45 motor vehicle accident - Unable to void, resistance encountered when catheter is inserted - Left hemothorax and pelvic fracture Portion of urogenital tract damage?

Posterior urethra - membranous segment - Bulbous segment most common damage in straddle injury

#5 Flashcards by jose isla

Boy slanted palpebral fissures, epicentral folds, thick nuchal folds, single palmar crease

Large reducible midline abdominal protrusion covered by skin, more pronounced when he cries
Umbilical stump is at the center of the protrusion

Cause?

Incomplete closure of umbilical ring

- Down syndrome ‘’ congenital umbilical hernia’’

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44 yo man type 2 DM

lost 7kg with occasional nausea, vomiting and sensation of fullness after eating
Previously taking metformin added new medication

If patient weight loss is due to new medication, which is it?

Glucagon like peptide 1 agonist

- Increase glucose -dependent insulin release. Enhance satiety and prolonged feeling of fullness

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Enzyme possess 3’ to 5’ exonuclease activity .

What action does this has?

Removal of mismatched base pairs during DNA replication.

- Proofreading activity.

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34 yo wo difficulty chewing, trouble speaking, symptoms worse after a long day.
- Symptoms reversible on administration of an acetylcholinesterase inhibitor

Pathogenesis similar to which disease?

Goodpasture syndrome
- Patient has myasthenia gravis
Type II hypersensitivity.

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18 yo man hematuria and intermittent flank pain
- Compression of left renal vein between SMA and aorta.

What will develop because of this?

Varicocele ‘‘nutcracker effect’’

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4 yo boy several episodes of vomiting

Found mushroom on kid hands
Poison stimulates muscarinic receptors

Effect of poison?

Nitric oxide synthesis

- Increase parasympathetic activity, relaxation and vasodilation.

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23 yo fever, vomiting , diarrhea, temperature 39

Diffuse erythematous macular rash resembling sunburn
Tampon in the vagina

Responsible for condition?

Macrophages and T lymphocytes

- Toxic shock syndrome caused by staph aureus.

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Oxygen-hemoglobin dissociation curve, what would cause a shift to the left?

Hypothermia, decrease 2,3 BPG, increased pH

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4 day old poor feeding and vomiting

exaggerated deep tendon reflexes and clonus
Impaired transport of ornithine from the cytosol to the mitochondria

Nutritional restrictions of which substance can improve this?

Proteins

- Ammonia accumulate

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45 yo man suicidal ideation

4.5 kg weight loss
He is responsible for all the evil in the world, he has heard a voice for the past week

Diagnosis?

Major depressive disorder with psychotic features.

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45 yo man severe dyspnea
- PaCO2 26 / PaO2 54
What is happening?

Alveolar hyperventilation

- acute pulmonary embolism causes hypoxemia

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33 yo man plays loud the piano nonstop.
- His mood is terrific, he claims is related to the president
- Hears voices telling him he is going to be famous entertainer
- Secret cameras are monitoring him
- No mood symptoms
Diagnosis?

Schizoaffective disorder

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52 yo wo, DM 6 months ago
- Metformin therapy is initiated
Physiological changes in hepatic gluconeogenesis / muscle glucose uptake / Endogenous insulin production?

Hepatic gluconeogenesis decreased
Muscle glucose uptake increased
Endogenous insulin production unchanged

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28 yo wo cesarian delivery

intermittent sharp pain over well healed transverse scar
Abnormal axonal regeneration is suspected

Ion channel most likely upregulated?

Sodium ‘‘propagation of action potentials’’

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38 yo right sided facial pain, knife stabbing my face
- Instigated by a meal or teeth brushing

Best initial treatment?

Carbamazepine

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36 yo man gout treated with prednisone

Uric acid level is 13.5
Allopurinol is prescribed

This last drug will increase activity of which medication?

Azathioprine

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95% confidence interval was 1.02 -1.85

Which p-values is most consistent with the results?

Either 5% or lower

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26 yo wo when she chews she hears a clicking noise in right ear

She has been grinding her teeth at night
Spasms of which muscle?

Masseter and pterygoid muscle

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35 yo man acute right knee pain and swelling

pain climbing stairs
Diarrheal illness 2 weeks before onset
Joint aspirate no bacteria

Most likely associated with symptoms?

Histocompatibility antigen HLA-B27
- Reactive arthritis occurs with chlamydia, campylobacter, salmonella, shigella or yersinia.
Deposition of Immune complexes

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20 yo flattening of right deltoid muscle

most likely injury?

Anterior dislocation of the humerus

- Axillary nerve injury

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45 motor vehicle accident

Unable to void, resistance encountered when catheter is inserted
Left hemothorax and pelvic fracture

Portion of urogenital tract damage?

Posterior urethra - membranous segment

Bulbous segment most common damage in straddle injury

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6 yo girl abdominal pain

2 episodes of non bilious emesis
erythematous macular rash over her legs and back
Urine blood and protein

Renal abnormality?

Mesangial deposition of IgA

- Henoch-Schonlein purpura

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32 yo woman vaginal discharge
- cytology shows clue cells

Organism?

Anaerobic gram-variable rod

- Bacterial vaginosis ‘’ gardenerella vaginalis’’

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78 yo man fever, cough shortness of breath

Living facilities owning several pets
Dullness to percussion and bronchial breath sounds
Left lower consolidation, gram negative diplococci

Most helpfull in preveting lung infection?

Vaccination with bacterial polysaccharide

- S pneumo most common

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30 yo man dyspnea and hypoxia - pulmonary angiography shows arteriovenous malformation Cause of hypoxia?

Increased right-to left shunting

baby with small head and eyes - cleft lip and palate, round punched out lesion with an overlying thin membrane on patient's scalp - Bowel protrudes from patient's abdominal midline Responsible for condition?

Patau syndrome | - Cutis aplasia ''membrane on scalp''

55 yo type II DM and obesity - bicarbonate is low - Normal anion gap Likely diagnosis?

Renal tubular acidosis , severe diarrhea, excesive saline infusion.

68 yo recurrent bacterial sinusitis, pneumonia and urinary tract infections - normocytic normochromic anemia - Bone marrow shows clock face cells Cause of increased susceptibility to infections?

Decrease production of functional immunoglobulins | - Multiple myeloma

73 yo severe pain and discharge from left ear - granulation tissue in left ear canal with scant amount of discharge - Culture grow gram-negative rod Describe organism?

Motile and oxidase positive | - Pseudomonas aeruginosa

66 yo shows 10cm perihilar mass in right lung - Results show non -small lung cancer - Plenty of people in the room Physician should ask?

Is there anyone you would like to remain in the room while we talk about your results

30 yo man sudden onset of severe headache and confusion - autosomal dominant polycystic kidney disease - Blood in subarachnoid space - New onset weakness in right arm and leg 5 day after admission Medication could have prevented the complications?

Calcium channel blocker | improves outcome of cerebral vasospasm by inducing cerebral vasodilation

ATP attaches to sarcomere, this causes?

Myosin head detachment from the actin filament

6 yo girl itchy rash on face - Rash began 3 weeks ago - Tacrolimus is prescribed MOA?

Inhibition of T-lymphocyte signaling

6 yo boy bruises easily, appears pale - Massive splenomegaly, platelet count is low/ Hepatomegaly - Marrow shows wrinkled tissue paper appearance Diagnosis?

Gaucher disease | - Lipid laden macrophages

``` 41 yo 4 months history of fatigue, headache, weight loss, sweating - Lid lag and fine hand tremor - Enlargement of thyroid gland TSH 10 T4 is 3 T3 is 400 ``` Cause of disorder?

pituitary tumor | Hyperthyroidism , elevated TSH pituitary adenoma

What hormone level would increase at breakfast , lunch and dinner time?

Ghrelin

40 yo wo malaise, fever, productive cough, pleuritic chest pain - HIV, injection drug - Lung examination reveal lancet shape image Pathogenic factor that contributes to lung infection?

Antiphagocytic microbial capsule | - Strep pneumo

35 yo genital warts on labia majora | - This could also infect?

True vocal cords

65 yo wo episode of syncope after standing - Advanced adenomatous changes in one polyp and adenocarcinoma in other Responsible for transformation of advanced adenoma to carcinoma?

TP53

Neural crest cell migration in human fetus is interrupted during the 12th week This results in lack of innervation where?

Rectum | - Hirschsprung disease

64 yo man severe abdominal pain, nausea, hypertension, MI, systolic heart failure Respirations are 24/min Sodium 136, bicarbonate 12, pH 7.2/ PaCO2 26/ lactic acid 6.2 Abdomen reveals distal ideal wall thickening and lack of enhancement Decreased activity of which enzyme?

Pyruvate dehydrogenase - Patient suffering from acute mesenteric ischema. Inadequate O2 present in tissues, pyruvate is converted to lactate

54 yo man, headaches and leg weakness - Physical examination shows neurofibromas and cafe au last spot Inheritance pattern?

Neurofibromatosis type I | - Autosomal dominant

2 yo boy - My boy is always sick, otitis media, skin infections, pneumonia, staph aureus - Testing shows absent CD18 antigen on surface of leukocytes Associated with?

Persistent leukocytosis - Leukocytes adhesion deficiency CD18 necessary for formation of integrins - Late umbilical cord separation

52 yo enlarging neck mass, fatigue and weight loss - enlarged tonsils and splenomegaly - Large B cells have replaces normal tissue. + for Epstein Barr virus Risk factor associated with condition?

Advanced HIV infection | - Non Hodgkin lymphoma , immune dysregulation

Therapy X Standard alive 1 year 40 51 Dead 1 year 60 69 Number need to harm for therapy regimen?

NNH = 1/ Absolute risk increase Adverse in therapy: 60/100 Adverse in standard: 69/120 0.6 - 0.575 = 0.025 ( 2.5%) 1/0.025 = 40 persons

65 yo man fevers and chills - Lives eastern massachusetts - enjoying gardening and swimming - Traveled to Thailand 2 years ago and to florida 2 months ago - Coarse crackles, palpable splenomegaly, nor rash or open wound Exhibit shows intraerythrocytic ring inclusions Diagnosis source?

Ixodes tick, | - Babesiosis

1 week old boy recurrent vomiting - Sunken fontanelle and dry mucous membranes - Sodium 122 / Potassium 5.7 Findings in cortisol / aldosterone/ serum ACTH / 17 hydroxyprogesterone?

Cortisol decrease Aldosterone decrease Serum ACTH increase 17 hydroxyprogesterone increase COngenital adrenal hyperplasia due to 21 hydroxylase deficiency

Ashkenazi jewish descent - enzyme deficiency that results in decreased degradation of phospholipid substrate to ceramide which leads to buildup of phospholipid. Clinical features of affected child?

Retinal opacification and splenomegaly | - Niemma pick disease deficiency of sphigomyelinase

Blurred vision worse when he reads - Took diphenhydramine for allergies - Visual symptoms are due to blockade of which mediator?

Acetylcholine | - Anticholinergic effect of 1st generation antihistamine cause these symptoms

28 yo insomnia - Hypersenstitive to loud sounds - Friend being blown up after step-in on a landmine - Anxious mood Appropriate pharmacotherapy?

SSRI's

21 day old boy - Bulge in his neck - Looks toward right and cries then head is turned left - Mass on neck does not move when child swallows Condition present prenatally?

Intrauterine malposition - Congenital torticollis - Sternocleidomastoid muscle injury

35 yo man respirations are 12/min pH7.54 / PaCO2 49 What study would be helpful in determining patient acid-base abnormality?

Urine chloride - Metabolic alkalosis - Low CL impairs renal excretion of HCO3

64 yo man dyspnea on exertion - Hypertension several years ago - Dullness to percussion and decreased breath sounds - Right sided pleural effusion ``` Pleuropulmonary changes are most likely in Vascular permeability Vascular hydrostatic pressure Vascular oncotic pressure Lymphatic flow ```

Vascular permeability normal Vascular hydrostatic pressure increase Vascular oncotic pressure normal Lymphatic flow increased

24 yo motorcycle collision - Patient opens eyes spontaneously gazing around the room but does not track objects - Moves all 4 extremities, but movements are not purposeful Diagnosis?

Persistent vegetative state

Prostate adenocarcinoma, radical prostatectomy is done. - Nerves within the fascia surrounding the gland are injured Consequence?

Erectile dysfunction ''prostatic plexus'' innervates corpus cavernosa

52 yo man right pupil is 3mm and left is 5mm. Light is dimmed, anisocoria increases - Location of lesion?

Right oculosympathetic pathway

12 yo rash posterior neck - Pruritic with the cooler weather and patient scratch his neck Cause of rash?

Genetically mediated skin barrier dysfunction | - Chronic atopic dermatitis , epidermal barrier dysfunction

40 yo wo anemia - increasing heavy irregular menses - 24hs After transfusion of blood developed yellowing of the eyes and face but no hepatosplenomegaly Antibody-antigen reaction?

Patient's antibodies against the blood product minor red blood cell antigen - Delayed hemolytic transfusion reactions.

65 yo man pain, redness and swelling in his calf - Cellulitis and clindamycin - Watery diarrhea and abdominal cramps - Toxin responsible affects what component?

Cytoskeleton integrity | - C difficile

35 yo man urethral discharge - neutrophils and intra gram negative diplococci - Infection resolves, but had similar 3 months ago Reason for recurrence of infection?

High variability of microbial antigenic structure

#5 Flashcards

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