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Uworld > #6 > Flashcards

#6 Flashcards

1
Q

diarrhea outbreaks in private school in columbus ohio
- Diarrhea is watery and without blood

Pathogen responsible?

A

Norovirus

- Rotavirus unlikely in unvaccinated children or developed countries

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2
Q

45 yo man fatigue

  • Unable to climb stairs
  • Construction worker
  • Constipation, decreased concentration
  • Overweight male
  • MCV is low

Seen on peripheral smear?

A

Basophilic stippling

- Lead poisoning

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3
Q

48 yo wo

  • Legs are like sticks while her belly is getting bigger
  • Homeless
  • Loss of adipose tissue from extremities and face

Responsible for symptoms?

A

Antiretroviral medication

- Redistribution of fat

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4
Q

Step involving processing and handling of mRNA occurs only within the cytoplasm?

A

Interaction with P bodies

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5
Q

Newborn O2 saturation 70%

  • Peripheral pulses are normal
  • Narrowed mediastinal shawod

Cause of cyanosis?

A

Right-to-left cardiac shunting

- Transposition of great arteries

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6
Q

20 yo man skipped beats
- Fixed splitting of S2

Repair is aimed at preventing irreversible changes to?

A

Pulmonary vessels

- Atrial septal defect causes right sided volume overload and ventricular enlargement

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7
Q

34 yo wo dyspnea
- Enlarged coronary sinus
Cause of findings?

A

Pulmonary hypertension

  • Coronary sinus delivers deoxygenated blood in right atrium.
  • Dilation reflects an elevated right sided heart pressure
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8
Q

27 yo nursing assistant depression and bulimia

  • Ingested diuretic pills
  • Na 122 / Bicarbonate 28 / Calcium 11.4

Medication did patient ingest?

A

Hydrochlorothiazide

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9
Q

62 yo wo itchy, watery , red eyes after working in her garden

  • She took medication for allergies
  • Elevated intraocular pressure

Medication used by patient?

A

Alpha adrenergic agonist

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10
Q

COPD effect on residual volume, lung capacity, and forced vital capacity?

A
  • Increased residual volume
  • Increased total lung capacity
  • Decreased vital capacity
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11
Q

which drug will lower HCL output after vagal, histamine and gastrin stimulation?

A

Lansoprazole

- PPI inhibit H/K ATPase proton pump

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12
Q

65 yo man exertional dyspnea

  • Late inspiratory crackles in both lung bases and digital clubbing
  • Dense collagen fibrosis, honeycomb changes
  • Patchy and consists of lymphoplasmacytic infiltrate
  • Hyperplasia of type 2 pneumocytes

Pharmacotherapy aimed at?

A

Transforming growth factor beta

- Pulmonary fibrosis give Pirfenidone to inhibit progression

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13
Q

38 yo man
- I’ve earned everything i have on my own, this hospital isn’t getting any of it. I wouldn’t call anyone my friend. And that’s none of your business.

Patient’s behaviour?

A

Paranoid personality disorder

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14
Q

5 yo boy food seeking behaviour

Could be explained by lesion causing impairment of which hypothalamic nucleus?

A

Ventromedial

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15
Q

62 yo difficulty focusing his eyes

  • Unable to adduct his left eye
  • Stimulation of cornea does not elicit reflex

Anatomical structure responsible for this?

A

Superior orbital fissure

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16
Q

Prospective cohort study investigate association between obesity and risk of developing diabetic nephropathy. In a group of adults with T2DM.

  • One group consist of Adults with T2DM , BMI >40 and no diabetic nephropathy

What would be the comparison group?

A

Adults with T2DM, normal weight and no diabetic nephroparhy

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17
Q

59 yo man MI one month ago
- Im concerned about my high pressure job, but I need to find time to exercise plus I should stop smoking and lose 20 pounds.

Appropriate response by physician?

A

You’ve brought up important issues. What are one or two small changes you feel most ready to tackle now?

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18
Q

47 yo shortness of breath

  • Wheezing and poor air movement
  • Light microscopy of tissue after treatment with acid-schiff staining shows globules of alpha 1-antitrypsin in hepatocytes.

What is the cause of shortness of breath?

A

Interalveolar septa destruction

- alpha1 antitrypsin deficiency

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19
Q

newborn mother has bipolar disorder
- Mass overlying the lower spine that is covered with a patch of hair

Maternal intervention that could have prevented this?

A

Vitamin supplementation

- Valproate can cause neural tube defects

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20
Q

25 yo heaviness and palpitations
- ECG shows narrow QRS complex tachycardia with a regular rythm

Cause?

A

Abnormal conduction through the AV node

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21
Q

24 yo 2 days of burning during urination.

  • Darkening of the urine
  • Sexually active

Pathogen most likely responsible ?

A

E.Coli

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22
Q

16 yo boy mild scrotal pain over last 12 h.

  • No history of traumatic injury
  • Inguinal hernia repaired a year ago
  • Hemiscrotum is swollen and tender

Mechanism of acute testicular pain?

A

Anatomic defect causing increased mobility of the testis

- Testicular torsion, spermatic cord twisting , inadequate fixation of testis

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23
Q

57 yo decreased donor kidney transplantation
- During operation Graft becomes cyanotic and mottled soon after its blood vessels are connected , blood flow ceases

How can this be explained?

A

Antibody recognition of graft HLA components

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24
Q

68 yo man worsening back pain
- Takes long acting oxycodone, also takes acetaminophen for pain and osmotic laxative fro constipation

Reason for decreased analgesic efficacy?

A

Pharmacodynamic tolerance due to decreased responsively of the opioid receptor system.
- Chronic opioid therapy - drug tolerance

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25
Q

24 yo man abdominal pain, watery diarrhea

  • Camping trip admits eating mushroom
  • Jaundice, liver is palpable

Synthesis of which is directly inhibited?

A

Messanger RNA

26
Q

16 yo boy lost 2.3 kg

  • difficulty focusing
  • Feels tired despite sleeping 10hr/night
  • Everything get on his nerves

appropriate step management?

A

Inquire about suicidal thoughts

27
Q

27 yo wo increasingly paranoid and disorganized behaviour

  • Listened devices are planted in the wall
  • She changes topics frequently and rambles about voices harassing her.

Additional mental status found in patient?

A

Decreased facial expressiveness

- Schizophrenia

28
Q

45 yo male, deep alteration on the palm of his right hand
- 3 weeks later, actin-containing fibroblast and increased metalloproteinase activity are detected at the site of injury

These findings are cause by what complication?

A

Contracture

- Excessive matrix metalloproteinase

29
Q

26 yo wo bilateral milky nipple
- Takes medication to stop the voices

Interruption of which pathway is the cause of presenting symptoms?

A

Tuberoinfundibular pathway

30
Q

56 yo chest pain, palpitations, shortness of breath

  • BMI 40 / BP 145/78
  • ECG shows sawtooth pattern

Ablation procedure should create conduction block though which area?

A

Area between tricuspid valve and inferior vena cava in the right atrium.

31
Q

32 yo woman elite long distance swimmer , recently retired
- Compared to a person of similar age and sex, what cardiac changes are most likely present in
- Left ventricular ejection fraction
- Left ventricular cavity size
Maximum cardiac output

A
  • Left ventricular ejection fraction Unchanged
  • Left ventricular cavity size increased
  • Maximum cardiac output increased
32
Q

MI nMI
Statin 10 990
Control 25 975

Patients need to be treated with statin to prevent 1 additional myocardial infarction?

A

NNT= 1/ ARR
Statin 10/1000 = 0.01
Control 25/1000= 0.025
ARR= 0.025 - 0.01 = 0.015

NNT= 1/0.015 = 67 patients

33
Q

15 yo boy neck mass

  • No neck pain
  • Stain + for calcitonin
  • RET mutation +

Additional testing should be performed to evaluate?

A

MEN2

- Evaluate for abnormality in adrenal medulla

34
Q

28 yo wo after delivery of fetus maternal laceration is noted at posterior vaginal opening though mucosa and submucosa

Structure damage?

A

Perineal body

35
Q

6 yo frequent nighttime awakening crying , saying he became lost in a crowd

Sleep stage associated with child frightening is characterized by?

A

Muscle paralysis

- REM

36
Q

55 yo pain worsens when abducting shoulder or when lying on shoulder at night

  • Weakness with abduction and external rotation
  • Partial rotator cuff tear
  • Injection to block C3 through C7 nerve roots is done

Muscle paralyzed?

A

Diaphragm

37
Q

2 yo boy wheezing after eating candy with peanuts

  • Intramuscular epinephrine is given
  • 15 min after allergy test skin is erythematous and raised
  • 4hs later the parents notice a hard, red swelling at the puncture site

What mediators are involved in secondary reaction?

A

Epithelial damage by major basic protein
- Type I hypersensivity
Late phase MBP and eosinophil peroxidase

38
Q

64 yo man 2 days of dysuria, urinary frequency and urgency

  • 30 pack year smoking
  • Urine culture gram + cocci in chains.

Organism demonstrate what?

A

Gamma hemolysis on blood agar

- Enterococcus

39
Q

22 yo wo, streak of blood present in sputum

  • Chronic sinusitis
  • She takes pancreatic enzyme supplements for chronic diarrhea
  • Nasal polyps and barrel shaped chest
  • Digital clubbing
  • Hyperinflated lungs and dilated thickened airways

Organism in culture?

A

Pseudomonas aeruginosa

- Patient has cystic fibrosis

40
Q

34 yo man type 1DM

  • Treated with rapid acting insulin injection
  • 2weeks ago passed out due to low glucose levels
  • Prescribed injectable that should be given when hypoglycaemia is associated with impaired consciousness

This improves hypoglycaemia by which mechanism?

A

Increasing glycogenolysis

- Emergency glucagon kits

41
Q

37 yo wo leakage of urine with cough

Mechanism for patient’s urinary incontinence?

A

Increased intraabdominal pressure
- Stress urinary incontinence
Common in pregnancy due to decreased external urethral sphincter tone and increased pelvic floor muscle laxity

42
Q

65 yo wo COPD

  • Cultures show lactose containing media grow rapidly dividing gram negative bacteria
  • Replication requires synthesis of 2 daughter strands processes

Which process differs most between 2 daughter strands?

A

Joining of DNA fragments by ligase

- Okazaki fragments (DNA ligase)

43
Q

30 year longitudinal study
- Cardio disease from 50 to 80

Patient at 80 are most likely to show which compared to 50?
- SBP/ DBP/ PP

A

SBP increased
DBP decreased
PP increased

44
Q

18 yo boy laughs inapropprotiately and seems sluggish
- Admits to smoke marijuana
Effect most likely to be observed?

A

Conjuctival injection

45
Q

20 yo blisters around her mouth associated with burning sensation
- Condition remains latent in neuronal cell bodies and sensory ganglia

Which protein is involved in transport of the process leading to disease?

A

Kinesin

- Herpes virus

46
Q

76 yo man acute bright red blood from rectum

  • Blood bowel movements this morning
  • Delayed capillary refill.

Physiological changes in kidney function ?

A

Increased urea reabsorption

- Hypovolemic shock

47
Q

52 yo post menopausal woman

  • Excessive warmth and sweating
  • Treatment with Estrogen containing hormone replacement

Medication would cause?

A

Increase total T4 level

- Increase in estrogen activity leads to raise in TBG levels

48
Q

56 yo man burning substernal pain began 6h ago.

  • ST elevation in leads
  • Shortness of breath worsens when lying flat

Histologic features present in patient lung?

A

Engorged capillaries and alveoli filled with acellular pink material
- Acute pulmonary edema

49
Q

We isolate small circular DNA molecules that resemble bacterial chromosome
- they code for proteins, transfer RNA and Ribosomal RNA

Where did these structures originate?

A

Mitochondria

50
Q

52 yo postmenopausal

  • Discomfort after fatty meal
  • BMI 33
  • Ultrasound shows small non obstructing gallstone

Best treatment for this condition?

A

Bile acid supplement reduces cholesterol secretion and increases biliary bile acid concentration.
- CHolesterol gallstones

51
Q

55 yo man shortness of breath, cough and chest tightness

  • History of asthma as a child
  • Recently diagnosed with essential tremor
  • Scattered expiratory wheezes

Symptoms recurrence is due to medication that affects what steps?

A

Essential tremor treated with nonselective beta blocker (propranolol) because of B2 receptors blockade causes wheeze and dyspnea.

52
Q

16 yo cough, dyspnea, wheezing
- Abdominal discomfort, anorexia and nausea

Image shows thick outer shell confirming ascaris lumbricoides

Cause of patients pulmonary symptoms?

A

Transpulmonary migration of larvae

- Loeffler syndrome = eosinophilic pneumonitis

53
Q

46 yo woman, right upper abdominal pain

  • BMI 33
  • Leukocyte 21000
  • Erythematous distended gallbladder with patchy necrosis

Events most likely initiated this condition?

A

Gallbladder outflow of the mucosal layer

54
Q

55 yo man depression treated with SSRI

Most likely side effect ?

A

Sexual dysfunction more common that serotonin syndrome

55
Q

23 yo male recurrent nosebleeds
- pink spider like lesions on oral and nasal mucosa, face and arms

Patient suffers from?

A
  • Osler weber rendu syndrome
    mucosal telangiectasis
    Autosomal dominant condition
56
Q

23 yo man myoclonic epilepsy onset

  • Proximal muscle weakness
  • muscle fibers with a blotchy red appearance
  • Probability that offspring will inherit condition?
A

0 % red ragged fibers MERRF mitochondria disease only transmitted by mother

57
Q

28 yo wo pain in left lower quadrant and vaginal bleeding

  • She had bilateral tubal ligation
  • There is 2cm mass in left adnexa adjacent to the ovary and thickened endometrial stripe

Finding expected in patient?

A

Dilated, coiled endometrial glands and oedematous stroma, these changes occur in menstrual cycle under influence of progesterone.
- Ectopic pregnancy

58
Q

45 yo man painful skin lesions in right axilla

  • Works as a roofer
  • Image shows hidradenitis suppurative

Cause of condition?

A

Obstruction of folliculopilosebaceous units caused by hyperprolifearion and abnormal keratinocyte differentiation.

59
Q

48 yo man progressive headache and double vision

  • Purulent nasal drainage and frontal headache
  • Ptosis, mydriasis, loss of corneal reflex of right eye
  • Unable to move right eye in any direction
  • Decreased sensation in right upper face

Structures involved in presentation?

A

Cavernous sinus

60
Q

24 yo postpartum woman follows up on gestational diabetes
- Fasting hyperglycaemia and gestational diabetes are suspected to be genetically predisposed

This is caused by reduced activity of which enzyme?

A

Glucokinase, functions as a glucose sensor for beta cells

Uworld (11 decks)

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