Score 95

kaposi sarcoma is another form of presentation in HIV Positive individual it present purple papule on skin and mucosa and metastazise to lymph nodee continuous secretion of progesterone by corpus luteum esential for develop of fetus, during first trimester, placental prod of hcg sustain the corpus luteum and ensures continued progesterone secretion, by the second trimester, progesterone production by placenta increase to level sufficient to sustain fetal growth and developmt ectopoic 40 yearold female present with amenorrhea and hirsutism, which hormone in excess in this woman with polycystic ovarian syn androgens\ in PCOD estrogen is usually elevated from non ovarian sources, progesterone levels are usually unchanged, FSH LOW, ANDROGEN Elevated and cause these sx SINGLE FIRM non tender freely movable breast mass in woman of this age likely fibroadenoma and is confirmed by bx. an ovarian mass raises possibility of tumor and vaginal hemorrhage in post menopausal woman suggests estrgen producing tumor, one of first estrogen producg tumor is granulosa cell tumour chlamydia are obligate intracellular parasites because they cannot synthesize ATP, they are classified as bacteria because they divide by binary fission to form polypeptides,produceRNA ,DNA and DNa gyrase, finally they synthesize 2 unique morphologic forms, ie extracellular infective and metabolically inert elementary body, and intracellular metabolically active reticulate body woman who is in 20 is sleeping with bf, later woman develop painful =swelling in her elbow, what characteristic? can live within neutrophils

the pattern of rash erythema infectiousum is self limited mild systemic disease caused by human parvo virus, usual therapy supportive measure such as antipruritic relieve itching, atmospheric air contain 159 mm hg,

humidified air contain 149.3 mm hg partial press of oxygen in alveolar air under normal circumstaces at sea level 104 mm hgsevere dyspnea in patient with chronic bronchitis bronchial mucus gland hypertrophhy common feat of chronic bronchitis transthoracic needle asp is most common cause of pneumothorax

patient has contracted HIV from shared needle and has suffered pneumocystitis carinni infecx, diffuse bilateral alveolar shadowing sparing lower zones, is typical on xray, pulm embolism is emergency with suden collpse or breathlessnes silicosis associated with increased susceptibility to tb/ asbestosis demonstrate diffuse interstitial fibrosis of lower lobe and dense hyalinized fibrocalcific plaque of parietal pleura,coal workers pneumoconiosi is related to exposure to coal dust, ARDS is sequela of Pancreaatic cancer,lead to death, signs and sympt include,resistant hypoxiam diffuse alveolar infiltrate on CXR, DYSPNEA, treat involve Oxygn, diuretics, and posiitive end exp pressure,this wil prevent airway collapse ina falling lung and expand alveoli for better diffusion, DM is sequela of long standing chronic pancreatitis, esophageal varices are ass with cirrhosis, MI and Pancreatic Ca are not ass with acute pancreatitis healthy 21 year old stdt preparing for 5 km race, he has been training for 3m onths, increasing his distance each week,what is likely effect on his body from training regimen venous Pco2 increases IL5 is resp for activating eosinophils TNF alpha is involved in type 1 hs reaction seen in asthma IL2 SECRETED by T helper cells,which help secrete cytotoxic and helper T cells. TNF ALPHA os secreted by macrophage resp for attracting and activating neutrophils interferon gamma is secreted by helper T cells and resp for stimulation of macrophages

histologic find is that of a pleural plaque, most common manifestation of asbestos exposure, these well circumscrbed plaque composed of dense collagen,asbestos usually affect lower lung lobes, upper lung lobes are affected in silicosis and coal worker;s pneumoconiosis, oat cells are characteristic of small cell carcinoma, HEMOSIDERIN laden macrophages are common in diffuse pulmonary hemorrhage syndromes 19 year old man dies of progresive renal failure, on autopsy lungs heavy with areas of red brown consolidationthere is also acute focal lesion necrosis on alveolar walls ie associated with intraalveolar hemorrages the alveoli contain hemosiderin laden macrophages, this disease is characterized by antibodiesfor which type of collagen patient died of good pasture syndrome characcterized by rapidly progressive glomerulonephritis and necrotizing hemorrhagic interstiial pneumonitis'type 1 in bone, type 2 in cartilage, type 3 is made of reticulin and found in skin bv, and granulation tissue, type 10 in epiphysel plate pseudomonas aerug is one of most common orgas to cause hospital acquired pneumonia, it cause lobar infiltrte to be present on CXRand produce blue greem pigment when cultured, atypical mycobacterium ass withpneumonia in HIV positiv patient when levelof CD4 CELLS Are decreased, h INFLUENZA cause pneumonia, but since advent of Hib vaccine, incidence has decreased, influenza vaccine can cause pneumonia but owing to viral properties does not produce lobar infiltrate, with influenza, b.l streaky infiltrates seen on CXR, m CATARRALIS CAUSE OF OTITIS MEDIA HOMOZGOTE for PIZ protein has severealpha 1 antitrypsin deff,which is resp for inhibiting proteases,such as neutrophil elastase which is capable of digesting lung tissue, THus with deff of alpha 1 at,neutrophil elastase and other protease will not be inhibited individual with Pizz protein increased risk of develping emphysema smokers have greater risk, so smoking cesation advised, eotaxin, major basic protein and PGD2 both involved in immune resp seen in asthma

the sup segment of right lower lobe is most likely segment ivolved in asp pneumonia oxacillin classfied as peniciilinase resistant penicliin that s relatively acid stable and theefore useful in oral administration, major adverse reactions include penicliin hypersensity and interstitial nephritis.with exception of

methicillin which is 35% bound to serum proteins all penicillinase resistant peniclin highly bound to plsma protein,oxacilin has very narow spectrum and used primarily as antistaphylococal agent flconazole inhibit ergosterol synthesis. it inhibit CYT p45o which is key enzyme system for cyt p450 dependent sterol 14 alpha demethylase,this lead to accumulation of 14 alpha sterol resulting in impairment of cytoplasmic memb fluconazole penetrate into CSF WHERE it is active against cryptococus neoformans,when given oraly, blood level are almost high as whenit is given parenterally, amphotericin administered intravenously and does not appear highly effectve in fungal infex wegener granulomatosis characterissed by necrotising granulomatous vasculitis of vessel of resp tract,kidney and other organ, it present with chronic sinusitis,hemoptysis otitis media cough,dyspnea comon find , Canca, CXR WITH large nodular granule,hematuria, and red cell casts.changes in lips and oral mucosa may be seen in Kawasaki disease which is acute necrotizing vasculitis of small and medium sized vessels,it is disease of infants and child. nail hemorage seen in bacterial endocarditis\pericardial pain in pericarditis

brown rod shaped bodies wth clubbed ends that stain for prussian blue are ferruginous bodies, these are characteristic of asbestosis pulmonary edema is due to incraeased hydrostatic presure in glandular stage 5-17 weeks ,resp not possible, at second cannalicular stage week 13 to 25 , resp bronchiole and terminal sacs form fetuses born prior to week 20 rarely survive, at 3rd or terminal sac stage week 24 to birth, type 1 and type 2 alveolar cells are presnt and resp is possible, premature infant born between 24 and 28 weeks of gestation survival with intensive care last stage alveolat stage birth to year 8 , in this stage, bronchile, terminal sac, alveolar ducts and alveoli proliferate

week 35 is when type 2 alveolar cells start to secrrete surfactant resp PfT value ratio less than 1 is obstructive lung disease for eg asthma, FEV1 Decreaes which leaves more air in lungs, thus increasing FVC. iN RESTRICTIVE lung disease, Ratio unchanged or increased slightly in severe cases,patient cannot inspire air into lungs,becuse of restriction so FVC decreses which cause increase in ratio, THE FEV1 is never equal to FVC

blastomycosis in mississpi riverr histoplamosis demonstrate yest form in macrophages and is found in ohio/msisipi river valleys cryptococus is encapsulted yeast that cause meningtitis,associated with pigeons coccidodomycosis in s western us COCCODOIDES spherules with endospore paracoccidoides in rurral latin americarom paracocidoides dimorphic yeast with bud in pattern resembling captain;s wheel lung abscess can result from aspiration of oropharyngeal or nasopharyngel contents, where bacterial orgs as part of normal flora can be picked up and transported into lungs,the straughter bronchus to right lung is more likely to conduct aspirated material with septicemia,multiple abscess likely to be present pneumocystitis carinii pneumonia associationg wth AIDS, pCP HAS an exudate composed of pneumocystitis cysts and trophozoites with little accompanying inflamation

silicosis associated with increased susceptibility to tb / asbestosis demonstrate diffuse interstitial fibrosis of lower lobe and dense hyalinized fibrocalcific plaque of parietal pleura,coal workers pneumoconiosi is related to exposure to coal dust, ARDS is sequela of Pancreaatic cancer,lead to death, signs and sympt include,resistant hypoxia/ diffuse alveolar infiltrate on CXR, DYSPNEA, treat

involve Oxygn, diuretics, and posiitive end exp pressure,this wil prevent airway collapse ina falling lung and expand alveoli for better diffusion, DM is sequela of long standing chronic pancreatitis, esophageal varices are ass with cirrhosis, MI and Pancreatic Ca are not ass with acute pancreatitis healthy 21 year old stdt preparing for 5 km race, he has been training for 3m onths, increasing his distance each week,what is likely effect on his body from training regimen venous Pco2 increases IL5 is resp for activating eosinophils TNF alpha is involved in type 1 hs reaction seen in asthma IL2 SECRETED by T helper cells,which help secrete cytotoxic and helper T cells. TNF ALPHA 's secreted by macrophage resp for attracting and activating neutrophils interferon gamma is secreted by helper T cells and resp for stimulation of macrophages histologic find is that of a pleural plaque, most common manifestation of asbestos exposure, these well circumscrbed plaque composed of dense collagen,asbestos usually affect lower lung lobes, upper lung lobes are affected in silicosis and coal worker;s pneumoconiosis, oat cells are characteristic of small cell carcinoma, HEMOSIDERIN laden macrophages are common in diffuse pulmonary hemorrhage syndromes 19 year old man dies of progresive renal failure, on autopsy lungs heavy with areas of red brown consolidationthere is also acute focal lesion necrosis on alveolar walls ie associated with intraalveolar hemorrages the alveoli contain hemosiderin laden macrophages, this disease is characterized by antibodiesfor which type of collagen patient died of good pasture syndrome characcterized by rapidly progressive glomerulonephritis and necrotizing hemorrhagic interstiial pneumonitis'type 1 in bone, type 2 in cartilage, type 3 is made of reticulin and found in skin bv, and granulation tissue, type 10 in epiphysel plate pseudomonas aerug is one of most common orgas to cause hospital acquired pneumonia, it cause lobar infiltrte to be present on CXRand produce blue greem pigment when cultured, atypical mycobacterium ass withpneumonia in

HIV positiv patient when levelof CD4 CELLS Are decreased, h INFLUENZA cause pneumonia, but since advent of Hib vaccine, incidence has decreased, influenza vaccine can cause pneumonia but owing to viral properties does not produce lobar infiltrate, with influenza, b.l streaky infiltrates seen on CXR, m CATARRALIS CAUSE OF OTITIS MEDIA HOMOZGOTE for PIZ protein has severealpha 1 antitrypsin deff,which is resp for inhibiting proteases,such as neutrophil elastase which is capable of digesting lung tissue, THus with deff of alpha 1 at,neutrophil elastase and other protease will not be inhibited individual with Pizz protein increased risk of develping emphysema smokers have greater risk, so smoking cesation advised, eotaxin, major basic protein and PGD2 both involved in immune resp seen in asthma

the sup segment of right lower lobe is most likely segment ivolved in asp pneumonia

55 year old present to 2 day hx in clinic of progresive cough/fever, he is sexualy active has numerous partners in past,cultur of sputum does nt reveal any organism,what is appropriate treatment for this patient? tetracycline chlamydial infecx patint present to ambulatory clinic with 5 month clinic hx of diarhea,polyarthralgia and mild pleuritic chest pain, a biopxy of small intestine reveal intestinal mucosa with macrophages laden with PAS POSITIVE GRANULE,what appropriate rx of this patient? tropheryma whipelli causative of whipple's disease, it is gram positive bacillus,appropriate rx is antibiotics, PAS positve macrophages are diagnostic for this disesae,this is not cancer, so it is not necesary to test for CEA, prednisone would be used to treat crohn's diseae, Mesalamine derivative would be used fr UC, fINALLY if left untreated, this patient will not improve clostridium difficle produce exotoxin, this kil. enteric cells and cause pseudomembranous colitis, antibiotic use often culprit, particularly clindamycin and ampicillin, erythromycin,clindamycin,azithromycin would not treat this and may exacerbate it, ors not sufficient for pseudomembranous colitis

potential side effect of antimalarial t herapy is aplastic anemia, which occur with some anti inflammatory medication folate deff anemia usualy grow in 1 of 3 ways, dietary imbalance, pregnancy, and int malabsorption, Iron deff anemia induced by pregnancy growth.dietary lack and chronc blood loss, pernicious anemia caused by type a gastritis, which lead to maked decrease in Intrinsic factor penicillin G doc for syphilis, doxycycline and tetra cycline alternative rx. tetracycline doxycycline not used in pregnant women, doxycycline oral tetracycline antibiotic used to treat urethritis and prostatitis, ketoconazole is antifungal agent used to treat hormone refractory prostate cancer 34 year old co excruciating pain in left toe, PE reveal red toe sensitive to touch,what approp treat ofthis patient/ aspirate fluid from joint and send it for cultures 27 year old HIV pos patient with granuloma lesion in right ling field and intracranial lesion on CT scan ,On pwe, he has decreased breath sounds at both lung bases and scattered rales, Crdiac exam reveal no evidence of rubs,murmurs or gallop what is app treat amphotericin B INTRAVENOUS ACYCLOVIR RECOMMENDED FOR RASH IN IMMUNOCOMPROMISED PEOPLE inh toxicity cause seizure rocky mountain spoted fever, doxycycline rx, efavirenz is non nucleoside reverse transcriptase inhibitor that act to prevent transcription of Viral RNA TO dna, OF OTHER CHOICES, zidovudine is nucleoside analog used in pregnancy, to prevent transmission of HIV TO fetus. zidovudine cause megalobalsticanemia 15 year old boy present to PCP with whar appears to be mild to moderate acne spread diffusely over face, his past medical hx notable for recurrent bouts of otitis media, his past medical hx note right inguinal hernia.hydrocele repairk PE of heart lung abd unremarkable he begun therapy with tetracycline, which follm potential side effect of drug concrening? tetracycline is bacteriostatic agent that bind to bacterialn 30 s subunit and prevent attachment of Aminoacyl T rna

fanconi's syndrome is acquired disorder due to prox tubule defect that result in decreased blood ph, bicarbonate,phosphate ,glucose amino acids because of leakage of kidney, of other toxicities, tetracycline cause tooth discloration, but this seen below 7 years of age,anothr side effect seen in this age group is inhibiton of bone growth cephalosporin c.i in patients alergic to penicillin 65 year old with 20 year hx of smoking present to PCP co chronic cough, sampling of epitheliial cells in patients trachea and bronchi would reveal ehat pathological change metaplasia specifically stratified squamous epithelial cells replacing normal columnarciliated epithelial cells metaplasia is replacement dysplacia is some times premalgnant tissue change charaterized by pleomorphism changes in spatial orientation of cell and increased mitotic activity child aspirated a button from shirtforeign object obstruct right middle lobe bronchus due to its vertical orientation with trachea, air wil be allowedinto obstructed lobe, but will not be exhaled as easilyy, leading to hyperinflation,ventilation of hyperinflated lobe will be inadequate m with resulting hypoxia leading to vasoconstriction of pulmonary vasculature, serving affected area,increased resistance in pulmonary artery system will lead to increased flow in left pulmonary artery system, a collapsed lung should decrease flow in right pulmonary artery, but hx does not sugest an etiology of collapsedlung tellurite agar, for corynebacterium diphtheriae

ankle sprain very common most involve lateral ligament complex particularly anterior talofibular ligament up to 85% og the time sprain inversion injury pain will be elicited with this motion, pain usually in morning and subside after few mins of ambulation where porto caval shunt, correct ans is splenic vein left renal vein,splenic vein drains into portal system and left renal vein drains directly into inferior vena cava, both left and right renal veins drain into caval system,the right testicular vein drains into caval system, the superor mesenteric vein drains into portal system smooth muscle is composed of short spindle shaped cell without

striation,smooth muscle cell activate myosin light chain kinase,contractio of smooth muscle slower and last longer than skeletal muscle because its rate of atp hydrolysis is slowe, organ most likely damaged by stab wound to left midaxillary line in refion of 9th and 11 th rib is spleen, spleen is characterized by red pulp removed from circulation and also white pulp which consist of lymphoid cells, PALS is collection of T lymphocytes surrounding splenic arterioles, enterochromaffin cells located in adrenal gland and produce epinephrine and norepinephrine, Hsals corpuscles are located in thymus, their function not entirely clear, islet of langerhan collection of endocrine cells in pancreas

neurologic sensation of C5 LEVEL IS associated with motor,reflex,and sensory level,this will result in shoulder abductionloss of biceps reflex and loss of sensation over lateral arm,lateral forearm supplied by C6 DERMATOME, medial arm supplied by t1 Dermatome, medial forearm supplied by C8 DERMATOME stroke in lateral medulla knwn as wallenburg synd, damage vestibular nucleus,causing vertigo,nystagmus and nausea,the spinotalamic tract cause c.l loss of pain and temp on body sympathtic tract causing i.l horner syndrome, 9th and 10th cranialnerve causing hoarsnes and dysphagia, spinocerebellar tract cause i.l limb ataxia, NUCLEUS TRACT OF 5TH cranial nerve cause pain.numbnes of I.L FACE nucleus solitarius and trractus solitarius causing loss of taste sensation syndrome most often caused by occlusion of vertebral artery , or less often posterior inf cerebellar artery or lateral medullary a cerebellum demonstrate somatotropic organization, midline of cerebellum is converned vermis more with axial tone and coordination with lower parts of body represented more anteriorly in vermis, DEGENERATION in area ocur more classically with chronic alcoholism lesion in hemispheres tend more to cause ipsilaeral limb ataxia, floculonodular lobe concerned with vestibular connections amino acid require transpt protein and cotransporter such as sodium to enter

cell they are genrally hydrophilic or too large to cross membrane unaided, oxygen and co2 are both soluble in lipid and read to pass the membrane of cell ,this is beneficial in that only rate limiting step for O2 to cross plasma memb is partial press gradient, Glucose is water soluble, and require transp prtein, and variety of ligand to cross hydrophobic cell memb, sodium ion are polar and unable to diffuse across membrane, they require channels voltage or ligand gated or a transporter potassium ion are polar and unable ddiffuse across plasma memb,they require channels,voltage or ligand gated or transport proteins 17 year old girl camping in Ohio 2 weeks, approx a week latr,she present toPCP c.O RED macule in her right leg, similar lesion in low back. what is treat? doxycycline

oxacilin classified as penicillinase resistant penicillin that is relatively acid stable and therefore useful for oral administration, major adverse react penicillin hyprsensitivity and interstitial nephritis, with exceptionof methicillin whch is 35% bound to serum proteins,all penicillinase resistant penicillin are highly bound to plasma proteins, oxacillin has very narrow spectrum and used primarily as an antistaphylococcal agent fluconazole penetrate into csf where it active against cryptococcus neoformans,when it is given orally,blood levels are almst high as when is given parentally ,amphotericin administered iv and does not appear to be highly effective in fungal meningitis, even when administered intrathecally oxacillin and MRSA RAPIDLY increasing in incidence MRSA AND MSSA coexist in hereogenous populations,treatment of pnnatient harboring this heterologous population may provide selective environment for MRSA famciclovir is guanosine that is phosphorylated to acycloGMP by viral thymidine kinase then to acyloGTP by cellular enzymes,it then act as chain terminator and viral dna polymerase inhibitor, specificity due to need for viral tk and higher affinity of viral DNA polymerase than humans DNA pol for acycloGTP. in short, inhibiton of viral DNA synthesis acyclovir is guanosine analogue that terminate viral DNA replication,it is activated in cells by virus encoded thymidine kinase which phosphorylate drug,only virus that produce thymidine kinase such as HSV 1 OR 2 OR VZV are suspectible to acyclovir

trimetoprim blocks nucleic acid synthesis by inhibiting DHF , an enzyme necesary in synthesis of Deoxythymidine nucleotide and involving interconversion of DIHYDROFOLATE to tetrahydrrofolate,MECH of resistance to TMP is acquisition of plasmid that code for formation of TMP resistant dihydrofolate reductase

macrolide inhibit protein synthesis by blocking translocation step, penicillin resp for inhibiting proper cell wall synthesis by blocking transpeptidase cross linking of cell wall, choramphenicol inhbit 50 s peptidyl transferase disrupting translation, aminoglycoside are resp for inhibiting formation of initiation complex needed to start protein synthesis cephalosporin and penicilline have similar structures, penicillin have penicillic acid and cephalosporin, cephalosporinic acid moiety, because patient and moiety.both groups inhibit transpeptidase enzyme ,necessary for cross linking of peptidoglycan layer necesary for cell wall stabilization,it appears that mechanism not totally identical for every drug for every bactrial process

30 year old college football player suffer a sevvere knee injury dislocating joint,even after team physician resect knee, pulses distal to injury

still absent what vessel posterior to knee joint often damages with knee dislocations? popliteal artery large portion of circulation of lower extremity begin with superficial femoral artery which forms popliteal artery passing behind the knee joint, the vessel then branches into anterior tibial , posterior tibial and peroneal arteries, with knee injuries,popliteal artery often damaged owing to its location just posterior to the joint, because of extensive supply of popliteal artery, it is always important to palpate for pulse in artery not just in knee injuries but in all patients in order to determine vascular supply to distal leg a common condition found in older woman is presence of varicose veins, which are abnormally dilated tortuous veins, they typically arise due to increased intraluminal pressure from standing erect for long periods of time,varicose vein found on surface of lower leg just medial to tibial bone

drained by which vein? great saphenous vein grat and small saphenous vein begin respectively as medial and lateral extensions of dorsal venous arch of foot,tributaries of great saphenous vein gather on anterior aspect of foot and profress upward anterior to medial malleolus, the tributaries of great saphenous vein serve to drain all superficial tissues of lower limb except those on side of foot , and posterolateral aspect of leg, the small saphenous vein extends upwaeds into leg, by passing behind the lateral malleolus and extending upward, usually uniting with popliteal vein,the accessory saphenous veins are lovated on proximal and medial aspect of thigh, the anterior tibial and peroneal veins are deep veins that do not drain superficial tissues the developing fetus depend on mother for oxygenation of its blood, the exchange occurs in umbilical cord and blood is transported back into fetal circulation once infant delivered and takes its first breath which structure immediately closes to block right to left shunt foramen ovale anterior cruciate ligament is most often stretched torn, or both by sudden twisting motion, posterior cruciate ligament most injured by direct contact,impact as in automobile accident, or football tackle, injury to cruciate ligament may not cause pain,tather patienthear popping sound, immediately followed by swelling and leg may buckle when he.she tried to stand on it, abnormal passive abduction indicate torn medial collateral ligament gynecoid pelvis is most favorable pelvis for vaginal delivery,this pelvis type is seen in 50 percent of woman and is characterized by oval inlet straight side walls , non prominent ischial spines,anthropoid pelvis common in african american woman marked by an ovall inlet with divergent pelvic side walls,platypelloid pelvis rare and characterixed by wide transverse diameter of inlet

44 year old man present to ED c.o Visual changes,when eye exam performed, it is noted right eye has normal motor function but left one continues to look in inferior and lateral direction,damage to which cranial nerve responsible for appearance of left eye/ cranial nerve 3 responsible for down and out position

37 year old gun shot person wound to abdomen, after initial exam,patient taken to ER, celiac trunk is branch of splenic artery

celiac trunk originates from abdominal aorta at level of T12-L1 intervertebral disc,it then give rise to splenic artery which is major blood supply to spleen splenic artery also gives rise to gastrowpiploic artery which supplies left greater curvature of stomach, the abdominal aorta gives rise to celiac artery which then give rise to splenicartery, superior mesenteric artery comes off abdominal aorta and supplies duodenum,jejenum,ileum, and proximal 2/3rd of transverse colon, right gastric artery supplies right leser curvature of stomach and does not give rise to any other arteries lateral epicondylar tendinitis, or tennis elbow is painful condition involving soft tissue over lateral aspect of elbow, pain originate at or near site of attachment of common extensors to lateral epicondyle and may radiate into forearm and dorsum of wrist, as in this patient, this conditionthought to be caused by small tears of external aponeurosis resulting from repeated resisted contraction of extensor muscle,passive flexion of fingers and wrist and having patient extend wrist against resistance can elicit pain, biceps tendinitis caused by friction on tendon of long head of biceps as it passes through bicipital groove, a patient will experience anterior shoulder pain that radiates down biceps into forearm, carpal tunne syndrom result from compression of of median nerve of carpal tunnel it manifest, numbness and pain in thumb as well as second and 3rd fingers and radial half of 4th, it is sometimes accompanied by thenar atrophy, medial epicondylar tendinitis or golfers elbow is similar disorder of common flexor mucle group at its origin, the medial epicondyle of humerus, pain can be elicited by resisting wrist flexion and pronation with elbow extended.

1 year old infant present with cardiomegaly and CHF she has increased ICP and cranial bruit A VEIN OF galen aneurysm , revealed by MRI shown to compress aqueduct of Sylvius,post part of 3d ventricle, and splenium of corpus callosum, normally cerebral vein of galen join which dural venous sinus? inf sagittal sinus superior thyroid artery lead to superior laryngeal artery

centroacinar cells are components of exocrine pancreas that contain zymgen granule which are released under action of cholecystokinin from duodenum, the zymogen granule contain inactive proenxymes, that normally become activated within duodenum, .premature activation of pancreatic enzyme such as trypsin lead to autodigestion of centroacinar cells of pancreatic acini which secrete these enzymes, this result in acute hemorrhagic pancreatitis, which can be caused by excessive alcohl ingestion, middle meningeal a arised from first or mandibular part of maxillary a ,it runs through foramen spinosum to reach middle cranial fossa, from there,art divides into anterior and post branch supplying meninges7 abnormal development of either septum primum or septu secundum in ostim secundum atrial septal defect in area of fossa ovalis, common type of Congenital heart defect manifested by patent foramen ovale betwen right and leftatria intranuclear opthalmoplegoa.MLF , conjugate movt of eyes depend on integrity of MLF, which link I.L lateral gaze center in pons with CL occulomotor nucleus in midbrain, Lesion of MLF disconect the brain nuclei resulting intranuclear opthalmoplegia and bilateral condition can be seen in patients with MS uterine artery crosees anterior and superior to ureter near lateral fornix of vagina, ureter is thus in danger of being clamped or severed by mistake during hysterectomy 18 Y EAR OLD patient thrown from house and suffered extensive damage to back and pelvic regon,after 2 weeks of recovey i t is noted patient was unable to initiate micturition, spastic neurogenic urrinary bladder,bladder periodically empties itself , what lesion control of bladder in this patient located? spinal cord above level of S2,THE MICTURITION reflex work s follows, when bladder become distended, sensory impulse travel back from blader to synapse onto preganglionic parasymapthetic neuron located at level of S2-4, THIS Neuron excite post ganglionic parasympathetic neuron which innervate and cause contraction of detrusor muscle of urinary bladder thus emptying bladder, this primitive reflex loop caomes under supraspinal influence in e arly childhood when child learns control of micturition reflex,when supraspinal influence removed,a s happens with spinal lesions above level of s2, PRIMITIVE reflex loop remain and neurogenic spastic bladder empties whenever it becomes ful

the internal laryngeal nerve supplies laryngeal mucosa above level of vocal fold as well as mucosa of piriform recess and epiglottic valleculae patient c.o heightened sensitivity to loud noises due to paralysis of stapedius muscle,patient also display neurologic signs manifested by injury to which foll? 7th cranial nerve supply stapedius muscle whch dampen sound by reducing movement of stapes in oval window, a patient with injury to facial nerve also display paralysis of facial musculature,loss of taste sensation and los of lacrimation on afected side, facial nerve provide motor innervation to musle of facial expressxion,taste sensation on anterior 2/3rds of tongue,Via chorda tympani and parasympathetic innervation to pterygopalatine ganglion via greater petrosal nerve jaw jerk reflex is monosynaptic reflex to masseter muscle, proprioceptive fibers from mucle travel by way of trigeminal nerve back to their cell bodies in mesencephalic trigmeninal nucleus stasis ulcer,failure of valve, varicose vein are tortuous dilated vein caused by increased hydrostatic pressure resulting in venous valve incompetency and failure, legs common location for varicose veins and pregnancy or obesity will increase risk for thiscondition, the varicosities may bleed leading to stasis ulcers in overlying skin and stasis dermatitis,varicose veins may be congenital or acquired femoral canal medial compartment of femoral sheath contain only slight amount of loose connective tissue and one or two lymphatic vessels and nodes which nerve involved in gag reflex? motor innervation of pharyngeal constrictor muscles derived from ambigus nucleus in medulla oblongata, these motor fibers reach constrictor muscles via vagusnerve arch of aorta is formed from left 4thaortic arch,part of 4th aortic arch become proximal portion of rght subclavian artery whereas rest of 4th arch disappears, however if it persists,right aortic arch is formed passing posterior to trchea and esophagus, with formation of normally occuring left aortic arch,which runs anterior to trachea and esophagus, a double aortic arch is created, this defect clamp trachea and esophafus resulting in respiratory sx individual sustained severe knife wound damaging spinal nerve adjoining its entry to spinal cord,if one could examine peripheral nerve and its cell body,

which following events would he .she likely to observe>\ displacement of nucleus toward periphery of cell damage to nerve fiber proximal to its cell body will cause among other changes retrograde degeneration of cell body, a no of changes occur in neuron during process of reterograde degeneration the cel body intiially shows some swelling and becomes distended, at beGINING OF DEGENERATIVE PROCESS, there is accumulation of mitochondria in axoplasm at Ranvier's nodes 15 year old boy present TO ed with paroxysm of dyspnea,cough,wheezing, his parents indicate he had these attacks,past winter and have worsened and become more frequent during spring allergy season,which foll cell types correctly matched to a funcx it may perform in patient;s disease? teenage patient suffering asthmatic attack probably allergen induced, mast cells key player , mast cells in bronchiles are stimulated to release histamine that induce contraction of smooth bronchiolar muscle and edema in wall, if bronchoconstriction is chronic, long term result is thickening of bronchiolar musculature

several days after yur teenage male patient fell on his outstretched hand,he reprt increasing pain movement of wrist, your exam reveal particular tenderness in area of anatomic snuffbox,which carpal bone likly injured scaphoid

macrophages have irregular morphology, and diameter of between 25 and 50 nm, their nucleus eccentriclly situated may be round.kidney shaped, and may contain 1 or more nucleoli, cytoplasm contain several large azurophilic granule,due to pinocytic acivity, periphery of cells often contain vacuoles,tendency of macrophages to adhere to glass surface may give them thinned appearance,with cell otganelles concentrated in centre of cell and leaving surface of cell with ruffled appearance

INFLUENZA VIRUS common org with resp tract infecx, it has single stranded,negative polarity 8 segmented

20 year man involved in motor vehicle accident which result mltiple blunt trauma and laceration to his lower extremties. the left femora; artery lacerated, and hw incur extensiv e blod loss and remain hypotensive for hour. which least metabolically active?\ sk muscleable to funcx with anaerobic glycolysis mural thrombi can form over damaged area of ventricular wall foll myocardial infarction,portions can break off and embolize to places such as cerebral circultion histamine lead to vasodilation and fluid exudatiion, that is why people with allergies take antihistamines alzheimer disease lead to senile dementia

5 year old boy brought to ED in resp distress with temp of 103 degree,he has difficulty swalowing and on PE,inspiratory stridor , his x ray swelling of epiglottis, culture used for this organism/ hemophilus influenxa , causative agent for epiglottitis, Neiseria gonorhea uses thayer martin agarmycobacterium TB uses LJ AGAR Charcoal yeast used to culture Legionaella pneumophila corticosteroid are now recomended as first line therapy in treatment of asthma they act by inactivating transcription factor NF kB WHCIH induces production of proinflamatory molecule TNF alpha THUS Inhibiting chronic reax of Asthmatic attack, Ipratropium block acetylcholine signalling, theophyllone inhibitis Phosphodiesterase, Cromolyn prevents mast cell Mediator release and albuterol activatES beta 2 receptors

LTD4 and other leukotrienes are thought to be responsible for bronchOconstriction, increased bronchial activity,increased secretion of mucus and edema,zafirleukast interupt leukotriene activity ,aspirin is NSAID responsible for DECREASING prduction of PG, which serve to limit inflamatory response, ASA shift pathway to leukotriene side, thus favoring bronchoconstriction,these agents do not inhibit lipooxygenase pathway or phosphodiesterase.Sildenafil is inhibitor of type 5 phosphodiesterase

33 year old G2P2 woman develop headache and nausea at 26 week gestation .she is found to have bP OF 168.1-08, A Urinalysis show 4+proteinuria,later in 3rd trimester 36 week gestation she suffer seizure emergent delivery done, baby;s apgar score 7 and 9 in 1 and 5 mins which foll cond likely affect baby? pregnancy induced HTN,toxemia of pregnancy produce intrauterine growth retardation probably from chronic placental insufficiency big fatty liver seen in conjunction with chronic alcoholism

48 year old man has chronic fatigue, a Pe yield no abnormal finds CBC show Hgb 10.7 gdl Hct 33% MCV 104 FL platelet count 239 000/microliter and WBC 7720/MICROLITER, HIS Serum vit B12 512 PG.ML and folate 4.7 NG.ML his serum haptoglobin 151 MG/DL , direct and indiret coombs test negative,whih underlying cond explain this find chronic alcoholism

penicillamine is effective agent in acute severe RA in those patient who can tolerate it, penicillamine is not first line treatment but gaining acceptance as alternative to gold, chloroquine , and cytostatic agents, s.e . 1/3rd patient taking this drug, most side effect,maculopapular dermatitis, gastrointestinal upset.loss of taste sensation,thrombocytopenia and leukopenia, salcicylate are drug of choice mild frm of inflamatory disease,these include acute rheumatic fever, RA, Oa, And mild systemic lupus erythemstous,chloroquine used in infex of plasmodium malaria ibuprofen,indomethacin and Naproxen are NSAIDS baby with low birth rate