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10yrs after total gastrectomy, 60yo man difficulty walking.
Diffuse spasticity in arms and legs, impaired proprioception in
his feet, increased muscle stretch reflexes in arms and knees,
absence of muscle stretch reflexes in ankles, bilateral extensor
plantar responses. Which vitamin is deficient? – ANSWER-B12
(cobalamin)
80yo man type 2 diabetes 2-month history severe constipation.
Laxatives haven't relieved symptoms. Abdominal exam shows
distention. Colonoscopy shows no abnormalities. Patient has
dysfunction of which nerve? – ANSWER-Pelvic splanchnic
27yo F in ED 30 min after being ejected through windshield
during collision. Unrestrained front-seat passenger. PE shows
marked edema and tenderness of the jaw. Panorex x-ray of
mouth shown. Which is injured? - ANSWER-Inferior alveolar
nerve?
Girl for well-child exam. Normal development includes pincer
grasp, finger
,feeding, standing while holding onto a table, and playing
peekaboo. Age (in months)? - ANSWER-9 months
60yo M exam prior to employment. PE normal. Labs show
Hb 14, HCT 42%, WBC 12k (PMN 45%, lymphos 50%, Monos
5%), platelets
250k. Flow cytometry analysis of peripheral lymphocytes
shows: CD3 50%, CD4 40%, CD8 10%, Kappa 47%, lambda 3%.
Which is most predictive of a clonal lymphoid proliferation? -
ANSWER-Surface kappa:surface lambda ratio
18yo M with yellow nodules on archilles tendons of his feet and
extensor tendons of his hands. Exam shows collection of
foamy histiocytes within the dermis. Serum cholesterol is 980,
and lipoprotein electrophoresis shows a
selective increase in LDL. Underlying disorder? -
ANSWER-Absence of
functional LDL receptors in
hepatocytes
35yo M with 4-day Hx of high-grade fever, sever muscle aches,
malaise, loss of appetite, and a nonproductive cough. wife and
kids had similar illness. Temp 39.2, PE normal. CBC and CXR
normal. Causal virus replicates its genome within the cell's
nucleus. Organism? - ANSWER-Influenza virus
28yo F at 18 weeks' gestation has palpitations. Labs show
increased serum
,total thyroxine (T4) concentration. Best test to confirm
hyperthyroidism? -
ANSWER-Free
T4
21yo M in ED 45 minutes after sustaining multiple injuries in a
MVC. His BP is 90/50, PE shows diffuse abdominal tenderness.
Dx with laceration of the spleen and undergoes splenectomy.
Predisposed to infection with? – ANSWER-Streptococcus
pneumoniae
70yo F in longitudinal study of effects of aging on pulmonary
function tests. Which represents woman now compared with
results at age of 20 years? - ANSWER-Residual volume UP,
Arterial Po2 DOWN, Alveolar-arterial Po2 difference UP
45yo F farmer in ED for 2-day hx of confusion, lethargy, fever,
headache, muscle pain, vomiting, and a rash on her wrists and
ankles. Bitten by a tick a few days ago. T 38.5 C, Red-purple
papules on distal extremities progress to trunk. Rx? -
ANSWER-Doxycycline
Study of breast cancer in women. Hundred healthy women
observed for 10 years. Goal is to determine if number of family
members who previously received dx of breast cancer
correlates with incidence of future development of cancer. Best
design? - ANSWER-Cohort
, 62yo F with recurrent pulmonary emboli comes for follow-up.
PE normal. Labs
show PT of 12 seconds. Warfarin begun. Which clotting
factors is first to be
decreased by 50% after initiation of Rx? - ANSWER-VII
(proconvertin)
48yo F with 2-month hx of fatigue and intermittent headaches.
BP 180/110, PE normal. Serum show a decreased potassium
concentration and increased aldosterone. CT abdomen shows
tumor on adrenal gland. Which additional findings supports
aldosterone-secreting adrenal adenoma? – ANSWER-
Decreased plasma renin activity
20yo F with 1-day hx of increasing urinary frequency and a
burning sensation with urination. One sexual partner, uses
condoms. VSS. PE shows mild suprapubic tenderness to deep
palpation. Urine shows rare epithelial cells and 10 WBC/hpf.
Urine grows E. coli > 100k. This bacterial strain has which
virulence factors? - ANSWER-Mannose-binding (type 1) fimbria
70yo M dies in a motor vehicle collision. Was undergoing
evaluation for occult blood in the stool. Photo of transverse
colon shown. Dx? - ANSWER-Tubular adenoma
38yo M with 1-week hx of watery, itchy eyes and a runny nose.
Physical shows
inflamed nasal mucosa. No congestion in lower lung.
Pharmacotherapy? -