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Terms in this set (54)
Woman with sickle cell. Malaise and fatigue for 1 week. Low hematocrit, high MCV, low reticulocyte count. Diagnostic test to explain pt's symptoms and decreased hematocrit?
Serum parvovirus B19 IgM antibody test
parvovirus will cause aplastic crisis of ERYTHROCYTES only (pure red cell aplasia)
46 XY newborn with female external genitalia. MRI shows male genital ducts. What isn't being expressed?
DHT normally leads to male external genitalia
5 alpha reductase deficiency -> inability to convert testosterone into DHT -> male internal genitalia, female EXTERNAL genitalia until puberty (when increased testosterone levels cause masculinization)
MRI showing loss of myelin in the fasciculus gracilis (most medial). Symptoms?
Loss of sensation to vibration over both feet
Dorsal column= pressure, vibration, fine touch, proprioception
fasciculus graciLis: lower body, legs
fasciculus cUneatus: Upper body, arms
Compound that induces increased titers of antibodies when conjugated to polysaccharides in a vaccine?
Toll-like receptors recognize PAMPs (pathogen associated molecular proteins) and lead to activation of NF-KB.
Examples of PAMPs include LPS (gram - bacteria), falgellin (bacteria), nucleic acids (viruses)
Why would high altitude lead to pulmonary HTN?
decreased alveolar PO2
chronic hypoxic pulmonary vasoconstriction (in response to decreased alveolar PO2) results in pulmonary HTN and RVH
30 y/o man on immunosuppressants after having a liver transplant. Pruritic rash on his lower back for past week. Vesicles containing clear fluid associated w/ ulcerated and crusted lesions. Diagnosis?
Varicella-zoster virus infection
Shingles triggered by immunosuppression
Pt with gout. Most likely cause of swelling?
Increased vascular permeability
Pt in cardiogenic shock. What is decreased?
mixed venous oxygen tension
indicates that the cardiac output is not high enough to meet tissue oxygen needs
Increased porphyrin and urine uroporphyrin III. 2-day history of blistering lesions on the sun-exposed area of her face, arms, and hands. Recurrent episodes over the past several years. Fluid-filled vesicle and bullae on the face and upper extremities. Which enzyme is deficient?
POPHYRIA CUTANEA TARDA
Antifungal agent that bind to sterols in the plasma membrane
Amphotericin B and Nystatin
Woman gave birth 2 weeks ago, developed SOB with exertion. JVD, pulmonary edema, mild hepatomegaly, and mild pitting edema in lower extremities. Cardiac abnormality?
she has both left and right heart failure, probably from peripartum dilated cardiomyopathy
Question pt's capacity to make a decision if they showed what?
Inability to understand the severity and prognosis of their condition
Identify the competitive inhibitor on Lineweaver-Burk plot
Competitive inhibitors Cross each other
Venous blood has more CO2 than arterial. What accounts for this?
HCO3- transported in the plasma
Majority of blood CO2 is carried as HCO3- in the plasma
Pt w/TB. Which cytokine plays dominant role in the inflammatory response?
Th1 cells secrete IFN Gamma activating macrophages. TNF alpha from macrophages induces and maintains granuloma formation.
Woman with papliptations and increased total T4. Best test to confirm a diagnosis hyperthyroidism?
decreased TSH in primary
increased free T3 and T4
decreased LDL, HDL, and total cholesterol
Primagravida with type II DM. Cervix is 7 cm dilates, fetak weight is estimated at 9 lb 1 oz. Most likely obstetric complication?
Shoulder dystocia is a complication that occurs during delivery when an infant's shoulders become lodged in the mother's pelvic, often because the baby is proportionately too big for the birth canal (cephalopelvic disorder, known as CPD).
Elderly woman with central venous catheter who just had surgery for cervical carcinoma has fever despite broad-spectrum antibiotics. Culture from tip of catheter. Picture of agar. Gram stain shows elliptical, purple, budding organisms. Causal organism?
Woman having partial thyroidectomy. A branch of the thyrocervical trunk is ligated to interrupt the blood supply of the resected specimen. Also ligate a direct branch of what?
(superior thyroid artery)
Autopsy shows myocardial softening and mottling involving the anterolateral wall of the left ventricle. Mechanism of death?
0-25 hours within MI -> ventricular arrhthmias, HF, cardiogenic shock
comatose woman 16 hrs onset of L arm and leg weakness. edematous R hemisphere. she dies one hour later. Microscopic examination of R lateral frontal lobe is most likely to show what?
Shrunken eosinophilic (red) neurons
A "red neuron" (acidophilic or "eosinophilic" neuron) is a pathological finding in neurons, generally of the central nervous system, indicative of acute neuronal injury and subsequent apoptosis or necrosis. Acidophilic neurons are often found in the first 12-24 hours after an ischemic injury such as a stroke. Since neurons are permanent cells, they are most susceptible to hypoxic injury.
OI. subsitition of alanine for glycine residue in type I collagen what happened as a result?
disruption of secondary structure of collagen molecules
OI= problems forming triple helix
400 pts assigned to surgery group, 75 don't have the operation. 400 pts assigned to medical management group, 50 have the operation. In an intention to treat analysis, how many pts will be analyzed in each group?
Pt with 10 yrs of irregular jerking mvmts and disjointed gait dies. Profound dementia during last 2 yrs. Father had similar disorder. Identify area of atrophy on MRI.
Atrophy of caudate and putamen (right below ventricles)
66 y/o woman w/fever, chills, LLQ pain for 1 day. Had sever constipation for 5 years. 3 separate, poorly delimited regions of narrowing of the lumen of the distal sigmoid. Photomicrograph of resected large intestine is shown. Diagnosis?
3 y/o boy w/nosebleed that cannot be stopped. Platelet count and thrombin time are within reference range. PTT and PT are prolonged. Which coagulation process is most likely to be affected?
Synthesis of factor X (Stuart factor)
PT: tests common and extrinsic pathways (factors I, II, V, VII, and X)
PTT: tests common and intrinsic pathways (all factors except VII and XIII)
Of the options, factor X was the only one from common pathway
34 y/o gave birth 6 weeks ago and has been fatigued and irritable. No interest, difficulty sleeping, argues w/husband, feels guilty. Appropriate statement?
"I'm concerned about how bad you've been feeling lately. Have you had any thoughts about death or wanting to be dead?"
4 y/o w/CGD. Txt w/INF-gamma is begun. Activity of which cells will be increased?
macrophages producing IL-1
Man w/rib fractures. CT shows possible pleural effusion. Afferent pathway of his chest pain is carried by which nerves?
Intercostal nerves are located under each rib. When one of these nerves or the tissue around it gets irritated or inflamed, it can cause pain.
Autopsy photograph of lung with pale mass around hilum. Diagnosis?
Squamous cell carcinoma= HILAR MASS arising from bronchus
78 y/o sudden onset L leg pain 1 hr ago. Cool, pale L lower extremity w/absent pulses. Irregularly irregular rhythm. Txt that will provide effective symptom relief?
Lesion leading to R lower quadrant hemianopia
Pariteal lobe, left
temporal lobe= UPPER quadrant hemianopia
17 y/o boy w/delay in growth and puberty. Serum gonadotropin levels are low. X-ray of skull shows suprasellar calcifications. Explanation for his condition?
Craniopharyngioma: most common childhood supratentorial tumor, calcification is common
Surgical shunt bw which veins will relieve bleeding from esophageal varices?
Splenic and left renal
the splenic vein is detached from the portal vein and reattached to the renal vein to selectively reduce the pressure in the varices. The blood flows from the varices through the splenic vein, to the left renal vein and empties into the inferior vena cava. The blood flow to the liver is maintained through the portal vein.
Findings in plasma after 2 weeks of ibuprofen treatment
Leukotriene C4: INCREASED
Arachidonic Acid: INCREASED
Prostaglandin H2: DECREASED
Ibuprofen inhibtis COX, which stops the conversion of Arachidonic acid to prostacyclins, prostaglandins, and thromboxane
Location of the right sphenoethmoidal recess
superior to superior concha
Catheter placement in IJV. Improper insertion can cause damage to which two structures?
Lung and common carotid artery
Cause of oxytocin concentrations increasing during labor
birth canal reflex
Stretch or dilation of the cervix and vagina are strong stimuli for oxytocin secretion, mediated by neural pathways called the Ferguson reflex.
55 diabetic woman on dialysis with bone pain. Decreased Ca2+; elevated creatinine, phosporous, and ALP. Bone pain caused by what change in serum concentrations?
Secondary hyperparathyroidism as a result of CKD
Cause of prolonged apnea in 4 y/o girl who was given sevoflurane and succinylcholine
Pseudocholinesterase deficiency is a condition that results in increased sensitivity to certain muscle relaxant drugs used during general anesthesia, called choline esters.
pseudocholinesterase is an enzyme present in the blood and certain organs that hydrolyzes acetylcholine more slowly than acetylcholinesterase.
Gland that produces the secretion responsible for the odor associated with sweat
Apocrine glands in the skin are scent glands, and their secretions usually have an odor.
right-handed woman w/spastic L hemiparesis and weakness of the lower 2/3 of the face on the left. find lesion area on MRI?
identify internal capsule
newborn delivered at 26 weeks has hyaline membrane disease. O2 sat is maintained at 92 to 95% to protect what?
vasoconstriction in the retina is an early response to oxygen that can lead to vasoobliteration, neovascularization, and retinal traction (retinopathy of prematurity)
mutation in TYRP1 gene causing more pheomelanin (red). what will this cause?
lack of choroidal pigment depostion in the macula
The TYRP1 gene provides instructions for making an enzyme called tyrosinase-related protein 1. This enzyme is located in melanocytes, which are specialized cells that produce a pigment called melanin. Melanin is the substance that gives skin, hair, and eyes their color. Melanin is also found in the light-sensitive tissue at the back of the eye (the retina), where it plays a role in normal vision.
antiretroviral causing increased amylase, epigastric tenderness, abdominal distension
Intercostal space at midaxillary line for needle placement in thoracentesis when the pt is seated for pleural effusion
pleura is present bw the 8th and 10th intercostal spaces
increased activity of amylase and lipase. CT shows enlargement of the pancreas and dilation of the pancreatic ducts. Gallstone lodged where??
The ampulla of Vater, also known as the hepatopancreatic ampulla or the hepatopancreatic duct, is formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla.
4 week old boy. nonbilous projectile vomiting after eating. visible abdominal peristalsis and a 2-cm, firm, ovoid mass in the RUQ. diagnosis?
olive shaped mass
nonbilous projectile vomiting
visible persitaltic waves
mutation in gene for a protein that controls the traffic of vesicle into the Golgi complex. EM of the cell will show what?
dilate rough endoplasmic reticulum
proteins from the ER won't be packaged
Niemann-Pick disease (AR). if incidence is 1/900 in Ashkenazki Jews, carrier frequency in this population?
A study to assess normal mean serum urea nitrogen in men age 65 an older to be used as reference values in a lab. random selection of whom will provide an inaccurate but precise estimate of the mean conc in this group?
500 men from a list of pts scheduled to be examined by a urologist
the same numbers will likely be reproduced
50 y/o woman with azotemina, bilateral hydroureters and hydronephrosis. primary carcinoma where?
lateral invasion can block ureters -> renal failure
80% power of detecting a mean diff of 0.4 at significance level of 0.05. Meaning?
if the txt really changes by mean diff of 0.4, there's an 80% chance a study of this size find a p-value less than or equal to 0.05
initial depolarization is mediated by non-NMDA-type glutamate receptors. why?
NMDA type are blocked by Mg2+ at resting membrane potential
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