VINGETTES Flashcards
45yo woman presents with headache, blurry vision and walking unsteadily. Fundoscopy shows tortuous retinal veins and clinical examination shows hepatosplenomegaly, Hb 9, lymphadenopathy, fever and weightloss. Bone marrow biopsy shows monoclobal B lymphocytes wih plasme cell features and IgM intrancuelar pseudoinclusions. what is the diagnosis?
waldenstrom macroglobulinaemia
IgM macroglobulinaemia
IgM
organomegaly
hyperviscosity (HA, blurry vision, bleeding)
B symptoms (fever, night sweats, weight loss)
peripheral neuropathy
anaemia
‘sausage like’ retinal veins - dilated, segmented
A 27-year-old man sustains a spinal cord transection at C-8 in a skiing accident. In which of the following situations is he most likely to be able to achieve and sustain an erection?
A) Erotic dreams
U B) Penile stimulation
U C) Reading erotic literature
D) Testosterone injections
E) Viewing erotic material
Penile stimulation
psychological (central) pathways
- erotic dreams, literature
- brain pathways and communication to the spinal cord may not be intact (C8)
physiological (autonomic) pathways
- penile stimulation
- direct stimulation - activate reflex arcs (S2-S4)
- responsible for PNS reflexes = erection
A 38-year-old woman, gravida 4, para 4, comes to the physician because of a 6-month history of urinary incontinence when sneezing and coughing. Physical examination shows
normal-appearing female external genitalia. When the patient is asked to perform a Valsalva maneuver, leakage of urine from the urethra is detected. She is given instructions to
perform Kegel exercises to strengthen the muscles of the perineum. Which of the following muscles in this patient is most likely to remain unaffected by the exercises?
A) Bulbospongiosus
B) Deep transverse perinea! muscle
C) External urethral sphincter
D) Internal anal sphincter
E) lschiocavernosus
Internal anal sphincter
it is smooth muscle under autonomic control not strengthened by exercise
21 yo women concerned about passing condition onto her son.
Mother and Uncle has Huntingtons.
what is the sons risk of inheriting it from his mother
25%
50% x 50% = risk 25%
**50% **chance of inheriting gene from her mother
(womans young age, potentially not seein gs/s yet)
If she inherited gene;
**50% **chance of passing onto her son
meg
24 year old man found on a park bench, stuperous, but arousable to shaking. There is vomitous next to him. RR 10, HR 54, mitosis. What is the best line treatment for this condition?
naloxone
opioid intoxication
meg
45yo woman is found at home by her neighbour, with 3 open bottles of wine on the kitchen counter. The woman is confused and aggitated, there are tremors in her upper limbs and her son reports a seizure earlier that afternoon. What is the best course of treatment?
benzodiazapines
lorazepam, diazepam
meg
a 32yo presents to ED very fatigued, he is sleepy and has to be shook awake to answer questions. He claims to feeling very low in mood and that he ‘cant take it anymore’. He ate two trays of meals when the meal warden came around earlier that night. What is the diagnosis?
cocaine withdrawal
meg
13yo boy complains of pain in his left abodmen and left arm. He appears in pain, with splenomegaly on examination, is sweating and tachycardic. He has had a similar episode before and is usally treated with hydroxyurea. what is the clinical presentation?
vaso-occlusive crisis
(sickle cell disease)
A 38yo female presents to her GP with fatigue. She appears pale and says she lacks energy to carry out daily tasks, and has had to stop her daily morning run. Her labs are: ferritin low, TBIC highA 38-year-old woman presents to her primary care physician with a 3-month history of fatigue. She reports that she tires easily with routine activities and has recently stopped her morning runs due to lack of energy. She also notes heavy menstrual periods over the past year. On physical exam, she appears pale. Her vitals are within normal limits. Laboratory results are as follows:
Hemoglobin: 9.8 g/dL (normal: 12–16)
Mean corpuscular volume (MCV): 72 fL (normal: 80–100)
Ferritin: 8 ng/mL (normal: 15–150)
Total iron-binding capacity (TIBC): 460 µg/dL (normal: 250–450)
Serum iron: 25 µg/dL (normal: 60–170)
Transferrin saturation: 5% (normal: 20–50%)
Which of the following is the most likely cause of this patient’s condition?
A) Chronic kidney disease
B) Dietary vitamin B12 deficiency
C) Gastrointestinal blood loss
D) Heavy menstrual bleeding
E) Anemia of chronic disease. What is the diagnosis?
Heavy menstrual bleeding
meg
a man returns from travelling to Cuba. He has had leg pain from the flight and has been taking NSAIDs to treat it. He reports a yellowing to his skin and petichiae. IT is known his mother had a similar condition. What is the cause of his presentation?
G6PD deficiency
(triggered by NSAIDs)
An 8-month-old boy presents to the emergency department with difficulty breathing. He appears pale, and his extremities are cyanotic. His mother reports that he has been increasingly tired and has not been feeding well for the past few weeks. On examination, he is noted to have hepatosplenomegaly. Laboratory results show the following:
Hemoglobin: 9.2 g/dL (normal: 11–13)
MCV: 78 fL (normal: 80–100)
Reticulocyte count: Elevated
Which of the following is the most likely cause of this patient’s symptoms?
A) Deletion of the beta-globin chain
B) Deletion of the alpha-globin chain
C) Iron deficiency anemia
D) Microangiopathic hemolytic anemia
E) Sickle cell disease
HbF
(beta thalassemia)
(A)
meg
A 3yo boy is brought in by his mother because she has noticed he has been fatigued and loosing weight. He has been less keen to play with his friends in the playground and has had multiple infections over the last 3 months. Bloods show: blasts >20%, leukocytes 12000, lymphocytes 80% and Tdt marker.
what is the first line treatment for this condition?
T-ALL
cytarabine
chemotherapy
a 51yo female presents to her GP following undesired weightloss and fatigue. Her blood tests show increased leukocyte count 13000 and markers CD13, CD33 with small eosinophilic rods within the examined cells. The drugs used to treat this condition attaches to what receptor?
AML
tretinoin (alltrans retinoic acid)
binds retinoic acid receptor-alpha
(RAR-α)
A 24-year-old female presents with complaints of increased facial hair, acne, irregular periods, and clitoromegaly. On pelvic examination, small pink crystals are noted. Laboratory testing reveals elevated testosterone levels. Imaging shows an ovarian mass. What is the most likely diagnosis?
A) Polycystic ovary syndrome (PCOS)
B) Congenital adrenal hyperplasia (CAH)
C) Sertoli-Leydig cell tumor
D) Adrenal adenoma
E) Ovarian cyst
sex cord - stromal ovarian tumours
(sertoli-leydig cell tumour)
meg
A young woman is seen by her doctor after exploration into her bloating and abdominal pain feeling of fullness. Histology from biopsy of the mass shoes large cells with clear cytoplasms and central nuclei. LDH was increased. She is worried about the prognosis of her findings, what should the GP say?
good prognosis
(dysgerminoma)
meg
A 36yo woman comes to her GP for a sexual health check up. She has not had one in 7 years and has had not vaccinations as a teenager. She reports she curertnly has 3 sexual partners, menarche was age 12 and her first sexual encouter was at 13yo. There is white patch noticed on wall of her vulva on examination. She tests positive for HPV type 16, 18. Which tissue does the likely carcinoma arise from?
squamout cell epithelium
vulvar carcinoma
(HPV type 16, 18)
meg
A pregnancy female at 33 weeks gestation comes to her GP complaining of palpitation,s sweating and feeling increasingly anxious. Her labs show: T4 inreased, T3 increased, FreeT4 normal, TBG increased. what is the cause of these findings?
oestrogen
A 38-year-old woman presents to the clinic with a 2-week history of neck pain, fatigue, and fever. She mentions that she has also experienced weight loss and palpitations during this time. On examination, her thyroid gland is tender to palpation, and there is mild swelling of the neck. Her pulse is tachycardic at 110 bpm. Laboratory results show the following:
TSH: Low
Free T4: High
Anti-thyroid peroxidase antibodies: Negative
Thyroid ultrasound: Reveals diffuse enlargement of the thyroid gland with no nodules.
Which of the following is the most likely diagnosis?
A) Graves’ disease
B) Subacute thyroiditis
C) Toxic multinodular goiter
D) Hashimoto thyroiditis
E) Thyroid adenoma
subacute thyroiditis
Toxic multinodular goiter: This condition involves autonomous thyroid nodules producing excess thyroid hormone. It presents with hyperthyroidism, but typically, there is no pain and no tenderness in the thyroid gland, and the ultrasound would show nodules (which is not seen here).
meg
Parents with alpha-thalessemia minor; mother (a-/a-) and father (aa/–). What is the chance of their offspring having a-thalassemia minor?
0%
meg
23yo female comes to see her GP after experiencing 1 week of watery, creamy vaginal discharge. she has also noticed dsicomfort in her wrists and ankles and red conjunctivae. she has had two sexual partners and gram stain shows gram negative diplococci, oxidase positive. What is the virulence factor of this infective organism?
pilus (fimbrae)
neisseriae gonorrhoea
antigenic variation
disseminated gonoccocal infection - triad: fever/bacteraemia, tenosinovitis/arthritis/dermatitis
gonorrhoea - no capsule
meg
26yo woman presents with watery vaginal discharge 3 weeks after intercourse with a new sexual partner. She has had mild bleeding following intercourse and mild dysuria. On Giemsa stain, stains for inclusions. What is the best treatment for this condition?
doxycycline
ceftriaxone (gonorrhoea - if not rules out)
azithromycin
A 22-year-old sexually active man presents with painful genital lesions that began 3 days ago. He describes the lesions as small blisters that ruptured into shallow ulcers. He also reports dysuria and tender inguinal lymphadenopathy. Physical examination reveals multiple vesicular lesions on an erythematous base over the penile shaft. Which of the following best describes the structure of the most likely causative virus?
A. Enveloped, double-stranded linear DNA virus
B. Enveloped, single-stranded positive-sense RNA virus
C. Non-enveloped, double-stranded circular DNA virus
D. Non-enveloped, single-stranded negative-sense RNA virus
E. Enveloped, double-stranded segmented RNA virus
HSV-2
enveloped DS linear DNA
(A)
meg
A female presents with thin white discharge and itching and burning on urination. She has recently had an increase in gymnastic training in the last month and hd a course of antibiotics for a graze on her leg which was infected. on KOH testing there is a strong amine odour and vaginal acidity >4.5. Which of the following is the most likely diagnosis?
A. Vulvovaginal candidiasis
B. Trichomoniasis
C. Bacterial vaginosis
D. Physiologic leukorrhea
E. Atrophic vaginitis
bacterial vaginosis
(Gardnerella vaginalis)
anaerobic
clue cells
Tx metronidazole
clindamycin
30yo female comes to her GP after 2 days of green-yellow vaginal discharge with itching and burning on urination. There is bleeding during intercourse where she doesn’t use contraception. Wet mount shows flagellated organisms. What is the carcinoma risk in this patient?
trichomonas vaginalis
increased risk cervical cancer
cervical inflammation
cervical dysplasia
cervical carcinoma
Tx metronidazole
HPV also increases this risk
