Q bank: Randomly Generated 5
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| Neonate born at 30 wks with fever and has a seizures. Lumbar puncture shows mononuclear pleocytosis and elevated proteins. MRI shows abnormalities in temporal lobes bilaterally. Diagnosis? | Neonatal herpes encephalitis; note the predilection for the temporal lobes
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| What Ericksonian stage is infancy (0-18 months)? | Trust vs. mistrust
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| What Ericksonian stage is the toddler (1.5 to 3) | Autonomy vs. shame and doubt
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| What Ericksonian stage is the play age (3-6)? | Initiative vs. guilt
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| What Ericksonian stage is the school age (6-12)? | Industry vs. inferiority
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| What Ericksonian stage is the adolescent (12-18)? | Identity vs. role confusion
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| What Ericksonian stage is the young adult (19-35)? | Intimacy vs. isolation
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| What Ericksonian stage is the Adult (35-60)? | Generativity vs. stagnation
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| What Ericksonian stage is the elder adult (60+)? | Inegrity vs. despair
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| In PCOS what biologic mechanisms forms the cystic ovaries? | Elevation in LH (or in some women insulin) stimulates theca cells to produce androgens, these androgens contribute to the overgrowth of immature follicles (the cysts)
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| Multiple small nodules on lips, tall and thin build with long fingers. Hyperextensible joints. What screening test should be ordered? | Presence of mucosal neuromas (small nodules on lips) in a patient with marfanoid syndrome; MEN IIb, patient should be screened for medullary carcinoma of thyroid (pentagastrin stimulated calcitonin)
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| Sharp, knifelike chest pains. Differential? | Dissecting aortic aneurysm; pericarditis and dissecting aortic aneurysm are about the only two things that are described this way, and pericarditis is a little more gradual in onset
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| Neonate develops bile-stained vomiting and progressive abdominal destention, and does not pass meconium over first 2 days of life. Anus is patent and bowel loops are palpable. Radiograph shows bubbly meconium in RLQ. Diagnosis? | Meconium ileus, manifestation of cystic fibrosis due to abnormally viscid pancreatic secretions that congest small bowel.
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| What is the mechanism of action of the drugs used to treat myasthenia gravis? | Neostigmine, pyridostigmine; carbamylating acetylcholinesterase
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| Cryptorchidism of one of the testes causes concern of which of the following: atrophy, cancer, infarction, infection, or sterility? | Cancer; infection and atrophy can occur but is not a significant concern in unilateral cryptochidism
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| How does one distinguish postmortem clots from premortem clots? | Premortem clots usually have lines of Zahn, red, cell-rich layers in a thrombus that appear dark, grossly, alternating with these lines are light layers rich in platelets and fibrin
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| What is the rate limiting step in catecholamine synthesis? | tyrosine to L-dopa by tyrosine hydroxylase
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| This enzyme converts norepinephrine to epinephrine. | Phenylethanolamine N-methyltransferase (PNMT)
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| Dwarfism is caused by impaired: cell signaling, fibrillin synthesis, or type I collagen | Impaired cell signalling (Fibroblast growthh factor receptor); impaired fibrillin is Marfan syndrome, and type I collagen mutation causes osteogenesis imperfecta
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| 62 yro woman with solid, yellow ovarian mass and endometrial carcinoma. What type of tumor is in the ovary? | Granulosa cell tumor; estrogen producing (risk factor for endometrial carcinoma)
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| Occlusion of this artery results in homonymous hemianopsia of the contralateral visual field with macular sparing. | PCA
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| Occlusion of this artery results in deficits in pain and temperature sensation over contralateral body; ipsilataral dysphagia, hoarseness, and diminished gag reflex; vertigo, diplopia and ipsilateral loss of pain and temp to the face. | Lateral medullary syndrome; occlusion of PICA
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| Occlusion of this artery results in contralateral hemiparesis of lower extremities and trunk, diminished proprioception, and ipsilateral paralysis of the tongue. | Medial medullary syndrome; occlusion of anterior spinal artery
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| Occlusion of this artery results in ipsilateral facial paralysis, deafness, nystagmus, and loss of pain and temperature of the face. | Lateral inferior pontine syndrome; occlusion of anterior inferior cerebellar artery
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| What is the test for the most common cause of neonatal meningitis? | CAMP test (Group B strep or Strep agalactiae); test produces and additional zone of beta hemolysis that appears in an arrowhead formation on blood agar
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| Volume distribution of a drug is 40L and the clearance is 2 L/hour, what is the halflife? | t1/2=(0.7*Vd)/Cl; 14 hours
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| This disease in it's secondary stage can cause AV nodal conduction defects in the absence of infarct or ischemia. | Secondary Lyme disease; borrelia burgdorferi
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| 10 yro patient presents with prolonged partial thromboplastin time and elevated bleeding time. What is the primary problem? | Most likely von Willebrand disease (most common hereditary coagulopathy); deficiency of vWF which carries factor VIII results in defective initial adhesion of normal platelets
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| Pertussis, in addition to inhibition of G protein complex, has this effect producing hypoglycemia | Activates pancreatic islets of langerhans
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| 4 yro retarded child presents with a marfenoid-like appearance, what substance would be elevated? | Homocysteineuria; Homocysteine or methionine (remethylated homocysteine via salvage pathway); like marfan but add mental retardation
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| A patient with HIV presents with prolonged diarrhea, what is the likely causative agent? | Mycobacterium avium or cryptosporidium parvum; crypto is more common but word association "prlonged diarrhea" matches for myco
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| What effect will a decline in prevalence have on specificity, sensitivity, positive and negative predictive value? | It will have no effect on specificity or sensitivity, negative predictive value will increase and positive predictive value will decrease
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| Patients with Maple syrup urine disease should avoid what amino acids in their diet? | Leucine, isoleucine, and valin
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| This syndrome is acute postviral injury damaging multiple systems but most notable for fatty liver with encephalopathy. | Reye syndrome; most commonly caused by VZV and influenza A and B
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| Thrombocytopenia, eczema, and recurrent sinopulmonary infections? | Wiskott-Aldrich syndrome; Serum IgM low, but IgG, IgA, and IgE are all increased
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| Patient has cutaneous mycetomas following lymphatic drainage. Tissue reveals cigar-shaped yeast. Diagnosis? | Sporotrichosis
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| Brazillian immigrant shows patchy, bilateral pneumonia and a lung mass. Biopsy reveals fungal organism with a few multiple budding yeast forms. Diagnosis? | Paracoccidiomycosis; budding yeast usually means blastomycosis, but that’s in the U.S.; if latin American than paracoccidiomycosis; bud’s will have “pilot’s wheel” appearance.
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| What is prosopagnosia? | Damage of the visual association cortex resulting in the inability to recognize faces.
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| What is Alexia? | Inability to read caused by deficits in central language processing
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| What is Anosognosia? | Deficit in cognition about one’s illness, or lack of awareness that one is suffering from a certain condition
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| Which is associated with production of prostaglandins important in renal blood flow, clotting, and GI protection: COX-1 or COX-2? | COX-1; COX-2 is involved with prostaglandins for pain and inflammation, Celecoxib is a COX-2 inhibitor, Naproxen is a nonspecific COX inhibitor (SE is GI upset from COX-1 inhibition)
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| Patient presents with confluent, fine, erythematous, macular rash, most pronounced on his trunk. Mild fever for 36 hours, but not does not appear very sick, playing happily. Reddened throat with tonsillar exudates and enlarged cervical nodes. Diagnosis? | Rubella “german measles”; notable is the mild constitutional symptoms (in measles patient would seem much sicker) and the rash would be blotchy, maculopapular, and begin on face and spread downward
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| Patient presents with high fever for 1 day, breaks and then develops a fine, macular rash on trunk which spreads to the extremities and disappears 1 day later. Diagnosis? | Roseola (HHV6 and 7); notable for fine, macular rash that follows break of fever, and also only lasts one day
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| What is Trousseau’s sign and Chvostek’s sign and what are they indicative of? | Trou: precipitation o f carpopedal spasm by reduction of blood supply to the hand; Chvost: involuntary twitching of facial muscles elicited by tapping facial nerve anterior to ear; Indicate hypocalcemia
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| What is anaplasia, desmoplasia, dysplasia, and metaplasia? | Ana: loss of differentiation and organization; desmo: excessive fibrous formation; Dys: atypical cellular proliferation (noncancerous); Meta: replacement of one tissue type by another
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| Patient presents with fever, headache, sore throat, malaise and myalgia. X-ray shows bilateral lower lobe infiltrate. Blood in extra heparinized tube is taken and placed on ice. Diagnosis and treatment? | Mycoplasma pneumonia; notable for cold agglutination which is only seen in a few things (leukemias and lymphomas, M. pneumonia, mononucleosis, and HIV); Treat with erythromycin (Reversible binding of 50S subunit )
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| Both stimulants (cocaine, amphetamine, meth) and anticholinergics (jimson weed) can cause agitation, mydriasis, and tachycardia. How would you tell one overdose from the other? | The skin; “Dry as a bone” with anticholinergics whereas stimulants will make you sweat
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| Elevation of AST without accompanying elevation of ALT or other liver enzymes. Diagnosis? | Myocardial infarction
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| What is Flumazenil? | Antagonist at the benzodiazepine receptor (treats diazepam overdose)
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| In what toxicity is CaNA2 EDTA used? | Chelator used in lead poisoning
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| 38 yro pregnant woman with swelling of feet and hands, hypertensions, proteinuria, elevated AST and ALT w/ low platelets. What was the initial event in the pathogenesis of this condition? | Placental ischemia; patient has pre-eclampsia w/ HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), placental ischemia induces release of prostaglandins --> DIC --> HELLP
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| 3 kidneys, one with wedge shaped areas of necrosis, one with finely granular surface , and the third with a mottled hemorrhagic appearance. What are the 3 conditions responsible? | Infective endocarditis (septic emboli causing renal infarct); Benign hypertension (diabetes may appear similar); Malignant hypertension
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| Burkitt lymphoma translocation? | t(8;14) most common; but also there is a t(2;8) and a t(8;22), just think, any translocation with an 8 in it (I don’t like this either but it was on Q bank)
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| Translocation for mantle cell, multiple myeloma, and small cell? | t(11,14)
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| Lateral expansion of a pituitary tumor will effect what cranial nerve? | Abducens nerve; leads to lateral rectus palsy, if it expands upward than optic nerve will be effected
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| Trisomy fetus is spontaneously aborted, what is the most likely karyotype: 8, 13, 16, 18, or 21? | 16 is completely incompatible with life; 8 is also a common cause, but rare mosaics do survive, 13 is Pautau, 18 is Edwards, and 21 is Down syndrome
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