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Uworld > #10 > Flashcards

#10 Flashcards

1
Q

43 yo man bad cold last about 10 days

  • Burst of coughing unable to clear mucur
  • He is a karate teacher

Cause of symptoms?

A

Pertussis whooping cough

- Gram-negative coccobacillus

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2
Q

48 yo wo, involuntary passage of urine when sneezing or coughing
- 4 uncomplicated vaginal deliveries

Cause of condition?

A

Urethral sphincter dysfunction
- Pudendal nerve damage
Stress incontinence with increased intraabdominal pressure due to prior vaginal deliveries

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3
Q

23 yo wo recent onset diplopia and ataxia

  • Areas of T2 hypersensivity consistent with axonal demyelination
  • Multiple sclerosis is diagnosed
  • Neuronal properties most likely to decrease as a result of demyelination?
A

Length (space ) constant

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4
Q

6 week old term

  • Wet diapers
  • anterior fontanelle is flat and mucous membrane are dry
  • Na 148 / ADH increased

Appropriate treatment ?

A

Hydrochlorothiazide

  • Nephrogenic diabetes insipidus
  • Thiazides reduces renal water losses by increasing water and Na reabsorption
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5
Q

13 yo boy acute appendicitis

  • Burning pain at scar radiating to suprapubic region
  • Loss of sensation over right suprapubic area

Cremasterix reflex is normal

Nerve most likely injured?

A

Iliohypogastric

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6
Q

28 yo man pruritic papule on dorsal of right foot prior to returning from florida beach 2 days ago
- Rash looks like worm

Cause of condition?

A

Hookworm infection
- Necator americanus penetrate basement membrane and spread to bloodstream

  • Vibrio vulnificus would cause necrotizing fasciitis
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7
Q

54 yo wo progressive pain and prolonged morning stiffness
- naproxen didn’t help with pain
- MCV of 86
Patient is prescribed methotrexate

What changes were present before start of methotrexate?

  • Circulating Iron level
  • Bone marrow iron
A

Circulating iron level low
Bone marrow iron High
- anemia of chronic disease mediated by hepcidin

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8
Q

46 yo wo episodes of dehydration due to ileostomy

  • reports right flank pain
  • Bowel gas pattern with no evidence of renal calculi
  • Stone in ureter, pure uric acid stone

Mechanism underlying stone formation?

A

Concentrated acidic urine

- Dehydration, kidneys compensate by excretion of hydrogen ions which lowers urine pH

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9
Q

35 yo man coffee-ground emesis and lightheadedness

  • Asthma, hepatitis C and HIV
  • CD4 was 550
  • Started on NAPROXEN for back pain
  • Allergy to penicillin that causes a rash and pruritus
  • Gastric mucosal erythema and erosions

What explains patient’s symptoms?

A

Predictable drug reaction

- NSAIDS inhibit COX which inhibits GI mucosal protection

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10
Q

36 yo man undergoes emergency cricothyrotomy

Procedure passes through which structures?

A

Superfical cervical fascia and cricothyroid membrane

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11
Q

17 yo girl yellow eyes

  • Prepating for high school exit examination and has felt stressed
  • 2 weeks after examination symptoms resolve

What contributed to hyperbilirubinemia ?

  • Hepatocyte bilirubin storage
  • Hepatocyte bilirubin excretion
  • Bilirubin conjugation
A
  • Hepatocyte bilirubin storage normal
  • Hepatocyte bilirubin excretion normal
  • Bilirubin conjugation decreased

Patient has gilbert syndrome

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12
Q 
48 yo wo metastatic cervical cancer
- Bilateral hydronephrosis and renal failure due to ureteral compression by the tumor
- Pain controlled by morphine
- Respiration are 10/min
Patient shows respiratory acidosis

What medication-related events precipitated her condition?

A

Increased metabolite accumulation

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13
Q

27 yo man hardly slept for past 7 days

  • Spent thousand of dollars on new power tools
  • He feels spectacular , but had 2 previous episodes of depressive moods.

Long term management of this patient should be?

A

Valproate

- Bipolar disorder

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14
Q

Study on manifestations of covid
- 11 patients with COVID-19 are recruited and their CT are studied

What best describes this study?

A

Case series

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15
Q

60 yo man

  • 35 pack year history of smoking
  • Dullness to percussion at lung base
  • Multiple pockets within pleural space
  • Small amount of thick pus

Intrapleural administration of a medication would improve chest tube drainage how?

A

Activation of fibrin bound plasminogen
- Empyema ‘’ pus accumulation’’ and organized fibrosis

Fibrinolytic agent can improve drainage

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16
Q

43 yo south asia man recent onset hemoptysis

  • 15 pounds weight loss
  • Culture shows acid-fast bacilli

Isoniazid mono therapy in this patient would result in?

A

Selective survival of bacterial cells secondary to gene mutation

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17
Q

Chromatin fibers with a beads on a string appearance
- DNA wrapped around a core of proteins

Which proteins is found outside this core and helps promote chromatin compaction?

A

Histone H1

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18
Q

42 yo man headache, nausea, vomiting

  • Primary essential hypertension
  • BP 240/150
  • Bilateral papilledema / S4
  • Platelets and hematocrit have decreased
  • Numerous schistocytes

Pathological finding found on renal biopsy?

A

Fibrinoid necrosis of small arteriolar walls

- Hypertensive emergency MAHA

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19
Q

42 yo man syncopal episode

  • Computer programmer spends time indoors
  • Liver span is increased
  • Skin is darkly tanned
  • Abnormal diastolic relaxation of left ventricle

Cause of condition?

A

Iron accumulation

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20
Q

32 yo wo

  • 4 abortions
  • Exhibit shows bicornuate uterus

Failure of which Mechanism cause condition?

A

Incomplete Lateral fusion of paramesonephric duct

  • Whereas complete lack of lateral fusion lead to uterine didelphys
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21
Q

33 yo primigravida

  • maternal alpha-fetoprotein is reduced
  • Increased nuchal translucency
  • Villous sampling shows 47 XX + 21

Fetus at risk of developing ?

A

Duodenal atresia

- Down syndrome

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22
Q

25 yo recurrent ear infections

  • Feel anxious in examination room
  • Heart start to race when she sees her roommate stethoscope

Phenomena?

A

Classical conditioning

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23
Q

19 yo hispanic woman
abdominal pain
- When asked about sex life she says no
- Diagnosis of rupture ectopic pregnancy is made

Intervention most likely have prevented delay in diagnosis?

A

Determining whether the patient needs language assistance

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24
Q

8 yo boy mass in right mandible

  • Immigrate from East africa
  • Diffuse lymphoid cells with numerous mitotic figures

Chromosomal translocation that directly alters which process?

A

Transcription activation
- Burkitt lymphoma
Epstaein barr virus

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25
Q

Pulmonary tissue regeneration capacity derived from which cells?

A

type II pneumocytes

26
Q

44 yo man

  • Renal transplant
  • 1 week later, low fever, body aches, decreased urine output
  • Graft biopsy demonstrate interstitial infiltration by mononuclear cells

Cause of condition ?

A

Host T cell sensitization against graft MHC antigens

- Acute rejection

27
Q

35 yo woman

  • Weight loss abdominal pain
  • Pigmentation around areola and anal and vaginal mucous membranes

Findings on autopsy?

A

Atrophy of both adrenal glands

- Chronic adrenal insufficiency ‘’ acute adrenal crisis’’

28
Q

4 day old boy progressive jaundice
- Scleral icterus and jaundice
Total bilirubin 8
Indirect bilirubin 7.2

Changes in bilirubin metabolism compared to an adult?

  • Bilirubin production
  • Bilirubin conjugation
  • Enterohepatic bilirubin circulation
A

Bilirubin production increase
Bilirubin conjugation decreased
Enterohepatic bilirubin circulation increased

29
Q

32 yo wo
Father apical baldness beginning at 20
- Maternal side no sign of baldness
- She start having thinning of hair at temporal areas

Inheritance pattern of hair loss?

A

Polygenic

30
Q

25 yo leg is fixed in a cast
- 2 weeks later he has right upper extremity weakness and numbness
- Absent triceps reflex
Nerve injured?

A

Radial nerve

31
Q

2 yo boy rash on cheeks, trunk and arms

  • Vax up to date
  • He attends day care facility
  • Rash shows atopic dermatitis

Patient at increase risk for?

A

Asthma
- Immune hypersensitivity
allergic rhinitis

32
Q

60 yo man

  • Brain injury in motor vehicle collision
  • Difficulty tasting food

Cause of patient’s symptoms?

A

Avulsion of olfactory nerve rootlets

33
Q

14 yo girl

  • Sickle cell disease takes folic acid supplement
  • Dyspnea and weakness preceded by a illness a few days ago
  • Reticulocyte is 0.1, hematocrit 16%

Virus responsible for current condition?

A

Parvo virus
- Nonenveloped single stranded DNA virus
Aplastic crisis

34
Q

34 yo woman reveals cardiomegaly and pulmonary congestion
- Presence of arteriovenous fistula

Changes due to fistula?

  • CO
  • SVR
  • Venous return
A

CO increased
SVR decreased
Venous return increased

35
Q

34 yo epigastric pain worse at night

  • Move from china 4 years ago
  • 1cm ulcer in duodenum

In addition to PPI’s what therapy would prevent recurrence of ulcer?

A

Antibiotics H. Pylori infection

36
Q

Pop 1000
- Prevalence asthma is 10%
Sensitivity 95% Specificity 90%

Likelihood that child with positive result really has asthma?

A

95/ ( 95+180)

37
Q

9 yo girl

  • Mild intermittent headaches
  • CT brain reveals mass lesion
  • Enlarged lateral and 3rd ventricles, normal 4th

Site of obstruction?

A

Cerebral aqueduct

38
Q

66 yo man lightheadedness

  • Medications for hypertension, angina pectoris, gout, BPH
  • Takes NSAIDS occasion
  • BP 120/80 pulse 70 in supine
  • BP 90/60 pulse 87 standing

Blockage of what receptors is causing current condition?

A

Orthostatic postural hypotension

- caused by blocking of A1 adrenergic

39
Q

45 yo man fever, headache, chest pain

  • Segmental pulmonary infiltrates
  • Empiric antibacterial therapy
  • Lung tissue shows spherules packed with endospores

History would reveal?

A

Travel to arizona

- Coccidioides

40
Q

38 yo man fevers, chills cough and shortness of breath

  • Temperature 39.4
  • Dullness to percussion and crackles over right lung
  • Th1 cells, interferon gamma and interleukin 2

Pathogen responsible for pneumonia?

A

Legionella pneumophila

- Other types are Mycobacteria tuberculosis or listeria monocytogenes

41
Q

3 yo boy left ear pain

  • Runny nose and cough
  • Normal external canal
  • Erythematous tympanic membrane with purulent fluid pooling within distal external canal

Cause?

A

Strep pneumo cause of otitis media

  • Other agents are H. Influenza and mortadella catarrhalis
42
Q

7 yo boy became inattentive, restless
- Thyroid is Diffusely enlarged to palpation without tenderness
-TSH 7/ Thyroxine 16
Triiodothyronine 210

Etiology of thyroid function?

A

Resistance to thyroid hormone

- All the levels are increased

43
Q

60 yo man nagging cough

  • occasional dizziness
  • He doesn’t make sense
  • Na 120 / K 4 / Ca 9.0

Mass in right lung

Additional finding?

A

apparent euvolemia

- SIADH, small cell lung carcinoma

44
Q

21 yo thirsty and drinking lots of water lately

Study would be best next step to establish diagnosis?

A

Hemoglobin A1c
Type 1 DM
- Or fasting plasma glucose

45
Q

50 yo wo, severe upper abdominal pain

  • Sudden sharp and colicky pain
  • Cessation of inspiration with deep palpation of right upper quadrant

Diagnosis most specific for acute cholecystitis?

A

Failed gallbladder visualization on radionuclide biliary scan

  • acute cholecystitis, gallstone obstruction of cystic duct
46
Q

62 yo

  • Hypertension 10y ago
  • Currently takes ramipril and chlorthalidone
  • BP 160/92
  • PR is prolonged and sinus bradycardia

which medication would lower BP without worsening ECG ?

A

Nifedipine

- Calcium channel blockers affect arterial smooth muscle

47
Q

41 yo wo for 5 years has eaten only vegetables, fruits and grains

Increased risk for deficiency of?
Folic acid
Iron
Thiamine
Vitamin B12
A

Folic acid No
Iron yes
Thiamine No
Vitamine B12 yes

48
Q

66 yo wo shortness of breath

  • Normal oropharynx
  • flat neck veins, midline trachea
  • Arterial pressure of O2 is normal at rest but fall with exercise

Which exercise related changes contributes to latter observation?

A

Increased pulmonary blood flow

49
Q

Estimate association between pesticide and head neck carcinomas

  • Controls were matched to cases by age and gender
  • Exposure was determined by interviewing subjects
  • Which of following will affect validity of study?
A

Misclassification bias

- questionnaires or interviews prone to this

50
Q

34 yo treatment for chemotherapy

  • Severe vomiting
  • Site of brain responsible for symptoms?
A

Area postrema

51
Q

80 yo man dry mouth, difficulty chewing

  • Decreased saliva production but no tenderness or swelling of salivary glands
  • Extensive caries are present

Age-related changes?

A

Acinar atrophy and fatty infiltration of salivary glands

52
Q

25 yo wo, jitteriness and mood swings

  • She may be having a heart attack
  • Warm moist skin and fine tremor

Which drug would provide fastest relief?

A

Propranolol

- Thyrotoxicosis beta blockers alleviate adrenergic symptoms

53
Q

64 yo man acute knee pain

  • Redness, swelling, severe pain
  • History of polycythemai vera, non-compliant with phlebotomy

Finding of synovial fluid?

A

Needle-shaped, negatively birefringent crystals

- Patient has gout ‘’ increased uric acid’’

54
Q

35 yo motor vehicle collision

  • lacerations on extremities and rib contusion
  • Treated with morphine and NSAIDS
  • Patient worried about developing dependance

Appropriate action by physician?

A

Prescribe a brief course of opioids to reused only for breakthrough pain

55
Q

80 yo man
- Weight loss
- Mass in right lung
I prefer not to be told anything, you can discus everything with my son. I trust his judgement

Response by physician?

A

I understand that you would not like to be told the results of the biopsy. I will share them with your son.

56
Q

26 yo man fevers, chills, vomiting, diarrhea

  • Epistaxis after a bar fight
  • Diffuse erythematous rash, anterior nasal packing in the left nostril

Essential in pathogenesis of the condition?

A

Binding of T-cell receptors by bacterial secretory products
- Staphylococcal toxic shock syndrome
Pyrogenic toxin superantigens TSST-1

57
Q

36 yo wo, dyspnea and weakness that are brought
- Medial hypertrophy, intimal fibrosis, decreased intraluminal diameter of small branches of pulmonary artery

Appropriate pharmacotherapy?

A

Bosentan

- Pulmonary hypertension

58
Q

5 month old boy

  • Unable to roll front to back or back to front does not seem to recognized his parents
  • Impaired tetrahydrobiopterin synthesis

Likely Deficiency of?

A

Serotonin

59
Q

67 yo man

  • MI a year ago
  • White scarring and enlargement of left ventricle

Type of collagen seen , is also present where?

A

Tendon type I collagen present in wound healing

- Tendon, skin, ligament

60
Q

65 yo man from eastern europe
- Erythematous rash on his face and trunk
- Positive for ANA antibodies
- Coronary artery disease
Congestive heart failure and cardiac rhythm abnormalities

Patient should be question about taking which drug?

A

Procainamide

Uworld (11 decks)

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