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28 Cards in this Set
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A 35 yo woman presents w/ fever, malaise, and stiffness.
Her hands are swollen and painful. Her knee joint is red, swollen, and warm to the touch. Joint deformity is noted. She has morning stiffness lasting 2 hours and gets better w/ activity. Which of the following is most characteristic of her joint disease? Weight bearing joints are principally affected Ankylosis and fibrosis Subchondral cysts and sclerosis Involvement of the distal interphalangeal joints Chronic granulomatous inflammatory reaction |
Ankylosis and fibrosis
This pt. has RA, characterized by morning stiffness for hours, joint deformity and constitutional symptoms. Involvement of the DIP is a sign of OA RA involves the PIP |
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Two worried parents bring their 2 yo daughter to your office.
She has a history of seizures, has not kept up with her developmental milestones, and has abnormal eye movements. You decide to run some labs and find that the girl has high lactate levels. Which is the most likely diagnosis? G6PD deficiency Pyruvate dehydrogenase deficience Glycotic enzyme deficiency Niemann pick disease McArdle's disease |
Pyruvate dehydrogenase deficiency
This deficiency is characterized by failure to convert pyruvate to acetyl coenzyme A, thus forcing the glycolytic pathway into lactate Glycotic enzyme deficiency (Von Gierke's Disease) would result in fasting hypoglycemia, increased glycogen in the liver and high lactate. It would NOT result in neurologic dysfunction |
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A 13 yo girl presents w/ scoliosis and cafe au lait spots.
Eye exam reveals pigmented hemartomas. Her mother states that she does poorly in school. She complains of leg pain. Which of the following additional findings is most likely? Bilateral acoustic neuroma Proliferation of peripheral nerves Precocious puberty Polyostotic fibrous dysplasia Autosomal recessive inheritence |
Proliferation of peripheral nerves
The diagnosis is Neurofibromatosis type I. Scoliosis, cafe au lait spots, and Lisch nodules in the iris (pigmented hamartomas) are virtually diagnostic Bilateral acoustic neuromas are diagnostic for Neurofibromatosis type II |
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A 10 yo girl suffered a non-productive cough and mild fever for 10 days.
She also complains of fatigue, headache and myalgia. Her temp is 101. Her plasma is positive for cold agglutins. Blood tests show evidence of hemolytic anemia. Which of the following best explains the mechanism of her anemia? Delayed type hypersensitivity reaction Type III hypersensitivity Toxin-mediated reaction Type II hypersensitivity Intracellular bacterial growth |
Type II hypersensitivity
This pt. has atypical pneumonia caused by Mysoplasma Pneumonia The positive plasma cold agglutins is pathomnemonic. Hemolytic anemias (like hemolytic anemia of the newborn) are Type II hypersensitivities |
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A 23 yo previously healthy female presents w/ abdominal pains.
She states that she is 27 weeks pregnant and has been feeling nauseous and has had cramps all day. She is admitted overnight and a urine specimen is collected. The diagnosis is due to mild endothelial vessel damage. It is determined to be mild because of the following criteria: The BP was measured once and it was 160/120. The proteinuria was greater than 5000mg/24hrs The BP was measured over a 6 hour period and it was 140/105 and 143/111. The proteinuria was greater than 300mg/24hrs The BP was measured 3 times and was 120/70, 110/78, and 123/79. The proteinuria was greater than 300mg/24hrs The BP was measured twice over a four-hour period and both times it was above 160/110. The proteinuria was greater than 5000mg/24hrs The BP was 200/130. The proteinuria was less than 300mg/24hrs |
The BP was measured over a 6 hour period and it was 140/105 and 143/111. The proteinuria was greater than 300mg/24hrs
Mild pre-eclampsia is defined as 2 serial BP measurements greater than 140/90 and proteinuria greater than 300mg/24hrs Severe pre-eclampsia is defined as serial BP measurements of greater than 160/100 and proteinuria greater than 5000mg/24hrs |
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A 35 yo woman has been taking oral contraceptive pills for the past 10 years.
For the past 6 months she has been feeling more tired and fatigued. Labs show elevated serum iron, ferritin, and transferrin as well as decreased MCV. Which of the following additional findings is most likely in this patient? Microcytosis of RBCs Decreased homocysteine Elevated serotonin levels Decreased frequency of headaches Hypotension |
Microcytosis of RBCs
The iron studies in this case indicate sideroblastic anemia. OCPs decrease the absorption of B vitamins, most notably in this case, B6 B6 deficiency leads to sideroblastic anemia, and thus microcytic anemia |
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A 23 yo pregnant woman comes to the ER in acute distress.
She has a BP of 90/60, a HR of 130 and is tachypneic. PE reveals petechial hemorrhages and blood oozing from mucous membranes. Lab findings include low fibrinogen levels. Which of the following is the most likely diagnosis? Thrombocytopenia vWFD Hemophilia A DIC Warfarin overdose |
DIC
Low fibrinogen, petechial hemorrhages, and blood oozing from mucous membranes are typical in DIC PLT count would be low, Bleed time would be high, PT & PTT times would both be high |
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A 25 yo female complains of fatigue, malaise, and arthritis.
She admits that her skin is sensitive to sunlight. Lab results show anemia and a positive indirect Coombs test. Serology is positive for anti-nuclear antibodies. Which of the following is most likely true about her diagnosis? Anti-DNA antibodies are the most sensitive diagnostic test Presence of anti-phospholipid antibodies may cause abnormal bleeding Anti-histone antibodies is the most sensitive diagnostic test Autoimmune cartilage destruction typically leads to joint deformities Kidney failure is the most common cause of death |
Kidney failure is the most common cause of death
This pt. has SLE and kidney failure is the leading cause of death This pt. is also suffering from autoimmune hemolytic anemia w/ warm agglutins (i.e. IgG autoantibodies) |
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A 65 yo chronic smoker presents w/ unintentional weight loss and a dull constant epigastric pain for the past 2 months.
PE reveals jaundice and a palpable mass in the right upper quandrant. Which of the following is the most likely diagnosis? Acute cholecystitis Primary sclerosing cholangitis Pancreatic cancer Primary biliary cirrhosis Chronic hepatitis |
Pancreatic cancer
A palpable RUQ mass is known as Courvoisier's sign Smoking is a risk factor for pancreatic cancer Jaundice is caused by obstruction of the bile duct due to the size of the pancreatic head |
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A 5 yo girl has skin lesions exuding a honey-colored serous fluid.
Culture reveals gram-positive cocci in chains with beta-hemolysis. Which of the following sequelae is most likely? Thrombocytopenia Ascending paralysis that starts at the lower legs RBCs casts and smoky-colored urine Paralysis of the facial nerve Damage to the mitral valve |
RBC casts and smoky-colored urine
This pt. has impetigo, caused by S. Pyogenes. S. Pyogenes skin infections are likely to lead to Post-streptococcal Glomerulonephritis S. Pyogenes oral infections are likely to lead to Rheumatic Fever |
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A 34 yo female complains of hearing loss for the past 6 months.
A careful history reveals that her mother also suffers from hearing loss. Otoscopic exam is normal. Rinne test indicates that bone conduction is audible longer than air conduction for both ears. Which of the following additional findings is most likely? Loss of stapedial reflex Damage to cranial nerve 8 Autosomal recessive inheritance Symptoms of ear fullness and tinnitus Her semicircular canals contain dislodged otocoria |
Loss of stapedial reflex
A young woman w/ bilateral conductive hearing loss and a positive family history most likely has otosclerosis (AD) This causes overgrowth of the middle ear bones, which interferes w/ sound conductance and movement of the stapeidal muscle |
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A 25 yo woman in her first trimester of pregnancy presents w/ edema of her ankles and feet.
Her blood pressure is 125/80 and trace amounts of protein are found in her urine. PE reveals a uterus that is large for her gestational age. Her hCG is 115,000 (normal = 19-7340). Ultrasound reveals the absence of fetal tissue. What is the most likely diagnosis? Eclampsia Ectopic pregnancy Partial mole w/ a triploid, 69XXY embryo mild pre-eclampsia Complete mole w/ 46XX genetic composition |
Complete mole w/ 46 XX genetic composition
Complete moles LACK fetal tissue PARTial moles have PARTS of fetal tissue |
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A 60 yo woman w/ a 25 year history of Type II diabetes complains of blurry vision for the past 4 weeks.
Decreased visual actuity is noted on PE. Funduscopic exam reveals evidence of diabetic retinopathy. Which of the following best describes the pathogenesis of this condition? Inflammation obscures the lens High ocular pressure damages the optic disc Thick retinal capillaries leads to microinfarcts Sorbitol accumulates causing osmotic swelling Glycosylated proteins cause optic nerve damage |
Thick retinal capillaries leads to microinfarcts
Remember: Sorbital accumulation is what leads to diabetic cataracts, not retinopathy |
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A 21 yo male presents w/ stiffness and swelling in his right knee, hip, and back for the past 2 weeks.
One month ago he was treated for a gonorrhea infection. He also complains of burning while urinating. Which of the following additional findings is most likely? Conjunctivitis Turbid synovial fluid with elevated neutrophils Fusion of the bertebrae Subcutaneous nodules Pitting of the nails |
Conjunctivitis
This pt. is demonstrating signs of Reiter's syndrome. Reiter's is often due to an untreated infection w/ Chlamydia Turbind synovial fluid would be caused be untreated gonorrhea but typically infects only one joint |
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A 35 old woman complains of uncontrollable episodes of flushing, diarrhea, and wheezing.
Urinalysis shows elevated 5-HIAA. This pt. is at increased risk for deficiency of: Riboflavin Thyroid hormone Thiamine Vitamin B12 Niacin |
Niacin
Carcinoid syndrome leads to serotonin deficiency. Tryptophan is a precursor to both serotonin and niacin. W/ serotonin deficiency, tryptophan is devoted to serotonin produciton and niacin becomes deficient |
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A 40 yo woman presents w/ headache, confusion, and fever.
She denies any history of trauma. She admits to a bout of bloody diarrhea about 1 month ago after eating a hamburger. Serum chemistry shows a Creatinine of 2.0 mg/dL. Blood tests indicate anemia and a platelet count of 95,000. PT and PTT are within normal limits. Which is the most likely diagnosis? Hemolytic uremic syndrome (HUS) Disseminated intravascular coagulation (DIC) Idiopathic thrombocytopenia Dehydration Thrombotic thormobocytopenic purpura (TTP) |
TTP
This pt. is presenting w/ the pentad of: Fever, Nurologic symptoms, Kidney failure, Anemia, and Thrombocytopenia. HUS doesn't present w/ neurologic symptoms and would present days after infectious diarrhea DIC would have high PT & PTT ITP only has low PLTs |
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A 45 yo female presents to the clinic w/ lethargy, weight gain, and cold intolerance.
PE shows slow deep tendon reflexes. She has a history of megaloblastic anemia and gastritis. Which of the following additional findings is most likely? No change in TSH Dry mouth and dental caries Antibodies that bind to the TSH receptor Diarrhea Helicobacter pylori infection |
Dry mouth and dental caries
The pt. is presenting w/ signs and symptoms of Hashimotos. Her history suggests pernicious anemia, another autoimmune disorder. Autoimmune diseases tend to run together. Thus B is the correct answer because the pt. likely also has SJOGREN'S SYNDROME |
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A 46 yo black woman presents to the ED w/ severe bilateral posterior eye pain.
She is complaining of bulging eyes, difficulty seeing, and light-headedness when she tries to stand up. She is currently on several medications, as she suffers from epilepsy, atherosclerosis, major deprssive disorder, and ADHD. What is the more likely medical culprit? Carbamazepine Methamphetamine L-Tyrosine Citalopram Propranolol |
Citalopram
SSRI's are associated w/ increasing intraocular pressure and causing acute angle glaucoma A leading side effect of this class of drugs is orthostatic hypotension |
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A 52 yo Hispanic male complains of upper abdominal pain radiating to his back for the past few months.
He also reports an unintentional weight loss. PE is remarkable for scleral icterus. Which of the following physical findings would be pathognomonic for your suspected diagnosis? Battle sign Rovsing sign Courvoisier sign Murphy sign Homan sign |
Courvoisier sign
Battle sign is redness behind the ear following a skull fracture |
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A 21 yo female has a history of unprotected sex.
Biopsy of an ulcerated papule is positive for Donovan bodies. Which of the following is the most likely diagnosis: Human papillomavirus Gonorrhea Herpes simplex virus Haemophilus ducreyi Granuloma inguinale |
Granuloma inguinale
This is a G- Rod, Klebsiella Granulomatis, and is characterized by Donovan bodies. These are aggregates of bacteria within macrophages |
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a baby is born w/ a severe egg allergy.
Which of the following viral vaccines would not be safe to administer to this newborn? DTaP MMR Varicella Zoster Polio Smallpox |
MMR
MMR, Influenza & Yellow Fever vaccines all contain egg |
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During a colostomy reversal in a 77 yo obese female, the left renal artery is nicked.
Blood is quickly observed rushing into the retroperitoneum, and the anesthesiologist places a stat order for blood products. The pt's blood type is B+. The most appropriate replacement blood product is: Packed RBCs, type AB- Packed RBCs, type A+ Packed RBCs, type O- Fresh frozen plasma, type B+ Fresh frozen plasma, type O- |
Packed RBCs, type O-
Hemorrhagic pts. require packed RBCs immediately Fresh frozen plasma is reserved for replacement of clotting factors Type B+ blood would be desired, but since this wasn't an option, type O- (universal donor) is the next best option |
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A 33 yo woman comes to your office complaining of heat intolerance, palpitations, tremor, and diarrhea.
You note bilateral proptosis. Which of the following is most likely to be found: Thyroid biopsy showing germinal centers Tender thyroid gland on palpitation Elevated TSH Hyperpigmented skin on the anterior legs Decreased uptake of radioactive iodine |
Hyperpigmented skin on the anterior legs
This pt. has Graves disease and pretibial myxedema (hyperpigmented skin on the anterior legs) is a sign EXCLUSIVE TO GRAVES DISEASE |
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A 3 yo male Caucasian male is accompanied by his mother for a PE.
Reviewing his chart you notice that he has suffered from several recurrent lower respiratory infections. His mother tells you that he has recently begun having some foul smelling stools that seem to float and she has noticed a small protrusion inside his nose. Which of the following is associated w/ his most likely diagnosis? Hypothyroidism Folate deficiency MEN II Insulin dependent diabetes Ankylosing spondylitis |
Insulin dependent diabetes
This pt. most likely has CF Blockage of the pancreatic duct can lead to insulin dependent diabetes The nasal polyps seen in the child are present in 25% of pts w/ CF CF is most often found in Caucasians CF causes poor absorption of fat-soluble vitamins, leading to steatorrhea |
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A 70 obese woman notices a lump in her breast.
She has a history of breast tenderness related to her menstrual cycle. Her mother's aunt died of breast cancer. Her menarche was at 16 and she has 5 biological children. PE shows crusting ulcers and fissures near the left nipple. Which of the following diagnoses is most likely? Invasive lobular carcinoma Invasive ductal carcinoma Intraductal papilloma Inflammatory carcinoma HPV infection |
Invasive ductal carcinoma
The vignette describes Paget's disease. Paget's is most commonly associated w/ underlying INVASIVE DUCTAL CARCINOMA Invasive ductal carcinoma is the most common type of breast cancer |
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A 50 yo male was diagnosed w/ AIDS 10 years ago.
Today he presents w/ mental status changes, weakness and blurry vision. CSF analysis is diagnostic for an infection causing progressive multifocal leukoencephalopathy (PML). Which of the following is true concerning his CNS infection? Infection is widespread in the population The main cells infected are the microglia The main cells infected are neurons It is caused by an RNA virus He will die of another infection before this one becomes fatal |
Infection is widespread in the population
PML is caused by the JC Virus which is found in 75% of the population, but only the immunocompromised display symptoms. PML only affects the white matter (leuko - encephalopathy) |
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A 44 yo obese Caucasian female presents to the ED w/ intense RUQ abdominal pain that radiates to her shoulder.
The pain has occured intermittently for the past 3 weeks, but now it is constant, of increasing severity, and associated w/ intense nausea. Anultrasound reveals stones and an enlarged cystic duct. One step of fatty acid degredation involves: Acetyl-CoA moving to the cytoplasm The citrate shuttle Acetyl-CoA conjugation to biotin Acetyl-CoA being transferred by carnitine Acyl-CoA oxidation in the mitochondria |
Acyl-CoA oxidation in the mitochondria
Fatty acid degradation occurs in the inner mitochondrial matrix It's a 3 step process: 1 = Fatty acid is activated to Acyl-CoA 2 = Acyl-CoA is transferred by carnitine into the mitochondria where it undergoes B-oxidation to Acetyl-CoA 3 = Acetyl-CoA enters the TCA cycle to produce NADH and FADH |
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An 18 yo obese female presents to the clinic with amenorrhea, acne and hirsutism.
Lab results show elevated LH and normal FSH. Which of the following is true concerning her most likely diagnosis? Increases the risk for ovarian cancer She has elevated corticosteroids Benign estrogen sensitive uterine turmos Increases the risk for type II diabetes Associated with blood-filled cysts on the ovaries |
Increases the risk for type II diabetes
PCOS presents w/ amenorrhea, hirsutism and labs showing elevated LH. Pts. are at increased risk for developing type II DM |
