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uworld > #8 > Flashcards

#8 Flashcards

1
Q

50 yo man

  • 20 pack smoking history
  • BP160/90
  • Blood glucose 155

Which intervention is likely to have the greatest effect on reducing mortality risk?

A

Smoking cessation

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2
Q

32 yo man severe right flank pain that radiates to the groin

- labs seen?

A

Normocalcemia, hypercalciuria

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3
Q

35 yo primigravida have gallstones at 38 weeks
- 1 year ago failed to demonstrate abnormality

Pathogenetic components contributed to this condition?

A

Estrogen-induced cholesterol hyper secretion and progesterone induced gallbladder hypo motility

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4
Q

18 yo high fever and confusion

  • Several episodes of pneumonia and meningitis a year ago
  • Examination reveals petechial rash on the trunk and extremities
  • Neck stiffness and photophobia

What immune system impairments is most responsible for recurrent infection?

A

Inability to form the membrane attack complex ( C5-C9)

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5
Q

30 yo wo chronic anxiety and tension

  • Worries about everything
  • Buspirone is initiated

Medication is associated with ?

A

No risk of dependence

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6
Q

43 yo wo dull abdominal pain

  • right upper quadrant pain after fatty meal
  • Several mobile echogenic foci within gallbladder lumen

Set of condition present in gallbladder
Cholesterol / Bile acids/ Phosphatidylcholine

A

Cholesterol increased
Bile acids decreased
Phosphatidylcholine decreased

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7
Q

25 yo oculocutaneous albinism

  • homozygous mutation in chromosome 15q12
  • hypopigmented skin with blonde hair

Husband has oculocutaneous albinism at 11q14.

Chance of having a child with albinism is O%

Why?

A

Locus heterogeneity

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8
Q

62 yo watery diarrhea and wheezing, becomes flushed and red
- Mass lesions in liver lobe

Medication to relieve symptoms?

A

Octreotide

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9
Q

72 yo difficulty hearing
- Hypertension, heart failure, chronic kidney failure

Bilateral sensorineural hearing loss

What medication contributed to this?

A

Furosemide

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10
Q

12 yo boy fever fatigue and easy bruising
- Anemia, thrombocytopenia, leukocytosis and lymphoblasts

  • Treated with chemotherapy and 6-mercaptopurine

Which enzyme inactivates this enzyme?

A

Xanthine oxidase and thiopurine methyltransferase

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11
Q

24 yo painful erection for past 6 hs unrelated to sexual excitement

Drug most likely caused this condition?

A

Trazodone

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12
Q

64 yo man acute onset right upper quadrant abdominal pain, nausea and vomiting undergoes bowel resection

  • Gallstones and edema of the gallbladder wall
  • No gallstones noted before bowel resection

Responsible for development of gallstones?

A

Decreased cholecystokinin release due to lack of enteral stimulation

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13
Q

In florida several individuals develop febrile illness during summer

  • Signs of meningeal irritation
  • Brain shows no abnormalities

Most helpfull in controlling disease outbreak?

A

Control of vector arthropods

- Arbovirus

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14
Q

3 day old boy diapers smell unlike what they should
- Lethargic with dry mucous membranes

What should be restricted from infant?

A

Leucine

- Maple syrup urine disease

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15
Q

12 yo boy excessive bleeding from tooth extraction

  • decreased factor VIII
  • Mutation in enhancer

accurate statement about enhancers?

A

It can be located upstream, downstream or within introns of the gene.

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16
Q 
25 yo wo intermittent fever and severe body aches
- Pale lips and conjuctivae
- There is no hepatosplenomegaly
Platelets 40000/ Leukocytes 2000
- Normocytic anemia

Bone marrow biopsy will show?

A

Hypocellular marrow filled with fat and stroma

- Aplastic anemia - dry tap

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17
Q

1h girl flat nasal bridge, up slanting palpebral fissures, small mouth and single palmar crease
- Holosystolic murmur heard best along sternal border

Abnormality?

A

Mosaicism
- Patient has down syndrome
Meiotic nondisjunction / unbalanced translocation / mosaicism

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18
Q

17 yo boy insomnia, headaches

  • Went on a field trip to study bats in a cave
  • Painful spasms, progressive paralysis, coma and dies

What could have prevented this ?

A

Inactivated vaccine

- Rabies

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19
Q

40 yo abdominal pain, watery diarrhea

  • Gastrin is elevated
  • Prominent gastric folds and multiple ulcers in duodenum

Patient should be assessed for?

A

Recurrent nephrolithiasis
- Zollinger ellison syndrome
MEN1
- Pituitary , parathyroid & pancreatic

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20
Q

42 yo heavy painful menstrual bleeding

  • Bilateral tubal ligation 3 years ago
  • Uterus is uniformly enlarged and tender
  • Urine B-Hcg is negative

Cause of symptoms?

A

Endometrial glands and stroma within the myometrium
- Adenomyosis

  • Leiomyomas are irregularly enlarged
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21
Q

study 41 patients with condition were recruited and received treatment
- All patients suffered toxicity’s

Phase of study ?

A

Phase II clinical trial

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22
Q

Obesity is 3 times higher in a cluster of 5 specific ZIP codes compared to the county average

  • What should be performed first to understand the etiology of disparity in obesity prevalence?
A

Cross-sectional analysis of demographic attributes and health belabours across community ZIP codes

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23
Q

Athlete comes with right knee pain
- Posterior aspect of MRI shows Asterisk on left upper corner

Attachment site to which ligament?

A

Posterior cruciate

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24
Q

45 yo woman end stage renal disease ADPKD

  • Transplanted kidney is reduced in size
  • Increase serum creatinine level over last 6 months

Biopsy of graft is most likely to show?

A

Obliterative vascular fibrosis

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25
Q

27 yo man, episodes of muscle weakness

  • BP 190/110
  • Low plasma renin activity

Overactivity of which structure is responsible for this?

A

Zona glomerulosa of the adrenals
- Primary hyperaldosteronism
Hypertension / Hypokalemia

26
Q

43 yo man with advanced HIV

  • Creatinine is elevated and phosphorus is decreased
  • Renal shows cytoplasmic vacuolization in the proximal tubules accompanied by loss of brush border and basement membrane denudation
  • Eosinophilic inclusion are also seen in proximal tubules

Diagnosis?

A

Tenofovir - induced nephrotoxicity

27
Q

38 homeless woman, pregnant at 27 weeks, and his 19yo son who has cerebral palsy

  • Which is eligible for medicare coverage?
A

Woman’s disabled son

28
Q

Embryonic kidney development
- signals exchanged between metanephric diverticulum and blastema

  • If insult occurs during fetal development that inhibits structures formed by metanephric blastema

What derivatives will fail to develop?

A

Distal convoluted tubules

29
Q

Pulmonary gas exchange

  • PO2 is 150
  • Alveolar PO2 is 104

what explains this findings?

A

Diffusion impairment

- Fibrosis or emphysema

30
Q

17 yo boy type 1 DM

  • Unresponsive at home
  • Given glucagon, this promotes binding to GTP to a specific receptor associated protein

This leads to rapid decrease in intracellular glycogen stores and release of glucose into blood

Mediator of these effects?

A

Protein kinase A

31
Q

4 week old vomiting

  • BP 182
  • No murmurs or gallops

Arterial blood gas analysis will show
-pH/ PaCO2 / HCO3/ Anion gap?

A

pH 7.49
PaCO2 46
HCO3 34
Anion gap normal

32
Q

30 yo wo depressed mood
- Course of psychotherapy is advised to which she responded: Have you ever had depression or been in therapy, doctor?

Best response to this patient?

A

I am curious to understand what makes you ask that question

33
Q

19 yo man painful subcutaneous forearm nodule

  • 2 weeks earlier he received a laceration on his left forearm
  • Biopsy shows granulomas and activated macrophages

What is responsible for this condition?

A

Reaction to a foreign body

34
Q

58 yo man difficulty carrying heavy bags out of overhead bins

  • Shoulder pain , weakness of shoulder abduction and loss of biceps reflex on the right side
  • pinprick sensation is decreased over right lateral arm and forearm

Pathologic process underlying this ?

A

Degenerative changes in the vertebral joints

- nerve root compression

35
Q

36 yo left wrist is swollen

  • Lunate dislocation
  • Greatest risk for impairment of?
A

Thumb abduction

  • Compression of median nerve
  • Carpal tunnel syndrome
36
Q

64 yo left lower extremity weakness

  • Hypertension and diabetes
  • Reflexes are 3+
  • Babinski sign is present

Structure cause of this symptoms?

A

Right anterior cerebral artery

37
Q

15 yo girl fever, fatigue, sore throat, splenomegaly and symmetric posterior cervical lymphadenopathy

Atypical cells show large lymphocytes with abundant cytoplasm

These cells are activated form of what?

A

CD8 cytotoxic lymphocytes

- Infectious mononucleosis

38
Q

67 yo diastolic murmur at left sternal border

  • erythematous macule on his hands and feet
  • Gram + cocci and catalase negative able to grow in hypertonic 6.5% saline and bile

Medical history should include which procedure in past month?

A

Cystoscopy

- enterococcal endocarditis

39
Q

49 yo woman 2 day history of flank pain, poorly controlled T2DM.

  • Respirations are 34/min
  • Flushed/ Diaphoretic,
  • Neck veins are flat

Effects on
PCWP/ Cardiac Index / SVR / Mixed Venous O2 saturation

A

PCWP decrease
CI increase
SCR decrease
MVO2 saturation increase

Patient has septic shock ‘‘distributive’’

40
Q 
CVP decrease
PCWP decrease
CI decrease
SVR increase
SvO2 decrease

Shock?

A

Hypovolemic

41
Q 
CVP increase
PCWP increase
CI decrease
SVR increase
SvO2 decrease

Shock?

A

Cardiogenic

42
Q 
CVP increase
PCWP decrease
CI decrease
SVR increase
SvO2 decrease

Shock?

A

Obstructive

43
Q

30 yo wo

  • 10kg weight loss
  • Increase in pigmentation of skin
  • Cortisol before and after administration of exogenous ACTH shows no difference

Serum values of patient?
Na/ K/ Cl /HCO3

A

Na decrease
K increase
Cl increase
HCO3 decrease

Patient has primary adrenal insufficiency ( addison disease)

44
Q

10 yo boy shortness of breath and failure to gain weight

  • Pulmonary stenosis and subaortic ventricular septal defect with deviation of the origin
  • Cyanosis , kid assumes squatting position

Which mechanism during squatting relieves this child’s symptoms?

A

Increasing systemic vascular resistance

45
Q

Properties of hemoglobin
- Oxygen unloading and loading

In a graph ( sigmoid shape)
Y % O2 saturation
X pO2

If point increase in both axes , hemoglobin molecules are most likely to release ?

A

Protons
- Increases O2 binding affinity, cooperative binding known as haldane effect

  • Decreases affinity for CO2 of hemoglobin, this causes acidity resulting in H ions release
  • In peripheral tissue high levels of CO2 shift hemoglobin curve to the right causing unloading of O2 (Bohr effect)
46
Q

10 yo boy shortness of breath, fever and fatigue.

  • tachypnea, tachycardia and hypotension
  • New holosystolic murmur
  • Biopsy shows aschoff body

what cause development of this?

A

Bacterial infection

- Group A streptococcal pharyngeal infection ‘’ pancarditis’’

47
Q

43 yo woman amenorrhea

  • increased serum prolactin level
  • normal TSH
  • Calcium is normal
  • Pituitary adenoma

If left untreated this patient creates risk of developing?

A

Loss of bone mass

- secondary amenorrhea, hypogonadism

48
Q

34 yo man bilateral femur fractures

  • Receives transfusion of RBC
  • A few minutes later he reports tingling sensation in fingers and toes.
  • serum ionized calcium is 4

Cause of symptoms?

A

Calcium chelation by a substance in the transfused blood

- RBC normally have citrate anticoagulant leading to chelation of calcium

49
Q

25 yo man schizoaffective disorder with previous suicide attempt

Started on haloperidol and sertraline
- Temperature is 40.6, diffusely rigid without clonus

Antidote for this condition MOA?

A

Inhibition of calcium ion release from SR of skeletal muscle

- Patient has neuroleptic malignant syndrome

50
Q

23 yo man, anesthesia was induced with propofol, succinylcholine was used for intubation
- Maintained via propofol and fentanyl infusions

Patient is slow to wake up

Reason for prolonged paralysis?

A

Decrease plasma hydrolysis

- Pseudocholinesterase deficiency ‘’ succinylcholine’’

51
Q

72 yo man lifelong smoker

  • Bibasilar crackles, elevated jugular venous pressure
  • Lower extremity pitting edema

LVEDP graph shows left upper movement of the curve compared to the normal

What is the cause of this?

A 
Transthyretin deposition ( amyloid protein) 
- Decompensated congestive heart failure shows reduced compliance = diastolic dysfunction
52
Q

63 yo blockage in left anterior descending artery 2 months ago

  • Hypertension, T2DM, degenerative joint disease
  • Presence muscle aches and cramps after exercises
  • Elevated serum creatine kinase

Medication cause also?

A

Increase hepatocyte LDL receptor recycling

- Statin induced myopathy

53
Q

52 yo cancerous polyp was removed, no evidence of invasive cancer,

  • Reassured of excellent prognosis
  • Patient replies : should i be happy of having cancer in the first place ? you don’t know what you talking about
  • Appropriate response?
A

I realize it can be very upsetting to be told something unexpected about your health. What is your understanding of the results?

54
Q

65 yo man non healing ulcer of the foot, foul smelling discharge
- Blood culture grow B-lactamase producing bactericides species

Most likely to provide coverage?

A

Piperacillin-tazobactam

55
Q

56 yo man local redness and swelling
- mixed hyperlipidemia, hypertension
- Swollen first metatarsophalangeal joint
- High leukocyte count
Gram stain = needle-shaped negatively birefringent crystals

Drug that precipitated this condition ?

A

Hydrochlorothiazide

- Hyperurecemia

56
Q

76 yo wo burning on urination
- right sided flank pain
Culture grows E.Coli

Organism found to have methyltransferase that methylates ribosomal RNA

This enzyme confers resistance to which class of antibiotics?

A

Aminoglycosides

57
Q

68 yo man gross hematuria

  • He takes metformin
  • Worked at a rubber manufacturing plant for 35 y

What would be discovered?

A

Bladder cancer

- Transitional cell

58
Q
  • CAAT base sequence is responsible for which function?
A

Initiation of transcription

59
Q

60 yo man acute bronchitis

  • Prostate cancer treated with leuprolide
  • DXA shows low bone mineral density

Underling mechanism of observed finding?

A

Decreased estrogen and testosterone levels

  • Leuprolide is GnRH analog used in a constant manner to induce hypogonadism ‘’ suppression of pituitary LH release’’
60
Q

8 yo boy acute facial puffiness

  • skin infection 2 weeks ago
  • edema in angles
  • Dark urine
  • Renal biopsy shows fluorescent areas

Presence of which substance in these areas?

A

C3
- Poststreptococcal glomerulonephritis granular deposits of IgG, IgM and C3
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