62 yo man evaluation of Jaundice - Presence of edema , elevated transaminases - Trichrome staining shows blue deposits Cell is responsible for the histologic ?

Stellate Ito cells - produce collagen in large quantities. '' hepatic fibrosis'' - Collagen stains blue with masson trichrome - Patient has hepatic cirrhosis

#3 Flashcards by jose isla

stage IV chronic kidney disease
- Cardiac auscultation reveals S4
- Anemia low reticulocyte count
Treatment with recombinant glycoprotein hormone is begun and improvement in hemoglobin level occurs.

MOA?

Janus Kinase 2/signal transducers and activators of transcription
- Recombinant EPO agents works by JAK2/STAT

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52 yo worsening right leg pain

injured while motorized watercraft on the ocean near florida
Small laceration on the dorsal of the right foot
Leukocyte and serum lactic acid are elevated
Yield curved gram-negative rods

Greatest risk factor for this patient’s infection?

Condition causing iron overload

- Vibrio vulnificus

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HLA DQA0501 - DQB 0201 haplotype is 0.2

However DQA0501 is 0.3 & DQB0201 is 02

What explains the difference ?

Linkage disequilibrium

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Congenital abnormalities and use of acetaminophen
- Interview mother to determine fetal exposure to acetaminophen

Susceptible to which bias?

Recall bias

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67 yo altered mental status
Unable to follow command
- Most appropriate in decision making ?

Ask them both to make a decision based on what they think the patient would have wanted if he was able to make the decision

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35 yo frequent urination
- Urine osmolality increased after 4h of dehydration
- Plasma osmolality found to be 298
Vasopressin was administered subcutaneously

Diagnosis?

Central diabetes insipidus

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2yo boy fever and mouth pain
Swollen gums and vesicular inflamed lesions on his hard palate and lips
Enlarged and tender cervical lymph nodes

Responsible agent?

DNA virus, DS, enveloped

Herpes virus

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27 yo woman several sexual partners

positive for HPV
Biopsy reveals low grade dysplasia

Features the distinguishes lesion from cervical malignancy?

Reversibility of changes

‘‘low grade dysplasia’’

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62 yo man evaluation of Jaundice

Presence of edema , elevated transaminases
Trichrome staining shows blue deposits

Cell is responsible for the histologic ?

Stellate Ito cells - produce collagen in large quantities. ‘’ hepatic fibrosis’’

Collagen stains blue with masson trichrome
Patient has hepatic cirrhosis

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Arterial pressure
75, 110, 80, 90, 75, 110
Median?

85mm Hg

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28 yo woman pregnant
- Fetus is not her husband child, she ask not to tell him

Appropriate response?

I will not tell your husband

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38 yo wo

It’s almost lunchtime and I still haven’t gotten my breakfast
Appropriate response by physician?

You must be very hungry, so let me find out what happened to your meal

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65 yo male, after stroke

presents with left upper and lower extremity weakness
Prescribed diazepam to decrease muscle spasticity

Cautioned to avoid?

Chlorpheniramine ( 1st generation antihistamine) can cause significant sedation

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patient given amiodarone

What should be tested before?

Serum TSH

Amiodarone can cause hypo and hypethyroidism

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55 yo several months of fatigue
- Significant for hypertension and obesity
Mucosal pallor
MCV 84

Cause of patient anemia?

Anemia of chronic disease

- Increased hepcidin

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Deletion in PECAM-1 gene, this will affect which neutrophil function?

Transmigration

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24 yo binge drinking
- Red blood vomit

Distal branch of which blood vessel is likely to be emboli zed during procedure?

Left gastric artery branch esophageal artery

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62 yo patient can’t feel anything on right side of her body
- Loss of body touch, temperature and vibratory sensation

Muscle is 5/5

Stroke affects ?

Left thalamus

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Pure sensory stroke, after years patient dies an we find cavities in the deep structures of her brain with clear fluid

What is responsible for this finding?

Lipohyalinosis with small vessel occlusion = liquefactive necrosis

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42 yo woman with parkinson disease
- Loss of function mutation in a gene that leads to accumulation of misfolded proteins

Process defective?

Ubiquitination

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Hand hygiene with alcohol based disinfectant is recommend because of pathogens that present?

Lipid bilayer envelope like influenza

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78 yo man abdominal pain and discomfort
- No bowel movement in 5 days
Polyethylene glycol is administered and movement is produced

Action is most similar to?

Lactase deficiency

- Osmotic laxative same as magnesium hydroxide

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38 weeks gestation neonate has respiratory distress after delivery
- cyanosis, tachypnea, poor perfusion
- Decreased left sided breath sounds
Chest X-ray shows tube entering left side of chest

Reason for respiratory distress?

Underdevelopment of pulmonary tissue

- Congenital diaphragmatic hernia causing pulmonary hypoplasia

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27 yo man dyspnea on exertion
- 3/6 systolic murmur along left sternal border that decreases in intensity when moving from standing to squatting position

Inheritance of this condition?

Autosomal dominant - consistent with hypertrophic cardiomyopathy
Affect cardiac myosin binding protein C and cardiac beta myosin heavy chain

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70 yo wo progressive dyspnea - No pain or edema - S4 is heard - Left atrial enlargement, concentric left ventricular hypertrophy Changes seen in: Left ventricular compliance, Angiotensin II signalling, myosin heavy chain beta ?

Compliance decrease, the rest increases

Ischemic injury to cardiomyocytes, left anterior descending coronary artery is ligated, ATP concentration decreases At which point in time does myocardium stops contracting?

Earliest point in the graph about 1 to 2 minutes

72 to man sudden abdominal pain - History of coronary artery disease - Small intestine is resected and several large-caliber vessels with needle shaped cholesterol clefts are present Patient at highest risk for?

Kidney injury

7 yo congestion with facial pain - Pain over cheeks - Yellow mucus, gram shiny masses - Lungs coarse breath sounds - Diagnosis?

Cystic fibrosis

50 yo wo large painful skin lesion - Started on warfarin not long ago Cause of skin lesion?

Protein C deficiency

25 yo wo at 37 week gestation - Abdominal pain and sudden vaginal bleeding - Fetal heart 105/min Cause of bleeding?

Premature placental separation - Vasa previa ( placenta implantation over cervix) bleeding is painless

46 yo 4 days of intermittent fever - 2 days of decreased urine output and skin rash - Petechial rash and facial puffiness - Bleeding time is prolonged - PT & PTT are normal -Presence of schistocytes and reduced platelets with giant forms There is proteinuria & Hematuria Seen on renal biopsy?

Platelet rich thrombi in glomeruli and arterioles | - TTP-HUS

2 month old, physician advise vaccine and mother doesn't want to , she has read that it is very harmful to the immune system. Appropriate response?

I understand your concern, and I believe that ensuring your children's health & safety is our shared goal

32 yo wo bloating, intermittent diarrhea - Diagnosed with irritable bowel syndrome Patient decide to start a strict vegan diet. Nutritional supplement should be given?

Calcium & vitamin D | Cobalamin deficiency may also occur

36 yo man, severe acute knee pain - Underwent renal transplant 8 weeks ago - Taking cyclosporine and low-dose prednisone Fluid from knee shows numerous neutrophils as well as intra and extracellular crystals Mechanism responsible for symptoms?

Decreased urinary excretion of uric acid | Patient has gout, cyclosporine impairs renal excretion of uric acid

32 yo cough and malaise - Tonsillectomy at age 8 - Outdoor adventure in the great lakes - KOH preparation reveals large yeast cell with a single bud Infected with?

Blastomyces dermatitidis

62 yo with cough and dyspnea - COPD, smoked for 40 years - Right lung reveals bronchial sound and crackles. Mediastinal contour on CT scan over right is formed by?

Right atrium - right middle lobe

16 yo boy burning with urination and penile discharge - Sexually active - gram stain shows gram negative diplococci Appropriate treatment?

Tetracycline and third generation cephalosporin | - Treat for gonorrhoea and Chlamydia at the same time

28 yo wo hing dose glucocorticoids improved hepatitis. - Jaundice Prednisone is tapered and azathioprine is prescribed. What should be monitored while patient takes new medication?

Complete blood count | - Azathioprine causes pancytopenia

62 yo man sudden onset severe headache BP 180/95, right pupil is larger - Right basal ganglia hemorrhage with compression of right lateral ventricle and shift of midline structures - Intravenous bolus of mannitol is administered Acute effect of medication on serum sodium concentration, renal tubular flow, glomerular filtrate osmolality?

Decreased serum sodium concentration, increased the rest

Respiratory epithelium changes in composition as airway continue distally from trachea to alveolar ducts Feature last to disappear?

Cilia, it will be present at the respiratory bronchioles

Girlfriend found unresponsive - History of major depression and anxiety disorder - Screen is positive for benzodiazepines Arterial blood gas present PaO2 / PaCO2 / Alveolar- arterial O2 gradient?

Decrease (55)/ Increase (60) / normal (10)

56 yo wo frequent urination, suprapubic pain, hematuria - Positive for breast cancer and started chemotherapy last month. What drug could have prevented current condition?

Mesna | Patient has hemorrhagic cystitis caused by cyclophosphamide

25 yo man persisten diarrea - History of HIV - Diarrhea has become bloody ''shigella'' - There has been transfer of nonchromosmal DNA between adjacent bacteria via a small hair like appendage Process responsible for bacteria resistance?

Conjugation '' cell to cell contact'' creates antibiotic resistance. Via pilus ( hair like appendage)

2yo boy sits in a corner playing with favourite truck, he forms no words - When pulling truck away he begins screaming and pulls it back Diagnosis?

Autism spectrum disorder

``` 84 yo wo sent to nursing home - urinary tract infection history - 3 days of fever and abdominal pain Patient started on ceftriaxone - Urine shows extended spectrum beta lactamase producing Escherichia coli ``` Features found in this organism?

Plasmid with drug resistance gene | This will rend cephalosporins and beta lactic antibiotics inactive

24 yo wo with partial bowel resection for crohn disease - Since surgery had difficulty eating and has inserted a central venous catheter. Blood cultures show positive for yeast Organism responsible for infection?

Pseudohyphae with blastoconidia | - Candida in catheter

62 yo wo end stage kidney disease due to diabetic nephropathy - She is given medication that prevent rejection by inhibiting the conversion of inosine monophosphate to guanosine monophosphate What medication was used?

Mycophenolate Inhibits de novo purine synthesis Can cause lymphopenia and diarrhea

46 yo recurrent nosebleeds - alcohol use disorder - Swollen gums, scattered ecchymoses and hyperkeratosis - Chronic ulcer in lower extremity What mechanism accounts for finding?

Abnormal proline hydroxylation | - vitamin C deficiency '' necessary for collagen synthesis''

Cell in which glycolysis of single glucose molecule always yields pyruvate but sometimes generates no net ATP?

Erythrocytes | Convert 1,3 BPG to 2,3 BPG this produces no ATP. In order to increased oxygen delivery

13 yo boy difficulty with breathing, hoarseness and dysphagia - Oropharyngeal examination reveals a large red lingual mass. Failure of which embryologic process is responsible for this?

Migration | - Remaining of thyroglossal duct causes a lingual thyroid

55 yo man watery diarrhea for last 2 weeks - Kidney transplantation 5 years ago - He is in immunosuppressive medication - Ziehl-Neelsen staining shows multiple acid-fast organism Cause of condition?

Cryptosporidium parvum | - Focal orally transmitted, oocyst identified by acid fast

Patient says to doctor '' you know noting, you are not even a real doctor'' Resident is reminded of her father, she replied you can't leave and Im ordering haloperidol to calm you down What process explains the resident's response?

Countertransference

mRNA sequences composed of CUC & CUU are incubated with ribosomes and amino acids. After hours it is found both chains contain leucine repeats - Observed finding is due to ?

Wobble | - Multiple codons code for same amino acid

45 yo man enlarging neck mass and hoarseness - Biopsy + for papillary thyroid cancer - After thyroidectomy patient develops tingling around mouth and muscle cramps in lower extremities Increase in which of the following best explain current symptoms?

Increase in urinary calcium excretion | - Hypocalcemia caused by unwanted removal of PTH

32 yo reveals enlarged cervical, axillary and lymph nodes, diffuse skin rash - serum added to cadiolipin, cholesterol and lecithin leads to clumping Antibodies directed agains what?

Treponema pallidum | - VDRL test secondary syphilis

32 yo wo stuck in elevator - dizziness, blurred vision and weakness Cause of symptoms?

Decreased arterial partial pressure of CO2 - Hyperventilation leads to decreased cerebral perfusion

68 yo woman right femoral neck fracture - Weakness in dorsiflexion, plantar flexion and knee flexion - Hip & Knee extension are normal - Sensation is decreased to touch on dorsal of right foot, ankle reflex is absent on the right Cause of findings?

Sciatic nerve injury (L4-S3) - L5 radiculopathy (disc herniation) will have back pain with normal ankle reflex

23 yo stab injury - laterally directed anterior chest wall stab wound at the 5th intercostal space along the midclavicular line Structure injured?

Left lung

64 yo hypertension history - Unable to sleep in flat position - BP 192/102 - Started on nitroglycerin infusion Physiologic changes most likely to occur in left ventricular end-diastolic pressure / peripheral venous capacitance / systemic vascular resistance?

Decrease ventricular end-diastolic pressure Increase venous capacitance Decrease vascular resistance

although eukaryotic genome is larger and more complex than of the prokaryote, eukaryotic DNA replication still occurs in a timely manner Why?

Multiple origins of replication