Vignettes- Anatomy, Behavioral and Biochem - sidebyside

Question 1

Baby vomits milk when fed and has gastric air bubble. What kind of fistula is present?

Answer 1

blind esophagus with lower segment of esophagus attached to trachea

Question 2

20-year old dancer with decreased plantar flexion and decreased sensation over the
back of her thigh, calf, and lateral half of foot. What spinal nerve?

Answer 2

Tibial (L4 to S3)

Question 3

Patient with decreased pain and temp sensation over lateral aspects of both arms.
Lesion?

Answer 3

syringomyelia

Question 4

Penlight in patient’s right eye produces bilateral pupillary constriction. In left eye, there is paradoxical bilateral pupillary dilation. Defect?

Answer 4

atrophy of left optic nerve

Question 5

Patient with decreased prick sensation on lateral aspect of leg and foot. A defi cit in what muscular action can also be expected?

Answer 5

dorsiflexion and eversion of foot (common peroneal nerve)

Question 6

Elderly woman with arthritis and tingling over lateral digits of right hand. Diagnosis?

Answer 6

Carpal tunnel syndrome, median nerve compression.

Question 7

Woman in car accident cannot turn her head to the left and has right shoulder droop.
What structure is damaged?

Answer 7

Right CN XI (runs through jugular foramen with CN IX and X), innervating sternocleidomastoid and trapezius muscles)

Question 8

Man with one wild, flailing arm. Where is lesion?

Answer 8

contralateral subthalamic nucleus (hemiballismus)

Question 9

Pregnant woman in 3rd trimester has normal blood pressure when standing and sitting. When supine, BP drops to 90/50. Diagnosis?

Answer 9

compression of IVC

Question 10

Soccer player was kicked in leg and su!ered a damaged medial meniscus. What else is likely to be damaged?

Answer 10

anterior cruciate ligament (remember the “unhappy triad”)

Question 11

Gymnast dislocates her shoulder anteriorly. What nerve is most likely to have been damaged?

Answer 11

Axillary nerve (C5, C6)

Question 12

Patient with cortical lesion does not know that he has a disease. Where is lesion?

Answer 12

Right parietal lobe.

Question 13

Child presents with cleft lip. Which embryologic process failed?

Answer 13

Fusion of maxillary and medial nasal processes.

Question 14

Patient cannot protrude tongue toward left side and has right sided spastic paralysis. Where is lesion?

Answer 14

left medulla, CN XII

Question 15

Right parietal lobe.

Answer 15

Ulnar nerve due to broken medial condyle

Question 16

24-year-old male develops testicular cancer. Metastatic spread occurs by what route?

Answer 16

para-aortic lymph nodes (recal descent of testes during development)

Question 17

Field hockey player presents to ER after falling on her arm during practice. X-ray shows mid-shaft break of humerus. Which nerve and what artery are most likely damaged?

Answer 17

Radial nerve and deep brachial artery, which run together.

Question 18

Patient cannot blink his right eye or seal his lips and has mild ptosis on the right side. What is diagnosis, and what nerve is often affected?

Answer 18

Bell’s palsy; CNVII

Question 19

eat some snacks my dear~~

Answer 19

honey bear~~^ ^

Question 20

Patient complains of pain, numbness, and tingling sensation. On exam, she has wasting of thenar eminence. What is diagnosis, and what nerve is often a!ected?

Answer 20

Carpal tunnel syndrome, median nerve

Question 21

Woman with anxiety about gyn exam is told to relax and imagine going through steps of exam. What process does this exemplify?

Answer 21

systematic desensitization

Question 22

65-year-old man is diagnosed with incurable

metastatic pancreatic adenocarcinoma. His family asks you not to tell the patient. What do you do?

Answer 22

Assess whether telling patient will negatively a!ect his health. If not, tell him.

Question 23

Man admitted for chest pain is medicated for ventricular tachycardia. The next day he
jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack. What defense mechanism?

Answer 23

denial

Question 24

You are attracted to your 26-year-old patient. What do you say?

Answer 24

Nothing! Tone must be professional. It is not
acceptable to have romantic relationship with patients. Invite a chaperone into room if you think your actions may be misinterpreted.

Question 25

Large group of people followed over 10 years. Every 2 years, it is determined who develops heart disease and who does not. What type of study?

Answer 25

cohort study

Question 26

Girl can groom herself, can hop on one foot, and has an imaginary friend. How old is
she?

Answer 26

Four years old

Question 27

Man has flashbacks about his girlfriend’s death 2 months ago following a hit-and-run
accident. He often cries and wishes for the death of the culprit. Diagnosis?

Answer 27

normal bereavement

Question 28

36-year-old woman with strong family history of breast cancer refuses a mammogram because she heard it hurts. What do you
do?

Answer 28

Discuss risks and benefits of not having mammogram. Patients must give informed
consent. If she refuses, you must abide by her wishes.

Question 29

During a particular stage of sleep, man has variable blood pressure, penile tumescence,
and variable EEG. What stage of sleep is he in?

Answer 29

REM sleep

Question 30

15-year-old girl of normal height and weight for her age has enlarged parotid glands but no other complaints. The mother confides that she found laxatives in the daughter’s closet. Diagnosis?

Answer 30

bulimia

Question 31

11-year-old girl exhibits Tanner stage 4 development (almost full breasts and pubic
hair). Diagnosis?

Answer 31

advanced stage, early development.

Question 32

4-year-old girl complains of burning feeling in her genitalia; otherwise she behaves and sleeps normally. Smear of discharge shows N. gonorrhoeae. How was she infected?

Answer 32

sexual abuse

Question 33

72-year-old man insists on stopping treatment for his heart condition because it makes him feel “funny.” What do you do?

Answer 33

Although you want to encourage him to take his medication, the patient has the fi nal say. You should investigate the “funny” feeling
and determine if there are drugs available that don’t elicit this side effect.

Question 34

Person demands only the best and most famous doctor in town. Personality disorder?

Answer 34

Narcissism

Question 35

Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C protein. Diagnosis?

Answer 35

Factitious disorder; self-scripted insulin.

Question 36

55-year-old businessman complains of lack of successful sexual contacts with women and lack of ability to reach full erection.
Two years ago he had a heart attack. What might be the cause of his problem?

Answer 36

Fear of sudden death during intercourse.

Question 37

Full-term neonate of uneventful delivery becomes mentally retarded and hyperactive and has a musty odor. Diagnosis?

Answer 37

PKU

Question 38

Stressed executive comes home from work, consumes 7 or 8 martinis in rapid succession before dinner, and becomes hypoglycemic.
Mechanism?

Answer 38

NADH increase prevents gluconeogenesis by shunting pyruvate and oxaloacetate to lactate and malate.

Question 39

2-year-old has increased abdominal girth, failure to thrive, and skin and hair depigmentation. Diagnosis?

Answer 39

Kwashiorkor

Question 40

Alcoholic develops rash, diarrhea, and altered mental status. Vitamin deficiency?

Answer 40

Vitamin B3 (pellagra)

Question 41

20-year-old man presents with idiopathic

hyperbilirubinemia. Most common cause?

Answer 41

Gilbert’s disease

Question 42

51-year-old man has black spots in his sclera and has noted that his urine turns black when he is standing. Diagnosis?

Answer 42

Alkaptonuria

Question 43

25-year-old male complains of severe chest pain and has xanthomas of his Achilles
tendons. What is the disease, and where is the defect?

Answer 43

Familial hypercholesterolemia; LDL receptor