Dit Hyq

Front 1

A gardener presents with shortness of breath, salivation, miosis and diarrhea.
What caused this?
What is the mechanism of action?

Back 1

Organophosphate (insecticide) poisoning
AChE inhibitor --> excessive ACh

Front 2

What drugs would be best to treat organophosphate poisoning?

Back 2

Pralidoxime (AChE reactivator - must be given early)
Atropine (Anti-muscarinic)

Front 3

What anticholinergic can help improve FEV1 in a pt with COPD?

Back 3

Ipratropium (Anti-muscarinic)

Front 4

A 30 yr old schizophrenic now has urinary retention due to his neuroleptic drug.
What cholinergic drug do you use to treat it?

Back 4

Bethanichol (BBB: Bethanichol = Bowel and Bladder)

Front 5

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?

Back 5

1. Anti-muscarinic
2. Sympathetic agonist

Front 6

What drug can be given to a patient in shock that also has renal failure (maintains renal blood flow)?

Back 6

Dopamine

Front 7

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?

Back 7

Carpel tunnel syndrome

Front 8

A 60 yr old male has a hard time driving at night because of eye pain with oncoming headlights.
What is his problem?

Back 8

Cataracts

Front 9

A gymnast sustains an anterior shoulder dislocation.
What nerve is most likely to have been injured?

Back 9

Axillary n.

Front 10

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?

Back 10

Broken medial epicondyle
Ulnar n.

Front 11

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?

Back 11

Radial n.
Deep brachial artery

Front 12

What organisms are most commonly implicated in subacute endocarditis?

Back 12

1. Strep viridans
2. Staph epidermidis
3. Entrococci

Front 13

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?

Back 13

Mastitis caused by Staph aureus
(Need to continue to get milk out in order to treat. OK for babies to drink milk)

Front 14

What is the most common aerobic skin flora?

Back 14

Staph epidermidis

Front 15

What complement is responsible for neutrophil chemotaxis?

Back 15

C5a (along with IL-8, LTB4)

Front 16

A young child presents with tetany and candidiasis. What is the diagnosis?

Back 16

DiGeroge syndrome (T cell deficiency)

Front 17

A young child has recurrent lung infections and granulomatous lesions.
What is the defect?

Back 17

NADPH oxidase deficiency in neutrophils
(Chronic Granulomatous Disease)

Front 18

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?

Back 18

Endoderm
(3rd and 4th brachial pouch--> missing thymus)

Front 19

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?

Back 19

Hyperimmunoglobonemia E syndrome
a.k.a. Job's syndrome

Front 20

A patient suffers from recurrent Neisseria infections.
What complement proteins are deficient?

Back 20

C6-8

Front 21

A 45 year old female complains of malar rash and arthritis.
The presence of which antibodies are specific for SLE?

Back 21

1. anti-Smith
2. anti-ds DNA (marker for renal disease in SLE)

Front 22

After a bone marrow transplantation, a patient suffers from dermatitis, enteritis, and hepatitis.
What disease process is occuring?

Back 22

Graft vs. Host Disease

Front 23

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?

Back 23

Case-control study

Front 24

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?

Back 24

High precision, Low accurracy

Front 25

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?

Back 25

Cohort study

Front 26

A certain screening test has a 1% false-negative rate.
What is the sensitivity of the test?

Back 26

99%
Sensitivity = 1 - false negative rate

Front 27

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?

Back 27

Duration of disease in population A is twice as long as duration of disease in population B

Front 28

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.?

Back 28

1. Validate good health efforts
2. Educate pr. on lung cancer risk factors
3. Do not belittle the patient

Front 29

You find yourself attracted to your patient.
How do you handle the situation?

Back 29

1. Maintain strict professionalisms
Do not date any former/current patients

Front 30

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?

Back 30

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

Front 31

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?

Back 31

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

Front 32

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?

Back 32

Educate her of the procedure, risks/benefits, alternatives (Informed consent) and document everything

Front 33

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?

Back 33

1. Investigate the feeling
2. Possibly change medications
3. Informed consent - document

Front 34

How shoudl you handle a situation where you smell alcohol on a physician's breath while that physician is practicing medicine?

Back 34

1. Notify the physician that you are aware of the situation
2. Notify their superior

Front 35

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?

Back 35

1. Her child is developmentally normal
2. 2-3 years of age

Front 36

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?

Back 36

Her child is developmentally normal and too young to know colors and ABCs

Front 37

A girl can speak in complete sentences, has an imaginary friend, and considers boys "yucky".
How old is she?

Back 37

6-11 years old

Front 38

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?

Back 38

1. Psychological
2. Athrosclerosis
3. Use of Beta-blockers

Front 39

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?

Back 39

1. Clostridium botulinum
2. inhibits release of ACh

Front 40

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?

Back 40

Staph aureus (specifically preformed toxins)

Front 41

What is a gram negative, oxidase positive diplococcus?

Back 41

Neisseria

Front 42

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?

Back 42

H. pylori

Front 43

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?

Back 43

Legionella pneumophilia

Front 44

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?

Back 44

1. Borrelia burgdorferi (Lyme disease)
2. Ixodes tick

Front 45

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?

Back 45

1. Neisseria gonorrhea
2. Ceftiaxone

Front 46

After taking a course of amoxicillin, an adult patient develops toxic megacolon and diarrhea.
What is the mechanism of the diarrhea?

Back 46

C. difficile overgorwith (Psudeomembranous colitis)

Front 47

A 25 yo with Mycoplasma atypical pnuemonia exhibits anemia due to cryoagglutinins.
What type of immunoglobins are responsible for the anemia?

Back 47

IgM (cold agglutanins)

Front 48

A homeless, alcoholic patient vomited while intoxicated and subsequently developed a foul smelling sputum.
What organism is most likely causing his infection?

Back 48

1. Klebsiella pneumoniae
2. anaerobes

Front 49

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?

Back 49

Regression

Front 50

Which defense mechanism underlies all other defense mechanisms?

Back 50

Repression
(not dealing with problem, which leads to emergence of defense mechanisms)

Front 51

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?

Back 51

Denial

Front 52

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?

Back 52

Anaclinis depression
(children that fail to thrive due to separation from a caregiver or lack of affection)

Front 53

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?

Back 53

Bulimia nervosa

Front 54

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?

Back 54

Sexual abuse

Front 55

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?

Back 55

Dementia

Front 56

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?

Back 56

Delirium

Front 57

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.?

Back 57

No BZ b/c will increase agitation
No anticholinergic b/c will cause delirium
Give haloperidol or trazadone

Front 58

A 28 yo woman has symptoms of mild depression for 6 years.
What is the diagnosis?

Back 58

Dysthymia

Front 59

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?

Back 59

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)

Front 60

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?

Back 60

She is experiencing normal bereavement. To treat her insomnia give a BZ (for 1 month only) or low dose trazadone.

Front 61

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?

Back 61

Give 2 pills of a short-term BZ
(1 for before exam, 1 extra)

Front 62

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?

Back 62

Systematic desensitization

Front 63

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?

Back 63

Normal berevement

Front 64

A nurse has episodes of hypoglycemia. Blood analysis reveals no elevation in C-protein.
What is her diagnosis?

Back 64

Factitious disorder

Front 65

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?

Back 65

Borderline personality disorder

Front 66

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?

Back 66

Borderline personality disorder

Front 67

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?

Back 67

Histrionic

Front 68

A person demands only the best and most famous doctor in town.
What personality disorder do they have?

Back 68

Narcissistic

Front 69

A pt has an aganglionic colon and other neural crest derivative deficiencies.
What other findings would you expect to see?

Back 69

Albinism (no melanocytes)

Front 70

Which fetal vessel has the highest oxygen content?

Back 70

Umbilical vein --> ductus venosus (liver)

Front 71

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?

Back 71

Postductal coarctation of aorta

Front 72

Describe the blood flow thru a PDA.

Back 72

Fetal = R --> L (pulmonary A. --> aorta)
Neonate = L --> R (aorta --> pulmonary A)

Front 73

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?

Back 73

Twin to twin transfusion
(only seen in monozygotic twins b/c they share a placenta)

Front 74

A child presents with cleft lip.
Which embryonic process failed?

Back 74

Fusion of maxillary and median nasal processes.

Front 75

A 23 yo pt presents with one testicle.
What is this pt. at risk for?

Back 75

Germ cell tumor of testicle.

Front 76

A 24 yo male develops testicular cancer.
Metastatic spread occurs by what route?

Back 76

Para-aortic lymph nodes

Front 77

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?

Back 77

Androgen insensitivity syndrome
(Male psuedohermaphrodite)

Front 78

A patient returns from a trip to New Mexico and now has pneumonitis.
What is the fungal cause of this pt's lung disease?

Back 78

Coccidiodomycosis

Front 79

A 30 yo female has "cauliflower" skin lesions. Tissue biopsy shows broad-based budding yeast.
What is the likely organism?

Back 79

Blastomyces dermatididis

Front 80

An HIV+ pt with CSF showing yeast suddenly dies.
What is the most likely diagnosis?

Back 80

Cryptococcal meningitidis

Front 81

A pt presents with a thorn prick with ulcers along lymphatic drainage. What is the infectious organism?

Back 81

Sporothrix schenkii

Front 82

A pt who visited Mexico presents with bloody diarrhea.
What infectious form is found in the stool?

Back 82

Entamoeba histolytica - trophozoites

Front 83

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?

Back 83

Entamoeba histolytica

Front 84

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?

Back 84

Marizoites that rupture out of the RBCs