FA Clinical Cases
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| Baby vomits milk when fed and has gastric air bubble. What kind of fistula is present? | blind esophagus with lower segment of esophagus attached to trachea
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| 20-year old dancer with decreased plantar flexion and decreased sensation over the back of her thigh, calf, and lateral half of foot. What spinal nerve? | Tibial (L4 to S3)
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| Patient with decreased pain and temp sensation over lateral aspects of both arms. Lesion? | syringomyelia
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| Penlight in patient's right eye produces bilateral pupillary constriction. In left eye, there is paradoxical bilateral pupillary dilation. Defect? | atrophy of left optic nerve
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| Patient with decreased prick sensation on lateral aspect of leg and foot. A deficit in what muscular action can also be expected? | dorsiflexion and eversion of foot (common peroneal nerve)
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| Elderly woman with arthritis and tingling over lateral digits of right hand. Diagnosis? | Carpal tunnel syndrome, median nerve compression.
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| Woman in car accident cannot turn her head to the left and has right shoulder droop. What structure is damaged? | Right CN XI (runs through jugular foramen with CN IX and X), innervating sternocleidomastoid and trapezius muscles)
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| Man with one wild, flailing arm. Where is lesion? | contralateral subthalamic nucleus (hemiballismus)
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| Pregnant woman in 3rd trimester has normal blood pressure when standing and sitting. When supine, BP drops to 90/50. Diagnosis? | compression of IVC
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| Soccer player was kicked in leg and suffered a damaged medial meniscus. What else is likely to be damaged? | anterior cruciate ligament (remember the "unhappy triad")
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| Gymnast dislocates her shoulder anteriorly. What nerve is most likely to have been damaged? | Axillary nerve (C5, C6)
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| Patient with cortical lesion does not know that he has a disease. Where is lesion? | Right parietal lobe.
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| Child presents with cleft lip. Which embryologic process failed? | Fusion of maxillary and medial nasal processes.
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| Patient cannot protrude tongue toward left side and has right sided spastic paralysis. Where is lesion? | left medulla, CN XII
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| Teen falls while rollerblading and hurts his elbow. He can't feel the medial part of his palm. Which nerve and what injury? | Ulnar nerve due to broken medial condyle
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| 24-year-old male develops testicular cancer. Metastatic spread occurs by what route? | para-aortic lymph nodes (recal descent of testes during development)
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| Field hockey player presents to ER after falling on her arm during practice. X-ray shows mid-shaft break of humerus. Which nerve and what artery are most likely damaged? | Radial nerve and deep brachial artery, which run together.
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| Patient cannot blink his right eye or seal his lips and has mild ptosis on the right side. What is diagnosis, and what nerve is often affected? | Bell's palsy; CNVII
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| Patient complains of pain, numbness, and tingling sensation. On exam, she has wasting of thenar eminence. What is diagnosis, and what nerve is often affected? | Carpal tunnel syndrome, median nerve
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| Woman with anxiety about gyn exam is told to relax and imagine going through steps of exam. What process does this exemplify? | systematic desensitization
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| 65-year-old man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you not to tell the patient. What do you do? | Assess whether telling patient will negatively affect his health. If not, tell him.
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| Man admitted for chest pain is medicated for ventricular tachycardia. The next day he jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack. What defense mechanism? | denial
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| You are attracted to your 26 year-old patient. What do you say? | Nothing! Tone must be professional. It is not acceptable to have romantic relationship with patients. Invite a chaperone into room if you think your actions may be misinterpreted.
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| Large group of people followed over 10 years. Every 2 years, it is determined who develops heart disease and who does not. What type of study? | cohort study
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| Girl can groom herself, can hop on one foot, and has an imaginary friend. How old is she? | Four years old
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| Man has flashbacks about his girlfriend's death 2 months ago following a hit-and-run accident. He often cries and wishes for the death of the culprit. Diagnosis? | normal bereavement
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| 36-year-old woman with strong family history of breast cancer refuses a mammogram because she heard it hurts. What do you do? | Discuss risks and benefits of not having mammogram. Patients must give informed consent. If she refuses, you must abide by her wishes.
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| During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG. What stage of sleep is he in? | REM sleep
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| 15-year-old girl of normal height and weight for her age has enlarged parotid glands but no other complaints. The mother confides that she found laxatives in the daughter's closet. Diagnosis? | bulimia
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| 11-year-old girl exhibits Tanner stage 4 development (almost full breasts and pubic hair). Diagnosis? | advanced stage, early development.
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| 4-year-old girl complains of burning feeling in her genitalia; otherwise she behaves and sleeps normally. Smear of discharge shows N. gonorrhoeae. How was she infected? | sexual abuse
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| 72-year-old man insists on stopping treatment for his heart condition because it makes him feel "funny." What do you do? | Although you want to encourage him to take his medication, the patient has the final say. You should investigate the "funny" feeling and determine if there are drugs available that don't elicit this side effect.
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| Person demands only the best and most famous doctor in town. Personality disorder? | Narcissism
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| Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C protein. Diagnosis? | Factitious disorder; selfscripted insulin.
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| 55-year-old businessman complains of lack of successful sexual contacts with women and lack of ability to reach full erection. Two years ago he had a heart attack. What might be the cause of his problem? | Fear of sudden death during intercourse.
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| Full-term neonate of uneventful delivery becomes mentally retarded and hyperactive and has a musty odor. Diagnosis? | PKU
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| Stressed executive comes home from work, consumes 7 or 8 martinis in rapid succession before dinner, and becomes hypoglycemic. Mechanism? | NADH increase prevents gluconeogenesis by shunting pyruvate and oxaloacetate to lactate and malate.
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| 2-year-old has increased abdominal girth, failure to thrive, and skin and hair depigmentation. Diagnosis? | Kwashiorkor
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| Alcoholic develops rash, diarrhea, and altered mental status. Vitamin deficiency? | Vitamin B3 (pellagra)
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| 20-year-old man presents with idiopathic hyperbilirubinemia. Most common cause? | Gilbert's disease
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| 51-year-old man has black spots in his sclera and has noted that his urine turns black when he is standing. Diagnosis? | Alkaptonuria
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| 25-year-old male complains of severe chest pain and has xanthomas of his Achilles tendons. What is the disease, and where is the defect? | Familial hypercholesterolemia; LDL receptor
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| An alcoholic vomits gastric contents and has foul smelling sputum. What organisms are most likely? | Anaerobes
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| Middle-age man has acute monoarticular joint pain and bilateral Bell's palsy. What disease and how? | Lyme, Ixodes tick
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| Pt with Mycoplasma pneumoniae, cryoagglutinins. What Ig types? | IgM
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| U/A with WBC casts. Dx? | Pyelonephritis
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| Young child with tetany, candidiasis, hypocalcemia, and immunosuppression. What cell is deficient? | Tcell (DiGeorge)
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| Pt with "rose gardener's" (thorn prick, ulcers along lymph drainage). What bug? | Sporothrix schenckii
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| 25yr old med student has "burning" gut after meals. Gram negative rods in Bx. What organism? | H. pylori
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| 32yr old man w/ "cauliflower" skin lesions. Bx shows broadbased budding yeasts. Organism? | Blastomyces
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| Breast feeding woman w/ redness & swelling of right breast. Fluctuant mass. Dx? | Mastitis by S. aureus
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| Young child w/ recurrent lung infxns & granulomatous lesions. What defect in neutrophils? | NADPH oxidase (chronic granulomatous disease)
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| 20yr old college student w/ lymphadenopathy, fever, hepatosplenomegaly. Serum agglutinates sheep RBCs. What cell infected? | B-cell (EBV; infectious mononucleosis)
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| 1hr after eating custard at a picnic, whole family vomits. After 10hrs all better. Organism? | S. aureus(produces preformed enterotoxin)
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| Infant eats honey -> flaccid. Organism? Mechanism? | Clostridium botulinum; inhibited release of Ach
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| Man w/ squamous cell carcinoma, penis. what virus? | HPV
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| Pt w/ endocarditis 3wks after prosthetic heart valve. Organism? | S. aureus or S. epidermis
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| Pathology Vignettes | p220
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| Woman w/ previous Csection has scar in lower uterus close to opening of the os. Risk for what? | Placenta previa
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| 35yr old man w/ hi BP in arms. Low in legs. Dx? | Coarctation of Aorta
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| Woman w/ diffuse goiter and hyperthyroidism. Values of TSH and thyroid hormones? | Low TSH, and high thyroid hormones
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| Pt w/ extended expiratory phase. Disease process? | Obstructive Lung Disease
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| Woman w/ headache, visual disturbance, galactorrhea, amenorrhea. Dx? | Prolactinoma
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| Baby has foul smelling stool and recurrent pulmonary infxns. Dx? Test to confirm? | Cystic fibrosis. Chloride sweat test.
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| Obese woman w/ hirsutism and hi serum testosterone. Dx? | Polycyctic ovarian syndrome
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| Man w/ pain and swelling in knees, subcutaneous nodules around the joints and Achilles, exquisite pain in the metatarsophalangeal join of right big toe. Bx shows needle-like crystals. Dx? | Gouty arthritis
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| 48yr old female w/ progressive lethargy and extreme sensitivity to cold temp. Dx? | Hypothyroidism
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| Pt w/ elevated serum cortisol levels undergoes dexamethasone supp. test. 1mg doesn't lower cortisol. 8mgs does. Dx? | Pituitary tumor.
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| During a football game, player collapses/dies immediately. Likely Cardiac disease? | Hypertrophic cardiomyopathy
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| Child anemic since birth. Splenectomy -> increased Hct in what disease. | Spherocytosis
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| 43yr old man experiences dizziness/tinnitus. CT shows enlarged internal acoustic meatus. Dx? | Schwannoma
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| Child exhibits weakness and enlarges calves. Disease? How inherited? | Duchenne's muscular dystrophy, X-linked recessive.
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| 25yr old female w/ sudden uniocular vision loss and slightly slurred speech. Hx of weakness and pareshesias that have resolved. Dx? | Multiple Sclerosis
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| Teenager w/ nephritic syndrome & hearing loss. Dx? | Alport's syndrome
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| Tall thin male teenager w/ abrupt-onset dyspnea & leftsided chest pain. Hyperresonant percussion on the affected side & diminished breath sounds. Dx? | Pneumothorax
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| Young man concerned about wife's URIs and inability to conceive. Also dextrocardia. What protein? | Dynein (Kartagener's)
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| 55yr old man who smokes & drinks has cough & flu-like Sx. Gram stain shows nothing. Silver shows gramneg rods. Dx? | Legionellapneumonia
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| Pt has stoke after incurring multiple long bone fractures in trauma stemming from MVA. Cause? | Fat emboli.
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| 25yr old woman w/ a low grade fever, rash across nose from sun, widespread edema. Should be concerned about what disease? | SLE
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| Pathology Vignettes | p222
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| 50yr old man w/ diarrhea, PE reveals plethoric face and heart murmur. Dx? | Carcinoid syndrome
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| Elderly woman w/ a headache and jaw pain. Elevated ESR. Dx? | Temporal arteritis.
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| Pregnant woman @16wks w/ an atypically large abdomen. Blood test abnormality? Disorder? | High hCG, hydatidiform mole
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| 80yr old man w/ a systolic crescendo-decrescendo murmur. Most likely cause? | Aortic stenosis
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| Woman of short stature w/ short 4th and 5th metacarpals. Endocrine disorder? | Albright's hereditary osteodystrophy or pseudohypoparathyroidism
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| After stressful event, 30yr old man w/ diarrhea and blood per rectum. Intestinal bx shows transmural inflamm. Dx? | Crohn's
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| Young man w' mental deterioration and tremors. Brown pigmentation in a ring around periphery of cornea and altered LFTs. Tx? | Penicillamine for Wilson's disease.
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| Pt w/ fatigue, blood tests show macrocytic, megaloblastic anemia. Why danger to give folate alone? | Masks signs of neural damage w/ vitamin B12 deficiency
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| 10yr old "spaces out" in class (stops talking midsentence and then continues as if nothing had happened). During spells, quivering of lips. Dx? | Absence seizure.
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| 85yr old man w/ knee pain and swelling. X-ray shows increased joint space w/o erosion. Dx? What does aspirate show? | Pseudogout. Rhomboid calcium pyrophosphate crystals.
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| X-ray shows bilateral hilar lymphadenopathy. Dx? | Sarcoidosis.
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| 5yr old boy w/ systolic murmur and a wide, fixed split S2. Dx? | ASD
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| 28yr old chemist w/ MPTP exposure. Neurotransmitter depleted? | Dopamine
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| Woman taking tetracycline is photosensitive. Clinical manifestations? | Rash on sun-exposed regions of body
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| Non-diabetic pt has hypoglycemia but low Cpeptide. Dx? | Surreptitious insulin injection
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| African-american man who goes to Africa develops a hemolytic anemia after taking malarial prophylaxis. Enzyme deficiency? | Glucose-6-Phosphate Dehydrogenase
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| 27yr old female w/ hx of psych illness now has urinary retention due to a neuroleptic. Tx? | Bethanechol
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| Farmer presents w/ dyspnea, salivation, miosis, diarrhea, cramping, blurry vision. Cause & mechanism? | Insecticide poisioning; inhibition of AChE
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| Pt w/ recent kidney transplant is on cyclosporine for immunosuppression. Requires antifungal agent for candidiasis. What antifungal > cyclosporine toxicity? | Ketoconazole
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| Man on several meds including antidepressants and antihypertensives, has mydriasis and becomes constipated. Cause? | TCA
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| 55yr old postmenopausal woman is on tamoxifen therapy. Risk? | Endometrial carcinoma
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| Woman on MAO inh has hypertensive crisis after a meal. What did she eat? | Tyramine (wine/cheese)
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| After taking clindamycin, pt dev toxic megacolon and diarrhea. Mechanism? | Clostridium difficile overgrowth
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| Man starts meds for hyperlipidemia. Then rash, pruritus, and upset GI. Drug? | Niacin
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| Pt on carbamazepine. What routine workup should always be done? | LFTs
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| 23yr old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why? | Rifampin augments estrogen metabolism in the liver, rendering it less effective.
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| Pt develops cough and must discontinue captopril. What is a good replacement? Why not same side effects? | Losartan, an angiotensin II receptor antagonist, does not increase bradykinin as captopril does.
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