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

Vignettes - Micro, Path and Pharm -sidebyside Flashcards

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USMLE® Step 1 flashcards
1
Q

Microbiology Vignettes

A

p174

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2
Q

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

A

Anaerobes

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3
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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4
Q

Pt with Mycoplasma
pneumoniae, cryoagglutinins.
What Ig types?

A

IgM

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5
Q

U/A with WBC casts. Dx?

A

Pyelonephritis

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6
Q

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

A

Tcell (DiGeorge)

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7
Q

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

A

Sporothrix schenckii

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8
Q

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

A

H. pylori

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9
Q

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

A

Blastomyces

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10
Q

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

A

Mastitis by S. aureus

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11
Q

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

A 
NADPH oxidase (chronic 
granulomatous disease)
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12
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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13
Q

Microbiology Vignettes

A

p175

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14
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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15
Q

Infant eats honey -> flaccid.

Organism? Mechanism?

A

Clostridium botulinum;

inhibited release of Ach

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16
Q

Man w/ squamous cell

carcinoma, penis. what virus?

A

HPV

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17
Q

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

A

S. aureus or S. epidermis

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18
Q

Pathology Vignettes

A

p220

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19
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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20
Q

35yr old man w/ hi BP in

arms. Low in legs. Dx?

A

Coarctation of Aorta

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21
Q

Woman w/ di! use goiter and
hyperthyroidism. Values of
TSH and thyroid hormones?

A

Low TSH, and high thyroid

hormones

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22
Q

Pt w/ extended expiratory

phase. Disease process?

A

Obstructive Lung Disease

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23
Q

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

A

Prolactinoma

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24
Q

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

A

Cystic fi brosis. Chloride sweat

test.

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25
Q

mua~!

A

^3^

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26
Q

Obese woman w/ hirsutism
and hi serum testosterone.
Dx?

A

Polycyctic ovarian syndrome

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27
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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28
Q

48yr old female w/
progressive lethargy and
extreme sensitivity to cold
temp. Dx?

A

Hypothyroidism

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29
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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30
Q

During a football game,
player collapses/dies
immediately. Likely Cardiac
disease?

A

Hypertrophic cardiomyopathy

31
Q

Pathology Vignettes

A

p221

32
Q

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

A

Spherocytosis

33
Q

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

A

Schwannoma

34
Q

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

A

Duchenne’s muscular
dystrophy, X-linked
recessive.

35
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

36
Q

Teenager w/ nephritic

syndrome & hearing loss. Dx?

A

Alport’s syndrome

37
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

38
Q

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

A

Dynein (Kartagener’s)

39
Q 
55yr old man who smokes & 
drinks has cough & flu-like 
Sx. Gram stain shows 
nothing. Silver shows gram-
neg rods. Dx?
A

Legionellapneumonia

40
Q

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

A

Fat emboli.

41
Q 
25yr old woman w/ a low 
grade fever, rash across nose 
from sun, widespread edema. 
Should be concerned about 
what disease?
A

SLE

42
Q

Pathology Vignettes

A

p222

43
Q

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

A

Carcinoid syndrome

44
Q

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

A

Temporal arteritis.

45
Q

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

A

High hCG, hydatidiform mole

46
Q

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

A

Aortic stenosis

47
Q

Woman of short stature w/
short 4th and 5th
metacarpals. Endocrine
disorder?

A

Albright’s hereditary
osteodystrophy or
pseudohypoparathyroidism

48
Q 
After stressful event, 30yr old 
man w/ diarrhea and blood 
per rectum. Intestinal bx 
shows transmural inflamm. 
Dx?
A

Crohn’s

49
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.

50
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
defi ciency

51
Q

I~~~

A

LOVE u~~~!!

52
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.

53
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.

54
Q

Pathology Vignettes

A

p223

55
Q

X-ray shows bilateral hilar

lymphadenopathy. Dx?

A

Sarcoidosis.

56
Q

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

A

ASD

57
Q

Pharmacology Vignettes

A

p286

58
Q

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

A

Dopamine

59
Q

Woman taking tetracycline is
photosensitive. Clinical
manifestations?

A

Rash on sun-exposed regions

of body

60
Q

Non-diabetic pt has
hypoglycemia but low C-
peptide. Dx?

A

Surreptitious insulin injection

61
Q 
African-american man who 
goes to Africa develops a 
hemolytic anemia after taking 
malarial prophylaxis. Enzyme 
defi ciency?
A

Glucose-6-Phosphate

Dehydrogenase

62
Q

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

A

Bethanechol

63
Q

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

A

Insecticide poisioning;

inhibition of AChE

64
Q 
Pt w/ recent kidney transplant 
is on cyclosporine for 
immunosuppression. 
Requires antifungal agent for 
candidiasis. What antifungal -
> cyclosporine toxicity?
A

Ketoconazole

65
Q 
Man on several meds 
including antidepressants and 
antihypertensives, has 
mydriasis and becomes 
constipated. Cause?
A

TCA

66
Q

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

A

Endometrial carcinoma

67
Q

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

A

Tyramine (wine/cheese)

68
Q

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

A

Clostridium

diffcileovergrowth

69
Q

hug~~

A

kiss~~~

70
Q

Pharmacology Vignettes

A

p287

71
Q

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

A

Niacin

72
Q

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

A

LFTs

73
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 e ! ective.

74
Q

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

A

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

USMLE (3 decks)

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