Integrated

Question 1

What is the drug choice for acute mania and to prevent relapse? What should be important to monitored?

Answer 1

Lithium

Important to monitored thyroid function

Question 2

What is the T cell response following action of natural killer cells?

Answer 2

Cell mediated response through Th1

Question 3

What is a complete mole?

Answer 3

2 sperms that meet an empty egg

Question 4

What is a partial mole?

Answer 4

2 sperms meeting a full egg

Question 5

What are the labs in a hyatidiform mole pregnancy?

Answer 5

Low or normal creatinine
Low hemoglobin
Normal TSH
Extremely High Beta- HCG

Question 6

What are the effects of vitamin B12 deficiency?

Answer 6

Increased homocysteine ( no conversion to methionine)
Increased MethylmalonylCoA ( no conversion to succinyl CoA)
Dementia
Neuropathy
Macrocytic anemia

Question 7

What can glycine deficiency cause?

Answer 7

Non iron deficiency anemia

Question 8

What amino acid is needed to grow legionella?

Answer 8

Grow on buffered charcoal yeast agar

Cysteine and iron is required for grow

Question 9

What are the characteristics of HUS?

Answer 9

Hemolytic anemia, renal failure and low platelet count in children 
Seen after food borne diarrheal illness
Caused by E. Coli O157H7
Toxin mediated inhibition of ADAMTS-13
Helmet or triangle cells

Question 10

What are the characteristics of TTP?

Answer 10

Hallmark symptoms of HUS
Fever
Altered mental status

Question 11

Patient with hepatomegaly, skin hyperpigmentation and impotence?

Answer 11

Mutation in HFE gene: hereditary hemochromatosis
Increased serum iron, ferritin and total iron binding capacity
Decreased transferrin saturation

Question 12

What is the treatment for prolactinoma?

Classic: bilateral milky discharge from breasts with normal physical

Answer 12

Dopamine agonist

Question 13

How does Herpes present itself?

Answer 13

Painful,ulcerated sores in the genital or oral mucosa
Tender lymphadenopathy
Positive tzanck test
Cowdry A inclusion bodies= multinucleated giant cells

Question 14

How does primary syphilis present itself?

Answer 14

Painless papule

Corkscrew organism visualized in dark field

Question 15

What is choriocarcinoma?

Answer 15

Highly aggressive form of primary testicular tumor
Metastasizes to the lung and brain
Normal AFP
HCG elevated

Question 16

What is yolk sac tumor?

Answer 16

Common in young children
Elevated AFP
Schiller-Duval bodies= papillary invaginations surrounding central vessel

Question 17

What are the characteristics of Struvite kidney stones?

Answer 17

Result of UTI with urease positive bacteria (klebsiella, proteus)
Branching stones that can fill the renal pelvis
Magnesium phosphate crystals on light microscopy

Question 18

What are the characteristics of calcium kidney stones?

Answer 18

Most common type of stone
Due to hypercalcemia
Oxalate crystals on light microscopy

Question 19

Young patient of ashkenazi jewish descent with osteopenia, avascular necrosis of distal femur, hepatosplenomegaly and thrombocytopenia-

Answer 19

Gaucher’s disease
Deficiency of beta glucocerebrosidase
Macrophages filled with lipids, appearance of wrinkled paper

Question 20

Young patient of ashkenazi jewish descent with developmental delay, blindness, and a cherry red spot on macula-

Answer 20

Tay-Sachs disease

Hexosominidase A deficiency

Question 21

Young patient of ashkenazi jewish descent with mental retardation,neurodegeneration, hepatosplenomegaly and cherry red spot on macula

Answer 21

Niemann-Pick disease

Sphingomyelinase deficiency

Question 22

Child going to day care,perianal itching, scotchtape positive

Answer 22

Enterobius vermacularis

Question 23

Bone abnormality and hearing loss

Answer 23

Paget disease of the bone

Question 24

Difficulty falling aslep and more daytime tiredness

Answer 24

Decreased REM sleep and increased REM sleep latency