibit DNA gyrase.
21. The Minimum Inhibitory Concentration for an antibiotic is
defined as the
A. amount of the antimicrobic that inhibits growth under standard
laboratory conditions.
B. amount of antimicrobic necessary to kill 99.9% of a predetermined
portion of a bacterial sample in a given time.
C. ratio of the dose of the antimicrobic that is toxic to the host
versus that which is effective against the infectious agent.
D. level of antibiotic necessary for the elimination of a microbial
infection when a bacteristatic antibiotic is used.
22. A unique feature of eucaryotic cells that is not found in
procaryotic cells is a
A. nuclear membrane.
B. periplasm.
C. peptidoglycan layer.
D. 70s ribosome.
23.The reason that Gram negative bacteria are not susceptible to
penicillin G is because
A. Gram negative bacteria constituitively produce penicillinase.
B. Gram negative bacteria have an altered peptidoglycan
structure.
C. The capsule of Gram negative bacteria is impenetrable to the
penicillin.
D. the outer membrane of Gram negative bacteria presented a natural
barrier to the penicillin.
24. The therapeutic index for the penicillins is very high because
of
A. potential allergic reactions.
B. their cellular target.
C. their size.
D. potential neurotoxic side effects in patients.
E. lack of specificity.
25.If you were treating a patient with a Mycoplasma pneumonia
what antibiotic would you clearly NOT use ?
A. streptomycin
B. erythromycin
C. rifampicin
D. chloramphenicol
E. penicillin
26.The outer membrane of a Gram negative bacteria is resistant to
the action of detergents largely due to the presence of
A. lipoteichoic acids.
B. phosphotidyl inositol.
C. cholesterol and ergosterol.
D. lipoprotein and lipopolysaccharide.
E. glycoproteins and the capsule.
27. A patient develops a fever, goes into shock and dies in the
hospital. Upon performing a blood culture you find that the patient
had a Gram negative sepsis. What is the likely cause of the patient's
fever and subsequent demise?
A. Peptidoglycan components that are released into the blood
B. The presence of pili on the bacterial cell
C. The presence of lipopolysaccharide in the outer membrane
D. The release of lipoprotein by the bacterial cell on autolysis |
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