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BR-First Aid
Vignettes, some micro too
| Question | Answer |
|---|---|
| Full-term neonate of uneventful delivery becomes MR and hyperactive and has musty odor | PKU |
| Stressed executive consumes 7-8 martinis quickly before dinner and becomes hypoglycemic, why? | NADH increase prevents gluconeogenesis by shunting pyruvate and oxaloacetate to lactate and malate |
| 2yo girl has inc abdominal girth, FTT, skin and hair depigmentation | kwashiorkor |
| alcoholic with rash, diarrhea, altered mental status, what is vitamin deficiency? | B3, pellagra |
| 20yo male with idiopathic hyperbilirubinemia; what is mcc? | Gilbert's disease |
| 51yo male w/black spots in sclera has noted urine turns black when standing | alkaptonuria |
| 25yo male with severe chest pain and xanthomas of Achilles tendon, what is dz and where is defect? | Familial hypercholesterolemia; LDL receptor |
| Baby vomits milk when fed and has gastric air bubble | blind esophagus with lower segment of esophagus attached to trachea (tracheoesophageal fistula) |
| 20yo dancer reports dec plantar flexion and dec sensation over back of thigh, calf, lateral half of foot; what spinal nerve is involved? | tibial (L4-S3) |
| Pt with dec pain and temp sensation over lateral aspects of both arms; what is lesion? | syringomyelia |
| penlight in pt's R eye produces bilateral pupillary constriction. when moved to L, there is paradoxical bilateral pupillary dilatation. what is defect? | atrophy of left optic nerve |
| pt has dec prick sensation on lateral aspect of leg and foot, what deficit in muscular action should be expcted? | dorsiflexion and eversion of foot (common peroneal nerve) |
| elderly woman w/arthritis and tingling over lateral digits of R hand | carpal tunnel syndrome; median nerve compression |
| car accident; cannot turn head to left and has R shoulder droop; which structure is damaged? | right CNXI (runs thru jugular foramen w/CNIX and X), innervating SCM and trapezius mm |
| man presents with one wild flailing arm, where is lesion? | contralateral subthalamic nucleus (hemiballismus) |
| pregnant woman in 3rd trimester has normal BP when standing and sitting. when supine it drops to 90/50; what is dx? | compression of IVC |
| soccer player was kicked in L leg and suffered a damaged medial meniscus; what else is likely to be damaged? | anterior cruciate ligament (part of "unhappy triad" |
| gymnast dislocates shoulder anteriorly; what nerve is damaged? | axillary nerve (C5-C6) |
| pt w/cortical lesion doesn't know he has a dz; where is lesion? | R parietal lobe |
| child w/cleft lip; which embryologic process failed? | fusion of maxillary and medial nasal processes |
| pt cannot protrude tongue toward left side and has a R sided spastic paralysis; where is lesion? | left medulla, CNXII |
| teen falls while rollerblading and hurts elbow. he can't feel medial part of arm, which nerve is injured? | ulnar nerve d/t broken medial condyle |
| 24yo male develops testicular cancer; metastatic spread occurs by what route? | para-aortic lymph nodes (recall the descent of testes during development AND the existance of blood-testes barrier) |
| field hockey player falls at practice; xray shows midshaft break of humerus; which nerve and artery are most likely damaged? | radial nerve and deep brachial artery, they run together |
| pt cannot blink R eye or seal his lips and has mild ptosis on R side; what is dx and which nerve is affected? | Bell's Palsy; CNVII |
| pt has pain, numbness, tingling with wasting of thenar eminance; what is dx? | Carpal tunnel syndrome; median nerve is compressed |
| Woman w/previous c-section has scar in lower uterus near os; what is she at risk for? | placenta previa |
| 35yo male, HTN in arms and low pressure in legs | coarctation of aorta |
| woman w/diffuse goiter and hyperthyroidism; what are expected TSH and thyroid levels? | low TSH and high thyroid hormones |
| pt w/extended expiratory phase | obstructive lung dz |
| woman w/HA, visual disturbance, galactorrhea, amenorrhea | prolactinoma |
| baby w/foul smelling stool and recurrent pulmonary infxns | cystic fibrosis, do chloride sweat test |
| obese woman w/hirsutism and inc testosterone | polycystic ovarian syndrome |
| xray w/ bilateral hilar lymphadenopathy | sarcoidosis |
| 5yo boy w/systolic murmur and wide fixed split S2 | ASD |
| 48yo female w/progressive lethargy, extreme sensitivity to cold | hypothyroidism |
| pt w/elevated serum cortisol; 1mg of dexamethasone suppression test does not decrease cortisol levels, but 8mg does; what is dx? | pituitary tumor |
| young athlete collapses and dies during a game | hypertrophic cardiomyopathy; idopathic hypertrophic subaortic stenosis |
| anemic child since birth; splenectomy would inc the hematocrit in what disease? | hereditary spherocytosis |
| 43yo male w/dizziness and tinnitus; CT shows enlarged acoustic meatus, what is dx? | schwannoma |
| child w/weakness and enlarged calves | duchenne's muscular dystrophy; x-linked recessive |
| 25yo female w/sudden uniocular vision loss and slurred speech; h/o weakness and paresthesias that have resolved | Multiple sclerosis |
| teenager w/nephritic syndrome and hearing loss | Alport's syndrome |
| tall, thin teen male w/abrupt onset dyspnea and L-sided chest pain; hyperresonant percussion on affected side and diminished breath sounds | spontaneous pneumothorax |
| young man concerned about wife's inability to conceieve and her recurrent URI; she has dextrocardia; what is defective? | dynein (Kartagener's) = immotile cilia |
| 55yo male smoker/drinker w/new cough and flu-like symptoms; gram stain shows no bugs, but silver stain shows G(-) rods | Legionella pneumonia |
| pt has stroke after multiple long bone fxs; what caused infarct? | fat emboli |
| 25yo woman w/low-grade fever, rash across nose that gets worse in sun, and widespread edema (anasarca) | worry about SLE |
| 50yo male w/diarrhea; face is plethoric and heart murmur is detected | Carcinoid syndrome |
| eldely woman w/HA and jaw pain; labs show elevated ESR | temporal arteritis |
| pregnant woman at 16wks w/atypically large abdomen and high hCG | hydatiform mole |
| 80yo man w/systolic crescendo-descrescendo murmur | aortic stenosis |
| woman w/ short 4th and 5th metacarpals; what associated endocrine disorder? | Albright's hereditary osteodystrophy OR Pseudohypoparathyroidism |
| aftere a stressful life event, 30yo man has diarrhea and blood per rectum; transmural inflammation on biopsy | Crohn's dz |
| young man w/mental detrioration and tremors; brown pigmentation in ring around periphery of cornea and altered LFTs; what treatment should he receive? | Penicillamine for Wilson's disease |
| pt w/fatigue, macrocytic megaloblastic anemia; what is danger of giving folate alone? | masks neuronal damage with vitamin b12 deficiency |
| 10yo child spaces out inclass; during spells there is a lip quiver | absence seizures |
| 85yo man w/acute knee pain and swwelling; xray show inc joint space without erosion; what is dz and what should you find on aspiration? | Pseudogout; rhomboid calcium pyrophosphate crystals |
| alcoholic vomits gastric contents; foul-smelling sputum | anaerobes |
| middle-aged man w/acute onset monoarticular joint pain and bilateral Bell's palsy | Lyme disease; bite from Ixodes tick |
| Pt w/M. pneumoniae exhibits cryoagglutinins during recovery phase; what types of Ig are reacting? | IgM |
| UA of pt shows WBC casts | pyelonephritis |
| child with tetany and candidiasis; hypocalcemia and immunosuppression are found | T cell deficiency; DiGeorge |
| Pt with "rose gardener's" rash (thorn prick w/lymph drainage) | Sporothrix schenckii |
| 25yo med student w/burning feeling in gut after meals; biopsy of gastric mucosa shows G(-) rods | H. pylori |
| 32yo male w/"cauliflower" skin lesions; tissue biopsy shows broad based budding yeast | Blastomyces |
| Breast feeding woman develops redness and swelling of breast; on exam it is a flucutant mass | mastitis d/t S. aureus |
| Young child has lung infxns and granulomatous lesions; what is defect in neutrophils | NADPH oxidase = chronic granulomatous dz |
| 20yo student w/lymphadeopathy, fever, hepatosplenomegaly; serum agglutinates sheep RBCs; what cell is infected? | B cells w/EBV, infectious mononucleosis |
| 1hr after eating custard a family at a picnic begins to vomit; after 10hours they feel better | Staph aureus d/t preformed enterotoxin |
| Infant becomes flaccid after eating honey; what bug and what is MOA | Clostridium botulinum; inhibited release of ACh |
| Man presents with squamous cell carcinoma on penis, what was he exposed to? | HPV |
| Pt develops endocarditis 3wks after getting a prosthetic heart valve, what bug is suspected? | S. aureus or S. epidermidis |
| All DNA viruses are HHAPPPy viruses | Hepadna, Herpes, Adeno, Pox, Parvo, Papova |
| All DNA viruses are double stranded EXCEPT | Parvo "part of a virus" = single stranded |
| All DNA viruses are linear EXCEPT | Papovirus (circular, supercoiled) and Hepadna (circular, incomplete) |
| All DNA viruses are icosohedral EXCEPT | Pox (complex) |
| All DNA viruses replicate in the nucleus EXCEPT | Pox (carries own DNA-dependent RNA polymerase) |
| Naked DNA viruses are PAP (you need to be naked for a pap smear) | Parvo, Adeno, Papova |
| Enveloped DNA viruses are HPH | Hepadna, Pox, Herpes |
| Hepadnavirus | HBV, not a retrovirus, but has reverse transcriptase; acute or chronic hepatitis; vaccine available |
| Herpesviruses | HSV-1, HSV-2, VZV, EBV, CMV, HHV6, HHV8 |
| HSV-1 | oral/genital lesions; keratoconjunctivitis; gC binds C3 and gE/gI binds Fc portion of Ab |
| EBV | mono, Burkitt's lymphoma |
| CMV | infxn in immunocompromised pts, especially trasnplant recipients; congenital infxns (liver/blood/vascular, silent - hearing loss) |
| HHV6 | roseola (xanthem subitum) |
| HHV8 | a/w Kaposi's sarcoma |
| Adenovirus | febrile pharyngitis (sore throat), pneumonia, conjunctivitis; fecal-oral (pools) causing watery diarrhea ~2wks |
| Parvovirus | smallest DNA virus; B19 = aplastic crisis in sickle cell pts, "slapped cheeks" rash (erythema infectiosum), hydrops fetalis |
| Papovavirus | HPV = warts, CIN, cervical cancer; JC = progressive multifocal leukoencephalopathy (PML) in HIV pts |
| Poxvirus | largest DNA virus; Smallpox = although eradicated, can be germ warfare; Vaccinia = cowpox; Molluscum contagiosum |
| All RNA viruses are single stranded EXCEPT | Reoviridae "repeato-virus"; double stranded |
| Helminth a/w brain cysts and seizures | Taenia solium; pork tapeworm/cestode; Tx = Praziquantel/niclosamide; Albendazole for cystericosis |
| Helminth a/w liver cysts | Echinococcus granulosus; eggs in dog feces; can cause anaphylaxis; Tx = Albendazole |
| Helminth a/w B12 deficiency | Diphyllobothrium latum |
| Helminth a/w biliary tract inflammation dz | Clonorchis sinensis trematode (fluke); undercooked fish; Tx = Praziquantel |
| Helminth a/w Hemoptysis lung inflammation | Paragonimus westermani trematode (fluke); undercooked crab; Tx = Praziquantel |
| Helminth a/w Portal hypertension | Schistosoma mansoni fluke (trematode); snail is host; cercariae enter skin - granulomas; Tx = Praziquantel |
| Helminth a/w Hematuria, bladder cancer | Schistosoma haematobium trematode (fluke); snail is host; Tx = Praziquantel |
| Helminth a/w perianal pruritis; eggs are flat on one side and round on other | Enterobius vermicularis nematode (roundworm); Pinworm; egg-contaminated food; Tx = Mebendazole/Pyrantel Pamoate |
| Larvae penetrate skin of feet; intestinal infection = anemia; thin-shelled multicell egg | Ancylostoma duodenale hookworm; Nematode (roundworm); Tx = Mebendazole/Pyrantel pamoate |
| Eggs are VISIBLE in feces as bumpy & thick shelled; intestinal infxn; migrates thru lung during maturation; causes type I hypersensitivity (allergen) | Ascaris lumbricoides (giant roundworm/nematode); Tx = Mebendazole/pyrantel pamoate |
| Larvae in soil penetrate skin; intestinal infxn; Rhabditiform larvae passed in stool | Strogyloides stercoralis (nematode/roundworm); Tx = Ivermectin/thiabendazole |
| Undercooked pork; Muscle inflammation, Periobital edema | Trichinella sporalis (nematode/roundworm); Tx = Thiabendazole |
| Present in drinking water; Skin ulcers and inflammation | Dracunculus medinensis; Tx = Niridazole |
| Transmitted by deer tick; skin swelling; crawls in conjunctiva | Loa loa (nematode/roundworm); Tx = diethylcarbamazine |
| Transmitted by black flies; river blindness | Onchocerca volvulus (nematode/roundworm); Tx = Ivermectin |
| Food contaminated w/eggs; Granulomas (retina = blindness); visceral larva migrans | Toxocara canis (nematode/roundworm); Tx = Diethylcarbamazine |
| Female mosquito; blocks lymphatics = elephantiasis | Wuchereria bancrofti (nematode/roundworm); Tx = Diethylcarbamazine |
| bloody diarrhea (dysentery), liver abscess; trophozoites or cysts in stool | Entamoeba histolytica; Tx = Metronidazole and Iodoquinol |
| Bloating, flatulence, foul-smelling diarrhea; trophozoites or cysts in stool | Giardia lamblia; Tx = Metronidazole |
| Severe diarrhea w/AIDS (mildly watery in healthy); Cysts on ACID FAST stain | Cryptosporidium; NO TX available |
| Brain abscess in HIV and birth defectsl; Cysts in meat or cat feces; Serology or Bx | Toxoplasma gondii; Tx = Sulfadiazine + Pyrimethamine |
| Malaria: cyclic fever, HA, anemia, splenomegaly; anopheles mosquito; blood smear | Plasmodium (vivax, ovale, malariae, faciparum - severe cerebral type); Tx = Chloroquinone (primiquine prevents vivax/ovale relapse), Sulfadoxine + pyrimethamine, mefloquine, quinine |
| Foul smelling, green vaginal discharge w/itching and burning; STD; Trophozoites on wetmount | Trichomonas vaginalis; Tx = metronidazole |
| Chagas disease (heart), reduvid bug; blood smear | Trypanosoma cruzi; Tx = Nifurtimox |
| African sleeping sickness; tsetse fly; blood smear | Trypanosoma gambiense or rhodesiense (rapid); Tx = Sumarin for blood or Melarosprol for CNS penetration |
| Visceral leishmaniasis (kala-azar); sandfly; MQs w/amastigotes | Leishmania donovani; Tx = Sodium stibogluconate |
| Babesiosis (flu-like); Ixodes tick; Blood smear no RBC pigment & "maltese cross" | Babesia; Tx = Quinine, Clindamycin |
| Rapidly fatal meningoencephalitis; acquired from swimming in lakes; enters nose; Amoebas found in CSF | Naegleria floweri; NO TX |
| Pseudohyphae + budding yeast; germ tubes at 37*C | Candida; thrush in immunocomp (neonates, AIDS, steroids, DM), vulvovaginitis (hi pH, DM, Abx); Tx = Nystatin for superficial or Amphotericin B for systemic |
| 45* angle branching septate hyphae; rare fruiting bodies; fungus ball in empty lung cavities; NOT dimorphic | Aspergillus; allergic bronchopulmonary infxn |
| 5-10um yeasts with wide capsular halo; narrow based unequal budding; pigeons/soil; Sabouraud's agar; India ink; latex agglutination for polysach capsular Ag; meningitis | Cryptococcus neoformans |
| Irregular broad (empty-looking) nonseptate hyphae w/wide angle (>90*) branching; Ketoacidotic diabetics or leukemia pts; blood vessel infarcts | Mucor and Rhizopus sp. |
| Diffuse interstitial pneumonia; immunosuppressed pts; Bx or lavage; Methenamine silver stain | Pneumocystis carinii; Tx = TMP-SMX (prophylax when CD4<200) |
| dimorphic fungus on roses; draining lymph nodules; cigar-shaped budding yeast in pus | Sporothrix schenckii; Tx = Itraconazole |
| San Joaqin valley/desert fever; SW states | Coccidiodomycosis |
| Bird, bat droppings in caves; Intracellular fungus usu in MQs (no person-person transmission); Mississippi/Ohio river valleys | Histoplasmosis |
| "Captain's Wheel" appearance; rural latin american fungus | Paracoccidiodomycosis |
| Big, Broad-Based Budding; SE states and central america | Blastomycosis |
| Systemic mycoses | Coccidiomycosis, histoplasmosis, paracoccidiodomycosis, blastomycosis; ALL are DIMORPHIC (mold in soil, yeast in tissue except coccidio. which is spherule) |
| Treatment for local infection with systemic mycoses | Fluconazole or Ketoconazole |
| Treatment for systemic infection with systemic mycoses (can mimic TB granuloma formation) | Amphotericin B |
| Systemc Mycoses Dimorphic fungus: Heat versus Cold | Mold versus Yeast |
| Cutaneous Mycoses | Tinea versicolor, Tinea nigra, Tinea pedis, cruris, corporis, capitus |
| Tinea versicolor; hypopigmented skin lesions in hot, humid weather | Malassezia furfur; Tx = Topical Miconazole, Selenium sulfide |
| Tinea nigra; infxn of keratinized layer of skin; appears as brown spot | Cladosporium werneckii; Tx = Topical Salicylic Acid |
| Tinea pedis, cruris, corporis, capitus; Pruritic lesions w/central clearing resembling a ring; Mold hyphae visualized with KOH prep (not dimorphic) | Dermatophytes (Microsporum, Trichophyton, Epidermophyton); Tx = Topical Azoles |
| Fungal Spores | Coccidiodomycosis and Histoplasmosis are inhaled as asexual spores (conidia) |
| chemist presents with MPTP exposure; what NT is depleted? | Dopamine; eliciting a parkinson-like effect |
| Woman on tetracycline is photosensitive; what are clinical manifestations? | rash on sun-exposed skin |
| Nondiabetic pt is hypoglycemic, but has low levels of C peptide; what is dx? | accidental insulin injection |
| African-American man goes to africa, develops hemolytic anemia after taking malarial prophylaxis; what is his enzyme deficiency? | Glucose-6-phosphate dehydrogenase |
| 27yo female with h/o psych illness now has urinary retention d/t a neuroleptic; how do you treat it? | Bethanechol |
| Farmer presents w/dyspnea, salivation, miosis, diarrhea, cramping, blurry vision; what caused it and what is MOA? | Insecticide poisoning; inhibition of ACh-esterase |
| Pt w/recent kidney transplant is on cyclosporine for immunosuppression; he requires an antifungal for candidiasis, which would result in cyclosporine toxiticy? | Ketoconazole |
| Man on many meds including antidepressants, antihypertensives, has mydriasis and becomes constipated; what is the cause of his symptoms? | TCA (amitriptyline) overdose |
| 55yo postmenopausal woman on tamoxifen; what is she at an increased risk for getting? | endometrial carcinoma |
| Woman on MAO inhibitor has hypertensive crisis after a meal, what did she ingest? | tyramines (wine or cheese) |
| After taking clindamycin, pt develops toxic megacolon and diarrhea; what is MOA of diarrhea? | Clostridium difficile overgrowth |
| Man starts meds for hyperlipidemia, but then develops rash, pruritis and GI upset, what drug is it? | Niacin |
| Pt on carbamazepin, which routine labs be done? | LFTs |
| 23yo female on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant; why? | Rifampin augments estrogen metabolism in liver, rending it less effective |
| Pt develops cough and must discontinue captopril; what is a good replacement drug and why doesn't it have the same side effects? | Losartan, and angiotensin II receptor antagonist; it does not increase bradykinin like ACE-i |
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bscaryp