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286 Cards in this Set
- Front
- Back
A gardener presents with SOB, salivation, miosis and diarrhea - what caused this and what's the mechanism?
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Most likely organophosphate poisoning.
Acetylcholinesterase inhibitor |
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What drug can you use if atropine alone does not reverse an organophosphate poisoning? What does that drug do?
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Pralidoxime - regenerates acetylcholinesterases.
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What drug helps to improve FEV1 in a patient with COPD?
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Ipratroprium
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What autonomic drug would you use to treat a schizophrenic suffering from urinary retention 2ary to neuroleptic tx? Mechanism?
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Bethanecol - direct cholinomimetic.
Neostigmine - AChE inhibitor (good because it won't cross CNS) |
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What autonomic drug classes (and specific drugs) causes mydriasis?
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Muscarinic blockers (atropine, homatropine, or tropicamide)
Alpha1 agonists (phenylepherine) |
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What autonomic drug that is used to tx shock also maintains renal blood flow?
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Dopamine
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What are you thinking if a 60 y/o pt comes to you complaining of eye pain when looking at oncoming headlights at night?
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Cataracts
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What nerve is most likely to be injured with anterior dislocation of the shoulder?
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Axillary (=no abduction or deltoid sensation)
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What was fractured and what nerve did it affect is someone has numbness in the medial palm after a fall?
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Ulnar - usually due to a medial epicondyle fracture ( = hand of benediction)
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What nerve and artery are most at risk with a mid-shaft fracture of the humerus?
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Radial nerve
Deep Brachial artery |
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What are you thinking when a pt presents with numbness and tingling of the lateral digits with thenar wasting?
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Carpal tunnel syndrome (median nerve injury)
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What organisms are most commonly the cause of subacute endocarditis?
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Viridans strep, staph epidermidis, and enterococci
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What is the most common organism in acute endocarditis?
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Staph aureus
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What are you thinking if a breast-feeding female complains of redness and swelling of her right breast in the last 24 hrs? What do you do?
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Mastitis secondary to a staph aureus infection
Keep pumping milk until it goes away |
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What is the most common aerobic skin flora?
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Staph epidermiditis
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What compliment factor is responsible for neutrophil chemotaxis?
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C5a
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What is the most likely defect in a kid that gets reccurent lung infections and granulomatous lesions?
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Chronic granulomatous disease = deficiency of NADPH oxidase (impairs PMN respiratory burst = increased susceptibility to catalase positive organisms)
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A hypocalcemic child with recurrent viral and fungal infections had a defect from which of the germ cell lines?
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Endoderm in the 3rd and 4th pharyngeal pouchs didn't develop = DiGeorge's Syndrome
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What is the most likely immune disorder in a kid who gets recurrent staph abscesses? What is the pathogenesis?
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Hyper-IgE (Job's syndrome = no INFalpha = no PMN chemotaxis)
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What compliment proteins are most likely deficient in a patient that suffers recurrent Neisseria infection?
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C5-8
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What ab are most specific to dx SLE in a female with malar rash and arthritis?
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anti-dsDNA
anti-Smith |
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What are you thinking if a patient suffers from dermatitis, enteritis and hepatitis after a bone marrow transplant?
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Graft vs. Host Disease (a type IV hypersensitivity)
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What type of study is being conducted if a group of hospitalized pts with pancreatitis and a group without are being interviewed to ID potential risk factors?
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Case-control study (retrospective to identify risk factors comparing a group with to a group without)
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What is the description of a test that gets similar numbers each time but they aren't near the true value?
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Good precision but poor accuracy
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What type of study is it if a group of people is followed over 20 years and every 2 years it's determined who develops cancer and who doesn't
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Cohort study (following over time and asking, "what will happen")
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What is the sensitivity if the false negative rate is 1%?
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99%
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What can you say about disease duration if population A has twice the prevalence but the same incidence as population B?
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Duration in A is twice that of B
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What should you say to an exercising smoker diagnosed with lung cancer?
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Educate on the risk factors, avoid belittling and validate their good habits
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What do you do if you're attracted to one of your patients?
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Never date (even if no longer a patient) and use a chaperone
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What should you do if the patient's friend says he never wanted surgery but the wife insists you save his life regardless?
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"substituted judgement" - get a court order so you can do what the patient would want
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What should you do if you've diagnosed a fatal disease and the family requests you don't tell the patient?
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Do what would be best for the patient's health
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What should you do if a pt with a strong family history is refusing a mammogram?
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Informed consent - Explain the risks and benefits and leave the decision up to her
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What should you do if a post-MI patient is refusing aspirin because it makes him feel "funny"?
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Investigate the "funny" feeling and possible alternatives and explain risks/benefits
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What should you do if you smell alcohol on a Dr's breath while he's working?
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Report it.
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Is a 1 yr old developing normally if they can walk and know 5 words? When can toilet training start?
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Yes.
2-3 years old |
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Is it normal if a 2 y/o can speak in short 2-3 word sentences but can't ID colors or say the ABC's?
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Yup (colors and ABCs = by 5 years)
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How old is a girl if she can speak in complete sentences, has an imaginary friend and considers boys gross?
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6-11 years
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What is the differential for a 60 year old that's 1 yr post MI that comes to you complaining of failure to achieve a full erection?
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atherosclerosis versus drugs (like beta blockers) versus fear of dying/psych issues
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What stage of sleep is a man in if he has variable BP and EEG and penile tumenscence (erection)?
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REM
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What are you thinking if a 6mo old becomes flaccid after being given honey?
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ACh release prevention due to botulinin toxin
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A family gets vomitting for 10 hrs after eating potato salad and then recovers, what are you thinking?
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Staph aureus's preformed enterotoxins in the mayo
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Gram negative, oxidase positive diplococci?
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Neisseria
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Gram negative rods in the stomach of patient c/o burning after meals?
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H.pylori
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50 y/o smoker c/o cough with flu like sx with rods in sputum on silver stain?
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Legionella pneumo
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40 y/o with acute onset unilateral knee pain and bilateral Bell's palsy - what organism is most likely?
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Borrelia burgdorferi (lyme disease from tick bite)
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21 y/o with 5 day hx of fever and an enlarged painful knee?
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Neisseria Gonorrhea if he's getting action - tx with ceftriaxone
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Adult with toxic megacolon and diarrhea after antibiotic tx?
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C.Difficle - injures mucosal membrane via actin depolymerization
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What defense mechanism is seen a in pt that asks her husband to spend the night in the hospital with her because she's afraid to be alone?
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Regression
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Which defense mechanism underlies all other defense mechanisms?
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Repression
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What defense mechanism is illustrated by a patient that jumps out of bed and does push-ups after being told he has an MI?
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denial
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What human problem's illustrated by a baby monkey that becomes withdrawn, socially isolated and grooms poorly after separation from it's mommy?
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Anaclitic Depression
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15 y/o old girl with enlarged parotids and laxatives in her closet?
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Bulemia
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4 y/o with n.gonorrhea?
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Sexual abuse
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72 y/o with decreased memory, poor judgement, and lack of abstraction ability (he doesn't know why I wish I hadn't payed for Milad when the milk was free)?
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Dementia
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72 y/old that's been napping excessively for the past few weeks and is not able to focus on your questions?
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Delerium
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Elderly demented patient needs sleep meds - what's not ok to give?
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Don't give diphenhydramine or benzos. Ok = haloperidol or trazadone
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What should you ask a patient who has attempted suicide that will help you assess their need for hospitalization?
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What did you do after you slit your wrists?
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What's the dx if a woman has 2/9 sx of depression + sadness for the past 6 years? What if she has sx of mild mania?
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Dysthymia
Cyclothymia |
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What's our dx if a patient has problems eating and sleeping 1 month after the death of her spouse?
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Normal bereavement (get 2 months)
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What can you do if a patient doesn't want to undergo a MRI because of claustrophobia?
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Drug with him with benzo's
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Young woman who's scared about her first pap is told to imagine it happening - what technique is this?
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Somatic desensitization
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What if a patient has hypoglycemia but no elevation in c protein?
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She's dosing exogenous insulin = facticious disorder
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What are you thinking if a 40y/o female tries to commit suicide after you switch her to a different doc after she hits on you?
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Borderline
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What are you thinking if a woman is dressed provocatively and is very flirtatious?
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histrionic
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What are you thinking if a patient says she can only have the best doctor in town?
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Narcissistic
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Why would a pt with mycoplasma have anemia?
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IgM cold agglutinins
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What's the most likely cause of an aspiration pneumonia?
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Klebsiella or an anarobe (like bacteriodes) = foul smelling sputum
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What other findings are expected in a patient with aganglionic colon and other neural crest derivative deficiencies?
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Albinism (failure of melanocyte migration)
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Name the drugs drugs that are contraindicated in pregnancy?
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Retinoic acid, alcohol, ace inhibs, aminoglycosides, alkylating agents, DES, cocaine, folate antags, iodide, tetracycline, thalidomide, valproate, vitamin A, Warfarin, anticonvulsants.
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What are you thinking if a pt presents with hypertension in both arms but no palpable pulses in ankles/feet?
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coarctation of aorta
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What is the direction of blood flow through a PDA after birth?
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From the aorta to the pulmonary artery
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List fetal blood flow from the umbilical cord and back?
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Umbilical vein to ductus venosis to inferior vena cava (where it mixes with systemic circulation) to superior vena cava to the rt ventricle to pulm/foramen ovale to aorta to inferior iliac to umbilical artery to mommy
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What can cause one twin to have a 15% hematocrit and the other to have a 55%? Which one typically does better?
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Monozygotic twins sharing placenta = twin-twin transfusion.
The 15% does better because intrauterine stress = increased lung development |
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What are the nerves associated with each of the brachial arches?
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I = 5 = muscles of mastication
II = 7 = muscles of facial expression III = 9 = stylopharyngeus IV/VI = 10 = swallow/speech muscles |
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23 year old with an undescended testicle = increased risk for what?
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Germ cell cancer
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Testicular cancer spreads through what routes?
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Para-aortic lymph nodes
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What are you thinking if a female presents at 16 with lack of a uterus and amenorrhea?
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Androgen insensitivity syndrome (male pseudohermaphroditism)
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Fungal cause of pneumonia in a patient who vacationed in new mexico?
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Coccidiomycosis
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"Cauliflower" lesions with broad-based budding yeast?
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Blastomycosis
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HIV+ pt with yeast in his CSF is most likely?
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Cryptococcus
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Thron prick = ulcers along lymphatic drainage is caused by?
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Sporothrix
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Parasitic infection from mexico that = bloody diarrhea?
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Entamoeba histolytic (check from trophozoites/cysts in stool)
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32 year old man who contracted diarrhea while camping and now has liver damage with jaundice - most likely causative?
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Entamoeba histolytica
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What's the cause of the cyclical fever of plasmodium infection?
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Merozoite release into blood when the RBCs rupture
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How does increasing the diameter of a vessel by 2 affect the resistance?
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Decreased by 16
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What changes in capillary/interstitial pressures can cause edema?
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Increased capillary pressure or permeability
Decreased plasma proteins Increased interstitial colloid osmotic pressure |
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What is the equation for net filtration pressure?
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(Capillary - interstitial fluid pressure) - (Plasma - interstitial colloid osmotic pressure)
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What's a good replacement drug for a patient on an ACE inhibitor that can't tolerating the coughing? Why doesn't it have the same effects?
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Losartan - angiotensin II receptor blocker - doesn't inhibit the breakdown mechanism for bradykinins
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What lipid lower drug is a patient on if they get first dose rash, pruritis, and diarrhea?
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Niacin
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How can the flushing reaction of niacin be prevented?
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Dose with aspirin
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What is the mechanism of action of the cardiac glycosides (digoxin/digitoxin)?
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Inhibits Na/K ATPase = decreased extracellular Na = no Na/Ca exchanger activity = increased intracellular calcium = increases contractility and stimulates the vagus nerve depressing the SA and AV nodes
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What is the most likely underlying cause of an abdominal aortic aneurysm?
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atherosclerosis
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What are the 5 deadly causes of chest pain?
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MI, aortic dissection, unstable angina, pulmonary embolism, tension pneumothorax
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What are you thinking if a patient with poorly managed htn has acute substernal sharp chest pain that radiates to the back and progresses to death in a few hours?
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ascending aortic dissection
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What type of cardiac disease is most suspected in a young athlete that collapses and dies?
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Hypertrophic cardiomyopathy
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What murmurs are heard best in the left lateral decubitus position?
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S3 and S4
mitral stenosis |
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What's the most likely cause of a systolic crescendo-decrescendo murmur following an ejection click in and 80 year old man?
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aortic stenosis caused by senile calcifications (can lead to syncopal episodes)
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What's the most likely cause of a stroke in a patient that recently suffered many long bone fractures in a trauma?
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Fat embolism or DVT via paradoxical embolism
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What are you thinking if you hear a high pitched holosystolic blowing murmur?
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Mitral or tricuspid regurg
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What are you thinking if you hear a holosystolic harsh-sounding murmur loudest at the tricuspid area?
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VSD
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What are you thinking if you hear a late systolic crescendo murmur with midsystolic click?
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mitral prolapse
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What are you thinking if you hear a high-pitched blowing diastolic murmur with wide pulse pressure and head bobbing?
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aortic regurg
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Opening snap with delayed rumbing late diastolic murmur?
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mitral stenosis
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What are you thinking if you hear a continuous machine-like murmur loudest at S2?
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PDA
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What the most likely cause of chest pain with dyspnea, tachycardia, and tachypnea in an IVDU?
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Staph aureus endocarditis with pulmonary bacterial embolism
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What's the most likely cause of chest pain with dyspnea, tachycardia, and tachypnea in a patient after an MVA
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tension pneumothorax
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What's the most likely cause of chest pain with dyspnea, tachycardia, and tachypnea in a patient after surgery?
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Pulmonary embolism
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What should you use in a patient with bacterial endocarditis due to a congenital valve disease?
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Vancomycin
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Under what conditions do you see pulsus paradoxus?
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cardiac tamponade or increased inspiratory effort (COPD, asthma, croup, etc)
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What would you see on CXR if a htn pt presents with sudden, sharp tearing pain radiating to the back?
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Mediastinal widening due to aortic dissection
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What are you thinking if a 3rd trimester prego has a normal BP when standing and sitting but it's 90/50 when supine?
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Compression of inferior vena cava
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What was 45 year old with squamous cell ca of the penis exposed to?
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HPV
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20 y/o student with LAD, fever and HSM who's blood agglutinates sheep RBCs - what type of cells are infected?
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B cells (with EBV)
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How does rabies virus travel through the CNS so it can cause fatal encephalitis with seizures?
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Retrograde up the axons
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What is the characteristic shape of the rabies virus?
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bullet
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What will a gram stain show in an adolescent with cough and rust colored sputum?
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gram positive diplococci
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What heavily encapsulated organism is responsible for meningitis in AIDs pts?
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Cryptococcus
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What is the most likely causative organism if an older patient has blood in his urine and renal stones?
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Proteus - especially if it's a staghorn caluculi
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50 y/o has an abdominal surgery 3 days ago, has been catheterized, and now has a fever - what's the cause?
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UTI
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Which of the nonepithelial/nonjunctional adhesion mechanism joins only cells of the same type and doesn't attach to the basement membrane?
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cadherins
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Where does new bone formation take place in growing long bones?
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epiphyseal plate
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A player was kicked in the leg and suffers damage to the medial meniscus - what else is likely to have been damaged?
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The ACL and MCL
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What's the diagnosis if a man has swelling in his big toe joint and the bx has needle-like crystals?
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gout
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What's the treatment for acute gout?
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NSAIDs and chochicine
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What else would you expect to see if a patient with anti-centromere antibodies and has difficulty swallowing and distal cyanosis in cold temperatures?
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Dry mouth and eyes with SubQ calcinosis (CREST)
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A patient has photosensitivity, arthritis, renal disease, and recurrent oral ulcers. She's taking primaquine and NSAIDs - what type of check should she be receiving twice a year?
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Renal disease screen
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30 y/o with low grade fever, rash across her nose, and wide spread edema - what lab tests would confirm diagnosis?
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anti-dsDNA and anti-smith
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What's the dx if you see bilateral hilar lymphadenopathy on CT?
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sarcoidosis
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X-ray of a joint in a 75 y/o man with acute knee pain and swelling shows no erosion of the joint space - what are you thinking and what would you see?
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Pseudogout with positively bifringent rhomboid crystals
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50 y/o female complains of double vision, amenorrhea, and headaches - what is the most likely diagnosis?
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pituitary adenoma (prolactinoma)
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Patient's MRI reveals sella turcica filled with CSF?
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Empty sella syndrome - usually asymptomatic but can cause deficiencies in pituitary hormones
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What hormones arise from the anterior pituitary?
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TSH, GH, prolactin, ACTH, LH, FSH, and MSH
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Which hormones share a common alpha subunit?
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TSH, LH, FSH, and betaHCG
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Young woman has short stature and shortened 4th and 5th metacarpals - what's the most likely endocrine disorder?
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Albright's hereditary osteodystrophy - kidney doesn't respond to PTH
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35 y/o female with diffuse goiter and hyperthyroid - what are the expected TSH and TH?
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Decreased TSH
Increased thyroid hormone |
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48 y/o female suffering from progressive lethargy and extreme sensitivity to cold - diagnosis?
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hypothyroid - most likely Hashimoto's
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Adult male with elevated serum cortisol and signs of Cushing's undergoes dexamethasone suppression test - if 1mg doesn't decrease but 8mg does - what's the dx?
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pituitary adenoma
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Tan child with pale mother presents to clinic as hypotensive - dx?
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Addison's
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28 y/o male comes in with DKA - he's recently been taking cold medicine - what's the cause of his current condition?
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infection stress
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How is hemoglobin glycosylated in DM to form HA1c?
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Non-enzymatically
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How dose UV damage DNA?
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thymine dimers on the same DNA strand
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What are the sourced of carbon in purines? What about pyrimidines?
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Purine = glycine and THF
Pyrimidine = CO2 and aspartate |
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What aa has more mRNA coding sequences than are represented in peptides from the mRNA?
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methionine
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How is hnRNA processed before it leaves the nucleus?
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Ploy a tail
5' cap (7 methyl guanosine) Introns spliced |
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What medications can cause cardiotox and bone marrow suppression?
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Danorubicin
Doxirubicin |
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Patient tries to commit suicide with digoxin OD - how do you tx it?
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anti-dig Fab
Normalize Mg and K Lidocaine |
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What are the inducers of P450?
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BCEG PQRS: barbituates, carbamazepine, chronic ethanol use, griseofulvin, phenytoid, quinidine, rifamipin, and st. johns wort
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What are the inhibitors of P450?
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PICK EGS: protease inhibitors, isoniazid, cimetidine, ketoconazole, erythromycin, grapefruit juice, and sulfonamides
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What enzyme is a black man deficient in if he develops anemia after taking malaria prophylaxis?
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G6PD
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Which of the man boob causing drugs is the worst offender?
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spironolactone
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What drugs could a patient be on if they develop tinnitus, dizziness, h/a and GI upset?
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Quinidine (IA antiarrhythmic)
Quinine (antimalarial) |
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Obese woman with amenorrhea and increased testosterone most likely has?
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polycystic ovarian disease
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What type of cancer has increased risk in patients with polycystic ovarian disease?
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endometrial
|
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Why is estrogen combo'd with progesterone in HRT?
|
To decrease the risk of endometrial cancer
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Under what conditions would you expect to see an increase in LH?
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PCOS, menopause, prior to ovulation, premature ovarian failure, androgen insensitivity disorder
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What is a prego with hx of c-section at increased risk for?
|
placenta previa and accreta (placenta either covering the os or in the muscle layer)
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A 16 wk prego has atypically large abdomen and hypertension - what's a possible cause (if she's not prego with multiples)?
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Complete mole - would see very elevated Hcg
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What substance is present at high levels in the case of a hyatidiform mole?
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BetaHCG
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23 y/o on rifampin and birth control gets prego - why?
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Rifampin (used in TB prophylaxis) induces P450 = lower levels of hormones
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What's the best type of birth control for the mentally retarded?
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IM depo provera (medroxyprogesterone)
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What does the drug Tamoxifen increase the risk of?
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Endometrial cancer
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What cells are responsible for maintaining high testosterone concentrations in the seminiferous tubules?
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Although Leydig cells make the testosterone, it's kept in high concentration by ABP from sertoli cells
|
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What BPH med can case increased testosterone, decreased DHT, gynecomastia and edema?
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finasteride
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Where does testicular cancer met to?
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the para-aortic lymph nodes
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A patient with a cortical lesion is unaware of this neuro deficit - where's the lesion?
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Right parietal lobe
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What are the findings of Brown-Sequard syndrome?
|
Ipsilateral = UMN sx and loss of tactile and proprioception
Contralateral = loss of pain and temperature At level of the lesion = no sensation and LMN sx |
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40 y/o develops dementia and uncontrollable movements - what is the gross change in his brain?
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Atrophy of the caudate (huntington's)
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Male presents with involuntary flailing of one arm - where's the lesion?
|
contralateral subthalamic
|
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Pt is exposed to MPTP - what neurotransmitter is depleted?
|
dopamine
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Patient can't abduct left eye by convergence is normal and she's having difficulty smiling - where's the lesion?
|
CN VI and VII = pontine
|
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What bone and vessel was injured if CT shows an intracranial hemorrhage that doesn't cross suture lines?
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temporal bone fracture - tearing the middle meningeal artery
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Marfan's pt presents with severe h/x and nl CT but bloody CSF - what's the deal?
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Ruptured berry aneurysm causing subarachnoid hemorrhage
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Alzheimer's pt falls and presents 3 days later with n/v and h/a - what the deal?
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Tearing of bridging veins = subdural hematoma
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After trauma, pt can't turn head to left and has a right shoulder droop - where's the injury?
|
Accessory nerve on the right (CN XI)
|
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What neuro deficits could be seen with infection of the cavernous sinus?
|
EOM deficits
Increased or decreased facial sensation |
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Patient can't blink eye or seal lips - where's the lesion and what's the dx?
|
Facial nerve lesion = Bell's palsy
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Pt has leftward deviation of the tongue on protrusion and right sided spastic paralysis - where's the lesion?
|
Left medulla at the hypoglossal nucli and corticospinal tract
|
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What's most at risk with an anterior should dislocation?
|
axillary nerve
posterior circumflex artery |
|
what's most at risk with a mid-shaft humerus fracture?
|
Radial nerve (main extensor)
Deep brachial artery |
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Where's the lesion if a patient presents with bilateral decreased pain and temp sensation over the lateral arm?
|
Anterior white commisure = Syringomylia (seen with Arnold - Chiari)
|
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Decreased prick sensation over lateral foot and leg - what nerves injured and what motor deficits would be seen?
|
Common peroneal nerve
Lack of foot eversion and dorsiflexion |
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Patient hits elbow then can't feel medial palm - what's damaged and how?
|
Medial epicondyle fracture = ulnar nerve injury
|
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What nerve's most at risk with a fibularneck fracture?
|
deep peroneal
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What's the dx on a patient that has numbness on their lateral digits and thenar eminence wasting?
|
Carpal tunnel = medial nerve injury
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Pt has decreased sensation over the back of their leg and lateral half of the foot with weak plantar flexion - what's damaged?
|
Tibia
|
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What's damaged if a patient can't adduct their eye but convergence is normal?
|
MLF
|
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what eye abnormality is seen with MS and internuclear opthalmoplegia?
|
Inability to adduct eye and nystagmus during abduction but normal convergence (MLF)
|
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Where's the defect if a patient has paradoxical bilateral pupillary dilation when a light's shone into the left eye but bilateral constriction when it's shone into the right?
|
Right optic damage prior to the pretectal afferents
|
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Dx if a patient has h/a, visual distrubances, and amenorrhea?
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pituitary adenoma
|
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Dizziness and tinnitus with enlarged internal acoustic meatus on CT - dx?
|
acoustic schwannoma
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Child with proximal muscle weakness and enlarged calves - dx?
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Duchenne's - xlinked
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25 y/o with sudden uniocular vision loss and slurred speech with hx of transient weakness and paresthesias: dx?
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MS
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10 y/o that "spaces out" during class - dx?
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absence seizures
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Patient presents with vertigo, tinnitus, and hearing loss - what's the dx?
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VIII issue = Meniere's disease
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A patient has an extended respiratory phase on a PFT, what's the dx?
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COPD
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A tall, thin teenager has abrupt onset of dyspnea and left sided chest pain with hyperresonance and decreased breath sounds on the left side - dx?
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Spontaneous pneumothorax
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How do you calculate total lung capacity?
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= Inspiratory reserve + Tidal + expiratory reserve + reserve
= Functional reserve capacity + Inspiratory capacity = vital capacity + reserve volume |
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Collapse of right middle lobe with right bronchial mass in a patient with history of recurrent pneumonia - dx?
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Bronchogenic carcinoma
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What's the immuno reaction behind asthma?
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mast cell and basophil degranulation due to crosslinking of IgE's = release of leukotrienes C3/4/5 (type I hypersensitivity)
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What's the dx if a premie has SOB with diffuse ground glass appearance on xray?
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Neonatal ARDS (should have given mommy steroids - now give artificial surfactant to the baby)
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What's the likely eitology of fatal lung abcesses in a ventilated patient?
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Aspiration pneumonia
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What is seen histologically in a patient recovering from ARDS?
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proliferation of type II pneumocytes to regenerate the damaged type I's
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Coal miner is a risk for bronchogenic carcinoma due to exposure to?
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Radon
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What protein is defective if a patient has infertility, recurrent UTI, and dextrocardia?
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Dyneine arm defect (Kartagener's)
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Causative organism if a sputum from pneumonia in an older male doesn't gram stain but has rods on silver stain?
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Legionella pneumophilia
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What happens to the trachea of a smoker?
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Metaplasia from columnar to squamous cells
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What are the clinical findings of a pneumothorax?
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Hyperresonance with decreased lung sounds and no fremitus. In a tension pneumo, the trachea deviates away from the affected side
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Caseous necrosis = ?
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TB
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Most likely diagnosis if a patient with fibroids is chronically tired?
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Anemia = decreased O2 content but normal saturation
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Dx in a patient with a normal cxr and no hx of COPD but recent tibial fracture? What can this mimic?
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Pulmonary embolism - can mimic MI
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Most likely cause of hypoxia in a patient with an enlarged heart on CXR?
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heart failure
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Plumber's lung biopsy shows elongated structures with clubbed ends in tissue? What's this man at increased risk of?
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Asbestosis
Increased risk of bronchogenic ca and mesothelioma |
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What is cut when cutting through the thyroid cartilage to establish an airway?
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Crichothryroid ligament
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What genetic principle do praderwilli and angelman's demonstrate?
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Imprinting = praderwilli's a paternal deletion, angelman's a maternal deletion
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Patient on NSAIDs gets an ulcer - what drug would most directly address the mechanism behind their current problem?
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Misoprostol (PGE1 analog)
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Newborn with difficulty feeding has gastric airbubble on xray - dx?
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tracheoesophageal fistula
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What's the most likely type of esophageal cancer in a patient with GERD?
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Adenocarcinoma
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Middle aged man has diarrhea and hematochezia with transmural inflam on intestinal biopsy - dx?
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Crohn's
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Weight lifter has emergency surgery to remove section of small bowel with focal hemorrhages - what's the problem?
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Incarcerated hernia
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40 year old has to poo 4 times a day for the past several months with low grade pain that's somewhat relieved by defecation has a nl colonoscopy - dx?
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Irritable bowel syndrome
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What drug should you give a pt with ataxia, tremors, and a ring at the periphery of his cornea?
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Penicillamine
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Pt has yellowing of palms and soles but no scleral icterus - what are you thinking?
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Excess consumption of carrots
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Idiopathic hyperbilirubinemia in an otherwise healthy patient with a recent hx of flu - dx?
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Gilbert's disease
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Fate of bilirubin after being excreted into the GI tract?
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80% excreted in stool as urobilinogen
20% reabsorbed - 90% back to liver, 10% excreted by kidney as urobilin |
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Right upper quadrant pain that can be localized with one finger and is tender to light touch - dx?
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Muscle tear or malingering/ factitious disorder
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What vitamin deficiency can cause convulsions and irritability?
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B6 (pyridoxine)
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What vitamin deficiency = gum bleeding , bruising, anemia, and poor wound healing?
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C
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Vitamin C is necessary for the hydroxylation of which amino acids in collagen synthesis?
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Prolyl
Lysylo |
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Which vitamins in excess can cause hypercalcemia?
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D and A
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What vitamins have functions similar to reduced glutatione?
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A, C, and E
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What's the vitamin deficient in an alcoholic that develops rash, diarrhea, and altered mental status?
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B3 (this is pellegra)
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How does acidosis affect extracellular K concentrations?
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Increases them
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What drug should be avoided when txing a fungal infection in a patient taking cyclosporin?
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ketoconazole
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What dosage changes need to be made to a patient's digoxin and digitoxin if they go into renal failure?
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Decrease digoxin
No change in digitoxin (not renally excreted) |
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What affect will an obstructive renal stone have on GFR and FF?
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Decrease in GFR and in FF (since PFR isn't changed)
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When do the renal glucose reabsorbtion mechanisms become saturated?
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350
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What BMP changes can be expected in a patient treated for status asmaticus
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Decreased pH and HCO3 due to the hypoxia. Beta blocker given = decreased K
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What are the causes of anion gap acidosis?
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MUD PILES = methanol, uremia, DKA, paraldehyde/phenformin, INH/iron, lactic acidosis (shock), ethylene glycol, or salicylate poisoning
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What drug can you switch a patient to if they get coughing after taking lisinopril?
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ARBs like losartan or valsartan
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What diuretic can be used if a patient with an exacerbation of CHF has a sulfa allergy?
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Ethacrymic acid
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What's the dx if a patient presents with HTN, hypokalemia, metabolic alkalosis and low plasma renin? Tx?
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Primary hyperaldosteronemia
Give aldosterone antagonist like spironolactone |
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What are you thinking if you see a glomerulus with multiple mesangial lesions?
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diabetic GN
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Dx if a teenager presents with nephrotic syndrome + hearing loss?
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Alport's (abnl type IV collagen)
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4 y/o with facial edema and proteinuria - dx? tx?
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Nephrotic syndrome/minimal change disease - tx with steroids
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What's a patient at increased risk of if they have a UTI caused by proteus vulgaris?
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Stuvite stones causing a staghorn calculi
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What's a patient with hx of long term acetominophen use at risk for?
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renal papillary necrosis
transitional cell cancer |
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What artery prevents the ascent of a horseshoe kidney?
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Inferior mesenteric
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What CMP changes will be seen in a patient with renal failure?
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Increased: BUN, Creatinine, Na, and K
Decreased: pH and Ca Other labs = anemia and increased TGs |
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What's the dx is U/S shows massively enlarged kidneys bilateral?
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APCKD
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What's the primary energy source in a patient that hasn't eaten in 2 days?
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Ketones
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What's the gibb's free energy equation?
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DeltaG = DeltaH - T(DeltaS)
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What's the most to least exergonic out of AMP, ATP, and PEP?
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PEP then ATP then AMP
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Why does someone who drinks a lot without eating become hypoglycemic?
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Increased liver NADH causes OAA to be shunted to malate and Pyruvate to lactate (away from gluconeogenesis/energy production)
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Dx if a patient develops intense muscle cramps and dark urine after exercising?
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McArdel's (myophosphatase defect/deficiency)
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What allows RBCs to change shape as they pass through vessels?
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spectrin
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What's the dx if a patient that's had hemolytic anemia since birth is cured by a splenectomy?
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Hereditary spherocytosis (ankrin or spectrin defect = increased MCHC)
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Why wouldn't you just give folate to a patient wiht a megaloblastic anemia?
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They could have a B12 deficiency which can result in permanent neuro damage
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What's the dx if a patient with anemia, hypercalcemia and bone pain has large round cells with off center nuclei on bone marrow bx? What could a UA show?
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MM
UA will be normal but Urine elctrophoresis may show the presence of bence-jones proteins |
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What neoplasms are associated with AIDs?
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B cell lymphoma (CNS lymphoma), kaposi's sarcoma and invasive cervical carcinoma
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Which chemotherapeutic agents should be avoided in a patient with CHF?
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Doxyrubicin
Danorubicin (both are cardiotoxic) |
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Chromosomal analysis of leukemia pt = t(9:22). What is the treatment?
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Imantinib (binds bcr-abl to tx CML)
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After a normal delivery a new mom bleeds profusely from her vagina and gums: What abnormal lab values would you suspect?
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DIC - Increased BT, PT, PTT and D-dimer with a decrease in platelets, clotting factors and fibrin.
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Pt = chronic non-healing ulcer on his foot and imaging shows a small calcified spleen: what drug can improve his symptoms?
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Pt has sickle cell so tx with hydroxyurea to increase HbF levels
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NSAIDS inhibit the production of which substance important in platelet aggregation?
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Thromboxane
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Does HbF have more or less affinity for 2,3-bisphosphosphoglycerate?
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Less = greater O2 affinity
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What's the defect in familial hypercholesterolemia?
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absent or decreased LDL receptors
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What dietary changes should a PKU patient make?
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No phenylalanine, increased tyrosine.
Pt with malignant form needs to replace THB in body |
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Dx if 2 y/o has increased abdominal girth with failure to thrive and skin/hair depigmentation?
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Kwashorkov
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Dx if a man has dark spots on his sclera and his urine turns black on standing?
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Alkapturia = homogenistic acid oxidase deficiency
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Dx if a patient must restrict protein so they don't get mental retardation, ketoacidosis and death?
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maple syrup urine disease
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18 y/o has moderate generalized abdominal pain and paresthesias in her lower extremities with normal WBCs and no fever - dx?
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Acute intermittent porphyria = defective porphobilinogen deaminase = increase in porphobilinogen and ALA
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What's the treatment for homocysteinuria?
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Depends on the type but decreased methionine with increased cysteine, B12, B6 and folate should cover all bases.
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What's the dx if an alcoholic gets blistering lesions in sun exposed areas and hypertrichosis of the face?
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Porphyria cutanea tarda (defective uroporphyrinogen decarboxylase = uroporphyrin in urine = tea colored)
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Artery closest to the mid-shaft of the femur?
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Deep femoral
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Artery running behind the knee?
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Femoral to popliteal
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Artery closest to the mid-shaft tibia?
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More proximal = anterior tibial
More distal = posterior tibial |
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Sensory to dorsum of foot and anterolateral leg?
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Common peroneal (injured with lateral leg trauma or fibular neck fracture). Does foot eversion, dorsiflexion, and toe extension
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Sensory to the sole of the foot?
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Tibial nerve (injured with knee trauma). Does foot inversion, plantarflexion and toe flexion
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Nerve injured if you have a positive Trendelenburg?
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Superior gluteal - injured with posterior hip dislocation or polio. Does Thigh abduction
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Venous drainage of thigh?
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Femoral, deep femoral and greater saphenous combine to form external iliac to IVC
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Dermatomes around the bum?
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S3-5
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Dematomes around back of legs and thigh?
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S1 and 2 (S2 also does genitals!)
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Dermatomes at front of leg?
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L3 and L2 = thigh
L4 at knee L5 at ankle |
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CYP system that breaks down statins?
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CYP3a4 (inhib by grapefruit juice!)
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Main mutation involved with Hirschprung's disease?
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RET on chromosome 10
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Virus present in 80% of normal urinary tracts that can cause hemorrhagic cystitis with immunosuppression?
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BK virus (polyomavirus = naked DS circular DNA)
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