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84 Cards in this Set

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A gardener presents with shortness of breath, salivation, miosis and diarrhea.
What caused this?
What is the mechanism of action?
Organophosphate (insecticide) poisoning
AChE inhibitor --> excessive ACh
What drugs would be best to treat organophosphate poisoning?
Pralidoxime (AChE reactivator - must be given early)
Atropine (Anti-muscarinic)
What anticholinergic can help improve FEV1 in a pt with COPD?
Ipratropium (Anti-muscarinic)
A 30 yr old schizophrenic now has urinary retention due to his neuroleptic drug.
What cholinergic drug do you use to treat it?
Bethanichol (BBB: Bethanichol = Bowel and Bladder)
In the dark a pt. has both pupils dilated. In the light a "control" pupil is miotic while the pupil given drug X remains mydriatic.
What is drug X?
1. Anti-muscarinic
2. Sympathetic agonist
What drug can be given to a patient in shock that also has renal failure (maintains renal blood flow)?
Dopamine
An elderly women w/chronic osteoarthritis now has numbness and tingling over the lateral digits of her right hand that radiates to elbow. Exam reveals wasting of the thenar eminence.
What is the diagnosis?
Carpel tunnel syndrome
A 60 yr old male has a hard time driving at night because of eye pain with oncoming headlights.
What is his problem?
Cataracts
A gymnast sustains an anterior shoulder dislocation.
What nerve is most likely to have been injured?
Axillary n.
An adolescent falls while skateboarding and injures his elbow. He can't feel the medial part of his elbow.
What is his injury?
Which nerve is injured?
Broken medial epicondyle
Ulnar n.
A high-school athlete falls on his arm during practice. In the ER a radiograph shows a midshaft break of the humerous.
Which nerve has the highest risk of being damaged?
Which artery has the highest risk of being damaged?
Radial n.
Deep brachial artery
What organisms are most commonly implicated in subacute endocarditis?
1. Strep viridans
2. Staph epidermidis
3. Entrococci
A woman that is breast-feeding develops redness and swelling of her right breast over a period of 24 hours. Examination reveals a warm, fluctuant mass.
What is the diagnosis?
Mastitis caused by Staph aureus
(Need to continue to get milk out in order to treat. OK for babies to drink milk)
What is the most common aerobic skin flora?
Staph epidermidis
What complement is responsible for neutrophil chemotaxis?
C5a (along with IL-8, LTB4)
A young child presents with tetany and candidiasis. What is the diagnosis?
DiGeroge syndrome (T cell deficiency)
A young child has recurrent lung infections and granulomatous lesions.
What is the defect?
NADPH oxidase deficiency in neutrophils
(Chronic Granulomatous Disease)
A mother brings in her 2 year old child who has had multiple viral and fungal infections and is found to be hypocalcemic.
Which of the 3 types of germ cells (ecto-, endo-, mesoderm) gives rise to the missing structure in this child?
Endoderm
(3rd and 4th brachial pouch--> missing thymus)
A child has an immune disorder in which there is repeated Staph. abscesses. It is found that the phagocytes fail to respond to chemotactic stimuli.
What is the most likely diagnosis?
Hyperimmunoglobonemia E syndrome
a.k.a. Job's syndrome
A patient suffers from recurrent Neisseria infections.
What complement proteins are deficient?
C6-8
A 45 year old female complains of malar rash and arthritis.
The presence of which antibodies are specific for SLE?
1. anti-Smith
2. anti-ds DNA (marker for renal disease in SLE)
After a bone marrow transplantation, a patient suffers from dermatitis, enteritis, and hepatitis.
What disease process is occuring?
Graft vs. Host Disease
A physician is looking for risk factors for pancreatitis. He interviews 100 hospitalized pts. with pancreatitis and 100 hospitalized pts. without pancreatitis.
What type of study is this?
Case-control study
A new glucose test arrives and you decide to see how well it works. There is a standard dubstance provided that has 90 mg/dl of glucose. Your repeated measurements of the substance reveal the following values: 54, 56, 55, 54, 53, 56, 55, 54.
What can you say about the precision and accuracy of your new glucose test?
High precision, Low accurracy
A group of people is followed over 20 years. Every 2 years it is determined who develops cancer and who does not.
What type of study is this?
Cohort study
A certain screening test has a 1% false-negative rate.
What is the sensitivity of the test?
99%
Sensitivity = 1 - false negative rate
The prevalence of varicella in population A is 2 times the prevalence of varcella in population B. The incidence is the same in populations A and B.
What can be assumed about the disease duration in population A versus population B?
Duration of disease in population A is twice as long as duration of disease in population B
You have to deliver bad news to a pt of yours who you have just found out to have lung cancer. The pt. is a 52 yo male that has smoked 1 ppd for 25 yrs, exercises regularly and maintains a healthy diet.
What do you say to the pt.?
1. Validate good health efforts
2. Educate pr. on lung cancer risk factors
3. Do not belittle the patient
You find yourself attracted to your patient.
How do you handle the situation?
1. Maintain strict professionalisms
Do not date any former/current patients
A patient has made it clear to you on previous visits that is something should happen to him that he would not want surgery. He now requires surgery, and can no longer make informed consents. His wife absolutely wants him to have surgery.
What should you do?
Abide by the husbands prior repeated wishes and withhold surgery.
(called substituted judgement)
* may need a court order since the wife is his next of kin and disagrees with you
A 68 yo man is diagnosed with incurable glioblastoma multiforme. His family asks you not to tell the patient.
How do you handle the situation?
1. Determine if disclosing information will negatively affect the pt's health (depression, suicide, etc.)
2. If so, withhold information
3. If not, disclose information
A 36 yo female has a first degree relative who had breast cancer at age 40. You recommend that she receive a mammogram, but she refuses b/c she says it is too painful.
What do you do?
Educate her of the procedure, risks/benefits, alternatives (Informed consent) and document everything
A 72 yo man in the hospital with an MI refuses to take his aspirin on the grounds that it makes him "feel funny".
What do you do?
1. Investigate the feeling
2. Possibly change medications
3. Informed consent - document
How shoudl you handle a situation where you smell alcohol on a physician's breath while that physician is practicing medicine?
1. Notify the physician that you are aware of the situation
2. Notify their superior
A mother presents with her 1 yo child that can stand alone, has yet to learned to walk, and has a 5 word vocabulary. She would like to know if her child id developmentally normal and when she can begin toilet trainings.
What do you tell her?
1. Her child is developmentally normal
2. 2-3 years of age
A 2 yo child speaks in short sentences of 2-3 words but cannot identify colors or recite his ABCs. The mother is concerned that he is not developing normally.
What do you tell her?
Her child is developmentally normal and too young to know colors and ABCs
A girl can speak in complete sentences, has an imaginary friend, and considers boys "yucky".
How old is she?
6-11 years old
A 60 yo businessman complains of lack of successful sexual contacts with women and a lack of ability to reach full erection. One year ago he had a heart attack.
What might be the cause of his problem?
1. Psychological
2. Athrosclerosis
3. Use of Beta-blockers
A 6-month-old child is given honey for sympathetic treatment of a cold and becomes flaccid.
What gram positive rod is implicated?
What is the mechanism of action?
1. Clostridium botulinum
2. inhibits release of ACh
One hour after eating potato salad at a picnic, an entire family began to vomit. After 10 hours, they were better.
What is the organism?
Staph aureus (specifically preformed toxins)
What is a gram negative, oxidase positive diplococcus?
Neisseria
A 22 yo medical student has a burning feeling in his gut after meals. An EGD is performed and biospy of the gastric mucosa shows gram negative rods.
What is the organism?
H. pylori
A 50 yo male smoker presents with a new cough and flulike symptoms. Gram stain of the sputum shows no organisms but silver stains show rods.
What is the diagnosis?
Legionella pneumophilia
A 40 yo female presents with acute onset of unilateral knee pain and bilateral Bell's palsy.
What oraganism is most likely responsible?
How is is transmitted?
1. Borrelia burgdorferi (Lyme disease)
2. Ixodes tick
A 21 yo male presents with 5 days of fever, chills, and an enlarged, painful knee.
What is the organism resposible?
What is the treatment?
1. Neisseria gonorrhea
2. Ceftiaxone
After taking a course of amoxicillin, an adult patient develops toxic megacolon and diarrhea.
What is the mechanism of the diarrhea?
C. difficile overgorwith (Psudeomembranous colitis)
A 25 yo with Mycoplasma atypical pnuemonia exhibits anemia due to cryoagglutinins.
What type of immunoglobins are responsible for the anemia?
IgM (cold agglutanins)
A homeless, alcoholic patient vomited while intoxicated and subsequently developed a foul smelling sputum.
What organism is most likely causing his infection?
1. Klebsiella pneumoniae
2. anaerobes
A 65 yo asks her husband to stay in the hospital overnight with her because she is afraid to be alone.
What defense mechanism is she exhibiting?
Regression
Which defense mechanism underlies all other defense mechanisms?
Repression
(not dealing with problem, which leads to emergence of defense mechanisms)
A 60 yo man admittted for chest pain jumps out of bed and does 50 push-ups to show the nurses he has not had a heart attack.
What defense mechanism is he using?
Denial
When a young monkey is separated from its mother, it becomes withdrawn, socially isolated, and grooms poorly.
It is thought that this behavior is the monkey equivalent of what human problem?
Anaclinis depression
(children that fail to thrive due to separation from a caregiver or lack of affection)
A 15 yo girl of normal height and weight for her age has enlarged parotid glands but no other complaints. The mother confides she found laxatives in the daughter's closet.
What is the diagnosis?
Bulimia nervosa
A 4 yo girl complains of pain in her genitalia. On exam a discharge is noticed and a smear of the discharge shows N. gonorrhoeae.
How was she infected?
Sexual abuse
A 72 yo patient is not able to recall 3 objects on a MMSE. The family reports that for the past year someone has had to stay with him at all times for his own safety. He stays awake all day and sleeps well at night.
What is the most likely diagnosis?
Dementia
A 72 yo patient is brought into the clinic by family b/c of strange behavior over the past week. She has been very agitated, takes many naps during the day, occationally urinates on herself, and is unable to focus when asked questions.
What is the most likely diagnosis?
Delirium
You are on call and receive a call from a nurse asking if she can give some sleep medication or diphenhydramine to an elderly pt with mild dementia who is currently hospitalized for MI.
What do you give the pt.?
No BZ b/c will increase agitation
No anticholinergic b/c will cause delirium
Give haloperidol or trazadone
A 28 yo woman has symptoms of mild depression for 6 years.
What is the diagnosis?
Dysthymia
A patient tries to commit suicide by slitting her wrists.
After she is appropriately managed in the ER, what question would you ask the pt. to determine her level of commitment of trying to take her own life?
What did you do after you slit your wrists?

(If went to show someone, then more attention-seeking. If hid in a closet/bathroom, then probably more serious)
Two months after the loss of her spouse, a 42 yo female is having trouble eating, concentrating and sleeping. She sleeps only 2-3 hours each night.
What would you do for this pt?
She is experiencing normal bereavement. To treat her insomnia give a BZ (for 1 month only) or low dose trazadone.
A patient on whom you wish to obtain an MRI tells you that he cannot go through with it because of claustaphobia.
What can you do to help this pt?
Give 2 pills of a short-term BZ
(1 for before exam, 1 extra)
A young woman that is anxious about receiving her first pap smear is told to relax and to imagine going through the steps of the exam.
What does this process exemplify?
Systematic desensitization
A woman has flashbacks about her boyfriend's death one month ago following a hit-and-run accident. She often cries and wishes for the death of the culprit.
What is the diagnosis?
Normal berevement
A nurse has episodes of hypoglycemia. Blood analysis reveals no elevation in C-protein.
What is her diagnosis?
Factitious disorder
A 40 yo women tells you during one of her office visits that she is in love with you. You refer her to someone else and she attempts suicide.
What type of personality disorder does this pt. have?
Borderline personality disorder
A 30 yo woman tells you during her visit that you are the best doctor she has every had but your nurse is very disrespectful. On a subsequent visit she threatens to change doctors because you do not feel a particular lab test is necessary.
What type of personality disorder does this person have?
Borderline personality disorder
A 55 yo woman comes to your office wearing all black including a black miniskirt and black feather boa. She is also wearing an excessive amount of lipstick, and she converses with many of the other patients in the waiting room.
What type of personality disorder do you suspect?
Histrionic
A person demands only the best and most famous doctor in town.
What personality disorder do they have?
Narcissistic
A pt has an aganglionic colon and other neural crest derivative deficiencies.
What other findings would you expect to see?
Albinism (no melanocytes)
Which fetal vessel has the highest oxygen content?
Umbilical vein --> ductus venosus (liver)
A 45 yo male presents with a BP of 160/90 ont he right arm and 170/92 on the left arm. There are no palpable pulses in the feet/ankle.
What problem does this pt most likely have?
Postductal coarctation of aorta
Describe the blood flow thru a PDA.
Fetal = R --> L (pulmonary A. --> aorta)
Neonate = L --> R (aorta --> pulmonary A)
Monozygotic twins are delivered. One is pale and has a hematocrit of 15%, and the other is flushed with a hematocrit of 55%.
What is the cause of these features?
Twin to twin transfusion
(only seen in monozygotic twins b/c they share a placenta)
A child presents with cleft lip.
Which embryonic process failed?
Fusion of maxillary and median nasal processes.
A 23 yo pt presents with one testicle.
What is this pt. at risk for?
Germ cell tumor of testicle.
A 24 yo male develops testicular cancer.
Metastatic spread occurs by what route?
Para-aortic lymph nodes
A 16 yo female pt presents with amenorrhea. It is later discovered that this pt lacks a uterus and uterine tubes, and there are two round structures in the midline jsut superior to the labia majora.
What is most likely diagnosis?
Androgen insensitivity syndrome
(Male psuedohermaphrodite)
A patient returns from a trip to New Mexico and now has pneumonitis.
What is the fungal cause of this pt's lung disease?
Coccidiodomycosis
A 30 yo female has "cauliflower" skin lesions. Tissue biopsy shows broad-based budding yeast.
What is the likely organism?
Blastomyces dermatididis
An HIV+ pt with CSF showing yeast suddenly dies.
What is the most likely diagnosis?
Cryptococcal meningitidis
A pt presents with a thorn prick with ulcers along lymphatic drainage. What is the infectious organism?
Sporothrix schenkii
A pt who visited Mexico presents with bloody diarrhea.
What infectious form is found in the stool?
Entamoeba histolytica - trophozoites
A 32 yo male pt went camping in northern California 2 weeks ago, had a 2 day stint of diarrhea and now presents with symptoms of liver damage and jaundice.
What is the organism?
Entamoeba histolytica
A pt returning from a 2 week vacation in west Africa present with symptoms of recurrent malaria.
What is the mechanism responsible for the recurrent fever?
Marizoites that rupture out of the RBCs