Vignettes- Anatomy, Behavioral and Biochem - sidebyside

Question 1

Anatomy Clinical Vignettes

Answer 1

p. 68, 69

Question 2

Baby vomits milk when fed
and has gastric air bubble.
What kind of fistula is
present?

Answer 2

blind esophagus with lower
segment of esophagus
attached to trachea

Question 3

20-year old dancer with 
decreased plantar flexion and 
decreased sensation over the 
back of her thigh, calf, and 
lateral half of foot. What 
spinal nerve?

Answer 3

Tibial (L4 to S3)

Question 4

Patient with decreased pain
and temp sensation over
lateral aspects of both arms.
Lesion?

Answer 4

syringomyelia

Question 5

Penlight in patient's right eye 
produces bilateral pupillary 
constriction. In left eye, there 
is paradoxical bilateral 
pupillary dilation. Defect?

Answer 5

atrophy of left optic nerve

Question 6

Patient with decreased prick 
sensation on lateral aspect of 
leg and foot. A defi cit in what
muscular action can also be 
expected?

Answer 6

dorsiflexion and eversion of
foot (common peroneal
nerve)

Question 7

Elderly woman with arthritis
and tingling over lateral digits
of right hand. Diagnosis?

Answer 7

Carpal tunnel syndrome,

median nerve compression.

Question 8

Woman in car accident cannot
turn her head to the left and
has right shoulder droop.
What structure is damaged?

Answer 8

Right CN XI (runs through 
jugular foramen with CN IX 
and X), innervating 
sternocleidomastoid and 
trapezius muscles)

Question 9

Man with one wild, flailing

arm. Where is lesion?

Answer 9

contralateral subthalamic

nucleus (hemiballismus)

Question 10

Pregnant woman in 3rd 
trimester has normal blood 
pressure when standing and 
sitting. When supine, BP 
drops to 90/50. Diagnosis?

Answer 10

compression of IVC

Question 11

Soccer player was kicked in
leg and su!ered a damaged
medial meniscus. What else is
likely to be damaged?

Answer 11

anterior cruciate ligament
(remember the “unhappy
triad”)

Question 12

Gymnast dislocates her
shoulder anteriorly. What
nerve is most likely to have
been damaged?

Answer 12

Axillary nerve (C5, C6)

Question 13

Patient with cortical lesion
does not know that he has a
disease. Where is lesion?

Answer 13

Right parietal lobe.

Question 14

Child presents with cleft lip.
Which embryologic process
failed?

Answer 14

Fusion of maxillary and

medial nasal processes.

Question 15

Patient cannot protrude
tongue toward left side and
has right sided spastic
paralysis. Where is lesion?

Answer 15

left medulla, CN XII

Question 16

Right parietal lobe.

Answer 16

Ulnar nerve due to broken

medial condyle

Question 17

24-year-old male develops
testicular cancer. Metastatic
spread occurs by what route?

Answer 17

para-aortic lymph nodes
(recal descent of testes
during development)

Question 18

Field hockey player presents 
to ER after falling on her arm 
during practice. X-ray shows 
mid-shaft break of humerus. 
Which nerve and what artery 
are most likely damaged?

Answer 18

Radial nerve and deep
brachial artery, which run
together.

Question 19

Patient cannot blink his right 
eye or seal his lips and has 
mild ptosis on the right side. 
What is diagnosis, and what 
nerve is often affected?

Answer 19

Bell’s palsy; CNVII

Question 20

eat some snacks my dear~~

Answer 20

honey bear~~^ ^

Question 21

Patient complains of pain, 
numbness, and tingling 
sensation. On exam, she has 
wasting of thenar eminence. 
What is diagnosis, and what 
nerve is often a!ected?

Answer 21

Carpal tunnel syndrome,

median nerve

Question 22

Behavioral Science Vignettes

Answer 22

p. 114,115

Question 23

Woman with anxiety about 
gyn exam is told to relax and 
imagine going through steps 
of exam. What process does 
this exemplify?

Answer 23

systematic desensitization

Question 24

65-year-old man is 
diagnosed with incurable 
metastatic pancreatic 
adenocarcinoma. His family 
asks you not to tell the 
patient. What do you do?

Answer 24

Assess whether telling patient
will negatively a!ect his
health. If not, tell him.

Question 25

``` Man admitted for chest pain is medicated for ventricular tachycardia. The next day he jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack. What defense mechanism? ```

Answer 25

denial

Question 26

You are attracted to your 26- year-old patient. What do you say?

Answer 26

``` Nothing! Tone must be professional. It is not acceptable to have romantic relationship with patients. Invite a chaperone into room if you think your actions may be misinterpreted. ```

Question 27

``` Large group of people followed over 10 years. Every 2 years, it is determined who develops heart disease and who does not. What type of study? ```

Answer 27

cohort study

Question 28

Girl can groom herself, can hop on one foot, and has an imaginary friend. How old is she?

Answer 28

Four years old

Question 29

``` Man has fl ashbacks about his girlfriend's death 2 months ago following a hit-and-run accident. He often cries and wishes for the death of the culprit. Diagnosis? ```

Answer 29

normal bereavement

Question 30

``` 36-year-old woman with strong family history of breast cancer refuses a mammogram because she heard it hurts. What do you do? ```

Answer 30

``` Discuss risks and benefi ts of not having mammogram. Patients must give informed consent. If she refuses, you must abide by her wishes. ```

Question 31

``` During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG. What stage of sleep is he in? ```

Answer 31

REM sleep

Question 32

``` 15-year-old girl of normal height and weight for her age has enlarged parotid glands but no other complaints. The mother confides that she found laxatives in the daughter's closet. Diagnosis? ```

Answer 32

bulimia

Question 33

11-year-old girl exhibits Tanner stage 4 development (almost full breasts and pubic hair). Diagnosis?

Answer 33

advanced stage, early | development.

Question 34

``` 4-year-old girl complains of burning feeling in her genitalia; otherwise she behaves and sleeps normally. Smear of discharge shows N. gonorrhoeae. How was she infected? ```

Answer 34

sexual abuse

Question 35

``` 72-year-old man insists on stopping treatment for his heart condition because it makes him feel "funny." What do you do? ```

Answer 35

``` Although you want to encourage him to take his medication, the patient has the fi nal say. You should investigate the "funny" feeling and determine if there are drugs available that don't elicit this side e ! ect. ```

Question 36

Person demands only the best and most famous doctor in town. Personality disorder?

Answer 36

Narcissism

Question 37

Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C protein. Diagnosis?

Answer 37

Factitious disorder; self- | scripted insulin.

Question 38

``` 55-year-old businessman complains of lack of successful sexual contacts with women and lack of ability to reach full erection. Two years ago he had a heart attack. What might be the cause of his problem? ```

Answer 38

Fear of sudden death during | intercourse.

Question 39

Biochemistry Clinical | Vignettes

Answer 39

p. 138

Question 40

``` Full-term neonate of uneventful delivery becomes mentally retarded and hyperactive and has a musty odor. Diagnosis? ```

Answer 40

PKU

Question 41

``` Stressed executive comes home from work, consumes 7 or 8 martinis in rapid succession before dinner, and becomes hypoglycemic. Mechanism? ```

Answer 41

NADH increase prevents gluconeogenesis by shunting pyruvate and oxaloacetate to lactate and malate.

Question 42

2-year-old has increased abdominal girth, failure to thrive, and skin and hair depigmentation. Diagnosis?

Answer 42

Kwashiorkor

Question 43

Alcoholic develops rash, diarrhea, and altered mental status. Vitamin deficiency?

Answer 43

Vitamin B3 (pellagra)

Question 44

20-year-old man presents with idiopathic hyperbilirubinemia. Most common cause?

Answer 44

Gilbert's disease

Question 45

``` 51-year-old man has black spots in his sclera and has noted that his urine turns black when he is standing. Diagnosis? ```

Answer 45

Alkaptonuria

Question 46

mua mua~~

Answer 46

I miss u so much~~

Question 47

``` 25-year-old male complains of severe chest pain and has xanthomas of his Achilles tendons. What is the disease, and where is the defect? ```

Answer 47

Familial hypercholesterolemia; LDL receptor