SCENARIOS 1. Robert Teeton, a 61-year old male, visited his...

SCENARIOS
1. Robert Teeton, a 61-year old male, visited his ophthalmologist, Dr. Green, for his annual eye 
examination. Mr. Teeton's chief complaint was decreased vision in the right eye for approximately 3
weeks. Upon examination by the physician, it was discovered that Mr. Teeton had a history of 
diabetic retinopathy. His medical history indicated that he has had insulin-dependent diabetes 
mellitus for 13 years, hypertension for 15 years, hypothyroidism, peptic ulcers, and cardiac 
arrhythmia. Dr. Green recommended a fluorescein angiogram to complete the diagnosis. The 
report from that procedure showed scattered microaneurysms in both eyes. Which of Mr. Teeton's
other conditions will increase the risk of diabetic retinopathy?
a. Hypothyroidism
b. Hypertension
c. Cardiac arrhythmia
d. Peptic ulcers
2. Symptom of early stage diabetic retinopathy:
a. Eyeball pain
b. Pressure within the eye
c. Spots or floaters in vision
d. No symptoms
3. Proliferative stage of diabetic retinopathy has:
a. Microaneurysms
b. Some occlusion of vessels
c. Many vessels occluded
d. Growth of new vessels
4. What is the purpose of the fluorescein angiogram?
a. To measure the thickness of the retina
b. To measure intraocular pressure
c. To view abnormalities in the optic nerve
d. To pinpoint closed or broken vessels in the retina
5. One possible complication of diabetic retinopathy is:
a. Vitreal hemorrhage
b. Corneal damage
c. Amblyopia
d.Nystagmus
6. Grace Patton is a 59-year old school teacher and a patient of cardiologist Dr. Martin. Grace is 4 
weeks post myocardial infarction and has an appointment today with Dr. Martin. Grace has a 10
year history of increased blood lipid levels, arteriosclerosis, and hypertension. She was 
diagnosed with diabetes mellitus and congestive heart failure about 3 months ago. Grace's 
Congestive heart failure would result in which of the following clinical manifestations?a. Edema of the lower extremities and shortness of breath
b. Anemia, infection, and small bruises
c. Intermittent claudication and altered peripheral pulses
d. One pale, cold, swollen extremity with a palpable cordlike vessel
7. The area of the heart affected by the myocardial infarction would be:
a. Inflamed 
b. Abnormally swollen
c. Replaced with scar tissue
d. Infected with bacteria
8. Initial treatment for a myocardial infarction includes:
a. Completing blood cultures and then administering 2 types of antibiotics
b. Administration of salicylates to reduce fever and pain
c. Administration of analgesics, complete bed rest with elevation of the extremities
d. Minimizing damage to the heart muscle by relieving pain, providing rest, stabilizing the 
heart rhythm, and reducing the workload of the heart
9. Which of the following best describes the typical symptoms of a myocardial infarction?
a. Pain, swelling, and muscle cramps with a feeling of heaviness in the left leg
b. Numbness, tingling, and pain (along with a pale color of the fingers on the left hand)
c. Prolonged heavy pressure or squeezing pain in the center of the chest sometimes radiating 
down the left shoulder to the fourth and fifth fingers
d. Lower extremities turn pale when elevated and cyanotic when allowed to dangle
10. Edward Thomas, 61-year-old male, visited his internist today for a physical exam. During the 
visit, Edward told the doctor that he was having difficulty when trying to start urination. He also
complained that he was not able to maintain a constant stream. Edward's internist will follow 
up on this history information by checking for benign prostatic hyperplasia (BPH) during the 
physical exam. The physician will check Edward for BPH by completing a :
a. Orchidectomy
b. Circumcision
c. Rectal exam
d. Cystoscopy
11. The following diagnostic tests may be ordered to rule out other conditions and confirm BPH:
a. KUB, Retrograde pyelogram
b. Urethrocystoscopy, Transrectal Ultrasound, and PSA
c. 24-hour urine collection, MRI
d. Creatinine Clearance, BUN
12. Treatment for BPH depends on the degree of:
a. Urinary obstruction
b. Lymph node involvement
c. Infection in the scrotum
d. Inflammation in the kidney

13. Other conditions that cause symptoms similar to those in BPH:
a. Renal cell carcinoma, Wilms tumor
b. Renal hypertension, Pyelonephritis
c. Urinary tract infection, Bladder stones
d. Polycystic kidney disease, Interstitial nephritis
14. One possible treatment for BPH is:
a. Digital rectal exam
b. TURP
c. Castration
d. circumcision
15. Robert White has an appointment with his primary physician today because he has been seeing 
blood in his urine. After arriving at his appointment, a nurse asked him to collect a urine sample 
for a urinalysis. The doctor examined Mr. White and assessed the results of the urinalysis. He 
then explained to Mr. White that he may have glomerulonephritis, and he ordered additional 
lab tests to confirm his diagnosis. Mr. White is also displaying classic symptoms of 
glomerulonephritis. They are:
a. Headache and dark-colored concentrated urine
b. Polyuria 
c. Generalized edema, low blood-pressure, and dilute urine
d. Glycosuria and ketonuria
16. Mr. White explained to the nurse that he had never had kidney problems before. The nurse 
informed him that acute glomerulonephritis is usually caused by:
a. A chromosome abnormality
b. Major trauma to the kidney
c. A streptococcal infection elsewhere in the body
d. Adhesion in the kidney following surgery
17. What blood test will the doctor order to confirm his diagnosis of glomerulonephritis?
a. BUN
b. CBC
c. Fasting Glucose
d. Uric Acid
18. What would the results of Mr. White's urinalysis been?
a. Presence of streptococcal bacteria
b. Presence of glucose
c. Presence of protein
d. Presence of ketones
19. Mr. White's treatment for glomerulonephritis will likely include:
a. Chemotherapy and radiation
b. Blood transfusions
c. Renal angioplasty
d. Administration of antibiotics and steroidsSCENARIOS CONTINUED
20. Tyler Jackson, 2 year old male, was seen by Dr. Bill Freeman in the outpatient Hematology Clinic 
today. The child presented symptoms of fever of 102°, bleeding gums, and fatigue. Dr. Freeman
ordered a Complete Blood Count (CBC), and the results showed marked thrombocytopenia, 
decreased hematocrit, a few lymphoblasts, and a WBC count of 102,000. RBCs were also noted 
to be slightly hypochromic. A bone marrow biopsy was performed with predominately 
immature lymphocytes present. Dr. Freeman diagnosed the child with Acute Lymphocytic 
Leukemia. Evaluate the patient's WBC count:
a. The WBC count is normal
b. Abnormally increased
c. Abnormally decreased
d. Slightly decreased
21. What is causing his gums to bleed?
a. Hypochromic RBCs
b. Presence of lymphoblasts
c. Thrombocytopenia
d. Fever
22. The likely cause of Tyler's fatigue is:
a. Fever
b. Anemia
c. Thrombocytopenia
d. leukocytosis
23. The presence of which type of cell is definitive for a diagnosis of acute lymphocytic leukemia?
a. Hypochromic RBCs
b. Lymphoblasts
c. Lymphocytes
d. Myeloblasts
24. Why was a bone marrow biopsy performed?
a. To treat the leukemia
b. To perform the CBC
c. To build up the hematocrit
d. To diagnose the leukemia
25. Treatment for Acute Lymphocytic Leukemia always begins with:
a. Radiation therapy
b. Chemotherapy
c. Bone marrow transplant
d. Autologous transfusion