Vignettes- Anatomy, Behavioral and Biochem - sidebyside Flashcards
Anatomy Clinical Vignettes
p. 68, 69
Baby vomits milk when fed
and has gastric air bubble.
What kind of fistula is
present?
blind esophagus with lower
segment of esophagus
attached to trachea
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?
Tibial (L4 to S3)
Patient with decreased pain
and temp sensation over
lateral aspects of both arms.
Lesion?
syringomyelia
Penlight in patient's right eye produces bilateral pupillary constriction. In left eye, there is paradoxical bilateral pupillary dilation. Defect?
atrophy of left optic nerve
Patient with decreased prick sensation on lateral aspect of leg and foot. A defi cit in what muscular action can also be expected?
dorsiflexion and eversion of
foot (common peroneal
nerve)
Elderly woman with arthritis
and tingling over lateral digits
of right hand. Diagnosis?
Carpal tunnel syndrome,
median nerve compression.
Woman in car accident cannot
turn her head to the left and
has right shoulder droop.
What structure is damaged?
Right CN XI (runs through jugular foramen with CN IX and X), innervating sternocleidomastoid and trapezius muscles)
Man with one wild, flailing
arm. Where is lesion?
contralateral subthalamic
nucleus (hemiballismus)
Pregnant woman in 3rd trimester has normal blood pressure when standing and sitting. When supine, BP drops to 90/50. Diagnosis?
compression of IVC
Soccer player was kicked in
leg and su!ered a damaged
medial meniscus. What else is
likely to be damaged?
anterior cruciate ligament
(remember the “unhappy
triad”)
Gymnast dislocates her
shoulder anteriorly. What
nerve is most likely to have
been damaged?
Axillary nerve (C5, C6)
Patient with cortical lesion
does not know that he has a
disease. Where is lesion?
Right parietal lobe.
Child presents with cleft lip.
Which embryologic process
failed?
Fusion of maxillary and
medial nasal processes.
Patient cannot protrude
tongue toward left side and
has right sided spastic
paralysis. Where is lesion?
left medulla, CN XII
Right parietal lobe.
Ulnar nerve due to broken
medial condyle
24-year-old male develops
testicular cancer. Metastatic
spread occurs by what route?
para-aortic lymph nodes
(recal descent of testes
during development)
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?
Radial nerve and deep
brachial artery, which run
together.
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?
Bell’s palsy; CNVII
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honey bear~~^ ^
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?
Carpal tunnel syndrome,
median nerve
Behavioral Science Vignettes
p. 114,115
Woman with anxiety about gyn exam is told to relax and imagine going through steps of exam. What process does this exemplify?
systematic desensitization
65-year-old man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you not to tell the patient. What do you do?
Assess whether telling patient
will negatively a!ect his
health. If not, tell him.
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?
denial
You are attracted to your 26-
year-old patient. What do you
say?
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.
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?
cohort study
Girl can groom herself, can
hop on one foot, and has an
imaginary friend. How old is
she?
Four years old
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?
normal bereavement
36-year-old woman with strong family history of breast cancer refuses a mammogram because she heard it hurts. What do you do?
Discuss risks and benefi ts of not having mammogram. Patients must give informed consent. If she refuses, you must abide by her wishes.
During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG. What stage of sleep is he in?
REM sleep
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?
bulimia
11-year-old girl exhibits
Tanner stage 4 development
(almost full breasts and pubic
hair). Diagnosis?
advanced stage, early
development.
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?
sexual abuse
72-year-old man insists on stopping treatment for his heart condition because it makes him feel "funny." What do you do?
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.
Person demands only the best
and most famous doctor in
town. Personality disorder?
Narcissism
Nurse has episodes of
hypoglycemia; blood analysis
reveals no elevation in C
protein. Diagnosis?
Factitious disorder; self-
scripted insulin.
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?
Fear of sudden death during
intercourse.
Biochemistry Clinical
Vignettes
p. 138
Full-term neonate of uneventful delivery becomes mentally retarded and hyperactive and has a musty odor. Diagnosis?
PKU
Stressed executive comes home from work, consumes 7 or 8 martinis in rapid succession before dinner, and becomes hypoglycemic. Mechanism?
NADH increase prevents
gluconeogenesis by shunting
pyruvate and oxaloacetate to
lactate and malate.
2-year-old has increased
abdominal girth, failure to
thrive, and skin and hair
depigmentation. Diagnosis?
Kwashiorkor
Alcoholic develops rash,
diarrhea, and altered mental
status. Vitamin deficiency?
Vitamin B3 (pellagra)
20-year-old man presents
with idiopathic
hyperbilirubinemia. Most
common cause?
Gilbert’s disease
51-year-old man has black spots in his sclera and has noted that his urine turns black when he is standing. Diagnosis?
Alkaptonuria
mua mua~~
I miss u so much~~
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?
Familial
hypercholesterolemia; LDL
receptor
