Terms in this set (75)
On the next day after beggining warfarin therapyand Pt is 12sec (control is 12.1sec, INR-1). Which of the following is the best explanation for normal PT and INR mesurments in this patient?
long half life of factor II
major component of surfactant
~40% dipalmitoylphosphatidylcholine (DPPC);
~40% other phospholipids (PC);
the fetal lung maturity may be tested by sampling the amount of surfactant in the amniotic fluid by amniocentesis, wherein a needle is inserted through the mother's abdomen and uterus. Several tests are available that correlate with the production of surfactant.
These include the lecithin-sphingomyelin ratio ("L/S ratio"), the presence of phosphatidylglycerol (PG), and more recently, the surfactant/albumin (S/A) ratio. For the L/S ratio, if the result is less than 2:1, the fetal lungs may be surfactant deficient. The presence of PG usually indicates fetal lung maturity.
Low dose dopamin stimulates mainly:
higher dose stimulates
large dose stimulates
dopaminergic receptors, producing renal and mesenteric vasodilation;
higher dose stimulates both beta1-adrenergic and dopaminergic receptors, producing cardiac stimulation and renal vasodilation;
large dose stimulates alpha-adrenergic receptors
gynecom,astia and liver failure due
decreased degradation of estrogen
petrolatum is a
The neurotransmitters implicated in the control of nausea and vomiting include
acetylcholine, dopamine, histamine (H-1 receptor), substance P (NK-1 receptor), and serotonin (5-HT3 receptor)"
"In the cerebral cortex, activation of H1 receptors leads to
inhibition of cell membrane potassium channels, depolarizing the neurons and increases the resistance of the neuronal cell membrane, bringing the cell closer to its firing threshold and increasing the excitatory voltage produced by a given excitatory current. H1 receptor antagonists produce drowsiness because they oppose this action, reducing neuronal excitation.
H2 receptors primarily stimulate
gastric acid secretion and vasodilation"
A 25-year-old man is admitted to the hospital because of severe crush injuries to the chest and extensive burns over 30% of his body surface area. Three hours later, he develops tachypnea and dyspnea. Arterial blood gas analysis on room air shows a decreased Po2 and Pco2. A chest x-ray shows bilateral interstitial and alveolar infiltrates. The patient is intubated and mechanically ventilated. Damage to which of the following is most likely to preclude restoration of normal tissue architecture and pulmonary function in this patient?
Patient with orthostatic hypotension, loose stools for 1 year, and history of type 1 DM. Stool studies are normal. What is the pathophysiological mechanism of the diarrhea?
8-month-old girl with 2 day progressive cough and hoarseness. T 102.2F, HR 88, RR 24, bp 100/70. Oxygen saturation 95%. PE mild erythema of oropharyngeal and laryngeal mucosa no exudate, harsh, barking cough heard. Improves within 4 days. Cause?
38-year-old man 1-week shortness of breath with exertion, light palpation of carotid artery shows upstroke is abnormally brisk and downstroke falls precipitously. Cause of finding?
19-year-old woman is admitted to the hospital for antibiotic treatment of meningococcal meningitis. She is stabilized. Three days later, her pulse is 120/min, and blood pressure is 60/30 mm Hg. Physical examination shows bilateral flank tenderness. Serum studies show a sodium concentration of128 mEq/L, potassium of 5.4 mEq/L, and bicarbonate of 20 mEq/L. Which of the following is the most appropriate next step to determine the cause of this patient's hypotension?
Adrenocorticotropic hormone stimulation test
48-year-old woman with gradual onset back pain past 2 weeks. No trauma. Doesn't smoke cigarettes, drink alcohol or use drugs. Hemogram, serologic studies and urinalysis unremarkable. Xray of spine shows two lytic lesions, in T-10 and L-1. Dx?
Metastatic carcinoma of the breast
68-year-old man with a 10-month history of shortness of breath and swelling of his feet, family history of cardiovascular disease. He smoked 2 packs of cigarettes daily for 50 years. Pulse 80/min, rr 24/min, BP 150/80. PE: 3+pitting edema of lower extremities. Diffuse, scattered wheezes are heard bilaterally on auscultation of the chest. Grade 2/6 pansystolic mumur heard best at lower left sternal border, which increases on inspiration. Maximal impulse palpated in sub-xiphoid area. S1 and S2 sounds are distant. Liver span 14 cm. Diagnosis?
35-year-old woman with infertile, receive injection of contrast material into cervix. On hysterosalpingogram (shown), contrast material (indicated by arrows) also seen in peritoneal cavity, which explain this finding?
Spillage of contrast which normal
A 70-year-old woman comes to the physician for a routine pelvic examination. During speculum examination of the vagina and cervix, the Valsalva maneuver causes a bulge of the anterior vaginal wall. Which of the following is the most likely cause of this finding?
Study designed to test the effectiveness of a new drug in the treatment of endometriosis, 100 women randomly assigned to one of two groups. 48 of women receive new drug, 52 receive standard therapy. The primary purpose of this method of assigning patients to different groups is to create which of the following ?
Two groups with similar underlying characteristics
52-year-old female with a history of breast cancer who received 4week course of radiations 6 months ago comes for followup. Exam shows no cancer recurrence. rr 26/min. CT chest shows b/l atelectasis in upper lung fields. Primary pathophysiological cause?
contraction (secondary to radiation)
32-year-old woman has operation for hyperparathyroidism. Three parathyroid glands found but one does not appear in normal superior location on right side. Embryologic event that led to this?
Abnormal migration of endoderm from fourth pharyngeal pouch
21-year-old woman with 10-days difficulty walking. Two years ago had loss of vision in left eye which improved. Neuro exam shows decreased visual acuity in left eye with pallor of optic disc. Has past-pointing on a finger-nose test. Broad-based gait. MRI shows brain lesions in white matter of cerebellum. Pathogenesis?
CD4+ T lymphocytes are activated by myelin basic protein
35-year-old primigravid woman 36 weeks' gestation with 6-hour history of heavy vaginal bleeding. No prenatal care. Ultrasound shows placenta over cervical os. Can't stop bleeding and has cesarean. Dx?
Newborn is found to have a cervical rib. Transformation of seventh cervical segment to thoracic identity. Which is true of HOX gene alteration?
Expression of a HOX gene normally expressed only caudal to C7
Child with XXY karyotype, genetic studies showed he received the extra "x" from his father. An error of chromosome segregation occurred during anaphase at which of the following stages of spermatogenesis in the patient's father?
Patient making sexual advances towards physician. Appropriate measure?
Have a chaperone join them
70-year-old woman comes to the physician because of increasingly severe pain in the right knee over the past 3 months. She has fallen repeatedly. She has a 10 year history of symptomatic osteitis deformans. She has bowed tibia and tenderness of the proximal right tibia. an X ray shows a fracture of the proximal tibia with elevated periostium and sunburst pattern. an xray of lungs shows pulmonary nodules of various sizes. which of the following findings is most likely on biopsy.
Pleomorphic neoplastic cells producing new woven bone
18-year-old man comes with cracked lips and peeling sunburned skin. Works as lifeguard. PE shows desquamation of sunburned skin. Lips are dry and cracked. Petrolatum to lips may reduce lip symptoms by which of following effects of the compound?
60-year-old man 1 day of fever, chills, confusion and memory loss. Returned from Gulf coast where he walked barefoot. Hx of severe cirrhosis and portal hypertension. T 39C (102.2 F), RR 22, bp 90/48. Physical shows early blister formation on right lower extremity. Blood culture: gram-negative, lactose-fermenting organism. Bug?
vibro vulnificus. This can cause food poisoning or it can cause wound infxns from contact with contaminated water or shellfish.
50-year-old man with pulmonary embolus. Treated with intravenous heparin. 24 hours later, warfarin added. Day 2, partial thromboplastin time is 52 seconds (control 26 sec), and prothrombin time is 12 seconds (control 12.1 sec; INR = 1). Best explanation for normal prothrombin time and INR?
Long half-life of factor II (prothrombin)
2-year-old girl with febrile seizure. PE shows nuchal rigidity and bacterial meningitis suspected. LP and immediate abx therapy planned, but parents unavailable for consent. Next step?
Initiate the procedure and treatment without consent
Fracture of left 9th and 10th rib injures what?
72-year-old woman comes to the physician because of a 6-month history of increased bruising on her forearms. She appears alert and well nourished. Physical examination shows extensive wrinkling, scaly erythematous patches on the face, and irregularly shaped brown macules on the face and forearms. There are ecchymoses in various stages of healing on both forearms; the ecchymoses are more numerous on the right side. Laboratory studies, including a complete blood count and coagulation studies, are within the reference ranges. She has noticed no bleeding from her gums after brushing her teeth. Which of the following is the most likely cause of the ecchymoses in this patient?
extensive solar elastosis/ acitinic elastosis (photoaging)
32-year-old man with X-linked recessive disease has deafness, hematuria and progressive renal failure. Protein abnormality?
Type IV collagen
19-year-old woman 2-day history of pain in left index finger. Injured it when catching a ball. PE shows erythema of left index finger. Unable to flex the distal phalanx when proximal interphalangeal joint metacarpophalangeal joints restratined. Xray normal. Injured structure?
Flexor digitorum profundus tendon
2-month-old female with T 102F, vomiting, diarrhea, dehydration. Exam of stool shows viral particles with wheel-like shape. Properties of virus?
Double-stranded RNA, segmented/no/icosahedral
Full-term newborn in respiratory distress. Imaging shows abdominal contents in left pleural cavity. Maldevelopment of which structure led to diaphragm defect?
Left pleuroperitoneal membrane
When you see ECG with low voltage QRS and electrical alternans, what should you think of?
Lose 15% blood volume - what is the effect?
Decreased sympathetic nerve activity to the veins
Unable to flex the DIP when MIP and PIP restrained - what is damaged?
Flexor digitorum profundus tendon
When is the fetus most susceptible to teratogens?
Valsalva maneuver - bulge of anterior vaginal wall
Area that is well ventilated but not perfused?
Physiologic Dead space
Area not well ventilated but well perfused?
Deafness, hematuria, progressive renal failure
Type IV collagen
Schizophrenia examination findings
lack of motivation
lack of speech
Virus within the vocal cords that is neoplastic
HPV Type 6
What cell is defective with celiac disease?
1. Aldosterone tumor
2. Bilateral adrenal hyperplasia
Increased renin and aldosteorne
1. Renovascualar hypertension
2. Malignant hypertension
3. Renin-secreting tumor
4. Diuretic use
Carbamazepine - are you able to drive?
Medically qualified to drive
Multiple sclerosis pathogenesis
CD4+ T cells activated by Myelin basic protein
2. Recurrent epsitaxis
3. Skin discolorations
4. AV malformations
5. GI bleedings
Two conditions with dry tap
Hairy cell leukemia
Tender thyroid, painful
Subacute granulomatous Thyroiditis
Crampy abdominal pain with relief with defecation
loperamide - mu receptor
Concentric enlargement of the left ventricle, enlarged myocardial cells with large nucleir
After transplant, high creatinine - what drug?
Cyclosporine/tacrolimus (cause renal failure)
Rheumatoid arthritis - what to give early on?
What causes the cardiac issues in Multiple myeloid?
What causes fatigue in schistosoma infection?
DOC for ADHD
Heart issue + <1% FeNa
What enzyme to repress DNA transciption
What enzyme to allow for transcription
Venous drainage of the liver
Right hepatic branch of portal, --> portal --> superior mesenteric --> ileocolic
Decreased antibiotic resistance
What will help you recover from neuromuscular blocking agents?
Organisms that cause infective endocarditis - most common
1. Staph Aureus
2. Viridans streptococci
Graft below renal arteries to the bifurcation of the aorta - which organ will lose primary blood supply
Which lung issue has cyanosis/COPD? What is destroyed?
pseudo stratified Columnar epithelial cells (cilia)
parainfluenza - croup
What must you NOT take with fluoroquinolones?