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#1 Flashcards

1
Q

14 month old girl, 2 month history of diarrhea. Well varied diet.

  • No history of travel or contact with similar symptoms
  • Duodenum shows villous atrophy and crypt hyperplasia
A
  • Celiac disease, we should modified grain diet

- Screen for anti-tissue transglutaminase antibodies

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2
Q

54 year old with cough & shortness of breath
- History of coronary artery disease
- Graph shows left ventricular pressure increase as well as volume to the left
Parameter is likely increased?

A

Stroke volume, the pressure volume loop shifts up and to the left = increase in cardiac contractility

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3
Q

29 yo woman sexually active
- Thin walled vesicles on an erythematous base , shallow ulcers on the labia
- Tender inguinal lymphadenopathy is present
- Tzanck smear of the genital lesions shows multinucleate giant cells
Drug that will prevent future episodes works by?

A

Incorporation into newly replicating viral DNA , ACYCLOVIR, is a nucleoside analog

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4
Q

Agent that inhibits bacterial glycosyltransferase enzyme is developed.
- Resistance to the drug is determined by measuring the zone of complete growth inhibition.
Which bacteria would be resistant?

A 
Mycoplasma hominis (lack wall) 
Peptidoglycan is main component of bacterial wall and glycosyltransferase is crucial component
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5
Q

25 yo brought after vomiting at a party, showing blood-tinged vomitus on shirt.
- Mental examination patient is alert, he insists in going home
Course of action?

A

Explain potential risks of leaving the hospital without further evaluation

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6
Q

32 yo woman 4 weeks of cough, shortness of breath and low grade fevers
- Methenamine silver staining of bronchoalveolar lavage shows image in blue
Appropriate pharmacotherapy?

A

Trimethoprim-sulfamethoxazole

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7
Q

56 yo woman, progressive weight gain
- Difficulty lifting heavy objects
- Persistent bronchial asthma she uses corticosteroids
- BP is 160/90, there is symmetric proximal muscle weakness of upper and lower extremities
- Glucose level is 135 and 24h urinary cortisol is increased
- High dose dexamethasone suppresses serum cortisol levels, serum ACTH levels are high normal
Cause of symptoms?

A

Pituitary adenoma ‘‘cushing disease’’ most common cause of endogenous cushing syndrome

  • Ectopic source of ACTH will not be suppressed by high-dose dexamethasone
  • Administration of exogenous glucocorticoids will suppressed ACTH
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8
Q 
32 yo migraines
- Anisocoria
- In Bright light Right pupil is dilated and left is not
- In dim light both pupils are dilated
Defect is in which pathway?
A
  • Parasympathetic innervation of the right eye.
  • Lesions preceding optic chiasm ‘’ retina- optic nerve’’ cause monocular vision loss
  • With sympathetic defects pupil anisocoria will increase in dim light, in bright light both pupils will constrict
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9
Q

6 month old boy
- Developmental milestone and hypotonia are delayed
- 2 years later presence of involuntary movements
- Aggressively bite his own lips and fingers
- Elevated uric acid
Enzyme most likely increased?

A

Phosphoribosyl pyrophosphate amidotransferase increased

- Patient has Lesch-nyhan syndrome, activity of HGPRT is decreased

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10
Q

Target protein involved in signal transduction

  • Protein contain multiple alpha-helical regions , each 20 amino acid residues of valine, alanine and isoleucine
  • This region will perform what function?
A

Anchoring to cell membrane ‘’ G-protein coupled receptor’’
- Transmembrane domain is made up of non polar hydrophobic amino acids

  • Binding to extracellular ligand can result in activation of cAMP and tyrosine kinase, opening of ion channels ‘’ composed of hydrophilic amino acids’’
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11
Q

1st study on RR of MI among woman who are taking HRT 1.3 (p=0.07)
2nd study on RR of MI among woman who are taking HRT 1.32 (p=0.03)
Problem in first study?

A

Sample size, because the alpha was too high, above 0.05

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12
Q

15 month old boy, large foul smelling stools
- Bacterial pneumonia 6 months ago
- 20th percentile for length and 3rd for weight
Non-distended abdomen
- Likely present in patient?

A

Decreased focal elastase

- Patient has cystic fibrosis with pancreatic insufficiency, steatorrhea and failure to thrive

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13
Q

34 yo evaluation of abdominal pain 10/10
- He has been hospitalized in the past year for similar symptoms twice
- He decline when trying to obtain past medical history
- Everything seems normal, patient ask for a note to excuse him from work
Additional features present?

A

Refusal of invasive medical procedures

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14
Q

23 yo fever, headache, confusion
- cerebrospinal fluid analysis reveals lymphocytic pleocytosis and a PCR is + for herpesvirus
- Treated with high dose acyclovir on third day of treatment creatinine increases to 3.4
This could have been prevented by?

A

Aggressive intravenous hydration because of acyclovir nephrotoxicity

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15
Q

23 yo lives at sea level, attempting to trek to mount everest

  • He reaches base camp after 7 days
  • What changes has occurred in the patient?
A

Increased erythrocyte 2,3-biphosphoglycerate ( shift of O2 Hemoglobin dissociation curve to the right)

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16
Q

Newborn with elevated TSH and low thyroxine on routine screening

  • Ectopic thyroid gland just below tongue
  • Cause of this patient’s otherwise normal physical examination despite thyroid findings?
A

Transplacental transfer of thyroxine

‘’ Congenital hypothyroidism’’ caused by abnormal gland development or location.

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17
Q

45 yo woman polyuria and nocturne
- Urine output and osmolality remain unchanged with water deprivation for several hours
- After administration of desmopressin, urine output decreases and urine osmolality increases
Clearance of what substance would decrease the most after the injection?

A

Urea transporters in the medullary collecting duct, increasing urea reabsorption and decreasing renal urea clearance = enhance medullary osmotic gradient

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18
Q

34 yo woman with dysuria
- Gram negative bacteria form pink colonies on lactose containing MacConkey agar
- Days later colonies appear white on same medium
This is caused by a single nucleotide deletion within the lac operon DNA sequence
- Change is most consistent with?

A

Frameshift mutation ‘’ deletion or insertion ‘’ of nucleotides not multiples of 3

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19
Q

6 yo boy persistent nasal bleeding
- Boy picking the nasal aloe for over 30 minutes
- Negative history of bleeding disorders
- Silver nitrate cautery is performed and bleeding stops
Cautery applied to which location?

A

Nasal septum known as Kiesselbach plexus

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20
Q

32 yo with paroxysmal supraventricular tachycardia

  • Focal atrial tachycardia that originates in the Arita terminalis of the right atrium
  • Nerve is close proximity to the treatment site and at risk for injury during ablation?
A

Phrenic nerve

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21
Q

36 yo woman with mitral valve prolapse

  • Continuous heparin and warfarin are initiated
  • INR >2.5 is achieved on day 5 and heparin is discontinued
  • What caused the delay in achieving therapeutic INR?
A

Clotting factors generated before warfarin initiation

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22
Q

28 yo primigravid

  • Administration of anti-Rh immunoglobulin
  • Antibodies belong to which immunoglobulin classes?
A

IgG

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23
Q 
83 yo woman from nursing home
- Past 24hs combative and agitated 
- History of anxiety and depression
- Cannot state days of the week backwards
- She strikes out at a nurse's aide
How to treat behavioural symptoms?
A

Haloperidol

- She is suffering from delirium ‘‘agitation and psychosis’’

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24
Q

26 yo woman, fever, joint pain
- week ago pain in small joints of her right hand
- Temperature is elevated, extremity joints are not erythematous or swollen
- Several small nontender pustules are seen on the extremities
- Culture grows on chocolate agar medium
What could have prevented the patient condition?

A

Using condoms consistently

Patient has Gonorrhoeae

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25
Q 
65 yo man with right lower abdominal pain that radiated to his groin
- Climbing stairs is difficult
- Patient takes warfarin
- Right patellar reflex is decreased 
- No signs of urinary stone
problem?
A

Retroperitoneal hematoma ‘’ common in patient receiving anticoagulant therapy’’ causing FEMORAL NERVE MONONEUROPATHY ( Loss of sensation on the anterior aspect of the right thigh)
- Nerve descends through the posts major muscle

26
Q

5 yo boy draining liver abscess undergoes hepatectomy

  • Cultures grow staph aureus
  • Inactivating mutation affecting neutrophil oxidase enzyme
  • Increased risk of infection for?
A

Burkholderia cepacia - chronic granulomatous disease

27
Q

3 day old boy poor feeding and emesis

  • Normotensive and tachycardic, dehydrated
  • Patient vomits and looks with green bile
  • Fibrous bands are seen extending from cecum and right colon to the retroperitoneum causing compression of duodenum
  • Embryologic process that failed?
A

Midgut rotation around the superior mesenteric artery

28
Q

67 yo man several nodules in his axilla
- History of malignant melanoma on upper back
- Pembrolizumab is initiated which leads to reduction in size
Which best correlate to treatment-response?

A

CD8 lymphocyte infiltration

- Programmed death ligand 1 (PD-L1)

29
Q

34 yo russian immigrant, dyspnea and swelling.
- Gained 4.5 kg
Jugular venous pressure tracing is shown, waveform indicated by first peak correspond to?

A

Atrial contraction

- Second peak occurs because of isovolumentric ventricular contraction

30
Q

Patient with increased right atrial pressure, CT scan shows white line around heart, + lower extremity edema and weight gain
Diagnosis?

A

Constrictive pericarditis

31
Q

6 yo boy with 3 days of fever and headaches
- Vaccinations up to date
- mild pharyngeal erythema in addition to neck stiffness
- CSF highly lymphocytes
Agent causing this?

A

Enterovirus ‘’ coxsackievirus, echovirus’’ cause of aseptic meningitis

32
Q

Prevalence of chronic disease in a population that sees young individuals emigrate.
What effect will have on the disease prevalence over the next few years?

A

Prevalence would increase

33
Q 
17 yo girl had a seizure
- She has a history of depression
- Pupils are dilated, bowel sound decreased
- Sinus tachycardia 
Cause ?
A

TCA overdose

34
Q

17 yo girl autopsy shows ovaries composed of connective tissue with no follicles
- Additional abnormalities is likely to be found on postmortem examination?

A

Bicuspid aortic valve

  • Turner syndrome 45 XO
  • Premature ovarian failure characterized by high LH and FSH levels
35
Q

New glycopeptide antibiotic
- Administration to adults and neonatal patients shows higher plasma concentration in adults.
What causes the difference in drug effectiveness between adults and neonates?

A

Neonates have higher body water content, larger volume of distribution

36
Q

New amino glycoside antibiotic is developed against Pseudomonas
- Vd is 4.5L
New drug is most likely to have which properties?

A

It is highly charged or has high molecular weight, high plasma protein binding and hydrophilicity
-Lipophilic drugs readily cross cell membranes therefore have a higher volume of distribution

37
Q

46 yo man hospitalized with diabetic ketoacidosis
- On call physician hands off the patient to day shift physician who arrives an hour late due to nightshift job
- Day shift physician forgets to check patient’s anion gap.
Cause?

A

Physician fatigue

38
Q

65 yo man weakness and lethargy, he has lost 5kg over past month
- Smokes 1-2 packs for 40 years
- Serum calcium is 14
- 8cm right lung mass with enlarged mediastinal lymph nodes
Serum levels of what substance is elevated?

A

PTH- related protein

39
Q

21 yo postcoital bleeding

  • Patient and partner do not use condoms
  • Have never been diagnosed with a sexually transmitted infection
  • Cervix has an area of erythema surrounding external os and scant clear discharge
  • Papanicolaou smear shows?
A

Koilocytes ‘‘HPV’’

40
Q 
29 yo woman left hip pain
- History of hyperthyroidism
- Large, hyperpigmented macule with irregular borders located on left shoulder
-Menarche at 7 yo
X-ray shows osteolytic lesions
Diagnosis?
A

McCune- Albright syndrome
( precocious puberty, fibrous dysplasia, café au lait)
- Mutation in GNAS gene, continuous activation in G-Protein/CAMP/ adenylate cyclase pathway

41
Q

62 yo abdominal swelling

  • Alcohol induced pancreatitis
  • Icteric sclera, spider angiomas
  • Serum sodium is 130

What would be seen in serum ADH, urine sodium and total body volume?

A

Increase body volume, increase ADH, decrease urine sodium

42
Q 
32 yo hearing and seeing things that do not exist.
- Painful throat spasms
- Returned from camping trip 4 weeks ago
- Mydriasis and neck rigidity
Which is  receptor of this condition?
A

Muscle acetylcholine receptors

- Patient has rabies

43
Q

15 yo girl, amenorrhea
- 5th height and 20th weight
- High arched palate and tanner stage i breast, widely spaced nipples
Evaluation will show?

A
  • Atrophic ovaries, patient has turner syndrome
44
Q

Image of sarcomere
- Monoclonal antibodies directed against the binding of actin to structural support elements
Region antibodies attack?

A

Line in black in the left periphery

45
Q

Study 300 patients
- 100 have UTI
- 70% sensitive 90% specific
How many false positives?

A

20

46
Q

Study demonstrate association between alcohol consumption and transitional bladder carcinoma
- RR of 1.81 and p-value of 0.03
- Divide in 2 groups smokers and non smokers
Presence of discrepancy explained by?

A

Confounding, same as show she and intelligence in a school

47
Q

52 yo woman with pain and redness in her leg.
- Severe leg cellulitis, given IV cefazolin
- Minutes later she develops itching, dizziness and drop in BP, bilateral wheezing
What is elevated because of her medication?

A

Tryptase ‘‘anaphylactic reaction’’

- Mast cell and basophil degranulation release histamine and tryptase

48
Q

Anaphylactic reaction determined by antigen-specific IgE antibodies attached to high affinity receptors on the surface of mast cells and basophils
What mechanism will trigger vasoactive substance release by these cells

A

Receptor aggregation

49
Q

Reduced number of ribosomes attached to ER. This change is likely to impair what function?

A

Synthesis of cell membrane proteins

50
Q

15 yo boy unexplained erythrocytosis
- Single base substitution at amino acid position 82, replace lysine with methionine.
- Impairs interaction of B subunit and 2,3 biphosphoglycerate
Hemoglobin will be similar to?

A

Hemoglobin F

51
Q

52 yo man severe low back pain
- Pain worse with back flexion and raising of the legs
- Pinprick in perianal area does not cause rapid contraction of the anal sphincter.
Nerve root involved?

A

S4

52
Q

Respiratory distress after eating at a buffet.

  • BP is low, pulse is high, respirations are 32/min
  • Diffuse wheezing and erythematous skin rash are present

Changes seen in CVP, Pulmonary capillary wedge pressure, systemic vascular resistance?

A

Everything will decrease in anaphylactic shock

53
Q 
27 yo herniated disc, 
- Pain and asks for dose increase and refill 
- Came twice already for pain medication
- Examination is unremarkable
What should the physician say?
A

You’re still experiencing a lot of pain, and it has not been easy managing it, let’s discuss how you have been taking the medication

54
Q

50 yo woman had myopia for decades, she rarely has to wear glasses now.
Which condition has same etiology as the changes in the patient?

A

Skin wrinkles

55
Q

29 yo wo at 28 weeks gestation
- 2/6 blowing systolic murmur best heard at the left sternal border.
- Murmur intensifies with inspiration
- 1+ pitting edema
Which is responsible for patient’s murmur?

A

High blood flow across the pulmonic valve

‘’ Increase cardiac output during pregnancy’’

56
Q

58 yo wo history of hypothyroidism
- Large amount of interferon gamma is detected in her blood
Which cell types is responsible for this finding?/

A

T lymphocytes

Latent tuberculosis infection

57
Q

40 yo wo with left leg weakness
- Symptoms began 3 days after her father ha a heart attack
- Physical examination reveals nothing
Diagnosis?

A

Conversion disorder

58
Q

53 yo man pins and needle sensation in right hand
- Loss of sensation over right 5th digit
Weakness of which go the following movements?

A

Wrist adduction , damage to ulnar nerve

  • It enters forearm passing posterior to the medial epicondyle of the humerus
  • It innervated flexor carpi ulnaris and medial portion of flexor digitorum
59
Q

65 yo disoriented, brought in by friend
- Sister lives in the area
- Needs to make a decision about treatment in the next 2-3 hours
What to do?

A

Attempt to contact the patient’s sister for consent to intubate

60
Q

54 yo wo non healing gastric ulcer

  • Shiny tongue and pale palmar crease
  • Gait is unstable, vibration sense is markedly decreased over lower extremities, With loss of strength

Spinal cord lesions?

A

Subactute combined degeneration ( B12 deficiency)

Damage to dorsal columns and lateral corticospinal tracts

Uworld (11 decks)

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