2016 Exam 10 Review

Question 1
While on a global health medical trip in southern China you
are exposed to unsanitary conditions and then develop watery
diarrhea. With loperamide in your possession, you recall that
loperamide

A. Binds bile salts and bacterial toxins

B. Crosses the blood brain barrier with ease
C. Decreases GI motility by acting as a mu receptor agonist
D. Does not have a mechanism similar to morphine
E. Will be converted to bismuth oxychloride in the stomach
 Question 1
Answer C
 Question 2
A 40 year old male with metastatic lung cancer has to
undergo chemotherapy. To help to alleviate some of the
nausea and vomiting associated with chemotherapy, the
most effective medication would be

A. Dimenhydrinate
B. Diphenhydramine
C. Meclizine
D. Ondansetron
E. Scopolamine
 Question 2
Answer D
 Question 3
The most accurate statement regarding melanoma is

A. Accurate staging and diagnosis of melanoma requires

full thickness excision
B. Areas of maximal UV exposure are the primary
location of melanoma
C. A shave biopsy can provide an accurate and precise
diagnosis and staging of melanoma
D. Melanoma is more common than basal or squamous
cell carcinomas
E. Melanoma has minimal risk of metastatic spread
 Question 3
Answer A
 Question 4
Skin lesion characteristics highly suggestive of
malignant melanoma would include

A. Diameter less than 3 mm

B. No elevation above the skin
C. Smooth borders and rounded edges
D. Symmetric appearance
E. Variable color throughout the lesion
 Question 4
Answer E

Asymmetry, irregular borders, elevation above

the skin, large size (greater than 6 mm), and
variable color would make malignant melanoma
the leading diagnosis
 Question 5
The most frequently encountered skin neoplasm
associated with sun exposure is

A. Basal cell carcinoma

B. Kaposis sarcoma
C. Melanoma
D. Seborrheic keratosis
E. Squamous cell carcinoma
 Question 5
Answer A

Basal cell carcinoma is found on sun exposed

areas, are translucent, rarely metastasize and is
the most common. Melanoma is the least
frequently encountered of the basal, squamous,
melanoma group but metastasizes
 Question 6
Your patient presents with double vision, difficulty with vocal
articulation, difficulty with phonation as well as flaccid
paralysis Sensation is not affected. Your patient is alert and
has a normal mental status. There is no history of fever. You
conclude that

A. A biological agent that can be transmitted person to

person is the primary cause
B. Clindamycin is the treatment of choice
C. Priority to the airway is your primary concern
D. Rapid assays are readily available to confirm your diagnosis
E. White blood cell counts are extremely helpful
 Question 6
Answer C

ABCs take priority. The classic triad of symmetric

descending flaccid paralysis with bulbar palsies
(diplopia, dysarthria, dysphonia, dysphagia) is
seen with botulism. Treatment is with antitoxin.
 Question 7
Botulism toxin

A. By weight is the most toxic substance known to

man
B. Causes an ascending paralysis
C. Is an anaerobic gram negative rod
D. Is only found in honey
E. Prevents the post synaptic breakdown of
acetylcholine
 Question 7
Answer A

Botulism is a gram positive anaerobic rod and by

weight is the most toxic substance known to
man. Botulism prevents the presynaptic release
of Ach and will cause a descending paralysis.
Cranial nerves and the autonomic nervous
system are affected initially
 Question 8
A 25 year old male presents with increased abdominal pain
and intermittent blood in his stool. He has had a prior history
of this over the last few years but has not sought care. You
suspect that this could potentially be ulcerative colitis. The
following findings would help support you in your diagnosis

A. Contiguous lesions throughout the rectum and colon

B. Skip lesions are found in the small intestine and colon
C. There is no involvement of the rectum
D. There is transmural inflammation
E. There are granulomas found on biopsy
 Question 8
Answer A
 Question 9
With regards to Smallpox
A. Animals as well as humans are the natural
reservoirs
B. Direct and aerosol contact are the usual
routes of transmission
C. Specific antiviral therapy for treatment exists
D. The rash will be in a centripetal distribution
E. The rash will not involve the palms and soles
 Question 9
Answer B

Humans are the only reservoir for smallpox.

Transmission is usually via the respiratory route as
well as through direct contact. Transmissibility and
mortality are high. The patient is not considered
infective once all lesions have scabbed over. The
rash will have a centrifugal distribution with more
lesions on the extremities rather than the trunk.
No known treatment exists.
 Question 10
Anthrax
A. Has spores that are not stabile
B. In the inhalational form creates very mild
disease
C. Is an anaerobic gram negative rod
D. Is a common occurrence in its natural form
in the US
E. Is a thrash metal band featuring Scott Ian
 Question 10
Answer E

Scott Ian has been with Anthrax since they started

back in 1981 and is the only remaining original
member of the band.
Anthrax is a gram positive aerobic rod and can
survive for decades. The inhalational form is the
most lethal and requires emergent treatment. Post
exposure antibiotic prophylaxis (cipro, doxy, amox)is
crucial. GI anthrax is rare