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USMLE > Vignettes- Anatomy, Behavioral and Biochem - sidebyside > Flashcards

Vignettes- Anatomy, Behavioral and Biochem - sidebyside Flashcards

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USMLE® Step 1 flashcards
1
Q

Anatomy Clinical Vignettes

A

p. 68, 69

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2
Q

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

A

blind esophagus with lower
segment of esophagus
attached to trachea

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3
Q 
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?
A

Tibial (L4 to S3)

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4
Q

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

A

syringomyelia

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5
Q 
Penlight in patient's right eye 
produces bilateral pupillary 
constriction. In left eye, there 
is paradoxical bilateral 
pupillary dilation. Defect?
A

atrophy of left optic nerve

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6
Q 
Patient with decreased prick 
sensation on lateral aspect of 
leg and foot. A defi cit in what
muscular action can also be 
expected?
A

dorsiflexion and eversion of
foot (common peroneal
nerve)

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7
Q

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

A

Carpal tunnel syndrome,

median nerve compression.

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8
Q

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

A 
Right CN XI (runs through 
jugular foramen with CN IX 
and X), innervating 
sternocleidomastoid and 
trapezius muscles)
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9
Q

Man with one wild, flailing

arm. Where is lesion?

A

contralateral subthalamic

nucleus (hemiballismus)

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10
Q 
Pregnant woman in 3rd 
trimester has normal blood 
pressure when standing and 
sitting. When supine, BP 
drops to 90/50. Diagnosis?
A

compression of IVC

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11
Q

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

A

anterior cruciate ligament
(remember the “unhappy
triad”)

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12
Q

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

A

Axillary nerve (C5, C6)

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13
Q

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

A

Right parietal lobe.

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14
Q

Child presents with cleft lip.
Which embryologic process
failed?

A

Fusion of maxillary and

medial nasal processes.

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15
Q

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

A

left medulla, CN XII

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16
Q

Right parietal lobe.

A

Ulnar nerve due to broken

medial condyle

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17
Q

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

A

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

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18
Q 
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?
A

Radial nerve and deep
brachial artery, which run
together.

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19
Q 
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?
A

Bell’s palsy; CNVII

20
Q

eat some snacks my dear~~

A

honey bear~~^ ^

21
Q 
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?
A

Carpal tunnel syndrome,

median nerve

22
Q

Behavioral Science Vignettes

A

p. 114,115

23
Q 
Woman with anxiety about 
gyn exam is told to relax and 
imagine going through steps 
of exam. What process does 
this exemplify?
A

systematic desensitization

24
Q 
65-year-old man is 
diagnosed with incurable 
metastatic pancreatic 
adenocarcinoma. His family 
asks you not to tell the 
patient. What do you do?
A

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

25
Q 
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?
A

denial

26
Q

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

A 
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.
27
Q 
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?
A

cohort study

28
Q

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

A

Four years old

29
Q 
Man has fl ashbacks 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?
A

normal bereavement

30
Q 
36-year-old woman with 
strong family history of 
breast cancer refuses a 
mammogram because she 
heard it hurts. What do you 
do?
A 
Discuss risks and benefi ts of 
not having mammogram. 
Patients must give informed 
consent. If she refuses, you 
must abide by her wishes.
31
Q 
During a particular stage of 
sleep, man has variable blood 
pressure, penile tumescence, 
and variable EEG. What stage 
of sleep is he in?
A

REM sleep

32
Q 
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?
A

bulimia

33
Q

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

A

advanced stage, early

development.

34
Q 
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?
A

sexual abuse

35
Q 
72-year-old man insists on 
stopping treatment for his 
heart condition because it 
makes him feel "funny." What 
do you do?
A 
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 e ! ect.
36
Q

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

A

Narcissism

37
Q

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

A

Factitious disorder; self-

scripted insulin.

38
Q 
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?
A

Fear of sudden death during

intercourse.

39
Q

Biochemistry Clinical

Vignettes

A

p. 138

40
Q 
Full-term neonate of 
uneventful delivery becomes 
mentally retarded and 
hyperactive and has a musty 
odor. Diagnosis?
A

PKU

41
Q 
Stressed executive comes 
home from work, consumes 7 
or 8 martinis in rapid 
succession before dinner, and 
becomes hypoglycemic. 
Mechanism?
A

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

42
Q

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

A

Kwashiorkor

43
Q

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

A

Vitamin B3 (pellagra)

44
Q

20-year-old man presents
with idiopathic
hyperbilirubinemia. Most
common cause?

A

Gilbert’s disease

45
Q 
51-year-old man has black 
spots in his sclera and has 
noted that his urine turns 
black when he is standing. 
Diagnosis?
A

Alkaptonuria

46
Q

mua mua~~

A

I miss u so much~~

47
Q 
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?
A

Familial
hypercholesterolemia; LDL
receptor

USMLE (3 decks)

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