Question 185
A 47-year-old female has a history of hypertension for many years that has been poorly controlled with medication. She is otherwise healthy and does not smoke. She decides to change physicians and her new physician conducts a thorough physical examination and identifies a bruit on the right side of the lower back. Of the following, which would best allow for definitive diagnosis of her underlying disease process?
A. Complete metabolic panel to include BUN and creatinine
B. Urine culture
C. Pelvic examination
D. Angiogram
E. CT scan of the abdomen
Answer for Question 185
Answer: D (Angiogram)
Explanation: The clinical scenario is consistent with fibromuscular dysplasia of the renal artery, which would cause secondary hypertension that might be difficult to control with medication and would potentially have a bruit upon physical examination. The disease is most common among women 40-60 years of age. As fibromuscular dysplasia causes thickening of segments of the affected artery and can produce outpouchings, an angiogram of the vessel would be the definitive diagnostic procedure.
Question 186
A researcher is attempting to trigger intracerebral hemorrhage in laboratory rats to study the development of the condition. To facilitate this process, he is dosing the rats with various substances. A substance or combination of substances that does which of the following would have the best chance to produce an intracerebral hemorrhage?
Answer for Question 186
Answer: E (Increase of all four–heart contractility, heart rate, peripheral resistance, and blood volume)
Explanation: One of the most common causes of intracerebral hemorrhage is hypertension. Blood pressure is cardiac output (which is determined by stroke volume and heart rate) x peripheral resistance. Heart contractility determines stroke volume and blood volume helps determine stroke volume. All other factors being equal, a substance or substances that increases heart contractility, heart rate, peripheral resistance and blood volume should cause the highest blood pressure, and should have the greatest chance to induce an intracerebral hemorrhage.
Question 187
A researcher wishes to study hypertension in vitro. Their lab has perfected a way to remove vascular tissue from rats and maintain their viability for several hours in which to conduct their experiments. To induce hypertension, the vessel is exposed to a mixture of four substances (prostacyclin, kinins, thromboxane and endothelin). Which combination of concentrations of substances below would be most effective in inducing hypertension?
Answer for Question 187
Answer: C (Decreased prostacyclin and kinins, and increased thromboxane and endothelin)
Explanation: Both thromboxane and endothelin are vasoconstrictors, which would increase peripheral resistance and thus help induce hypertension in the vessel, whereas both prostacyclin and kinins are vasodilators, so a decreased concentration of these two substances would indirectly help induce hypertension (i.e., as there would be less opposition to the effects of the thromboxane and endothelin).
Question 188
A 23-year-old male presents to an acute care clinic complaining of pain in both his eyes and sensitivity to light that developed over night. He was no past medical history; however, he reports that he frequently develops ulcers in his mouth, about 5-6 times per year, which last for around 1 week, and four months ago he had a painful ulcer on his penis, which resolved over one week but he was afraid to report his symptoms. He has one sexual partner and they always use condoms for birth control. Of the following, what is the most likely diagnosis?
A. Herpes simplex infection
B. Syphilis
C. Cholesterol emboli
D. Drug reaction
E. Behcet disease
Answer for Question 188
Answer: E (Behcet disease)
Explanation: Behcet disease occurs in younger adults, and characteristic features are recurrent oral apthous ulcers, ocular symptoms, and genital ulcers. Patients can also have musculoskeletal complaints, and GI or CNS involvement. While HSV can cause painful genital ulcers, the recurrent involvement of the mouth, eyes, and genitalia, in a patient with essentially no risk factor for a sexually transmitted disease would be more consistent with Behcet syndrome. Syphilis causes painless genital ulcers. While cholesterol emboli and a drug reaction could produce multi-system involvement, the history does not suggest either as a cause for the patient’s symptoms and past medical history.