42 yo heavy painful menstrual bleeding - Bilateral tubal ligation 3 years ago - Uterus is uniformly enlarged and tender - Urine B-Hcg is negative Cause of symptoms?

Endometrial glands and stroma within the myometrium - Adenomyosis - Leiomyomas are irregularly enlarged

#8 Flashcards by jose isla

50 yo man

20 pack smoking history
BP160/90
Blood glucose 155

Which intervention is likely to have the greatest effect on reducing mortality risk?

Smoking cessation

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32 yo man severe right flank pain that radiates to the groin

- labs seen?

Normocalcemia, hypercalciuria

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35 yo primigravida have gallstones at 38 weeks
- 1 year ago failed to demonstrate abnormality

Pathogenetic components contributed to this condition?

Estrogen-induced cholesterol hyper secretion and progesterone induced gallbladder hypo motility

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18 yo high fever and confusion

Several episodes of pneumonia and meningitis a year ago
Examination reveals petechial rash on the trunk and extremities
Neck stiffness and photophobia

What immune system impairments is most responsible for recurrent infection?

Inability to form the membrane attack complex ( C5-C9)

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30 yo wo chronic anxiety and tension

Worries about everything
Buspirone is initiated

Medication is associated with ?

No risk of dependence

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43 yo wo dull abdominal pain

right upper quadrant pain after fatty meal
Several mobile echogenic foci within gallbladder lumen

Set of condition present in gallbladder
Cholesterol / Bile acids/ Phosphatidylcholine

Cholesterol increased
Bile acids decreased
Phosphatidylcholine decreased

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25 yo oculocutaneous albinism

homozygous mutation in chromosome 15q12
hypopigmented skin with blonde hair

Husband has oculocutaneous albinism at 11q14.

Chance of having a child with albinism is O%

Why?

Locus heterogeneity

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62 yo watery diarrhea and wheezing, becomes flushed and red
- Mass lesions in liver lobe

Medication to relieve symptoms?

Octreotide

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72 yo difficulty hearing
- Hypertension, heart failure, chronic kidney failure

Bilateral sensorineural hearing loss

What medication contributed to this?

Furosemide

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12 yo boy fever fatigue and easy bruising
- Anemia, thrombocytopenia, leukocytosis and lymphoblasts

Treated with chemotherapy and 6-mercaptopurine

Which enzyme inactivates this enzyme?

Xanthine oxidase and thiopurine methyltransferase

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24 yo painful erection for past 6 hs unrelated to sexual excitement

Drug most likely caused this condition?

Trazodone

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64 yo man acute onset right upper quadrant abdominal pain, nausea and vomiting undergoes bowel resection

Gallstones and edema of the gallbladder wall
No gallstones noted before bowel resection

Responsible for development of gallstones?

Decreased cholecystokinin release due to lack of enteral stimulation

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In florida several individuals develop febrile illness during summer

Signs of meningeal irritation
Brain shows no abnormalities

Most helpfull in controlling disease outbreak?

Control of vector arthropods

- Arbovirus

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3 day old boy diapers smell unlike what they should
- Lethargic with dry mucous membranes

What should be restricted from infant?

Leucine

- Maple syrup urine disease

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12 yo boy excessive bleeding from tooth extraction

decreased factor VIII
Mutation in enhancer

accurate statement about enhancers?

It can be located upstream, downstream or within introns of the gene.

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25 yo wo intermittent fever and severe body aches
- Pale lips and conjuctivae
- There is no hepatosplenomegaly
Platelets 40000/ Leukocytes 2000
- Normocytic anemia

Bone marrow biopsy will show?

Hypocellular marrow filled with fat and stroma

- Aplastic anemia - dry tap

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1h girl flat nasal bridge, up slanting palpebral fissures, small mouth and single palmar crease
- Holosystolic murmur heard best along sternal border

Abnormality?

Mosaicism
- Patient has down syndrome
Meiotic nondisjunction / unbalanced translocation / mosaicism

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17 yo boy insomnia, headaches

Went on a field trip to study bats in a cave
Painful spasms, progressive paralysis, coma and dies

What could have prevented this ?

Inactivated vaccine

- Rabies

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40 yo abdominal pain, watery diarrhea

Gastrin is elevated
Prominent gastric folds and multiple ulcers in duodenum

Patient should be assessed for?

Recurrent nephrolithiasis
- Zollinger ellison syndrome
MEN1
- Pituitary , parathyroid & pancreatic

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42 yo heavy painful menstrual bleeding

Bilateral tubal ligation 3 years ago
Uterus is uniformly enlarged and tender
Urine B-Hcg is negative

Cause of symptoms?

Endometrial glands and stroma within the myometrium
- Adenomyosis

Leiomyomas are irregularly enlarged

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study 41 patients with condition were recruited and received treatment
- All patients suffered toxicity’s

Phase of study ?

Phase II clinical trial

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Obesity is 3 times higher in a cluster of 5 specific ZIP codes compared to the county average

What should be performed first to understand the etiology of disparity in obesity prevalence?

Cross-sectional analysis of demographic attributes and health belabours across community ZIP codes

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Athlete comes with right knee pain
- Posterior aspect of MRI shows Asterisk on left upper corner

Attachment site to which ligament?

Posterior cruciate

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45 yo woman end stage renal disease ADPKD

Transplanted kidney is reduced in size
Increase serum creatinine level over last 6 months

Biopsy of graft is most likely to show?

Obliterative vascular fibrosis

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27 yo man, episodes of muscle weakness - BP 190/110 - Low plasma renin activity Overactivity of which structure is responsible for this?

Zona glomerulosa of the adrenals - Primary hyperaldosteronism Hypertension / Hypokalemia

43 yo man with advanced HIV - Creatinine is elevated and phosphorus is decreased - Renal shows cytoplasmic vacuolization in the proximal tubules accompanied by loss of brush border and basement membrane denudation - Eosinophilic inclusion are also seen in proximal tubules Diagnosis?

Tenofovir - induced nephrotoxicity

38 homeless woman, pregnant at 27 weeks, and his 19yo son who has cerebral palsy - Which is eligible for medicare coverage?

Woman's disabled son

Embryonic kidney development - signals exchanged between metanephric diverticulum and blastema - If insult occurs during fetal development that inhibits structures formed by metanephric blastema What derivatives will fail to develop?

Distal convoluted tubules

Pulmonary gas exchange - PO2 is 150 - Alveolar PO2 is 104 what explains this findings?

Diffusion impairment | - Fibrosis or emphysema

17 yo boy type 1 DM - Unresponsive at home - Given glucagon, this promotes binding to GTP to a specific receptor associated protein This leads to rapid decrease in intracellular glycogen stores and release of glucose into blood Mediator of these effects?

Protein kinase A

4 week old vomiting - BP 182 - No murmurs or gallops Arterial blood gas analysis will show -pH/ PaCO2 / HCO3/ Anion gap?

pH 7.49 PaCO2 46 HCO3 34 Anion gap normal

30 yo wo depressed mood - Course of psychotherapy is advised to which she responded: Have you ever had depression or been in therapy, doctor? Best response to this patient?

I am curious to understand what makes you ask that question

19 yo man painful subcutaneous forearm nodule - 2 weeks earlier he received a laceration on his left forearm - Biopsy shows granulomas and activated macrophages What is responsible for this condition?

Reaction to a foreign body

58 yo man difficulty carrying heavy bags out of overhead bins - Shoulder pain , weakness of shoulder abduction and loss of biceps reflex on the right side - pinprick sensation is decreased over right lateral arm and forearm Pathologic process underlying this ?

Degenerative changes in the vertebral joints | - nerve root compression

36 yo left wrist is swollen - Lunate dislocation - Greatest risk for impairment of?

Thumb abduction - Compression of median nerve - Carpal tunnel syndrome

64 yo left lower extremity weakness - Hypertension and diabetes - Reflexes are 3+ - Babinski sign is present Structure cause of this symptoms?

Right anterior cerebral artery

15 yo girl fever, fatigue, sore throat, splenomegaly and symmetric posterior cervical lymphadenopathy Atypical cells show large lymphocytes with abundant cytoplasm These cells are activated form of what?

CD8 cytotoxic lymphocytes | - Infectious mononucleosis

67 yo diastolic murmur at left sternal border - erythematous macule on his hands and feet - Gram + cocci and catalase negative able to grow in hypertonic 6.5% saline and bile Medical history should include which procedure in past month?

Cystoscopy | - enterococcal endocarditis

49 yo woman 2 day history of flank pain, poorly controlled T2DM. - Respirations are 34/min - Flushed/ Diaphoretic, - Neck veins are flat Effects on PCWP/ Cardiac Index / SVR / Mixed Venous O2 saturation

PCWP decrease CI increase SCR decrease MVO2 saturation increase Patient has septic shock ''distributive''

``` CVP decrease PCWP decrease CI decrease SVR increase SvO2 decrease ``` Shock?

Hypovolemic

``` CVP increase PCWP increase CI decrease SVR increase SvO2 decrease ``` Shock?

Cardiogenic

``` CVP increase PCWP decrease CI decrease SVR increase SvO2 decrease ``` Shock?

Obstructive

30 yo wo - 10kg weight loss - Increase in pigmentation of skin - Cortisol before and after administration of exogenous ACTH shows no difference Serum values of patient? Na/ K/ Cl /HCO3

Na decrease K increase Cl increase HCO3 decrease Patient has primary adrenal insufficiency ( addison disease)

10 yo boy shortness of breath and failure to gain weight - Pulmonary stenosis and subaortic ventricular septal defect with deviation of the origin - Cyanosis , kid assumes squatting position Which mechanism during squatting relieves this child's symptoms?

Increasing systemic vascular resistance

Properties of hemoglobin - Oxygen unloading and loading In a graph ( sigmoid shape) Y % O2 saturation X pO2 If point increase in both axes , hemoglobin molecules are most likely to release ?

Protons - Increases O2 binding affinity, cooperative binding known as haldane effect - Decreases affinity for CO2 of hemoglobin, this causes acidity resulting in H ions release - In peripheral tissue high levels of CO2 shift hemoglobin curve to the right causing unloading of O2 (Bohr effect)

10 yo boy shortness of breath, fever and fatigue. - tachypnea, tachycardia and hypotension - New holosystolic murmur - Biopsy shows aschoff body what cause development of this?

Bacterial infection | - Group A streptococcal pharyngeal infection '' pancarditis''

43 yo woman amenorrhea - increased serum prolactin level - normal TSH - Calcium is normal - Pituitary adenoma If left untreated this patient creates risk of developing?

Loss of bone mass | - secondary amenorrhea, hypogonadism

34 yo man bilateral femur fractures - Receives transfusion of RBC - A few minutes later he reports tingling sensation in fingers and toes. - serum ionized calcium is 4 Cause of symptoms?

Calcium chelation by a substance in the transfused blood | - RBC normally have citrate anticoagulant leading to chelation of calcium

25 yo man schizoaffective disorder with previous suicide attempt Started on haloperidol and sertraline - Temperature is 40.6, diffusely rigid without clonus Antidote for this condition MOA?

Inhibition of calcium ion release from SR of skeletal muscle | - Patient has neuroleptic malignant syndrome

23 yo man, anesthesia was induced with propofol, succinylcholine was used for intubation - Maintained via propofol and fentanyl infusions Patient is slow to wake up Reason for prolonged paralysis?

Decrease plasma hydrolysis | - Pseudocholinesterase deficiency '' succinylcholine''

72 yo man lifelong smoker - Bibasilar crackles, elevated jugular venous pressure - Lower extremity pitting edema LVEDP graph shows left upper movement of the curve compared to the normal What is the cause of this?

``` Transthyretin deposition ( amyloid protein) - Decompensated congestive heart failure shows reduced compliance = diastolic dysfunction ```

63 yo blockage in left anterior descending artery 2 months ago - Hypertension, T2DM, degenerative joint disease - Presence muscle aches and cramps after exercises - Elevated serum creatine kinase Medication cause also?

Increase hepatocyte LDL receptor recycling | - Statin induced myopathy

52 yo cancerous polyp was removed, no evidence of invasive cancer, - Reassured of excellent prognosis - Patient replies : should i be happy of having cancer in the first place ? you don't know what you talking about - Appropriate response?

I realize it can be very upsetting to be told something unexpected about your health. What is your understanding of the results?

65 yo man non healing ulcer of the foot, foul smelling discharge - Blood culture grow B-lactamase producing bactericides species Most likely to provide coverage?

Piperacillin-tazobactam

56 yo man local redness and swelling - mixed hyperlipidemia, hypertension - Swollen first metatarsophalangeal joint - High leukocyte count Gram stain = needle-shaped negatively birefringent crystals Drug that precipitated this condition ?

Hydrochlorothiazide | - Hyperurecemia

76 yo wo burning on urination - right sided flank pain Culture grows E.Coli Organism found to have methyltransferase that methylates ribosomal RNA This enzyme confers resistance to which class of antibiotics?

Aminoglycosides

68 yo man gross hematuria - He takes metformin - Worked at a rubber manufacturing plant for 35 y What would be discovered?

Bladder cancer | - Transitional cell

- CAAT base sequence is responsible for which function?

Initiation of transcription

60 yo man acute bronchitis - Prostate cancer treated with leuprolide - DXA shows low bone mineral density Underling mechanism of observed finding?

Decreased estrogen and testosterone levels - Leuprolide is GnRH analog used in a constant manner to induce hypogonadism '' suppression of pituitary LH release''

8 yo boy acute facial puffiness - skin infection 2 weeks ago - edema in angles - Dark urine - Renal biopsy shows fluorescent areas Presence of which substance in these areas?

C3 - Poststreptococcal glomerulonephritis granular deposits of IgG, IgM and C3 starry sky appearance