#6 Flashcards by jose isla

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

Pathogen responsible?

Norovirus

- Rotavirus unlikely in unvaccinated children or developed countries

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45 yo man fatigue

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

Seen on peripheral smear?

Basophilic stippling

- Lead poisoning

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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?

Antiretroviral medication

- Redistribution of fat

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

Interaction with P bodies

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Newborn O2 saturation 70%

Peripheral pulses are normal
Narrowed mediastinal shawod

Cause of cyanosis?

Right-to-left cardiac shunting

- Transposition of great arteries

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20 yo man skipped beats
- Fixed splitting of S2

Repair is aimed at preventing irreversible changes to?

Pulmonary vessels

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

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

Pulmonary hypertension

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

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27 yo nursing assistant depression and bulimia

Ingested diuretic pills
Na 122 / Bicarbonate 28 / Calcium 11.4

Medication did patient ingest?

Hydrochlorothiazide

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

She took medication for allergies
Elevated intraocular pressure

Medication used by patient?

Alpha adrenergic agonist

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

Increased residual volume
Increased total lung capacity
Decreased vital capacity

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

Lansoprazole

- PPI inhibit H/K ATPase proton pump

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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?

Transforming growth factor beta

- Pulmonary fibrosis give Pirfenidone to inhibit progression

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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?

Paranoid personality disorder

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5 yo boy food seeking behaviour

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

Ventromedial

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62 yo difficulty focusing his eyes

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

Anatomical structure responsible for this?

Superior orbital fissure

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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?

Adults with T2DM, normal weight and no diabetic nephroparhy

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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?

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

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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?

Interalveolar septa destruction

- alpha1 antitrypsin deficiency

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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?

Vitamin supplementation

- Valproate can cause neural tube defects

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

Cause?

Abnormal conduction through the AV node

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24 yo 2 days of burning during urination.

Darkening of the urine
Sexually active

Pathogen most likely responsible ?

E.Coli

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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?

Anatomic defect causing increased mobility of the testis

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

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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?

Antibody recognition of graft HLA components

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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?

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

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24 yo man abdominal pain, watery diarrhea - Camping trip admits eating mushroom - Jaundice, liver is palpable Synthesis of which is directly inhibited?

Messanger RNA

16 yo boy lost 2.3 kg - difficulty focusing - Feels tired despite sleeping 10hr/night - Everything get on his nerves appropriate step management?

Inquire about suicidal thoughts

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?

Decreased facial expressiveness | - Schizophrenia

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?

Contracture | - Excessive matrix metalloproteinase

26 yo wo bilateral milky nipple - Takes medication to stop the voices Interruption of which pathway is the cause of presenting symptoms?

Tuberoinfundibular pathway

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?

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

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

- Left ventricular ejection fraction Unchanged - Left ventricular cavity size increased - Maximum cardiac output increased

MI nMI Statin 10 990 Control 25 975 Patients need to be treated with statin to prevent 1 additional myocardial infarction?

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

15 yo boy neck mass - No neck pain - Stain + for calcitonin - RET mutation + Additional testing should be performed to evaluate?

MEN2 | - Evaluate for abnormality in adrenal medulla

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

Perineal body

6 yo frequent nighttime awakening crying , saying he became lost in a crowd Sleep stage associated with child frightening is characterized by?

Muscle paralysis | - REM

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?

Diaphragm

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?

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

64 yo man 2 days of dysuria, urinary frequency and urgency - 30 pack year smoking - Urine culture gram + cocci in chains. Organism demonstrate what?

Gamma hemolysis on blood agar | - Enterococcus

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?

Pseudomonas aeruginosa | - Patient has cystic fibrosis

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?

Increasing glycogenolysis | - Emergency glucagon kits

37 yo wo leakage of urine with cough Mechanism for patient's urinary incontinence?

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

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?

Joining of DNA fragments by ligase | - Okazaki fragments (DNA ligase)

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

SBP increased DBP decreased PP increased

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

Conjuctival injection

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?

Kinesin | - Herpes virus

76 yo man acute bright red blood from rectum - Blood bowel movements this morning - Delayed capillary refill. Physiological changes in kidney function ?

Increased urea reabsorption | - Hypovolemic shock

52 yo post menopausal woman - Excessive warmth and sweating - Treatment with Estrogen containing hormone replacement Medication would cause?

Increase total T4 level | - Increase in estrogen activity leads to raise in TBG levels

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?

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

We isolate small circular DNA molecules that resemble bacterial chromosome - they code for proteins, transfer RNA and Ribosomal RNA Where did these structures originate?

Mitochondria

52 yo postmenopausal - Discomfort after fatty meal - BMI 33 - Ultrasound shows small non obstructing gallstone Best treatment for this condition?

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

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?

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

16 yo cough, dyspnea, wheezing - Abdominal discomfort, anorexia and nausea Image shows thick outer shell confirming ascaris lumbricoides Cause of patients pulmonary symptoms?

Transpulmonary migration of larvae | - Loeffler syndrome = eosinophilic pneumonitis

46 yo woman, right upper abdominal pain - BMI 33 - Leukocyte 21000 - Erythematous distended gallbladder with patchy necrosis Events most likely initiated this condition?

Gallbladder outflow of the mucosal layer

55 yo man depression treated with SSRI Most likely side effect ?

Sexual dysfunction more common that serotonin syndrome

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

- Osler weber rendu syndrome mucosal telangiectasis Autosomal dominant condition

23 yo man myoclonic epilepsy onset - Proximal muscle weakness - muscle fibers with a blotchy red appearance - Probability that offspring will inherit condition?

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

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?

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

45 yo man painful skin lesions in right axilla - Works as a roofer - Image shows hidradenitis suppurative Cause of condition?

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

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?

Cavernous sinus

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?

Glucokinase, functions as a glucose sensor for beta cells