Blocks 45, 46

Question 1

4 day history of progressively worsening abdominal pain and bloody diarrhea. Diagnosed with ulcerative colitis 6 months ago (noncompliant with treatment). 102F, BP 100/70, lethargic, dry mucous membranes, abdominal distention and tenderness. What is the next step? What does he have?

Answer 1

XRAY

Toxic Megacolon

Question 2

Disorder of conjugate horizontal gaze in which the affected eye (IPSI to the lesion) is unable to adduct and the contralateral eye abducts with nystagmus. Convergence and the pupillary light reflex are preserved.

Answer 2

Internuclear Ophthalmoplegia

Damage to the Medial longitudinal Fasciculas - a paired neural tract that mediates communication between CN 3 and CN 6 allowing for coordinated horizontal eye movements.

Found in dorsal pons

Unilateral = lacunar stroke in pontine artery distribution

Bilateral = MS

Question 3

If a gram + bacteria disintegrates in a hypotonic solution after being exposed to an antibiotic, that means there was damage to the cellular wall. What drugs could do this?

Answer 3

Penicillins

Cephalosporins

Vancomycin

Question 4

5 month old baby with chronic diarrhea, failure to thrive, low blood T lymphocyte count, severely decreased serum immunoglobulin level

Answer 4

SCID

X-linked or

Adenosine Deaminase Deficiency (AR) - unable to eliminate excess Adenosine within cells leading to toxic accumulations

Question 5

What surgical landmark can help a surgeon distinguish an indirect hernia from a direct inguinal hernia?

Answer 5

Inferior epigastric vessels

Question 6

Illegal drug that causes violent behavior, dissociation, Hallucinations, amnesia, Nystagmus, and ataxia.

Answer 6

Phencyclidine (PCP)

Works as an N-methyl-D-aspartate receptor antagonist, leading to the excess release of excitatory neurotransmitters.

Question 7

Gross painless hematuria in an older adult should be considered a sign of what?

Answer 7

Urinary Tract Cancer (urothelial or renal cell carcinoma) until proven otherwise

Question 8

65 y/o man with painless hematuria. Renal Biopsy is preformed. What is the likely etiology and what makes up these cells?

Answer 8

Clear Cell Carcinoma - most common renal malignancy

Cells made up of glycogen and lipid accumulation

Question 9

If complement C1 protein is excessively cleaving C2 and C4 by itself, what is deficient? What is the manifestation?

Answer 9

C1 inhibitor (C1INH) deficiency - normally there to limit activation of the complement cascade AND the block kallikrein-induced conversion of kinnogen to bradykinin

Pt will have Elevated Bradykinin and hereditary angioedema (facial swelling, laryngeal edema, colicky GI pain, diarrhea)

Question 10

What 2 populations are covered by Medicare?

Answer 10

Over 65 y/o

Younger individuals with disabilities

Question 11

What converts Ribulose-5-Phosphate to Fructose-6-Phosphate?

Answer 11

Transketolase

Question 12

Superior Mesenteric Artery syndrome occurs when what structure gets trapped between the SMA and the aorta?

Answer 12

Transverse portion of the Duodenum

Symptoms of partial intestinal obstruction.

Happens when the aoromesenteric angle critically decreases, secondary to diminished mesenteric fat, pronounced lordosis, or surgical correction of scoliosis.

Question 13

In chronic kidney disease, what part of Vitamin D metabolism can be impaired?

Answer 13

Conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D