Term
| A 29-year-old woman presents to the ER with an acute onset of severe right-sided pelvic pain that began 6 hours ago while she was playing basketball with her son. She also reports nausea and vomiting. There is no fever. A pelvic exam reveals an absence of bleeding, a normal-appearing vaginal discharge, and a right adnexal mass with tenderness. On abdominal exam, there are no peritoneal signs. CBC is normal. Beta-hCG is negative. What is the most likely diagnosis? |
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Definition
Ovarian torsion: ovary rotates around the infundibulopelvic ligament and the uterine/ovarian ligament
Predisposing factors: ovarian cyst or neoplasm
Diagnosis: Pelvic ultrasound |
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Term
| You are asked to perform a pulmonary function test on a young asthmatic. What is the definition of tidal volume? Of residual volume? Of vital capacity? |
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Definition
Tidal: volume of air in normal, quiet breath
Residual: volume of air left in lungs after forced expiration
Vital: max amount of air you can take into your lungs, minus residual volume |
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Term
| What physiologically is taking place in decompression sickness? |
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Definition
| Gases that had dissolved at high pressure come out of solution and form bubbles that occlude blood vessels |
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Term
| An active 31-year-old woman who frequently hikes comes to your office on Monday. A few days ago she went hiking and now has diarrhea. From what she describes, you begin to suspect Giardia infection. What are the typical symptoms of a Giardia infection of the GI tract? |
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Definition
| Bloating, flatulence, foul-smelling, fatty diarrhea |
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Term
| A 34-year-old AIDS patient is brought to the ER by his partner. The patient is sleeping when you arrive but his partner reports that over the past few days the patient has been increasingly confused and lethargic. What opportunistic CNS infections are common in AIDS patients? |
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Definition
JC viral encephalopathy
Toxoplasma
Cryptococcus neoformans
Cytomegalovirus
HIV causes dementia |
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Term
A 20-year-old man is stabbed in the back at a party. He is brought to the ER and taken to the OR by the neurosurgeon. The knife blade is found to have hemisected the spinal cord. What clinical findings will this patient have? Which division of the dorsal column relays sensory information from the lower extremities?
Brown-Sequard syndrome |
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Definition
Ipsilateral:
- Loss of motor function
- Loss of vibration sense and fine touch
- Loss of proprioception
- Loss of two-point discrimination
- Weakness
Contralateral:
- Loss of pain and temp
Fasciculus gracilis: relays lower extremities |
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Term
| A patient who recently suffered a brain hemorrhage as a result of a motor vehicle accident is now complaining of difficulty concentrating. You perform a full neurological exam and suspect that her symptoms may be due to a frontal lobe lesion. How would patient symptom complaints differ between a parietal and a frontal lobe lesion? |
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Definition
Frontal: disinhibition, problems with concentration/orientation, poor judgment, reemergence of primitive reflexes
Parietal: Spatial neglect syndrome (contralateral to lesion) |
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Term
| A young man with sickle cell anemia comes in for periodic blood transfusions as part of his therapy. What long-term complication is associated with having to receive multiple blood transfusions? |
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Definition
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Term
| You are rotating with an anesthesiologist and learning to calculate dosages of anesthetics with her. How does the rate of elimination differ between zero-order elimination and first-order elimination? Which type of elimination behaves as though the enzymes responsible for the elimination are saturated? |
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Definition
Zero: constant amount eliminated per unit time
First: constant fraction eliminated per unit time
Zero behaves as though enzymes saturated |
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Term
| A 40-year-old woman comes to the ER with a painful, red right eye. The eye is rock hard on gentle palpation. What is the diagnosis and what’s the next step? |
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Definition
Closed angle (narrow angle) glaucoma
Avoid epinephrine
Give beta-blocker (timolol), alpha-2 blocker (apraclonidine), cholinergic agonist (pilocarpine) |
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Term
| In cystic fibrosis thick, mucous secretions inhibit digestive enzymes, which can lead to fat soluble vitamin deficiency. What are the fat soluble vitamins? What are the corresponding symptoms of fat soluble vitamin deficiency? |
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Definition
ADEK
A: night blindness, dry skin
D: Children – rickets; adults – osteomalacia, hypocalcemia, tetany
E: Fragile erythrocytes, muscle weakness, CNS demyelination
K: Heavy menstrual bleeding, anemia, bruising, bleeding gums, epistaxis |
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Term
| A 34-year-old man has had an elevated BUN and creatinine for the past 4 days. The patient’s urine osmolality is 600mOsm/L, urine Na 5mmol/24hours, FeNa 0.5%, and Serum BUN/Creatinine 25:1. What type of azotemia does this patient have? What is the primary mechanism of this patient’s azotemia? What are some causes of postrenal azotemia? |
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Definition
Prerenal: FENa<1%; BUN:creatinine ratio >20:1
Low renal blood flow -> low GFR
Postrenal: obstruction of urine outflow – urinary tract stones, BPH, tumors, congenital anomalies; both kidneys need to be obstructed |
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Term
| At what positive G force does visual “black-out” occur? Why does this occur? |
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Definition
4-6G
Centrifugal force pools blood in the abdomen and legs
Insufficient blood return to the heart
Insufficient pumping of blood to the brain |
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Term
| A 57-year-old man comes to his internist complaining of peripheral edema, flushing, and constipation after starting a calcium-channel blocker for his hypertension. Which calcium channel blockers work primarily on the heart? Which ones work on vascular smooth muscle? |
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Definition
Heart: Verapamil
Vascular smooth muscle: dihydropyridines (nifedipine, felodipine, amlopdipine, etc) |
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Term
| What is the rate-limiting enzyme for glycolysis? For gluconeogenesis? |
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Definition
Glycolysis: phosphofructokinase 1
Gluconeogenesis: fructose-1,6-bisphosphatase |
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Term
| In performing a lumbar puncture to obtain a sample of CSF, what structures are pierced, starting with the most exterior? |
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Definition
Skin and superficial fascia
Ligaments: supraspinous, interspinous, ligamentum flavum
Epidural space
Dura mater
Subdural space
Arachnoid mater |
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Term
| A 3-day-old preterm infant delivered at 34-weeks gestational age develops respiratory distress syndrome (RDS). What types of pneumocytes are affected in RDS? What is the mechanism that leads to poor O2-CO2 exchange at the gas exchange barrier in preterm infants with RDS? What structures make up the gas exchange barrier? |
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Definition
Type II pneumocytes secrete surfactant
Gas exchange barrier: Type 1 epithelial cells, basement membrane
RDS: inflammation and hyaline membranes (fibrin, cellular debris, RBC, neutrophils, macrophages) |
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Term
| What is PPAR-gamma? How is it relevant to the treatment of diabetes mellitus? |
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Definition
PPAR gamma: peroxisome proliferator-activated receptor gamma
Nuclear receptor and transcription factor found in adipose tissue
Important in adipocyte differentiation
TZDs bind PPAR-gamma and improve insulin sensitivity |
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Term
| How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? |
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Definition
2 umbilical arteries
1 umbilical vein: highest O2 content |
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Term
| A 43-year-old man presents with right-sided flank pain and hematuria. A helical abdominal CT reveals a right-sided 1.5cm ureterovesicular calculus. The stone is passed after being treated with fluids, pain control and lithotripsy. Incidentally the abdominal CT also reveals an isthmus connecting the inferior poles of the kidneys. During fetal development, what structure traps the inferior poles of the kidney resulting in a horseshoe kidney? Do patients with horseshoe kidneys have abnormal renal function? |
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Definition
| IMA, no abnormal renal function |
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Term
| A 25-year-old man “took a sick blow” to his right shoulder after colliding into a tree narrowing while mountain biking. The patient’s right arm is hanging by his right side in pronation and medial rotation. The patient’s clavicle, right arm and shoulder x-rays do not reveal a fracture or dislocation. What are the common causes of Erb-Duchenne palsy? Where is the brachial plexus insult with Erb-Duchenne palsy? |
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Definition
Severe traction/tear of the upper trunk of brachial plexus: C5 and C6 roots
Causes: blow to shoulder, trauma during delivery |
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Term
Which anticancer agent fits the following description?
1) Given for estrogen-sensitive breast cancers
2) S-phase antimetabolite; myelosuppression reversible with leucovorin
3) S-phase antimetabolite; myelosuppression not reversible with leucovorin
4) Ototoxic and nephrotoxic (much like aminoglycosides and loop diuretics)
5) 2 agents known for causing pulmonary fibrosis
6)Inhibits topoisomerase II |
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Definition
1) Given for estrogen-sensitive breast cancers: Tamoxifen
2) S-phase antimetabolite; myelosuppression reversible with leucovorin: Methotrexate
3) S-phase antimetabolite; myelosuppression not reversible with leucovorin: 5-FU
4) Ototoxic and nephrotoxic (much like aminoglycosides and loop diuretics): Cisplatin, carboplatin
5) 2 agents known for causing pulmonary fibrosis: Busulfan, Bleomycin
6)Inhibits topoisomerase II |
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Term
Which GI ligaments match the following descriptions?
1) Separates the greater and lesser sacs
2) May be cut during surgery to access the lesser sac
3) 2 ligaments that connect the spleen to other structures
4) Contains the portal triad |
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Definition
1) Separates the greater and lesser sacs: Gastrohepatic, gastrosplenic
2) May be cut during surgery to access the lesser sac: Gastrohepatic
3) 2 ligaments that connect the spleen to other structures: Splenorenal, Splenogastric
4) Contains the portal triad: Hepatoduodenal |
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Term
| A 27-year-old woman has been experiencing 1-2 panic attacks every month for the past 3 months. She reports that she cannot establish a specific trigger for the panic attacks but the attacks are beginning to affect her work performance. You choose to use a benzodiazepine as needed, in combination with cognitive behavioral therapy. How does the mechanism of benzodiazepines differ from the mechanism of barbiturates? What toxicities of barbiturates can be fatal? |
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Definition
Both affect GABA-A receptors (Cl channels)
Benzos: increase frequency of opening
Barbituates: increase duration of opening
Barbituates: Cause respiratory depression, hypoventilation; cardiovascular depression, bradycardia |
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Term
| A kidney transplant patient begins to experience renal failure seven years after receiving her kidney transplant. What type of rejection is this, and how is it mediated? |
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Definition
| Chronic rejection: T-cell and antibody-mediated vascular damage: obliterative vascular fibrosis |
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Term
| A 66-year-old man crashes on his motorcycle and suffers a head injury that leaves him in a coma. Prior to this injury the man was met with his lawyer to write out specific instructions in case an event like this happened. What is it that this man and his lawyer put together? |
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Definition
| Written advance directive: Living will |
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Term
You are counseling a preoperative patient who has concerns about side effects related to anesthesia. Which intravenous anesthetic fits the following description?
1) Associated with hallucinations and bad dreams
2) Most common drug used for endoscopy
3) Used for rapid anesthesia induction
4) Decreases cerebral blood flow (important in brain surgery) |
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Definition
1) Associated with hallucinations and bad dreams: Ketamine
2) Most common drug used for endoscopy: Midazolam
3) Used for rapid anesthesia induction: Propofol
4) Decreases cerebral blood flow (important in brain surgery): Barbituates |
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Term
| You are examining an 84-year-old woman who has just come into the hospital for a suspected CHF exacerbation. What heart sound is associated with dilated congestive heart failure? What heart sound is associated with chronic hypertension? |
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Definition
Dilated: S3
Chronic hypertension: S4 |
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Term
| A 60-year-old male long-time patient of yours comes to your office complaining of sexual dysfunction. What is your immediate differential diagnosis? What drugs are known for causing sexual dysfunction? |
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Definition
Hormonal disturbances: low testosterone, hyperprolcatinemia
Depression
Diabetes mellitus
Psychological origin
Medication adverse effect
Drugs: antihypertensives, neuroleptics, SSRIs, ethanol |
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Term
| What is the cause of hypertrophic cardiomyopathy? |
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Definition
Genetic mutations encoding sarcomeric proteins: B-myosin heavy chain, cardiac troponin T, A-tropomyosin, myosin-binding protein C
Myocyte hypertrophy and disarray; massively hypertrophic LV, decreased compliance and poor chamber filling: impaired diastolic filling, reduction of stroke volume |
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Term
| Describe the flow of blood into and out of the thyroid gland. |
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Definition
External carotid -> superior thyroid artery
Thyrocervical trunk -> inferior thyroid artery
Venous:
Superior thyroid vein
Middle
Inferior |
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Term
| A 36-year-old female smoker wants to begin taking birth control. What are some disadvantages and contraindications that need to be discussed before initiating oral contraceptive pills? |
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Definition
Smokers over 35, increased risk of CV events
Contraindicated with history of thromboembolism: increased risk of blood clots
Hx of estrogen-dependent cancer |
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Term
| What is a cholesteatoma, and how does it present? |
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Definition
Overgrowth of desquamated keratin debris within the middle ear space
May eventually erode the ossicles and external auditory canal
Grayish-white “pearly” lesion behind the TM
Conductive hearing loss
Vertigo |
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Term
| A 25-year-old man presents with an anterior midline neck mass that moves with swallowing. The most common midline mass of the neck is a thyroglossal duct cyst. What feature of this neck mass distinguishes the mass from a branchial cleft cyst? What is the remnant of the thyroglossal duct? Explain the development of the thyroid gland. |
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Definition
Branchial cleft cyst: lateral part of neck
Thyroglossal duct cyst: midline location, moves with swallowing
Foramen cecum is remnant
Thyroid diverticulum arises from the floor of the primitive pharynx, descends into the neck
Thyroid remains connected to the tongue by the thyroglossal duct, which normally disappears |
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Term
Hashimoto thyroiditis can present with hyperthyroidism in the early stages of the disease. Given the following presentations, distinguish between which are associated with hyper- and hypothyroidism.
1) Constipation
2) Elevated TSH
3) Fine hair
4) Brittle hair
5) Dry skin
6) Pot-bellied, pale neonate
7) Proptosis |
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Definition
1) Constipation: Hypo
2) Elevated TSH: Hypo
3) Fine hair: Hyper
4) Brittle hair: Hypo
5) Dry skin: Hypo
6) Pot-bellied, pale neonate: Hypo
7) Proptosis: Hyper |
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Term
| A 54-year-old white man presents with a single non-healing skin lesion on the right ala of the nose for 6 months. The skin lesion has a rolled border with central ulceration and associated telangiectasia. You decide to use 5-fluorouracil (5-FU) a topical treatment for this skin lesion. What type of cancerous lesion does this patient have? What are some other uses for 5-FU? |
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Definition
Basal cell carcinoma
Other uses: colon cancer and other solid tumors, topical treatment of actinic keratoses |
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Term
| A 53-year-old electrician develops a gradual onset of poorly localized right shoulder pain that improves with ibuprofen and rest. The patient has full range of motion in his right shoulder, but has pain with overhead movements. The patient exhibits weakness when performing the “empty can” test which isolates the supraspinatus portion of the rotator cuff. This finding most likely indicates an impingement syndrome of the right shoulder. What muscles compose the rotator cuff? |
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Definition
| SITS: Supraspinatous, infraspinatous, teres minor, subscapularis |
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Term
| A 15-year-old boy is brought to the pediatric ER with change of mental status and vomiting. Capillary blood glucose (CBG) is 550 mg/dL. What are the signs and symptoms of diabetic ketoacidosis (DKA)? What is the treatment? |
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Definition
Kussmaul respirations, nausea, vomiting, abdominal pain, delirium and altered mental status, dehydration, fruity breath (ketones)
Treatment: IV fluids, IV K+, IV insulin, follow the anion gap |
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Term
| You are seeing a 3-year-old boy while on an international rotation in Uganda. The patient is experiencing right sided jaw edema. What viral illness is associated with Burkitt lymphoma? Is Burkitt lymphoma a neoplasm of mature T-cells or B-cells? Where are T-cells found in the spleen? Where are B-cells found in the spleen? |
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Definition
EBV, B cell lymphoma
T cells are in the white pulp and periarterial lymphatic sheath(PALS)
B cells are in the white pulp |
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Term
| A 40-year-old man is beginning to have symptoms of a resting tremor, postural instability, and mask-like (expressionless) facies. Name the antiviral drug and its mechanism of action that could be used against this disease. |
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Definition
Amantidine: increases release of dopamine
Parkinson’s disease |
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Term
| A fetus at 34 weeks gestational age is diagnosed with intrauterine growth retardation on third trimester sonogram. What weight is the cut-off for low birth weight? What complications associated with low birth weight might the physician discuss with the expectant parents? |
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Definition
<2500 g is low birth weight
Physical and emotional problems
Infections (sepsis, pneumonia, meningitis)
RDS
Nec enterocolitis
Intraventricular hemorrhage
Persistent fetal circulation |
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Term
| An elderly man is in the ICU after a joy ride on his classic American motorcycle went horribly wrong. The patient was placed in the ICU because of multiple rib fractures that resulted in a flail chest which, combined with his mild COPD, made his respiratory status very fragile. During the first few days in the ICU, the patient was clear-headed. However, now he is uncooperative and is trying to crawl out of bed and leave the unit. He also doesn’t seem to have any idea where he is or why he is in the hospital. What are the main differences between delirium and dementia? Which is more commonly reversible? |
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Definition
Delirium: waxing/waning levels of consciousness, abnormal EEG, secondary to other illnesses, acute, reversible
Dementia: no alterations in consciousness, normal EEG, slow decline in cognitive function, not caused by acute medial illness |
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Term
How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation?
1) Anterior Shoulder Dislocation 2) Posterior Shoulder Dislocation |
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Definition
1) Anterior Shoulder Dislocation
External rotation and slight abduction
Axillary artery and nerve at risk
Blow to abducted, externally rotated, extended arm
Prominent acromion, loss of shoulder roundness
2) Posterior Shoulder Dislocation
Internal rotation and adduction, unable to externally rotate
Unusual to have neurovascular compromise
Blow to anterior shoulder, seizures, electrocution
Posterior prominence, anterior shoulder is flat |
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Term
| A 6-week-old child is referred to the pediatric cardiologist for failure to thrive, exertional cyanosis, and washing machine-like heart murmur. What are the early cyanotic heart diseases? What are the late cyanotic heart diseases? |
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Definition
Persistent trunctus arteriousus
Tetrology of Fallot
Transposition of great vessles
Tricuspid atresia
Total anomalous pulmonary artery venous return
Late cyanotic:
ASD, VSD, PDA |
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Term
| A study of post-diabetes education examination scores reveals results in a normal gaussian distribution. What percentage of the sample population falls 1 standard deviation, 2 standard deviations, and 3 standard deviations? |
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Definition
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