DIT High Yield Questions

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A gardener presents with SOB, salivation, miosis, and diarrhea. What is the cause/ MOA?

Organophosphate poisen, anticholinesterase

Atropine is not effective in reversal of organophosphate poisoning. Why? What helps?

No effect on cholinesterase, use Pralidoxime

What muscarnic agonist / antagonist is used in asthma / COPD?

Ipratropium (an antagonist)

30 YO has urinary rentention due to neuroleptic, what do you treat with?

Cholinergic Agonist (problem is anti cholinergic s/e's

In Dark both pupils dialate. In light one pupil is miotic while another, given drug X, is mydratic. What is X?

Anticholinergic (atropine)

What drug is most apropriate in a pt with shock in order to Dopamine (although clinically doesn't really work) maintain renal blood flow 60 YO male. Has a hard time driving at night due to worsening vision and halos appearing around headlights. Cataracts What is causing this? A gymnast sustains and anterior sholder dislocation. What nerve is injured

Axillary n.

A kid falls while skateboarding and injures his elbow. He can't feel the medial part of his palm. What nerve is injured? What "sign"?

Ulnar N. Ulnar Claw (can't extend 4/5 digits)

A highschool athlete falls on his arm. Radiograph shows midshaft break of humerous. Which nerve / artery are at risk?

Radioal n. Deep Brachial Art.

What patients are suseptible to Listeria?

Immunocompromised, Neonates, Pregnant Women

What Organisms are implicatd in subacute endocarditis? S. Veridians, Staph Epi, Enterococci. Staph Aure A woman is breast feeding develops swelling and redness over her right breast. Exam reveals a warm, fluctuant Acute Mastitis -> Staph Aur mass. What is this? Most common aerobic skin flora?

Staph Epi

6 month old child is given honey for a cough and cold and C. Botulinum (Gm + Rod) inhibist Ach release becomes flaccid. What causes this? Moa? One hour after eating a potato salad at a picnic. Whole family vomits. 10hrs later they are better. Whats the cause? Which Complement is responsible for neutrophil

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Staph Aureus. Preformed toxin ingested (no infection) C5a (also leukotriene B4, IL8)

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chemotaxis Child presents with tetany from hypocalcemia and candidias due to immune suppression. What is defienent? Tcells, No Thymus What Dz? young child has recurrent lung infection and granulomatous lesions. What defect in neutrophils causes Lack of NADPH oxidase this? Mother brings 2 YO child w/ Hx of multiple viral, fungal infections and his hypo calcemic. Which Germ layer gives No Thymus, DiGeorge, Endoderm (from tongue) rise to the missing structure? (Endo, Ecto, Meso) A child with immune diorder w/ repeated Staph Abcesses. Neutrophils do not respond to chemotactic stimuli. What Hyper IgE aka Job Syndrome is diag? A patient Suffers recurrent Neisseria Infections. What part C5-C9, (LatE) of complement is defective? How does mechanism of Type 2 Hyper sensitivity differ from Type3

Type 2

45 YO female, Malar rash and arthritis. Which Ab is specific for the dz?

Anti dsDNA, Anti Smith. ANA is nonspecfic

After bone marrow transplant a patient suffers dermatitis, Graft vs Host Dz. enteritis, and hepatitis. What dz is this? A physican is looking for a risk factor for Pancreatitis. He interviews 100 w/ and 100 w/o pancreatitis. What kind of study is this?

Case Control

New glucose test arrives. You test it with a solution of 90mg of glucose. The test gives you thefollowing readings: 54, 56, 55, 54, 53, 56, 55, 54. What is its presions and accuracy?

High Precision low accuracy

A group of ppl who smoke and do not smoke are followed over 10 years. Every two years they check who develops Cohort cancer. What kind of study is this? A certain screening test has a 1% false negative rate. What is the sensitivity?

99%

Prevalence of varicella in Pop A is 2x that of Pop B. It has the same incidence in both populations. Why is the Dz in Pop A has longer duration prevalence different Gm (-), oxidase (+), diplo cocci

Niesseria

22 YO medical student. Burning feeling after meals. EGD H. Pylori shows gm (-) rods in gastric mucosa, what are they? 50 YO male smoker with new cough and flu like symptoms. Gm stains shows nothing. Silver stains shows Legienella (atypical pneumonia) rods. Daig? 40 Yo female. Acute unilateral knee pain and bilateral Bells Palsy. What organism? How is it transmitted?

Lyme Dz via Burreli Burgdorferi via Tick

21 YO male. 5 day hx ofr fever chills and enlarged painful Gonorrhea -Ceftriaxone or Azithyromyocin if

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knee. What oranisim? And what treatement?

allergy

After taking a course of Amoxicillin, and adult pts develops toxic megacolon and diarrhea. What caused this?

C. Diff

25 YO with mycoplasma atypical pneumonia, exhibits anemia due to cryoagglutinins. What type of Ig is responsible for anemia?

IgM

Homeless alcoholic pt vomited while intoxicated. Develops foul smelling sputum. What organism?

Klebsiella or anerobe

65 YO ask husband to stay in hospital overnight b/c she Regression is afraid of being alone. What defnese mechanism is this? Which defense mechanism underlies all others?

Repression

60 Yo man admitted for chest pain, jumps out of bed and does 50 push ups to show he has not had a heart attack. Denial What is the defense mechanism? 4 Yo girl complains of painful genitalia. On exam discharge with smear showing N. gonorrhoeae. What happened?

Sexual Abuse

72 YO patient is unable to recall 3 objects during mini mental status exam. When asked what he would do if he smelled smoke he says "yell fire". When asked what a table can chair have in common he says both are made of wood. Family reports he needs consta

Dementia

72 YO brought to the clinic by family. Strange behaviors in last week. Very agitated, naps frequently during the day, urinates on self, poor appetite. Unable to focus during exam. Diag?

Delerium

You are on call and receive a call from a nurse asking to give sleep medication (diphenhramine) to an elderly pt. with dementia. What do you do?

No diphenhydramine, no Benzos, use Trazadone or Haliperidol

A patient tries to commit suicide by cutting wrists. After What did she do after cutting her wrists? Call beening cared for in the ER what question would you ask someone? Lie in a bathtub? to determine her level of commitment? 28 Yo female with mild depression for 6 yrs. What diag?

Dysthamia

2 months after losing her spouse a 42 YO female is having trouble eating, concentrating, and sleeping/ What do you do?

This is still with in normal. But you can tx the insomnia and help with trazadone or something else

A patient on whom you want an MRI tells you they are claustophobic. What can you do?

Give two Benzos for during tx.

a young woman is anxious about her 1st pap smear and is told to realx and to imagine what the steps are. What is Systamatic Desensitization the process and example of? A woman has flashbacks about her boy friends death one monnth ago in a hit and run accident. She often cries and Normal Greif wishes for justice. Diag?

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Nurse has hypoglycemia with no elevation of C-protein. Diag?

Malingering or Facistious depenidng on 2nd gain

40 YO female tells you she is in love with you. You refer her (which you should never do during USMLE) and she attempts suicide. What is this personality disorder?

Splitting (Borderline )

30 Yo woman tells you that you are the best doctor and the nurses are very bad. On subsequent visit she threatens to change doctors because you do not feel a specific lab test is justified. You also notice several "scartches" on her left arm. What persona

Splitting (Borderline )

55 YO female wearing all black with a black feather boa and excess lipstick. What type of personality disorder?

Histrionic

A pt. demands only the best most famous doctor in town. Narcissistic What personality disorder? A patient returns from a trip to New Mexico, now has pneumonitis. What is fungal cause?

Coccidioidomycocces

A 30 Yo female has "cauliflower" skin lesion. Tissue biopsy shows broad based budding yeast. What is this organism?

Blastomycoisis

an HIV (+) pt with CSF showing 75/mm3 lymphocytes suddenly dies. Yeast is identified in the CSF. What is the Cryptococcus diag? A pt presents with a "rose garden scenario" (thorn prick with ulcers along lymphatic drainage). What is infection?

Sporothrix

A Pt who visted Mexico presents with Bloody Diarrhea. What infection could be found in the stool?

Cryptosporidium (usually filtered from city water supply....) more severe in AIDS

32 YO male went camping in N. California 2 wks ago. Pt had a 2 day stint of diarrhea and how has liver damage and Jaundice. What is diag?

Entamoeba Histolytica (not Giardia b/c Jaundice is present)

Pt returns after 2 wk vacation in Africa. Typical malaria presentation and recurrent fever. what is the mechanism for the cyclic?

Malaria cycle in RBS's causing lysis every 48-72 hrs

Which Fetal Vessel has the highest 02 concentration?

Umbilical Vein (1 verin, 2 arteries)

45 YO male with BP 160/90 on right arm and 170/92 on the left arm. No pulse in feet or ankle. What is diag?

Coarctation of the Aorta (adult type)

Describe blood flow through a PDA? Just for fun what keeps it open, what closes it?

Left to right shunt. (during pregnancy not called "patent" so incorrect to say R-> L then becomes L-> R). Hear a continuous machine murmer. Open

Monozygotic twins are delivered. One is pale and has a hematocrit of 15% the other is flushed with hct of 55%. What caused this? who will do better?

This is twin transfusion, mostly like due to monochorionic, mono amniotic pregnancy. Twin with lower hct will do better due to "sludging" in the one with high hct.

A child presents with Cleft lip. What process failed?

Fusion of the maxillry process with the Medial Nasal Process. Cleft lip is mostly a aesthetic defect were cleft pallate has functional defiect as well

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23 YO male presents with one testicle. what is he at risk for?

Germ Cell tumor of teste

24 YO male develops testicular cancer. Mets spread where?

via Inguinal canal to para-aortic LN's

16 Yo female with amenorhea. Pt lacks uterus and uterine tubes. Has two round structures in midline just superior to labia majora. What is diag?

Androgen Insensitive (46XY)

While on an ACE-i a pts develops a cough. Why? what is No Ang II a replacement? %0 yo male on lipid lower meds. Develops rash, puritis and diarrhea. What drug? Is this a allergic rxn? what mediates this response?

Niacin, not allergic due to prostaglandins (take asprin b4 hand to decrease) also dec with long term therapy

What is mechanism of action of Cardiac Glycosides (Digoxin)?

Blocks the Na/K atpase pump. Na leaves cell via Na/Ca counter transporter and increases intracellular Ca lvls

An abdominal Aortic aneurysm is most likley due to?

Atheroscerois

a pt with poorly controlled HTN has actue sharp substernal pain raidiating to the back. Death occurs within Disecting Aorta a few hours. Diag? During a high school football game a young althlete collapses and dies immediately. What Dz?

Hypertrophic cardiomyopathy

What murmers are heard best in the Left Lateral Decubitous Position?

Mitral Stenosis/ Regurg. And Left sided S3 / S4

80 yo male. systolic cresendo decresendo murmur. Diag? Aortic Stenosis (probabley due to calcified aorta IV drug user presents with Chest pain, dyspnea, tachycardia, tachypnea. Diag?

Bacterial Endocardidits -> PE (remeber drug users get it on the right)

pt brought to ER after MVA presents with Chest pain, dyspnea, tachycardia, tachypnea. Diag?

Tension Pneumothorax most likely, could be CArdiac Tamponade too

Post-op pt presents with Chest pain, dyspnea, tachycardia, tachypnea. Diag?

PE

A young girl with a congeital valve dz is given penicillin prophylactically. In the ER bacterial endocarditis is diag. What is next?

IV Vancomyocin and possible echo to check valves (might need replacement)

An adult pt with hx of HTN presents with sudden sharp, tearing pain, radiating to his back. What do you see on CXR?

Widening of the mediastinum (Disecting Aorta)

On auscultation of a patient you hear a pansystolic murmur at the apex with radiation to the axilla. Cause?

Mitral Regurg (Aortic Stenosis is not PANsystolic)

A 25 yo pregnant woman in her 3rd trimester has normal BP when standing and sitting but drops to 90/50 when she lies supine. Diag?

Compression of IVC, dont lie on your back.

45 YO male with squamous cell carcinoma of the penis. He had exposure to what Virus?

HPV - 16 / 18

20 yo college student presents with LAD, fever, and hepatosplenmegaly. His serum agglutinates sheep

B Cells - EBV mononucleosis (+) monospot.

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RBC's. What cell is infected?

Cause of (-) monospot mononucleosis? CMV

How does rabies travel through the CNS to cause fatal encephalitis and seizures?

Retrograde along neurons

What is the characteristic shape of rabies?

Bullet Shaped

An adolescent presents with cough and rust colored sputum. What does gm stain show?

Strep. Pneumo -> Gm (+) diplococci

HIV (+) pt with a CD4 count of 250 presents with signs of meningitis. CSF shows a heavily encapsulated organism. Cryptococcus Neoformans What is it? An older patient has blood in his urine and renal stones. What organism?

Proteus

A 50 yo pt is recovering from Abd surgery from 2 days ago. He has had an internal catheter in place since then. He now has a fever of 100F. Most likely org?

EColi (UTI)

Hemidesmisomes, cadherin, integrin, ICAM-1. Which joins only cells of teh same type and does not attach to the basement membrane?

Cadherin

Where does new bone formation take place in growing long bones?

Epipseal Plate

A football player was kick in the legs and suffered a damaged medial meniscus. What else is likely to have been damaged?

ACL, MCL

A man presents with pain and swelling of the knees, subcutaneous nodules around the joints and achilles tendon, equisite pain in the metatarsophalangeal joint of his right big toe. Biopsy reveals needle like crystals. DIag?

Most likely Gout

Treatment of Acute Gout exacerbation?

NSAID, Colchicine

A patient has difficulty swallowing, distal cyanosis in cold temp, anti-centromere antibodies. What other S/S will you CREST: Calcinosis, Sclerodactyly, Telangiectasia see? A patient presents with photosensitivity, arthritis, renal disease and recurrent oral ulcers. She is taking Primaquine and NSAIDS. What should be checked 2/yr?

Renal Fxn (SLE)

30 yo woman presents with low grade fever, rash across her nose and gets worse in the sun and widespread edema. What blood test would you use to screen?

ANA - SLE

A CT scan of the chest shows bilateral hilar LAD. Diag?

Sarcoidosis

a 75 yo male presents with acute knee pain and swelling. X ray reveals erosion of the joint space and calcium PsuedoGout -> Calcium pyrophosphate deposits in the menisci. What is Diag? What would be found on FNA of joint? a 50 YO female complains of double vision, amenorrhea and headaches. What is likely diagnosis?

Prolactinoma

A patients MRI shows replacment of tissue in the sella

Most likley asymptomatic or defieciency in

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tursica with CSF. What is presentation?

Pituitary Hormones

What hormones come from the anterior pituitary?

FSH, LH, ACTH, GH, prolactin, TSH

Which hormones share a common alpha unit?

FSH, TSH, LH, bHCG

A young woman is found to have short stature and shortened 4th and 5th metacarpals. What endocrine disorder is this?

Albrights osteodystrophy (Pseudohypoparathydroiism) aka body not responsive to PTH

35 yo female presents with diffuse goiter and hyperthyroidism. What is TSH / T3/t4?

Low TSH High T3,T4

48 yo female presents with progressive lethargy, and extreme cold sensitivity. What is Diag? Lab values?

Hypothyroid / Hasimotos most likely (High TSH low T3/4)

And adult male with elevated serum cortisol and signs of cushing syndrome undergoes dexamethasone suppresion. 1mg does not decrease cortisol, 8mg does. What is diag?

ACTH secreting pituitary adenoma

A very tan child with pale mother comes in and is found to Addisons be hypotensive. Diag? 28 yo male with normal well managed IDDM comes in with DKA hae had recently been taking OTC cold medicine. What caused his DKA?

Infection

How is hemoglobin glycosylated in DM to make HA1c?

Non enzymatically (slowlly do to glucose build up)

What are the sources of Carbon for Purine formation? For Co2, Glycine, tetrahydrofolate / CO2 and pyrimidine? aspartate How does UV light damage DNA?

Causes Thymine Dimers to form

What ammino acid frequently has more coding sequences in mRNAt the represented in the peptide?

AUG - methione

What happens to hnRNA before it leaves the nucleus?

Spliced (remove introns), Poly A tail, and 5' Cap

Two pts have the same mutation on chromosome 15. but they have different phenotypic expressions. One has a Genetic Imprinting mutation from the father the other from the mother. What is this an example of? Frequency of CFTR mutation X in pts with cystic fibrosis is 0.1. CF is (in this scenario) caused by either mutation X P^2+2PQ+Q^2 or Y. What percent of pts are homozygotes for y? an obese woman presents with amenorrhea and increased serum testosterone. Diag?

Polycystic Ovarian Syndrome (stein-leventhaul)

What type of cancer are patients with polycystic ovarian dz are risk for?

endometrial

Why is progesterone used in combo with estrogen in hormone replacement therapy?

To protect Uterus / endometrium from unregulated hyperplasia / cancer

What circustance would cause an elevated LH?

Polycystic Ovarian Syndrome (stein-leventhaul), physiological LH surge, low estrogen lvls, turners,

A pregnant woman with previous C section is at increased risk for what pregnancy complications?

Placenta Accreta, Previa

A pregnant women at 16 weeks gestation presents with

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Hydatifrom Mole, increased beta HCG

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large abd and HTN. Diag? Lab values? What substance is elevated in hydatifrom moles

beta HCG (Really high in complete, slightly elevated in partial)

15 yo pt who normally comes in with her parents presents Check for delayed puberty, talk about how you alone. She states she is sexually active but knows she is can get pregant on your first time even before you not pregnant because she has never menstrated. What menstrated, STDs and maybe contraceptives should you tell her? 23 yo female is on rifampin for TB and OCP. She gets pregnant. Why?

Rifampin increase Cyp450 metabolism of OCP, decreasing their effectiveness

Medroxyprogesterone (injection q3 months) (and What is the best option of birth control of mental retarted what do you do if you find a mentally retard pt in a pts? room with a bat?) A 58 yo post menopausal women is on Tamoxifen. What is she at risk of aquiring?

Endometrial Carcinoma

What cells are responsible for maintaing a high testosterone concentration in the seminiferous tubules?

Leydig Secrete, Sertoli - release ABG hold testosterone in place

A 55 yo man undergoing tx for BPH has increased testosterone and decreased DHT as well as gynecomastia and edema. What medication is he on?

Finasteride - 5 alpha reductase inhibitor

Where does testicular cancer first metastasize?

Para Aorotic Lymph Nodes

What protein is involved in transporting an endocytosed vesicle from the plasma membrane to the endosome?

Clatherin

What molecule targes proteins in the endoplasmic reticulum for lysosomes?

mannose 6 phosphate

A patient with a corticol lesion is unaware of hi neurologic Located on his non Dominate parietal Lobe deficiency. Where is the lesion? (usually right)

What are the findings of Brown Sequard Syndrome?

Ipsilateral UMN lesion below the lesion | Ipsilateral loss of tactile, vibration and proprioception below lesion | Contralateral pain and temp loss below lesion | ipsilateral all sension for a few levels above lesion | LMN at level of lesion

A man in his 40s begins to develop early dementia and uncontrolable movements of his upper extremities. where Caudate -> Huntingtons in the brain do you expect to see atrophy? A Male presents with involuntary flailing of one arm. Where is the lesion?

This is hemibalismus. Contral lateral thalamus

28 yo chemist presents with MPTP exposure. What neurotransmitter is depleted?

Dopamine

A patient cannot abduct her left yere on lateral gaze but convergence is normal. She also has difficulty smiling. Where in the CNS is the lesion?

CN IV (MLF tract) + CN VII. Both are at level of Pontine

28 yo woman in a MVA. Initally feels fine then loses consiousness. CT shows intracranial hemorrhage that MMA, and temporal bone does not cross suture lines. What bone and vessel where damaged?

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85 yo man with alzheimers falls at home and presents 3 days later with severe headache and vomiting. What is the diag? What is dmg?

Subdural hematomaBridging veins

woman involved in a accident cannot turn her head to the CN XI - accessory left and has a right sholder droop. What is dmged? a 19 yo pt presents with a furuncle on his philtrum and the cavernous sinous becomes infected. What might you defects in CN 3, 4, 6 see? a pt has a leftward deviation of the tongue on protusion and has a right sided spastic paralysis. Where is the lesion?

Left Medulla + corticospinal tract (happens before the tract decusates)

A pt can not blink his right eye or seal his lips. What is the CN7 due to bells palsy diag and which nerve? Pt falls off a motorcycle and lands on his right shoulder. PE shoulder has abnormal configuration. X Ray shows anterior dislocation. What artery and nerve are likley dmg?

Axillary Nerve, Posterior circumflex artery

a pt fractures there humerous mid shaft. What nerve and Radial nerve and Deep Brachial artery artery are dmged? A pt presents with decreased pain and temperature Syringomylenia (congential defect, enlarged sensation over the lateral aspects of both arms. Where is central canal in SC) teh lesino? Exam shows decreased pin prick sensation over the lateral aspect of foot and leg. What muscular defect is also present?

Dec Dorsal Flexion and Toe Flexion, Foot Drop

a pt falls while rollerblading hurts his elbow. He cant feel the medail part of his palm. What nerve is dmg?

Ulnar N via medial epicondyle

an elderly womand complains of pain, numbness and a tingling sensation over the lateral digits of her right hand. Median, Carpal Tunnel Exam shows thenar wasting. What nerve is dmg? 20 yo dancer reports decreased planter flexion and decreased sensation over the back of her thigh, calf and lateral foot. What Spinal nerve?

Tibial N.

a pt fractures her fibula neck. What nerve is dmg

Deep perioneal

MS + internuclear opthalmoplegia. What is the abnormality?

Can't abduct eye on lateral gaze but can converge

a pt can not look laterally but can converge. What is dmged?

Medial longituidinal Fasiculous

Light stimulus in the pts right eye produces bilateral constriction. When the light is shown in the left eye there is paradoxical bilateral pupilllary dilation. Defect?

Damage in afferent of affect eye (ishchemia of CN3)

Woman with headache, visual disturbance, amenorrhea.

Pit Adenoma

43 yo man with dizziness and tinnitus. CT shows enlarged internal acoustic meatus

Schwannoma

a child exhibits proximal muscle weakness and enlarged

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Duschanes Muscular Dystrophy

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calfs 25 yo female with sudden uniocular vision loss and slurred speech. Hx of weakness and paresthesia that resolved.

MS (relapsing remitting)

10 yo child spaces out in class and then continues as if nothing has happened

Abssence Sezuire

Pt has vertigo, tinnitus and hearing loss

Schwannoma

What is primary energy soucre in pt that has not eaten for fatty acids two days? what is the equation for gibbs free energy?

Delta G

Arrange the following in decreasing level of exergonic energy. AMP, ATP, phosphoenol pyruvate

PEP>ATP>AMP

stressed physician comes home from work, consumes 7 to 8 shots of tequila in rapid succession, then becomes hypoglycemic. What is mechanism?

Increase in NADH/NAD ratio

A woman commenly develops intense muscle cramps and darkening of her urine after exercise. Diag?

McArdels Dz

What histological changes occur in a smoker? (in the trachea?

Columnar epithelium -> squamous

A pt in the ER is having anaphylaxis. Incision below thyroid cartilage. What are you cutting through?

Criciothyroid

A young woman has infertility, recurrent URI and dextrocardia. What is defective?

Cilia, Dyien Arm

Pt has the following Lung volumes. FRC

5, IRV

42 yo female with fibroids is chronically tired. what is diag? what changes to O2 content and saturation?

Chronic Dz / microcytic anemia. No change in O2 sat (normal lungs) no change in Concent. Only change in amount of hemoglobin being in blood

Pt has hypoxia and a CXR reveals and enlarged heart. What is likley cause of hypoxia

Pulmonary HTN -> poor lung perfusion

A pt suffers a stroke after incurring multiple long bone fractures in a skiing accident. What caused the infract?

Fat Embolism + VSD or ASD

A pt with a recent tibial fracture and no hx of COPD or asthma presents with hypoxia. CXR is normal. What is cause

PE

a pt with asthma attack. What is the immune rxn occuring?

Bronchoconstriction via Mast cell and IgE histamine release

A pt has an extended expiratory phase. What type of dz? Obstructive lung dz H&E of lung biopsy from a plumber shows elongated structures with clubbed ends. Diag? Risk?

Asbestos -> Mesothelium + Bronchogenic carcinoma

a preterm infant has difficulty breathing. X ray reveals diffuse ground glass. Diag? What could have prevented this?

Neonatal ARDS -> steroids giving to mother prior to birth

pt develops ARDS from occupational inhalation of NO. What histological change is seen?

Hylanien membrane, increase in type 2 pneomocytes (repair / replace dmg type 1 )

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Tall teenage male, abrupt onset dyspnea and left sided chest pain. perccussion on the affected side reveals hyperresonance and deminished breath sounds. Diag?

Phemothorax

CXR shows plueral effusions. What are PE findings?

Dull resonance, dec. Breath sounds, dec. Fremitus

CXR shows collapsed middle lobe of right lung and mass in right bronchus. pt has hx or recurrent pneumonias. Lung cancer - bronchogenic diag? Pt developds brochogenic lung cancer but has never smoked. He is a coal miner. What but him at increased risk?

Not coal, Radon (heavy element)

Exam on lung autopsy reveals peropheral lesion with caseous necrosis. Diag?

TB

30 yo comatose man on ventilator support in ICU develops and infection and dies. Autopsy shows pus filled Psuedomonis cavity in right lung. Etiology? 55 yo who is smoker and heavy drinker. Presents wtih new cough and flu like symptoms. Gm stain shows no organisms, Silver stain shows gm (-) rods. Diag?

Legionella

What deficiency causes familial hypercolesterolemia?

Defect or lack of LDL receptor

Pt with PKU should have a diet low in phenylalanine. What other dietary modifications should a pt make?

Increase tyramine, replace THF and biotin

Full term neonate becomes mentally retarded and hyperactice, has a musty odor. Diag?

PKU

2 yo girl has an increase in abd girth, failure to thrive, and Kwashiorkowr skin/hair depigmentation. Diag? middle aged man has dark spots on sclera and has noted Alkaptouria urine turns black on standing. Diag? Tx for a pts genetic dz includes protein restriction to prevent mental retardation, ketoacidosis, and death. Diag?

Maple Syrup Urine dz

18 yo female has moderate generalized abd pain, normal WBC and no fever. Paresthesias in her lower extremities. Acute intermittent porphoria Diag? 45 yo male alcholic gets blisters lesions in sun exposed areas especially the dorsum of the hands. also has hyper Porphia Cutania tichosis of the face. Diag? Tx for homocystineuria

Decrease methione, increase cystine and B6/B12

Pt taking NSAID for management of her gout, develops anemia, pain on eating and (+) ocult blood. What drugs i best at treating the cause?

Misopristol

new born is having trouble feeding. vomits milk when fed TE Fistula and has gastric air pubble. What is diag? a 60 yo man with chronic reflux presents with esogeal cancer. What type?

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Adenocarcinoma

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after loss of job a 35 you man has diarrhea and hematochezia. Intestinal biopsy shows transmural inflammation. Diag?

Crohns.

Weightlifter undergoes emergency surgery for a life threatening condintion. Exam of small bowel reveals focal Ibguinal hernia -> bowel incaruration hemorrhages. What is responsible a 40 yo woman presents with having to defecate 4x per day for several months and a low grade abd pain. colonoscopy is normal. Diag?

IBS

50 YO man complains of diarrhea on exam his face is plethoric and a heart murmur is detected. Diag?

Carcinoid tumor

young man presents with ataxia and tremor. brown pigmentation in a ring around the periphery of cornea. Tx?

Wilsons dz -> plasmaphoresis

80 yo woman comes to your clinic b/c her family is concerned about her yellowing skin. Yellowing skin of palms and soles but no scleral icterus. Cause?

No Jaundice

20 yo man contracts influenza then presents with an idiopathic hyperpilrubinemia. Cause?

Gilberts dz (infection caused flair)

what is fate of bilirubin after it is conjugated and secreated into GI tract?

Urobiliogen

pt complains of pain in URQ that is localized to one finger. Area is tender touch and pains is worse when pts raises arms. Diag?

Viserceral pain is usually diffuse (not locallized) this is musculoskeletal, rectus abd tear

How does acidosis/alkalosis affect K+ lvls

Acid

Pt is on cyclosporin post renal transplant and develops and fungal infection. what antifungal would caused problmes?

ketaconazole (p450)

pt presents with renal insuffiency. What changes do digoxin and digitoxin?

Decrease digoxin, no change to digitoxin

what effect does a renal stone ->hydronephros have on GFR / FF?

Decreases both

What is maximal serum glucose conc that can be absorbed in renal?

Spill into urine at 200g/dl, max at 350

what change in metabolic panel would you see in a young Beta agonist pt being treated for status asthmaticus Causes of Acidosis with anion Gap

MUDPILES: Methanol, uremia, DKA, Paraldehyde/Phenformin, Iron tablets / INH, Lactic Acidosis, Ethylene glycol, Salicylates

Pt is taking lisinopril complains of new onset constant coughing. Medication alter?

ARB

Pt with CHF needs diauresis but is sulfa allergic. What drug>

Ethacrynic Acid

pt presents with HTN, hypoK, metabolic alkosis and low plasma renin. Diag?

Conn Syndrome

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Glomerular histology shows multiple mesangial nodules. What dz?

DM - kimmel wilson lesion

teenager with nephrotic syndrome and hearing loss. Dz?

Alports

4 yo boy with facial edema and proteinuria. Diag?

Minimal Change Dz

UIT caused by proteus vulgaaris. What kidney problem?

Renal Stone (Phosphate, magneuisum, ammonium)

pt with hx of acetaminophen use. Risk for?

Papillary necrosis

What prevents a horseshoe kidney from ascending in the IMA abd What electrolytes changes seen in kidney failure?

Inc in K, PO4, BUN, Cr, dec in Ca

CT shows massive bilateral enlarged kidneys. Diag?

ADPCKD

A child has been anemic since birth. Cured with splenectomy. Dz?

Hereditary spherocytosis

Pt diag with macrocytic megaloblastic anemia. Danger of W/o co adminsitering B12 could hide concurring folate? B12 defiency Pt with anemia, hyper Ca and bone pain receives bone marrow biopsy. Shows large plasma cells. Diag? found on urinalysis?

Multiple Myeloma. Bence Jones Protines

Heart failure pt is newly diag with cancer and is being evaluated for chemo. What should be avoided?

Doxrubucin

chromosomal analysis of a leukemia pt reveals PHL chromasome (9:22) Tx?

CML tx with imatinib

After a normal spontaneous vaginal delivery, new mom bleeds profusely. Lab abnormalities?

DIC -> DDimer and Inc and PT/PTT

11 yo child presents with a chronic non healing ulcer on his foot. img shows small calcified spleen. Diag / Drug?

Sickle cell (autosplenectomy) use hydroxyurea

NSAIDs inhibit what that leads to platetlet aggregation?

Thromboxane A2

Does fetal hgb have more or less affinity for 23 BPG?

Less affiinty for 2,3BPG

 

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