#2 Flashcards by jose isla

22 yo man, knife wound to his neck

Right sided hemiplegia
Loss of proprioception and vibration sensation below C8
On left side loss of pain and temperature below T2

Spine will reveal?

Right sided hemisection of the spinal cord

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53 yo man weight loss, fatigue, anorexia
- Gastric cancer followed by total gastrectomy
Must receive lifelong administration of?

Water soluble vitamin

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23 yo wo anxious, symptoms appear for no reason

Panic disorder
Received medication and feels better within an hour

MOA of drug?

Bonds allosterically to the GABA receptor ‘‘benzodiazepines’’ increased frequency of chloride ion channel opening

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34 yo man history of HIV and drug use
- India ink staining of cerebrospinal fluid demonstrate spherical yeast forms with thick capsules

Site of primary infection in patient?

Lungs ‘‘cryptococcus neoformans’’

- Inhalation with polysaccharide antigen.

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8 month old vomiting and watery diarrhea for past 3 days
- Dry membranes and decreased skin turgor
Sets of laboratory finding compared with pre-illness : Hematocrit - Serum albumin concentration - Serum Uric acid concentration?

Everything will be increased because of hypovolemia with consequent decreased in plasma volume

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26 yo recurrent nausea and vomiting

Feels full after eating
Emesis contains particles of food
Upper GI endoscopy is unremarkable
15 y history of Diabetes type 1

Mechanism responsible for current symptoms?

Dysfunction of gastric enteric neurons
‘‘Diabetic gastroparesis is an autonomic neuropathy’’
- Chronic hyperglycaemia leads to destruction of enteric neurons

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17 yo girl irregular menses

increase hair growth in chest and face
Testosterone is high, 17-hydroxyprogesterone is high too

Enzyme reaction step is disrupted?

Progesterone conversion to 11-deoxycorticosterone

- 21-hydroxylase deficiency

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6h boy feeding difficulties
- several bouts of coughing and perioral cyanosis
- Oxygen saturation 85%
Cause ?

Failure of primitive foregut to separate from airway

- Tracheoesophageal fistula with esophageal atresia

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25 yo man penile lesions
- Soft, flesh colored, papillary lesions
- Topical agent acts as a toll-like receptor agonist to increase antiviral cytokine production
Medication prescribed?

Imiquimod, patient has HPV

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16 yo boy focus on endurance training

- Increase in what group of large skeletal muscle components?

Mitochondrial content, develop type I fibers, they use oxidative phosphorylation

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44 yo man hypercholesterolemia
- Father died of MI at age 56
- BP is 160/100
Started on enalapril 
GFR decreases a little bit
What is affected by enalapril?

Efferent arterioles constriction

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43 yo man chemo for Acute myeloid leukaemia

Neutrophil count of 100
Dense infiltrate involving the right upper lung lobe
Bronchoscopy grow mold

Organism responsible?

Aspergillus fumigatus

Invasive pulmonary aspergillosis ‘’ septet narrow hype’’ branch at 45 angle

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56 yo man with type 2 diabetes mellitus
- Treatment with empagliflozin is initiated
Effects of treatment?

Reduction in glomerular hyperfiltration ‘‘SGLT2 inhibitors’’

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42 yo man with enlarging mole
- local anesthesia is administered lidocaine mixed with epinephrine
Impact of mixing?

Prolonged duration of action of anesthetic agent

‘‘Epinephrine causes vasoconstriction’’

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Patients with atrial fibrillation are compared after giving drugs at rest and with 10 minutes of moderate exercise
What drug will have an effect at rest but not during exercise?

Digoxin

Increased parasympathetic tone
Poorly controls ventricular rate during exercise

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55 yo wo breast cancer undergoes mastectomy

ER/PR + but HER-2 negative
Patient started on tamoxifen, she experiences flashes that come and go

What condition is likely to experience?

Endometrial hyperplasia

- selective estrogen receptor modulators

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Newborn, low set of ears, small mandible and prominent occiput

Clenched hands with second and fifth digits on top of the third
IV/VI holosystolic murmur

Chromosomal abnormality?

47 XX + 18

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32 yo wo sudden left flank pain and nausea
- Pain radiates to groin

Recommendation?

Drink plenty of water daily ‘’ patient has nephrolithiasis’’

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27 yo daily headaches for 3 months
- Constant Dull pressure
- History of seasonal allergies and sister has migraine headaches
Diagnosis?

Tension headache

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Epidermis reveals stellar cells that contain granules with the shape of tennis racquet

Cells are referred as?

Langerhans cells ‘’ dendritic cells are professional antigen presenting ‘’ brubeck granules

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5 month old boy, right sided scrotal enlargement

Increase when he cries or strains to pass bowel movement
Doesn’t feel pain
Fluid collection around testis

Defect can also lead to ?

Indirect inguinal hernia

- Failure of obliteration of the processus vaginalis - communicating hydrocele develops from fluid leakage

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25 yo man azoospermia
- History of recurrent pneumonia
- Digital clubbing
- Absence of vas deferens
Tests would confirm the diagnosis?

Chloride level in the sweat

Patient has cystic fibrosis

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Signal transduction in type 2 diabetes mellitus
- TNF-a results in decreased insulin-mediated glucose uptake
This effect is mediated through up regulation of ?

Serine residue phosphorylation

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What portion of ECG will be affected by esmolol?

PR interval

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4 yo boy had seizure, upper respiratory illness for the last 2 days - Temperature is 40 C - Clear nasal discharge and mild erythema but is alert and cooperative Cause of seizure?

Hyperthermia induced diffuse neuronal dysfunction

45 yo man with focal epilepsy - Given drug that blocks voltage gated calcium channels This affects which steps in neurotransmission?

Fusion and release of neurotransmitter vesicles | Gabapentin

37 yo wo dry cough and shortness of breath - Pulmonary infiltrates and hilar adenopathy - Presence of non-caseating granulomas Set of immune cells responsible for development?

Patient has sarcoidosis | - Th1. IL-2, interferon y

54 yo woman right upper limb weakness and fatigue - No sensory loss , but difficulty abducting her arm past the horizontal position. - medial border of right scapula lifts off the thoracic wall when press against wall Patient was hospitalized for which condition?

Mastectomy with axillary lymph node removal | - Paralysis of serratus anterio, due to long thoracic nerve injury

20 yo woman with painful swelling of right axilla - Lymph node shows necrotizing granulomas and stellate microabscesses containing pleomorphic gram negative coccobacilli Route of transmission?

Scratch from and infected cat | - Bartonela henselae

24 yo man drinks a lot - he says it helps him unwind and relax after a long workday, I can't see quitting Appropriate statement?

I can understand your reasons for using alcohol. What are the downsides to drinking from your perspective

8 yo boy he never listens, rarely sits, always interrupts, forgets to do his chores What would be helpful in establishing the diagnosis?

Teacher evaluations

18 month old hospitalized for pneumonia 2 times since age 3 months - Pleural effusion once contained numerous neutrophils and a large number of intact gram-positive cocci Organism responsible for patients recurrent infections produce what virulence factors?

Catalase, patient has CGD, impaired NADPH oxidase

18 month old, neurologic regression - Inability to sit with with support ''regression'' - Enlarged liver, spleen - Diminshed deep tendon reflexes in all limbs and hypotonia - Cherry red macular spot Accumulation of?

Sphigomyelin - Niemman pick disease

Serum insulin level is higher when given oral glucose vs IV Why?

Glucagon like peptide 1 | ''Incretin'' functions by stimulating release following oral consumption of glucose.

``` 76 yo wo found unresponsive - Ate less dinner than usual - Blood glucose is 34 - Rapidly improve after bolus of dextrose Confuse again several hours later ``` Medication cause of this?

Glyburide ''sulfonylurea '' persistent hypoglycaemia

4 week infant episodes of hypoglycaemia - elevated insulin levels during periods of fasting - Mutation involving potassium channels Which substance binds and regulates ion channel responsible for hypoglycaemia?

ATP- sensitive potassium channel

46 yo woman hiatal hernia and GERD - Gastric fundus is mobilized and wrapped around the lower esophagus Structure traversing esophageal hiatus of diaphragm was injured Potential effect of injury?

Delayed gastric emptying, damage to vagal trunks

68 yo woman abdominal pain an dvomiting - Episode of acute calculous cholecystitis - Exam shows tympanic abdomen with high-pitched bowel - Air in gallbladder and biliary tree Gallstone lodged in?

Ileum

32 yo wo worsening headaches and double vision - Nasal discharge for several days - Weakness of lateral rectus muscle What nerve is involved?

Abducens nerve

68 yo wo - Confusion and lower extremity weakness - She is visiting family in texas for the summer - Flaccid paralysis of lower extremity - CSF shows lymphocytic pleocytosis and elevated protein Viral RNA Mode of transmission of agent infecting ?

Insect bite '' west nile virus''

Summer camp, 4 children with cough congestion, sore throat and red eyes Cause of outbreak?

Adenovirus

2day old boy mother has beta thalassemia trait and father is normal - Hemoglobin composition of infant?

A2y2 will be there for the first 6 months

Present Absent Test + 45 30 Test - 5 120 Likelihood that patient with negative test does not have disease?

120/125 = 0.96

23 yo woman with sickle cell disease - Is given hydroxyurea MOA of drug?

Increased fetal hemoglobin synthesis

2 month old girl restricted movements of upper and lower extremities - Mother had inconsistent prenatal care - Mild pallor, generalized lymphadenopathy, hepatosplenomegaly - Knee joints reveal metaphysical erosions with periosteal reaction Cause?

Transplancental transmission of a spirochete '' T palladium'' Congenital syphilis

17 yo girl right wrist mass - Swelling on top of wrist, rounded mass on dorsal that transilluminates with penlight - Painless Underlying ethology?

Degeneration of periarticular tissue | '' ganglion cyst''

Case control SLE 1040 , nonSLE 1260. - Among SLE 240 have endometriosis, nonSLE 210 Odds ratio of endometriosis in women of SLE compared to non SLE?

SLE + SLE - Endometriosis + 240 210 Endometriosis - 800 1050 Odds ratio 240/800 = 0.3 exposure Odds ratio 210 / 1050= 0.2 controls 0.3/0.2 = 1.5

32 yo woman after delivery of placenta patient losses large amount of vaginal bleeding - Postpartum hemorrhage Dose of tranexamic acid is administered, MOA?

Inhibits plasminogen cleavage and prevents fibrin degradation

Kidneys response to hypoperfusion apply a clip to a pig's right renal artery - After 6 months which cells would undergo hyperplasia as a result of clip?

Modified smooth muscle cells of afferent arteriole (JG cells)

26 yo woman gives birth - Baby has protruding tongue, excessive skin at the nape of the neck, upsetting palpebral fissure - Harsh III/VI systolic murmur heard over left sternal border ( ventricular septal defect) Karyotypes likely to be found?

46xx t(14:21) down syndrome

25 yo wo low mood because landlord won't allow pets in building - Her mood would improve if she could get a letter saying the dog needs to live with her. Statement by physician?

I can see you miss your dog very much, let's start by talking about the mood symptoms you've been experiencing

58 yo man progressive fatigue , dyspnea and orthopnea - BP is 160/95 , bilateral lung crackles and lower extremity edema - Maximal impulse is displaced toward axilla. Potassium is 4.2 Long term use of which medication will reduce mortality?

Lisinopril ''reduced cardiac remodelling'' | - Patient has heart failure with reduced ejection fraction

76 yo Diastolic murmur - Cultures grow Enterococcus '' mitral valve vegetations'' endocarditis - Antibiotic develops tinnitus and hearing loss Antibiotic moa?

mRNA genetic code reading | - Aminoglycoside

32 yo man with crohn disease - high dose glucocorticoids - Azathiprine is maintenance therapy Expected effects of this medication on Lymphocyte count, immunoglobulin level and IL-2 activity?

Everything will decrease | Azathiprine disrupts DNA and RNA replication

47 yo woman progressive joint pain and swelling of hands - Morning activities are difficult - Autoantibodies against what component are most specific?

Citrullinated peptides | - Rheumatoid arthritis

22 yo woman give birth - Boy external genitalia are ambiguous - Mobile masses are palpable bilaterally Karyotype shows 46 XY Deficiency in which of the following enzymes?

5a reductase - Converts testosterone to DHT ''external male genitalia''

42 yo man fever, diarrhea - colonoscopy reveal areas of erosions and ulceration - Cells with viral intranuclear and intracytoplasmic inclusions Patient given an agent that does not require intracellular activation and binds to DNA polymerase What is the agent?

Foscarnet | Patient is suffering from cytomegalovirus

46 yo left sided flank pain radiating to the groin left ureteral calculus - Left lower lobe lung nodule and foci of calcification in the spleen - Small calcified nodules in both lungs and mediastinal lymph node - Farmer who live in Ohio Tuberculosis test is negative Most likely cause?

Fungal infection | -Suspicion of granulomatous infection, most likely cause is Histoplasma capsulatum

38 yo dies suddenly at his work place - He was overweight - Maternal uncle reportedly dies of heart attack at age 50 - Myocardial findings show neutrophil invasion Diagnosis?

Acute myocarditis caused by Viral infection - Myocarditis shows myocyte necrosis or degeneration accompanied by an inflammatory mononuclear cell infiltrate * Ventricular arrhythmias leading to sudden cardiac death

12yo boy intermittent substernal chest pain occurs with heavy activity - Troponin is elevated and ECG reveals ST segment elevations - Increased serum methionine level Which amino acid is essential?

Cysteine Patient has homocystinuria - cystathione synthase deficiency, condition leads to hyper coagulability and thromboembolic occlusion. Results in hypermethioninemia ''Ectopia lentis and intellectual disability''