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USMLE > Vignettes - Micro, Path and Pharm -sidebyside > Flashcards

Vignettes - Micro, Path and Pharm -sidebyside Flashcards

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1
Q

Microbiology Vignettes

A

p174

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2
Q

An alcoholic vomits gastric
contents and has foul
smelling sputum. What
organisms are most likely?

A

Anaerobes

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3
Q

Middle-age man has acute
monoarticular joint pain and
bilateral Bell’s palsy. What
disease and how?

A

Lyme, Ixodes tick

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4
Q

Pt with Mycoplasma
pneumoniae, cryoagglutinins.
What Ig types?

A

IgM

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5
Q

U/A with WBC casts. Dx?

A

Pyelonephritis

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6
Q

Young child with tetany,
candidiasis, hypocalcemia,
and immunosuppression.
What cell is deficient?

A

Tcell (DiGeorge)

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7
Q

Pt with “rose
gardener’s” (thorn prick,
ulcers along lymph drainage).
What bug?

A

Sporothrix schenckii

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8
Q

25yr old med student has
“burning” gut after meals.
Gram negative rods in Bx.
What organism?

A

H. pylori

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9
Q

32yr old man w/ “caulifl ower”
skin lesions. Bx shows broad-
based budding yeasts.
Organism?

A

Blastomyces

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10
Q

Breast feeding woman w/
redness & swelling of right
breast. Fluctuant mass. Dx?

A

Mastitis by S. aureus

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11
Q

Young child w/ recurrent lung
infxns & granulomatous
lesions. What defect in
neutrophils?

A 
NADPH oxidase (chronic 
granulomatous disease)
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12
Q 
20yr old college student w/ 
lymphadenopathy, fever, 
hepatosplenomegaly. Serum 
agglutinates sheep RBCs. 
What cell infected?
A

B-cell (EBV; infectious

mononucleosis)

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13
Q

Microbiology Vignettes

A

p175

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14
Q

1hr after eating custard at a
picnic, whole family vomits.
After 10hrs all better.
Organism?

A

S. aureus(produces

preformed enterotoxin)

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15
Q

Infant eats honey -> flaccid.

Organism? Mechanism?

A

Clostridium botulinum;

inhibited release of Ach

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16
Q

Man w/ squamous cell

carcinoma, penis. what virus?

A

HPV

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17
Q

Pt w/ endocarditis 3wks after
prosthetic heart valve.
Organism?

A

S. aureus or S. epidermis

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18
Q

Pathology Vignettes

A

p220

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19
Q

Woman w/ previous C-
section has scar in lower
uterus close to opening of the
os. Risk for what?

A

Placenta previa

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20
Q

35yr old man w/ hi BP in

arms. Low in legs. Dx?

A

Coarctation of Aorta

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21
Q

Woman w/ di! use goiter and
hyperthyroidism. Values of
TSH and thyroid hormones?

A

Low TSH, and high thyroid

hormones

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22
Q

Pt w/ extended expiratory

phase. Disease process?

A

Obstructive Lung Disease

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23
Q

Woman w/ headache, visual
disturbance, galactorrhea,
amenorrhea. Dx?

A

Prolactinoma

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24
Q

Baby has foul smelling stool
and recurrent pulmonary
infxns. Dx? Test to confi rm?

A

Cystic fi brosis. Chloride sweat

test.

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25
mua~!
^3^
26
Obese woman w/ hirsutism and hi serum testosterone. Dx?
Polycyctic ovarian syndrome
27
``` Man w/ pain and swelling in knees, subcutaneous nodules around the joints and Achilles, exquisite pain in the metatarsophalangeal join of right big toe. Bx shows needle-like crystals. Dx? ```
Gouty arthritis
28
48yr old female w/ progressive lethargy and extreme sensitivity to cold temp. Dx?
Hypothyroidism
29
``` Pt w/ elevated serum cortisol levels undergoes dexamethasone supp. test. 1mg doesn't lower cortisol. 8mgs does. Dx? ```
Pituitary tumor.
30
During a football game, player collapses/dies immediately. Likely Cardiac disease?
Hypertrophic cardiomyopathy
31
Pathology Vignettes
p221
32
Child anemic since birth. Splenectomy -> increased Hct in what disease.
Spherocytosis
33
43yr old man experiences dizziness/tinnitus. CT shows enlarged internal acoustic meatus. Dx?
Schwannoma
34
Child exhibits weakness and enlarges calves. Disease? How inherited?
Duchenne's muscular dystrophy, X-linked recessive.
35
``` 25yr old female w/ sudden uniocular vision loss and slightly slurred speech. Hx of weakness and pareshesias that have resolved. Dx? ```
Multiple Sclerosis
36
Teenager w/ nephritic | syndrome & hearing loss. Dx?
Alport's syndrome
37
``` Tall thin male teenager w/ abrupt-onset dyspnea & left- sided chest pain. Hyperresonant percussion on the a !ected side & diminished breath sounds. Dx? ```
Pneumothorax
38
Young man concerned about wife's URIs and inability to conceive. Also dextrocardia. What protein?
Dynein (Kartagener's)
39
``` 55yr old man who smokes & drinks has cough & flu-like Sx. Gram stain shows nothing. Silver shows gram- neg rods. Dx? ```
Legionellapneumonia
40
Pt has stoke after incurring multiple long bone fractures in trauma stemming from MVA. Cause?
Fat emboli.
41
``` 25yr old woman w/ a low grade fever, rash across nose from sun, widespread edema. Should be concerned about what disease? ```
SLE
42
Pathology Vignettes
p222
43
50yr old man w/ diarrhea, PE reveals plethoric face and heart murmur. Dx?
Carcinoid syndrome
44
Elderly woman w/ a headache and jaw pain. Elevated ESR. Dx?
Temporal arteritis.
45
Pregnant woman @16wks w/ an atypically large abdomen. Blood test abnormality? Disorder?
High hCG, hydatidiform mole
46
80yr old man w/ a systolic crescendo-decrescendo murmur. Most likely cause?
Aortic stenosis
47
Woman of short stature w/ short 4th and 5th metacarpals. Endocrine disorder?
Albright's hereditary osteodystrophy or pseudohypoparathyroidism
48
``` After stressful event, 30yr old man w/ diarrhea and blood per rectum. Intestinal bx shows transmural inflamm. Dx? ```
Crohn's
49
``` Young man w' mental deterioration and tremors. Brown pigmentation in a ring around periphery of cornea and altered LFTs. Tx? ```
Penicillamine for Wilson's | disease.
50
Pt w/ fatigue, blood tests show macrocytic, megaloblastic anemia. Why danger to give folate alone?
Masks signs of neural damage w/ vitamin B12 defi ciency
51
I~~~
LOVE u~~~!!
52
``` 10yr old "spaces out" in class (stops talking midsentence and then continues as if nothing had happened). During spells, quivering of lips. Dx? ```
Absence seizure.
53
``` 85yr old man w/ knee pain and swelling. X-ray shows increased joint space w/o erosion. Dx? What does aspirate show? ```
Pseudogout. Rhomboid calcium pyrophosphate crystals.
54
Pathology Vignettes
p223
55
X-ray shows bilateral hilar | lymphadenopathy. Dx?
Sarcoidosis.
56
5yr old boy w/ systolic murmur and a wide, fixed split S2. Dx?
ASD
57
Pharmacology Vignettes
p286
58
28yr old chemist w/ MPTP exposure. Neurotransmitter depleted?
Dopamine
59
Woman taking tetracycline is photosensitive. Clinical manifestations?
Rash on sun-exposed regions | of body
60
Non-diabetic pt has hypoglycemia but low C- peptide. Dx?
Surreptitious insulin injection
61
``` African-american man who goes to Africa develops a hemolytic anemia after taking malarial prophylaxis. Enzyme defi ciency? ```
Glucose-6-Phosphate | Dehydrogenase
62
27yr old female w/ hx of psych illness now has urinary retention due to a neuroleptic. Tx?
Bethanechol
63
Farmer presents w/ dyspnea, salivation, miosis, diarrhea, cramping, blurry vision. Cause & mechanism?
Insecticide poisioning; | inhibition of AChE
64
``` Pt w/ recent kidney transplant is on cyclosporine for immunosuppression. Requires antifungal agent for candidiasis. What antifungal - > cyclosporine toxicity? ```
Ketoconazole
65
``` Man on several meds including antidepressants and antihypertensives, has mydriasis and becomes constipated. Cause? ```
TCA
66
55yr old postmenopausal woman is on tamoxifen therapy. Risk?
Endometrial carcinoma
67
Woman on MAO inh has hypertensive crisis after a meal. What did she eat?
Tyramine (wine/cheese)
68
After taking clindamycin, pt dev toxic megacolon and diarrhea. Mechanism?
Clostridium | diffcileovergrowth
69
hug~~
kiss~~~
70
Pharmacology Vignettes
p287
71
Man starts meds for hyperlipidemia. Then rash, pruritus, and upset GI. Drug?
Niacin
72
Pt on carbamazepine. What routine workup should always be done?
LFTs
73
``` 23yr old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why? ```
Rifampin augments estrogen metabolism in the liver, rendering it less e ! ective.
74
Pt develops cough and must discontinue captopril. What is a good replacement? Why not same side e ! ects?
Losartan, an angiotensin II receptor antagonist, does not increase bradykinin as captopril does.

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