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Uworld > #9 > Flashcards

#9 Flashcards

1
Q

35 yo man decreased libido and erectile potency

  • B-hCG is elevated and serum TSH is normal
  • Irregular testicular mass with cystic area

Cause of gynecomastia?

A

Increased Leydig cell aromatase activity

  • Increase ratio of estrogens
  • HCG secretion germ cell tumor
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2
Q

46 yo wo slipped while getting out of shower

  • Left knee pain
  • Patella fracture is present

Findings on examination?

A

Inability to extend the knee against gravity

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3
Q

4 yo boy worsening cough for past 2 days

  • history of recurrent pulmonary infections
  • High chloride content in sweat

Abnormality seen?

A

Abnormal post-translational processing of a transmembrane protein
CFTR

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4
Q

Urine + Urine -
test + 60 20
test - 140 180

Specificity of the test?

A

90%

180/200

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5
Q

80 yo wo urinary incontinence

  • Leaking urine all the time
  • Mild cognitive impairment
  • Vaginal atrophy
  • No leaking with cough

What medication would be most helpful?

A

Stimulation of B3 adrenergic receptors
- Urgency incontinence ‘’ detrusor instability’’

Mirabegron causes detrusor smooth muscle relaxation

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6
Q

48 yo wo painless left breast mass
- Dimpling of the skin
- Mass invasive ductal carcinoma, overexposes HER2
Treated with monoclonal antibody

Which host factor is responsible for mediating response?

A

Natural killer cells and granzymes

- Fc portion is identified by NK CD16

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7
Q

8y boy fever, runny nose
Lymph node is shown, pointing at germinal centers

Process undergoing at this location?

A

Isotype switching

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8
Q

46 yo wo nausea , sweating, feeling like going to pass out

  • Glucose was 50
  • Glyburide was added to her regimen

MOA?

A

Membrane ion channels

K-ATP

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9
Q

Agent activates G protein dependent phospholipase C

Which intracellular substance is likely to increase after exposure ?

A

Ca

- IP3 activates protein kinase C via an increase in intracellular Ca

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10
Q

42 yo man acute shortness of breath

  • Box handler at a warehouse
  • Short systolic murmur is heard at apex
  • Chordal rupture and severe mitral regurgitation

Patient left ventricular hemodynamics compared to normal heart ?

A

Afterload decrease
Preload increase
Ejection fraction increase

Acute mitral regurgitation, which leads to pulmonary edema

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11
Q

42 yo man tonic clonic seizure

  • Works on construction
  • MRI of brain shows multiple circle enhancing lesion

Most likely cause?

A

Toxoplasmosis

- Patient likely has HIV , low CD4, toxoplasmic encephalitis

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12
Q

55 yo forced into early retirement

  • Irritable, started to curse his coworkers
  • Developed a sweet tooth

Neuropathologic finding?

A

Aggregations of phosphorylated tau protein & abnormal TDP-43 protein inclusions

  • Frontotemporal dementia
    ‘‘disinhibition’’
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13
Q

65 yo wo sudden chest heaviness

  • Extremities are cold and clammy
  • ST segment elevation in lateral leads

Changes in Cardiac contractility / SVR / Pulmonary artery systolic pressure?

A

Cardiac contractility Decreased
SVR increased
Pulmonary artery systolic pressure Increased

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14
Q

1 day old boy hyperphenylalaninemia

  • phenylalanine restricted diet with tyrosine
  • Axial hypotonia and microcephaly
  • Elevated prolactin

Physician suspects cofactor deficiency , which enzyme is it?

A

Dihydrobiopterin reductase

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15
Q

35 yo man swelling of leg

  • Crepitus is present
  • Gas in tissues

Microorganism commonly associated with which condition?

A

Transient watery diarrhea and abdominal discomfort

  • Clostridium perfringens
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16
Q

14 yo anterior knee pain

  • swelling 3 cm below inferior border of patella
  • Overuse of which muscle contributed to this?
A

Quadriceps femoris

- Osgood - Schlatter disease

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17
Q

64 yo occasional dizziness
- left vertebral artery reveals retrograde flow instead of anterograde

artery most likely occluded ?

A

Left subclavian

- Subclavian steal syndrome

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18
Q

56 yo wheezing, cough
- Smoked 2 packs per day

Best Ratio to explain pathological index to determine severity is?

A

COPD
Reid index
Mucous gland / submucosa + lamina propria

c/ b+c+d

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19
Q

42 yo heavy weight lifter
- his arm suddenly and involuntary give away and he drops the weight

What structure is responsible for sudden muscle relaxation?

A

Golgi tendon organ

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20
Q

14 yo girl
- Short and thick neck
Shortened fourth metacarpals

Most likely seen in echocardiogram?

A

Bicuspid aortic stenosis

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21
Q

24 yo wo give birth and 5 days later she finds herself crying constantly
- She has no suicidal ideation of thoughts of harming the baby

Appropriate response?

A

Postpartum mood changes are common, please call me if you do not start to improve within the next week

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22
Q

19 yo wo, dysuria, urinary frequency and urgency
- Day after having sexual intercourse with boyfriend

Reveal bacteria and white blood cells

Appropriate pharmacotherapy?

A

TMP-SMX

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23
Q

7 yo boy swelling of hands and feet

  • Anaphylaxis following a bee sting
  • urine became frothy + protein

Biopsy of kidney will show what under Light microscopy / Immunoflorescence / Electron microscopy?

A
  • Light Normal histology
  • Immune Negative for complement and IgG
  • Electron Effacement of podocytes
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24
Q

Crohn disease patients start new treatment ( monoclonal antibody)
- Some have renal or hepatic dysfunction

Which of following is most appropriate dose adjustment to decrease drug toxicity?

A

No dose adjustment is necessary

- Monoclonal antibody not eliminated by hepatic or renal clearance

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25
Q

32 yo woman fatigue, malaise

  • Severe thrombocytopenia
  • TTP is suspected

What is required to make the diagnosis?

A

Hemolytic anemia

- Adamts13 deficiency result in MAHA

26
Q

44 yo greenish sputum
- Dullness to percussion, crackles and egophony

What account for the color of patients sputum?

A

Myeloperoxidase

27
Q

32 yo wo, 35 weeks
- Fetus reveal incomplete separation of cerebral hemispheres with single ventricle

Associated mutation with?

A

Trisomy 13

- Holoprosencephaly

28
Q

39 yo robbed and hit in the head

  • Initially had difficulty walking
  • Since the attack terrible rude , insults customers

Damage to which region of the brain?

A

Orbitofrontal cortex

29
Q

74 yo forgetfulness over past 2 years

  • Don’t have movement or gait abnormalities, feelings or depression
  • Hypertension and renal artery stenosis

Pathogenesis associated with this condition?

A

Microtubule-associated protein polymerization

  • Alzheimer disease present with Beta amyloid plaque and neurofibrillary tangles
30
Q

68 yo recurrent syncopal episodes

  • History of hypertension and chronic kidney disease
  • Takes lisinopril, amlodipine and clonidine

Offending medication is discontinued and syncopal episodes stop.

Drug MOA?

A

Decreasing presynaptic release of norepinephrine

- Clonidine (alpha 2 adrenergic receptors) bradycardia

31
Q

34 yo weight gain

  • Easy bruising, irregular periods
  • elevated cortisol not suppressed after low dose dexamethasone

Pathological finding in adrenal glands?

A

Hyperplasia of the zone fasciculate and reticularis

- Cause of cushing syndrome , excess ACTH

32
Q

45 yo woman numbness and painful tingling of right hand

  • Plays tennis
  • Diminished sensation in lateral palm, thenar eminence

Injury at which nerve?

A

Humeral and Ulnar heads of the pronator teres muscle

  • damage to median nerve
33
Q

15 yo boy difficulty with movement

  • Kyphoscoliosis and high plantar arch
  • Brother suffered from neurologic disorder and died of heart failure

Neuropathological finding?

A

Degeneration of spinocerebellar tracts

- Friedreich ataxia

34
Q

32 yo man substernal burning sensation

  • associated with fatty meals and food regurgitation
  • History of cystic fibrosis complicated by pancreatic insufficiency
  • He is prescribed omeprazole

Absorption of nutrients most likely improve after medication?

A

Dietary fat

- PPI’s decreased gastric hydrochloric acid production and increase lipase activity

35
Q

Counseling patient regarding diet and exercise habits would be an example of which of the following?

A

Health promotion

36
Q

34 yo man fatigue and lightheadedness

  • Upper respiratory infection last week
  • Pulse becomes undetectable to palpation during inspiration
  • Jugular veins are distended

Diagnosis?

A

Cardial tamponade

  • Constrictive pericarditis can present the same way but it takes several weeks to months to develop
37
Q

46 yo worsening blurry vision, dry mouth

  • Potluck event he consumed home-canned foods
  • Shows bilateral ptosis

which step in neuromuscular transmission is affected?

A

Botulinum toxin block snares protein

- Block Ach release

38
Q

25 yo wo week of cough and dyspnea

  • Travelled to myanmar
  • Intermittent pain and diarrhea
  • Immune thrombocytopenia
  • Scattered wheezes and eosinophilia

Pathogen transmitted via?

A

Larval skin penetration

  • Strongyloidiasis
  • Rhabditiform larvae
39
Q

62 yo wo, hyperlipedimia

  • T2DM, obese
  • 30 pack year history
  • Cardiac arrest due to ventricular arrhythmia
  • Obstruction of left anterior descending artery + narrowing of right renal artery

Compared to right kidney, left kidney will demonstrate what?

A

Arteriolar wall thickening

- Systemic hypertension

40
Q

22 yo man

  • 9 months ago decided to work on his research without being disturbed
  • Showers once a week, he is agitated and accused her parent of being one of the black suits when ask him about his project

Most appropriate medication MOA?

A

Dopamine receptor antagonism

- Schizophrenia

41
Q

Osteocytes remain connected to each other by?

A

Gap junctions

42
Q

57 yo man, severe pyelonephritis

  • Diabetes, hypertension
  • He needs to start antibiotic that depends mainly on non-renal clearance

Which characteristics should antibiotic have if hepatic metabolism and clearance is desired?

A

High lipophilicity

- Drugs more lipophilic are processed by liver into more polar compounds for easier elimination in bile and urine

43
Q

Influenza epidemic

  • Cause is antigenically novel virus strain carrying strain hemagglutinin and neuraminidase
  • Reassortment between influenza and swine influenza occurs

Which virus can undergo similar process?

A

Rotavirus ( segmented )

44
Q

28 yo man bump on his right testicle
- Lactate dehydrogenase and alpha-fetoprotein levels are elevated

Histological diagnosis?

A

Nonseminomatous germ cell tumor

45
Q

38 yo man

  • 5 y history of lumbar pain
  • 2y history of bilateral knee pain
  • Works in construction
  • Blue black sports on his sclerae and auricular helices

Cause of arthritis ?

A

Homogentisic acid dioxygenase deficiency

- Alkaptonuria ‘’ autosomal recessive’’

46
Q

68 yo man

  • right lower lobe consolidation and right sided pleural effusion
  • Exudate shows rapid neutrophil locomotion

Component responsible for this?

A

Leukotriene B4

47
Q

31 yo man progressive dyspnea

  • recurrent episodes of nosebleeds since childhood
  • Accentuated S2 over upper left sternal border
  • Diggital clubbing
  • exhibit shows spider angiomatas

Cause of patient dyspnea?

A
  • Vascular malformation

Patient has rendu-osier weber syndrome ‘’ hereditary hemorrhagic telangiectasia

48
Q

22 yo man 3 month of back pain

  • Emigrated from neap
  • Lumbar spine reveals destruction of anterior portion of L1-L3 bodies
  • Fluid collection beneath anterior longitudinal ligament

Diagnosis?

A

Tuberculosis

- potts disease

49
Q

12 yo boy gait instability and pruritic skin rash

  • Several episodes of similar skin rash
  • Scaly erythematous skin lesion in sun-exposed areas and cerebellar ataxia
  • Increased level of amino acids in urine

Patient will respond to which supplement?

A

Niacin

- Hartnup disease patients have pellagra like symptoms

50
Q

52 yo wo
metastatic non-small cell lung cancer

Treated with cisplatin and neurokinin1 antagonist

Later medication will improve what?

A

Chemotherapy induced nausea

51
Q

56 yo wo with schizophrenia

  • Diagnosed with cholecystitis
  • Patient doesn’t want surgery, God will take care of her
  • She wants to go home
  • She is oriented to person, place and time

Next step in management?

A

Assess patient’s understanding of the risk of going home

52
Q

4 yo girl fever, vomiting, tenderness over mastoid

  • Recurrent episodes of otitis media
  • Mother prefers natural healing

appropriate response by physician?

A

Can you please tell me what you currently understand about your child’s infection?

53
Q 
4 week old boy 
- Urine appeared dark yellow and pale colored stools, skin has also appeared yellow
- mildly enlarged and firm liver
Total bilirubin is 7.3
Direct 5

Mechanism causing this?

A

Extrahepatic obstruction of bile ducts

54
Q

Androgens synthesized in this patient’s ovaries are converted to estradiol in which cell?

A

Granulosa, this is done thanks to aromatase

55
Q

69 yo sudden onset and palpitations

  • Hypertension and GERD
  • Irregularly irregular rhythm, narrow QRS complex and no P waves

What determines ventricular contraction rate in patient?

A

AV refractory period

- atrial fibrillation

56
Q

25 yo man requires kidney transplant
- Takes medication that inhibits lymphocyte proliferation by blocking interleukin 2 signal transduction

MOA of which drug?

A

Sirolimus

57
Q

19 yo man stabbed in right arm

  • Laceration of volar(flexor) surface of proximal forearm
  • Wound to nerve that course between flexor digitorum superficial and profundus

Movement impaired?

A

Opposition of the thumb
- Median nerve

  • Ulnar nerve courses between flexor digitorum profundus and flexor carpi ulnaris
58
Q

43 yo man painful muscle cramps

  • Tingling sensation in mouth
  • High BP and thyroid disorder
  • Light tapping anterior to ear elicits twitching

Patient will reveal ?

A

Recent thyroid surgery

- Removed PTH glands by accident - hypocalcemia

59
Q

Lesions on vulvar area are shiny, round paupers with central indentation

Cause of condition ?

A

Poxvirus is cause of molluscs contagiosum

60
Q

24 yo wo with male fetus

  • He has enlarged fetal kidneys with diffuse small cysts
  • Amniotic fluid volume is very low

Present in newborn after delivery ?

A

Respiratory distress

- autosomal recessive polycystic kidney disease causes oligohydramnios

Uworld (11 decks)

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