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USMLE Vignettes > Vignettes - Micro, Path and Pharm -sidebyside > Flashcards

Vignettes - Micro, Path and Pharm -sidebyside Flashcards

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USMLE® Step 1 flashcards
1
Q

An alcoholic vomits gastric contents and has foul smelling sputum. What organisms are most likely?

A

Anaerobes

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2
Q

Middle-age man has acute monoarticular joint pain and bilateral Bell’s palsy. What disease and how?

A

Lyme, Ixodes tick

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3
Q

Pt with Mycoplasma pneumoniae, cryoagglutinins. What Ig types?

A

IgM

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4
Q

U/A with WBC casts. Dx?

A

Pyelonephritis

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5
Q

Young child with tetany, candidiasis, hypocalcemia, and immunosuppression.
What cell is deficient?

A

Tcell (DiGeorge)

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6
Q

Pt with “rose gardener’s” (thorn prick, ulcers along lymph drainage). What bug?

A

Sporothrix schenckii

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7
Q

25yr old med student has “burning” gut after meals. Gram negative rods in Bx. What organism?

A

H. pylori

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8
Q

32yr old man w/ “caulifl ower” skin lesions. Bx shows broad-based budding yeasts.
Organism?

A

Blastomyces

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9
Q

Breast feeding woman w/ redness & swelling of right breast. Fluctuant mass. Dx?

A

Mastitis by S. aureus

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10
Q

Young child w/ recurrent lung infxns & granulomatous lesions. What defect in
neutrophils?

A

NADPH oxidase (chronic granulomatous disease)

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11
Q

20yr old college student w/ lymphadenopathy, fever, hepatosplenomegaly. Serum agglutinates sheep RBCs. What cell infected?

A

B-cell (EBV; infectious mononucleosis)

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12
Q

1hr after eating custard at a picnic, whole family vomits. After 10hrs all better. Organism?

A

S. aureus(produces preformed enterotoxin)

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13
Q

Infant eats honey -> flaccid. Organism? Mechanism?

A

Clostridium botulinum; inhibited release of Ach

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14
Q

Man w/ squamous cell carcinoma, penis. what virus?

A

HPV

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15
Q

Pt w/ endocarditis 3wks after prosthetic heart valve. Organism?

A

S. aureus or S. epidermis

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16
Q

Woman w/ previous C-section has scar in lower uterus close to opening of the os. Risk for what?

A

Placenta previa

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17
Q

35yr old man w/ hi BP in arms. Low in legs. Dx?

A

Coarctation of Aorta

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18
Q

Woman w/ diffuse goiter and hyperthyroidism. Values of TSH and thyroid hormones?

A

Low TSH, and high thyroid hormones

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19
Q

Pt w/ extended expiratory phase. Disease process?

A

Obstructive Lung Disease

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20
Q

Woman w/ headache, visual disturbance, galactorrhea, amenorrhea. Dx?

A

Prolactinoma

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21
Q

Baby has foul smelling stool and recurrent pulmonary infxns. Dx? Test to confirm?

A

Cystic fi brosis. Chloride sweat test.

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22
Q

mua~!

A

^3^

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23
Q

Obese woman w/ hirsutism and high serum testosterone.

Dx?

A

Polycyctic ovarian syndrome

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24
Q

Man w/ pain and swelling in knees, subcutaneous nodules around the joints and
Achilles, exquisite pain in the metatarsophalangeal join of right big toe. Bx shows needle-like crystals. Dx?

A

Gouty arthritis

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25
Q

48yr old female w/ progressive lethargy and

extreme sensitivity to cold temp. Dx?

A

Hypothyroidism

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26
Q

Pt w/ elevated serum cortisol levels undergoes dexamethasone supp. test.
1mg doesn’t lower cortisol. 8mgs does. Dx?

A

Pituitary tumor.

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27
Q

During a football game, player collapses/dies

immediately. Likely Cardiac disease?

A

Hypertrophic cardiomyopathy

28
Q

Child anemic since birth. Splenectomy -> increased Hct in what disease.

A

Spherocytosis

29
Q

43yr old man experiences dizziness/tinnitus. CT shows enlarged internal acoustic
meatus. Dx?

A

Schwannoma

30
Q

Child exhibits weakness and enlarges calves. Disease? How inherited?

A

Duchenne’s muscular dystrophy, X-linked

recessive.

31
Q

25yr old female w/ sudden uniocular vision loss and slightly slurred speech. Hx of
weakness and pareshesias that have resolved. Dx?

A

Multiple Sclerosis

32
Q

Teenager w/ nephritic syndrome & hearing loss. Dx?

A

Alport’s syndrome

33
Q

Tall thin male teenager w/ abrupt-onset dyspnea & left-sided chest pain.
Hyperresonant percussion on the a !ected side & diminished breath sounds. Dx?

A

Pneumothorax

34
Q

Young man concerned about wife’s URIs and inability to conceive. Also dextrocardia.
What protein?

A

Dynein (Kartagener’s)

35
Q

55yr old man who smokes & drinks has cough & flu-like Sx. Gram stain shows nothing. Silver shows gram-neg rods. Dx?

A

Legionellapneumonia

36
Q

Pt has stoke after incurring multiple long bone fractures in trauma stemming from MVA. Cause?

A

Fat emboli.

37
Q

25yr old woman w/ a low grade fever, rash across nose from sun, widespread edema.
Should be concerned about what disease?

A

SLE

38
Q

50yr old man w/ diarrhea, PE reveals plethoric face and heart murmur. Dx?

A

Carcinoid syndrome

39
Q

Elderly woman w/ a headache and jaw pain. Elevated ESR. Dx?

A

Temporal arteritis.

40
Q

Pregnant woman @16wks w/ an atypically large abdomen. Blood test abnormality?
Disorder?

A

High hCG, hydatidiform mole

41
Q

80yr old man w/ a systolic crescendo-decrescendo murmur. Most likely cause?

A

Aortic stenosis

42
Q

Woman of short stature w/ short 4th and 5th

metacarpals. Endocrine disorder?

A

Albright’s hereditary osteodystrophy or

pseudohypoparathyroidism

43
Q

After stressful event, 30yr old man w/ diarrhea and blood per rectum. Intestinal bx shows transmural inflamm. Dx?

A

Crohn’s

44
Q

Young man w’ mental deterioration and tremors. Brown pigmentation in a ring
around periphery of cornea and altered LFTs. Tx?

A

Penicillamine for Wilson’s disease.

45
Q

Pt w/ fatigue, blood tests show macrocytic,

megaloblastic anemia. Why danger to give folate alone?

A

Masks signs of neural damage w/ vitamin B12

deficiency

46
Q

I~~~

A

LOVE u~~~!!

47
Q

10yr old “spaces out” in class (stops talking midsentence and then continues as if
nothing had happened). During spells, quivering of lips. Dx?

A

Absence seizure.

48
Q

85yr old man w/ knee pain and swelling. X-ray shows increased joint space w/o erosion. Dx? What does aspirate show?

A

Pseudogout. Rhomboid calcium pyrophosphate crystals.

49
Q

X-ray shows bilateral hilar lymphadenopathy. Dx?

A

Sarcoidosis.

50
Q

5yr old boy w/ systolic murmur and a wide, fixed split S2. Dx?

A

ASD

51
Q

28yr old chemist w/ MPTP exposure. Neurotransmitter depleted?

A

Dopamine

52
Q

Woman taking tetracycline is photosensitive. Clinical manifestations?

A

Rash on sun-exposed regions of body

53
Q

Non-diabetic pt has hypoglycemia but low C-

peptide. Dx?

A

Surreptitious insulin injection

54
Q

African-american man who goes to Africa develops a hemolytic anemia after taking
malarial prophylaxis. Enzyme deficiency?

A

Glucose-6-Phosphate Dehydrogenase

55
Q

27yr old female w/ hx of psych illness now has urinary retention due to a neuroleptic. Tx?

A

Bethanechol

56
Q

Farmer presents w/ dyspnea, salivation, miosis, diarrhea, cramping, blurry vision.
Cause & mechanism?

A

Insecticide poisioning; inhibition of AChE

57
Q

Pt w/ recent kidney transplant is on cyclosporine for immunosuppression. Requires antifungal agent for candidiasis. What antifungal -> cyclosporine toxicity?

A

Ketoconazole

58
Q

Man on several meds including antidepressants and antihypertensives, has
mydriasis and becomes constipated. Cause?

A

TCA

59
Q

55yr old postmenopausal woman is on tamoxifen therapy. Risk?

A

Endometrial carcinoma

60
Q

Woman on MAO inh has hypertensive crisis after a meal. What did she eat?

A

Tyramine (wine/cheese)

61
Q

After taking clindamycin, pt dev toxic megacolon and diarrhea. Mechanism?

A

Clostridium diffcile overgrowth

62
Q

hug~~

A

kiss~~~

63
Q

Man starts meds for hyperlipidemia. Then rash, pruritus, and upset GI. Drug?

A

Niacin

64
Q

Pt on carbamazepine. What routine workup should always be done?

A

LFTs

65
Q

23yr old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why?

A

Rifampin augments estrogen metabolism in the liver, rendering it less effective.

66
Q

Pt develops cough and must discontinue captopril. What is a good replacement? Why not same side effects?

A

Losartan, an angiotensin II receptor antagonist, does not increase bradykinin as
captopril does.

USMLE Vignettes (2 decks)

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