Prededicated Flashcards
83 yo man confused, hx of DM, gluc at 50 because accidentally took insulin twice. Duaghter says inc forgetfulness with bills and groceries, MRI of brain shows no issues. What is cx of cognitive sxs? A. Alz Dx B. Benzos use C. Normal Aging D. Parkinsons E. Vasc Dementia
A. Alz Dz
- slow progessing trouble with ADLs and MRIs normal during early stage. Late stage = temporoparietal atrophy esp in hippocampus region
- B. benzos = delirium in elderly, wax/wane of consciousness. contra in old ppl
- C. norm aging = no issue woth ADLs
- D. Parkinsons = bradykinesia, shuffling gait. loss of Dopa in substantia nigra. lewy bodies present
- E. Vasc Dementia = decline via discrete CVA events. MRI shows mini infarcts. common in DM, HTN, smoking. often moody
28 yo female with hx of asthma thats worsening. takes albuterol but doesnt want corticosteroid. Dr gives step up tx directly interacting with these cells (mast cells) Which med was prescribed? A. cromolyn Na B. Ipratropium bromide C. Montelukast D. Omalizumab E. Salmeterol F. Theophylline
A. cromolyn Na
- stab mast cells to dec degran = no histamine rls
- B. ipratrop = antimusc of M3, used in COPD or refract asthma. no interaxn with mast cells
- C. Montelukast = blocks LT recep, no interaxn with mast
- D. omalizumab = used for severe persistent asthma, binds IgE to dec degran of mast
- E. Salmetrol = long acting B agonist of B2 recep, no interaxn with mast
- F. Theopylline = inhib phosphodiesterase= inc cAMP = bronchodil, no mast cells
A 60-year-old postmenopausal woman comes to her gynecologist because of abnormal vaginal bleeding. The bleeding has occurred for the past 6 months and has been accompanied by decreased appetite with a 7-kg (15-lb) weight loss. Further history reveals onset of menses at age 12 years with normal 28-day cycles; completion of menopause occurred at age 52 years. She also had three uncomplicated vaginal deliveries. Review of family history is negative for gynecologic malignancies in her first and second-degree relatives. Physical examination reveals a discrete mass in the uterus. The patient undergoes hysterectomy and a postoperative biopsy specimen is shown in the image. (looks like smooth m cells). Most likely dx? A. Adenocarc B. Papilloma C. Sarcoma D. Teratoma E. urothelial carc
C. Sarcoma
- leimyosarcoma bc sm cells, atypia, postmeno bleeding
- A. Adenocarc = should see glands/mucus producing cells
- B. papilloma = benign, surf epithel, form fingers
- C. teratoma = all three germ layers
- D. urothel carc = no vag bleeding with this
A 73-year-old man in the cardiac care unit has had nausea, vomiting, and chills for the past 24 hours. He underwent a cardiac artery bypass procedure 6 days ago. His post-operative course has been complicated by new-onset atrial fibrillation treated with direct current cardioversion. His medical history is significant for insulin-dependent type 2 diabetes and post-operative urinary retention after a past hernia operation. Because of this, the surgical team keeps his urinary catheter in place. His current medications include amlodipine, carvedilol, aspirin and pantoprazole. On evaluation today, his temperature is 100.6°F (38.1°C), blood pressure is 122/80 mm Hg, pulse is 66/min, respiratory rate is 12/min, and oxygen saturation is 95% on room air. His height is 180 cm (5’10”), and his weight is 99 kg (BMI is 30). His heart rhythm is regular, but he has a decrescendo diastolic murmur best heard when leaning forward. The murmur was not present during an examination yesterday. He has left costovertebral angle (CVA) tenderness. The Foley catheter is in place and is draining clear yellow urine. All intravenous sites are clean without erythema. Laboratory studies show:
WBC: 12,000/mm3 Hemoglobin: 11 g/dL Platelets: 220,000/mm3 BUN: 20 mg/dL Cr: 1.2 mg/dL
Urinalysis shows positive leukocyte esterase, negative nitrite, and negative hematuria with a pending bacterial culture. Blood cultures are drawn and the patient is started on empiric antibiotics to treat the presumed infection.
Which of the following pathogens is most likely responsible for this patient’s symptoms? A. Enterobacter cloacae B. Enterococcus faecalis C. Escherichia coli D. Klebsiella pneumoniae E. Proteus mirabilis F. Staphylococcus saprophyticus
B. Enterococcus faecalis
- pt is nitrate neg indicating gram + infxn. pt has pyeloneph with bacteremia bc heart murmur, CVA tenderness, + leuk esterase, and endocarditis sxs. this bac cxs nosocom UTIs and endocard
- A. Enterobac cloacae = gram -, cx of nosocom UTI, surg site infxn, and pneumo. nitrite pos, no endocard
- C. E. Coli = gram -, nitrite +, no endocard, can cx nosocom UTI
- D. Kleb pneumo = gram -, can cx nosocom UTI, pneumo, and peritonitis. no endocard
- E. Proteus mirabilis = gram -, stones, usually CA-UTI. no endocard
- F. Staph saproph = gram +, mostly cx CA-UTIs (sex active females). no urosepsis or endocard
A researcher is interested in studying the process of oogenesis. To do this, she harvests an oocyte from a healthy 18-year-old woman with regular menstrual cycles and no history of prior pregnancies or abortions. She decides to harvest the oocyte after its release from the ovary into the fallopian tube.
At what stage of meiosis will the oocyte be arrested, assuming it is not fertilized? A. Anaphase I B Anaphase II C Metaphase I D Metaphase II E Prophase I F. Prophase II
D. Metaphase II
- oocyte arrested in prophase I until ovulation and then metaphase II until fertilization
A 28-year-old man presents to the emergency department complaining of increasing muscle weakness. He states he first noticed that he had some mild weakness in his feet and legs 4 days ago. He initially attributed the weakness to “being tired,” but became concerned when he began to have difficulty walking. He states that his symptoms have progressed over the past few days, and the weakness has now spread to his arms and hands. Other than a recent episode of diarrhea and vomiting, the patient has been in good health. His neurologic exam is notable for 1+ Achilles and patellar reflexes, 2+ reflexes in the brachioradialis and biceps, 3/5 strength on foot dorsiflexion and plantarflexion, and 4/5 strength on knee extension.
Which of the following organisms is most commonly associated with this patient’s neurologic symptoms?
A. α-Hemolytic, encapsulated, gram-positive cocci that produce an IgA protease
B. Curved, oxidase-positive, gram-negative bacteria that can be grown at 42°C
C. Non-lactose-fermenting, oxidase-positive, gram-negative, aerobic bacilli
D. Rod-shaped, gram-positive, spore-forming anaerobe that produces a heat-labile toxin
E. Spiral-shaped bacteria with axial filaments, visualized using dark-field microscopy
B. Curved, oxidase-positive, gram-negative bacteria that can be grown at 42°C
- this describes Gullian Barre Syndrome via Campylobac jejuni. mild gastroenteritis and ascending paralysis
- A. α-hemolytic, encapsulated, gram-positive cocci that produces an IgA protease = Strep pneumo= bacteremia, meningitis, osteomyelitis, septic arthritis
- C. non-lactose-fermenting, oxidase-positive, gram-negative, aerobic bacilli = Pseudomon aerug = otitis externa, UTI, pneumo, sepsis in immunocomp
- D. od-shaped, gram-positive, spore-forming anaerobe that produces a heat-labile toxin = Clostrid botulinum = blocks ach at NMJ = flaccid paralysis
- E. Spiral-shaped bacteria with axial filaments, visualized using dark-field microscopy = Treponema pallidum = syphilis = tabes dorsalis = loss of proprio/fine touch
A 5-month-old child is brought for evaluation because of a 1-month history of breathlessness and fatigue. On physical examination of the child, the physician notes an enlarged tongue, severe generalized muscular hypotonia, and a palpable liver. In addition, the physician finds evidence of pitting edema in the child’s extremities. ECG reveals a short PR intervals with giant QRS complexes; blood work reveals increased serum creatine kinase and decreased leukocyte acid maltase concentrations.
Which of the following enzymes is most likely deficient in this infant? A α-1,4-Glucosidase B α-Galactosidase C β-Glucocerebrosidase D Glucose-6-phosphatase E Glycogen phosphorylase
A. alpha 1,4 - Glucosidase
- Pompes Dz = heart issues, dec acid maltase (gly stor dz), hypotonia, HSM, large QRS = biventric HT = cardiomegaly
- B α-Galactosidase deficiency would present with peripheral neuropathy symptoms (Fabry disease).
- C. β-Glucocerebrosidase deficiency (Gaucher disease) is characterized by femur necrosis and bone crisis.
- D. glucose-6-phosphatase deficiency have signs and symptoms of severe hypoglycemia and increased blood lactate levels (von Gierke)
- E. Glycogen phosphorylase deficiency presents with severe muscle cramping. (McArdle Dz)
A 65-year-old woman who recently immigrated from China presents to her physician with a swollen abdomen. Her appetite is poor, and she reports a weight loss of 6.8 kg (15 lb) during the past 6 months. The patient denies alcohol use, and she has no family history of malignancy. On physical examination, the patient has scleral icterus, abdominal distension, and a positive fluid wave. Laboratory studies demonstrate the following:
HBsAg negative Anti-HBc negative Anti-HBs positive HCV antibody negative Anti-HAV IgM negative Anti-HAV IgG negative
Given this patient’s background, exposure to which of the following environmental substances is MOST likely linked to her underlying condition? A Aflatoxin B Arsenic C Asbestos D Naphthalene (aniline) dyes E Nitrosamines
A. Aflatoxin
- cxs HCC via aspergillus flavis. banned in US but common in Asia
- B. arsenic = squam cell carc of skin or liver angiosarc (much less common than HCC)
- C. Asbestos = mesothelioma and broncho carc
- D. Napthtalene/dye = medical/industrial dyes that cx bladder trans cell carc
- E. Nitrosamines = in cured meats, cx esophageal or stomach carc (uncommon HCC)
An HIV-positive 43-year-old man is brought by his caregiver to the physician. His caregiver reports that the patient has experienced significant cognitive and behavioral decline over the last 6 months. Recent CD4+ count was 150/mm3. According to the caregiver, the patient has not had fevers or headaches. His temperature is 98.7°F (37.0°C). No focal neurologic deficits are detected on physical examination. The cerebrospinal fluid (CSF) analysis from lumbar puncture is unremarkable except for an HIV viral load of 700 copies/mL. A biopsy specimen obtained from the patient’s brain is shown in the image.
Which of the following cell types has most likely become infected in this patient's central nervous system? A Astrocytes B Langerhans cells C Microglia D Neurons E Oligodendrocytes
C. microglia
- pt has HIV encephalop = infxn of macrophages and microglia in CNS with diffuse cortical atrophy. HM of microglia = multinucleated giant cells, Common manifestations include severe impairment in cognition and the inability to perform activities of daily living.
- A. astrocytes = start shaped, common in Toxoplasmosis infxn = CNS abscesses = fever, HA, seiz
- B. Langerhans cells = macrophages of the skin, not the CNS
- D. neurons = damaged indirectly due to infection and inflammation of the glial cells, neurons themselves are rarely infected in HIV.
- E. oligodendrocytes = not infxd in HIV, However, JC virus is a human polyomavirus that infects oligodendrocytes after it becomes reactivated. JC virus is often acquired in childhood and remains latent in the kidneys and lymphoid organs of most adults. However, if the immune system becomes severely compromised, as it does in the late stages of AIDS, JC virus can become reactivated, resulting in progressive multifocal leukoencephalopathy (PML), which leads to lysis of oligodendrocytes. Since oligodendrocytes are the myelin-producing cells within the CNS, their destruction by JC virus causes an appearance of small foci of demyelination within the subcortical white matter. Seizures, ataxia, aphasia, hemiparesis, and sensory deficits are common manifestations.
Arsenic
squam cell carc of skin
asbestos
mesothelioma or bronch carc
aflatoxin
HCC via aspergillus flavis
napthtalene/dyes
transitional cell carc of bladder
α-galactosidase A deficiency
Fabry disease is lysosomal storage disease
- eripheral neuropathies of the hands and feet, angiokeratomas, and cardiovascular and renal disease
β-glucocerebrosidase deficiency
Gauchers dz lyso stor dz
- hepatosplenomegaly, aseptic necrosis of the femur, bone crises, and Gaucher cells
