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Uworld > #7 > Flashcards

#7 Flashcards

1
Q

If incidence stays the same but prevalence increase, what can explain this phenomenon?

A

Improved quality of care

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2
Q

32 yo wo, 28 we gestation

  • She has history of epilepsy
  • Marked elevated amniotic fluid levels

Which fetal anomaly would account for patient polyhydramnios?

A

Anencephaly

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3
Q

24 yo meningeal irritation
- Naegleria Fowleri is suspected

portal of entry of pathogen?

A

Nasal mucosa through olfactory nerve.

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4
Q

38 yo wo abdominal pain

  • watery diarrhea
  • History of crohn disease treated with adalimumab

Undetectable trough adalimumab level

Explanation for worsening symptoms?

A

Development of anti drug antibodies by adalimumab declining effectiveness

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5
Q

5yo girl, anorexia, nausea

  • Pruritic eruptions between toes
  • Attributed to insect bites from walking barefoot
  • Stool microscopy reveals smooth thin walled eggs

Untreated condition will lead to?

A

Microcytic anemia

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6
Q

Hereditary defect in fructose metabolism, but asymptomatic

- Patient remains able to metabolize fructose due to compensatory activity of which enzyme?

A

Hexokinase

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7
Q

7 yo boy lethargic, open bottle of pulls

  • The mother has medication for anxiety, depression and chronic lower back pain.
  • Boy became somnolent but other values are stable.

Drug capable to reverse this?

A

Flumanezil

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8
Q

48 yo man, carpenter

  • Lower lobe crackles
  • Potassium hydroxide preparation shows broad-based bud

Cause of condition?

A

Blastomyces dermatitis

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9
Q

64 yo, unintentional weight loss

  • Massive pulmonary embolism
  • Liver shows multiple nodules
  • Analysis shows intranuclear fragments of foreign DNA

Pathogen?

A

Hepatitis B virus

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10
Q

50 yo woman
- Ducts distended by pleomorphic cells with prominent central necrosis, it does not extend beyond ductal basal membrane.

Origin of lesion?

A

Ductal carcinoma in situ, originates in the duct

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11
Q

34 yo man daily injections of insulin

  • Pain in shoulders, elbows and thighs
  • Low serum calcium, high PTH

Inhibition of which of the following enzymatic steps is responsible for this?

A

25-hydroxivitamin D3 TO
1,25 Dihydroxivitamin B3

Because of chronic kidney disease

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12
Q

30 yo wo, excessive weight gain

  • more tired lately
  • Diffuse enlarged thyroid with no nodules
  • Hair is thin and skin appears dry

Values of TSH/T4/T3

A

TSH increased
T4 decreased
T3 Normal

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13
Q

28 yo wo at 31 we gestation

  • Increasing shortness of breath
  • no abnormalities in heart

Changes due to pregnancy in pH/PaCO2/PaO2/Urine HCO3?

A

pH 7.46
PaCO2 29
PaO2 102
Urine HCO3 increase

Hyperventilation leads to respiratory alkalosis

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14
Q

22 yo wo with turner syndrome

- Method used to achieve pregnancy?

A

In vitro fertilization

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15
Q

MI nMI
Test + 200 50
Test - 120 80

if patient has a + test what is the probability that the patient has MI?

A

80%

200/250

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16
Q

26 yo man + for gonorrhoeae he is treated
But several weeks later he redevelops infection

Reason for lack of long-lasting immunity?

A

Antigenic variation

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17
Q

29 yo man right tibial and fibular shaft fractures
- After immobilization, patient presents with increased tension in anterior compartment

What structure will be compromised?

A

Deep perineal nerve

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18
Q

8 month old infant, sudden death
- Leptomeningeal inflammation and + for enterovirus by PCR

Patient would have present with which laboratory finding?

A

Low circulating B lymphocyte count

- X linked agammaglobulinemia

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19
Q

25 yo man says he has superpowers
- History of bipolar disorder
- Found with 40.6 degree, BP 157/90, pulse 102.
There is diaphoresis and diffuse rigidity in extremities

Explanation for symptoms ?

A

Neuroleptic malignant syndrome caused by antipsychotics

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20
Q

46 yo wo elevated CA-125 shows ovarian mass
- Cells have high telomerase activity

Enzyme promotes cell growth by which action?

A

Preventing chromosomal shortening

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21
Q

86 yo prostate cancer, gout, osteoarthritis
- Indwelling urinary catheter is placed
On 8th day tract infection is diagnosed

Strategy to prevent this?

A

Prompt removal of catheter when no longer indicated

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22
Q

8 yo girl shortness of breath

  • Diffuse wheezing
  • after medication we see increase in airflow rate

Medication affected how the lungs of patient?

A

Bronchial smooth muscle tone

- B2 receptor agonist ‘’ increase cAMP’’ ALBUTEROL

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23
Q

46 yo dizzy spells

  • Symptoms improve after orange juice
  • T2DM, she has lost 10kg

Mechanism responsible for symptoms when exercising?

A

Translocation of glucose transporter 4 to the cell membrane

Muscle contraction uses GLUT4 channels for insulin

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24
Q

56 yo puffy face, dry cough

  • conjunctival edema, pupils are equal, headache, dyspnea
  • Dilated veins noted over his neck
  • Cause of condition?
A

Mediastinal mass- superior vena cava syndrome

  • Pancoast tumors can also cause SVC syndrome however shoulder pain is also present and horner syndrome (ptosis, mitosis, anhidoris). This makes the difference
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25
Q

26 yo wo 36 weeks gestation

  • BP 150/100
  • Urinalysis shows protein +2

Condition decrease activity of?

A

Vascular endothelial growth factor

  • Patient has pre-eclampsia , this cause endothelial dysfunction due to increased antiangiogenic factor release
26
Q

45 yo man gain weight

  • T2DM
  • Fasting blood glucose is 157
  • No detectable albuminuria

Renal change most likely present in this patient?

A

Increased glomerular filtration rate

  • Patient has diabetic nephropathy, as this progresses, glomerular filtration falls with a concurrent increase in urine albumin loss.
27
Q

26 yo man insists in wearing a cap lined by aluminium to prevent laser beams
- Hears voices

Second generation antipsychotic medication compared with first generation is associated with?

A

Lower risk of acute dystonia

28
Q

23 yo wo chest wound
- Penetrating wound in the 4th intercostal space along the left sternal border

Structure most likely injured?

A

Right ventricle

29
Q

28 yo man, fatigue and vivid, disturbing dreams
- Irritable, withdrawn , hypersomnolent and hyperphagic
- History of substance abuse
He appears lethargic and dysphoric

Cause?

A

Cocaine withdrawal

30
Q

4 yo decreased appetite
- 3 episodes of otitis media
Prescribe amoxicillin
Adding clavulanic acid would serve which purpose?

A

Decrease amoxicillin cleavage by bacterial cells

31
Q

7 yo boy avoids outdoor activities

  • Holosystolic murmur at the lower sternal border
  • Apical displacement of tricuspid valve leaflets.

Side effect of which drug taken during pregnancy?

A

Bipolar disorder

32
Q

71 yo wo dyspnea and orthopnea

  • Started on dobutamine
  • ECG shows improvement in cardiac contractility

MOA?

A

Gs protein-adenylate cyclase activation

33
Q

14 yo boy parents are getting a divorce

  • He thinks they are angry at him
  • Patient appears sullen and report his mood is fine

What defense mechanism is using the patient?

A

Projection

34
Q

65 yo worsening dyspnea

  • 86% O2 on room air
  • Decreased breath sound over the right chest
  • Imaging shows right lung collapse

Cause?

A

Occlusion of right mainstream bronchus by mucus plug

35
Q

58 yo right sided weakness

  • Anticoagulant was prescribed
  • Nonadherent with therapy
  • Weakness and sensory loos in right leg has returned.

Embolic occlusion affecting which of the following regions is the cause of symptoms?

A

Anterior cerebral artery DISTAL to the origin of the anterior communicating artery

  • If lesion occurs proximally, symptoms may not happened because of anastomoses
36
Q

12 yo episodes of abdominal pain

  • Diarrhea
  • Decreased serum C4 & C1

Drug contraindicated?

A

Captopril ‘’ can cause angioedema = bradykinin accumulation’’
- Patient has hereditary angioedema

37
Q

autopsy on MI shows neutrophil infiltration

injury timeframe?

A

1 to 3 days

38
Q

67 yo progressive fever and lethargy

  • Right shoulder and abdominal pain
  • Chest x ray shows air under right lung

Cause of condition?

A

Perforated viscus

- Pneumoperitoneum

39
Q

68 yo severe fatigue

  • 7kg weight loss
  • Hepatomegaly and enlarged spleen
  • Pancytopenia, presence of dacrocytes
  • Bone marrow is attempted but yields no marrow

Biopsy will show?

A

Diffusely fibrotic marrow with clusters of megakaryocytes

- Patient has primary myelofibrosis

40
Q

7 yo facial puffiness

  • Intermittent asthma controlled with albuterol
  • Nephrotic range proteinuria mainly of albumin

Mechanism causing the finding?

A

Increased infiltration of plasma protein , loss of negative charge leads to selective albuminuria.
- Minimal Change disease - podocyte foot process fusion

41
Q

Circuit has an inflow of 120 and an outflow of 40

4 vessels with resistance of 2 each

Total peripheral resistance?

A 
1/TPR = 1/2+1/2+1/2+1/2 = 2
TPR= 1/2 = 0.5
42
Q

Mean SBP + SD 120 + 20
Hypertension considered after SBP>140

What percentage will be classified as having hypertension?

A

16%

1sd above the mean

43
Q

23 yo wo premature rupture of membrane at 30’s week
- Clear vaginal discharge

Drug with greatest + impact on fetal survival?

A

Dexamethasone, decrease surface tension and helps maturation of type II pneumocystis

44
Q

24 yo nurse needle stick injury from a Hep B positive patient

  • she received complete hep B vaccination series prior to her hospital employment a year ago
  • Serologies does not show evidence of infection

Mechanism of immunity?

A

Impaired vision entry into hepatocytes

45
Q

54 yo man with cirrhosis

  • vomited bright red blood
  • Cirrhosis secondary to hep C
  • Irregular flexion-extension tremor involving his hands is seen in wrist extension

What is elevated in this patient astrocyte?

A

Glutamine
- Patient has hepatic encephalopathy , increased levels of ammonia
Disruption of excitatory neurotransmission

46
Q

61 yo wo severe pain in her hands at age 30

  • she takes nsaids
  • deformity of multiple joints shows ulnar deviation

Disease would also affect what?

A

Cervical spine

- Rheumatoid arthritis

47
Q

32 yo wo anxiety and stress over past 6 weeks due to upcoming tax deadline

  • she feels shaky, dizzy and nauseated
  • I’ve stopped going out with friends because i never know when I’m going to feel this way again

Diagnosis?

A

Panic disorder

48
Q

33 yo wo been monogamous for 5 years

  • used oral contraceptive for 15 years
  • she was treated with ceftriaxone seven years ago

Cause of patients infertility?

A

Prior incomplete antibiotic coverage - fallopian tube obstruction- PID

49
Q

57 yo man with ALS
- Physician tells the wife he is optimistic about a new treatment, and ask if she would like to enrol as a healthy control

Physician is violating which principle?

A

Voluntariness

50
Q

43 yo woman borderline personality

  • she took some pills
  • pH 7.46 / PaCO2 19 / Bicarbonate 13
  • Na 139 / Cl 98

Acid - base disturbance?

A

Respiratory alkalosis and metabolic acidosis ( salicylate poisoning)

Anion base gap+ 139 - ( 98 +13) = 28 so secondary condition

51
Q

32 yo woman request medication for back pain

  • MRI was normal
  • Patient says pain is 10/10
  • Becomes frustrated when physician suggest nonprescription pain medication

Appropriate next step?

A

Obtain confirmation of the patient’s prescription history

52
Q

38 yo man headaches, loss of libido and erectile dysfunction

  • peripheral vision loss, gynecomastia
  • Normal serum prolactin, normal B-HCG, low serum LH, low serum testosterone

Mechanism for gynecomastia?

A

Persistent aromatization of adrenal estrogen precursors.

- Pituitary mass increased estrogen/testosterone ratio in zone reticularis of adrenals

53
Q

71 yo man acute MI, right coronary femoral artery

  • Arterial wall penetrated superior to right inguinal ligament
  • patient becomes clammy, cold and hypotensive
  • 5cm region of ecchymosis surrounding femoral puncture site

Location of blood location?

A

Retroperitoneal space

- Puncture above the inguinal ligament

54
Q

54 yo man pain in left neck and shoulder are

  • decreased sensation in palm and index and middle fingers along with weakness of left wrist extension
  • Triceps reflex is diminished

Region of brachial plexus affected?

A

Median and radial nerves deficit

C7 root , cervical spondylosis

55
Q

48 yo man stool as voluminous and found smelling
- Excessive excretion of fecal fat

Involvement of which structure is common?

A

Pancreas

56
Q

72 yo man with severe aortic stenosis
- Harsh systolic ejection murmur radiating to the neck
MCV is 76
Activated PTT is 50

Colonoscopy reveals angiodysplasias in right colon

What is contributing to patient bleeding ?

A

Acquired vWF factor deficiency

Decreased ADAMTS13 metalloprotease activity seen in patients with TTP marked by microvascular thrombosis

57
Q

severe pharyngitis reported in immigrants

  • Thick pharyngeal exudates, neck swelling, and difficulty swallowing
  • Toxin has a MOA similar to?
A

Pseudomonas aeruginosa
- Patient has diphtheria
Both inactivate EF-2 via ribosylation inhibiting cell protein synthesis

58
Q

30 yo wo at 35 we gestation

  • nausea, vomiting, watery diarrhea
  • Cultures grow gram + rods

Major virulence factor of organism responsible?

A

Cytotoxin that creates pores in phagosomes ( listeriolysin o)
- Caused by gram-positive rods ‘’ listeria monocytogenes’’

59
Q

24 yo man bloody diarrhea

  • trip to egypt
  • Negative for C difficile
  • Colonic ulcers with undermining edges that contain trophozoites

Causative organism can also produce ?

A

Liver abscess
- Entamoeba histolytica
- Flask shaped colonic ulcers
Amebic liver abscess, it demonstrate contact-dependent cytotoxicity.

60
Q

56 yo wo T2DM

  • Takes metformin
  • Takes lisinopril and amlodipine for hypertension
  • He decides to add pioglitazone, before starting patient should be educated about which adverse effect?
A

Weight gain and edema

- Fluid retention, congestive heart failure and increase adipose weight gain

Uworld (11 decks)

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