USMLE Cases Flashcards
Young woman with neuro sx of tingling & difficulty concentrating + recurrent episodes of nonspecific abdominal pain. Sx are relieve by administration of hemin. What condition and what enzyme is deficient and which enzyme does hemin downregulate?
AIP (Acute intermittent porphyria)
Def. of PBG (Porphobilinogen deaminase)
Hemin downregulates ALA synthase (Aminolevulinate synthase)
What is the best way to manage a pt with Somatic Symptom disorder?
Schedule regular outpatient visits –> this will help avoid repeat unnecessary diagnostic testing and specialist referrals.
What is the best treatment for treatment-resistant schizophrenia?
Clozapine
What organism should you suspect in someone who is not up to date on vaccinations and has a paroxysmal cough lasting greater than 2 weeks. The coughing fits are significant and sometimes cause vomiting afterward.
Pertussis
Pulsus paradoxus (decrease in systolic BP of > 10 mmHg during inspiration) is seen in what conditions?
Cardiac tamponade (#1) / pericardial diseases
Others: COPD and severe asthma
This is caused by a lack of CD18 antigens on surface of leukocytes. You will often see delayed umbilical cord separation ( >21 days), poor wound healing, & recurrent infections with no pus. There will also be peripheral leukocytosis with neutrophilia. Why? And what is the disorder?
Leukocyte adhesion deficiency
Your leukocytes and neuts cannot migrate. Therefore you cannot form abscesses and will also have peripheral leukocytosis b/c they are all stuck in the blood.
A pt overdoses on SSRI’s or takes them in combo with MAOI’s, then develops serotonin syndrome. What amino acid is used in the synthesis of this? What is the antidote?
Tryptophan is the precursor to 5HT.
Antidote: Cyproheptadine
This disorder has a triad of Cafe-au-lait spots, endocrine abnormalities (esp precocious puberty and hyperthyroidism at early age), and fibrous dysplasia of bone (multiple osteolytic-appearling lesions of hip and pelvis). What is it and what is the pathogenesis?
McCune-Albright syndrome
Due to mosaic somatic mutation in the GNAS gene, which encodes for the stimulatory alpha subunit of G protein
