CARDIO
33 year old man is found unconscious outside his home. PE shows erythematous marks in a Fern leaf pattern on his lower extremities. ECG shows ventricular fibrillation. what is the cause of the patient findings
a. cholesterol emboli b. hypothermia c. opiod overdose d. lightening strike e. infective endocarditis
what is D, lightening strike
21 y male involved in a MVA has pain and weakness in right arm. pt has decreased grip strength. X-ray shows a midshaft humerus fracture. Which structure is likely injured?
what is radial nerve injury?
65 year m, with 10 month hx of progressive SOB and sputum. b/l wheezes, TLC 108% of predicted, FEV1:FVC 62% of predicted. which of the following interventions is most likely to slow the decline in FEV1 in this patient
a. smoking cessation b. breathing exercises c. salmeterol therapy d. fluticasone therapy e. alpha 1 antitrypsin therapy
what is A. smoking cessation
5 week old male infant with 4 day history of recurrent nonbillious vomiting after feeding. He was born at 36 weeks, NSVD. PE shows a 2 cm epigastric mass. What is the diagnosis?
what is pyloric stenosis?
24 year old male presents with hematuria and hemoptysis. urine dipstick's shows 2+ proteins, 80 RBC. Crackles heard at both lung bases. further evaluation will show increased titers of which antibody
Anti GDM Antibody
63 year old woman with 6 months history of fatigue, presents with SOB and 1 month hx of b/l ankle swelling. ECG shows right bundle branch block and exam shows widely split S2, all consistent with right heart failure. what is the etiology of lower extremity swelling?
what is increased capillary hydrostatic pressure
3y old boy brought in by parents for clumsiness and multiple falls over the past 4 months. he started walking at 18 months, walked up steps at 27 months, now struggles to walk without assistance. He crawls onto his knees and slowly walks himself up with his hands. There is bilateral calf hypertrophy. What is the diagnosis
what is Duchenne muscular dystrophy
28 y woman G3P2, at 34wk gestation comes to the physican because of 1 day hx of SOB, dry cough and chest pain. Pulse 112/ min, RR 24/min, BP 108/78, O2 sat 90%. PE shows JVD, b/l pitting edema below the knee, worse on the right side. dullness to percussion over the right lung base. what is her most likely diagnosis
A. aortic dissection B. spontaneous pneumothorax C. panic attack D. bacterial pneumonia E. pulmonary embolism F. Myocardial Infarction G. acute pericarditis
What is E pulmonary embolism
6 year old boy with acute intermittent abd pain and multiple episodes of nonbillious vomiting for 4 hours. Pain radiates to the RLQ, and occurs every 15-30 mins. during episodes of pain, he draws his knees to his chest. Abdominal U/S shows concentric rings of bowel. What is the diagnosis?
what is intusscusseption
34 year old man with frequent HAs, and blurry vision. he has difficulties achieving an erection over the past few weeks. on PE, there is temporal visual field deficit b/l. MRI shows a mass. the mass is most likely derived from which of the following types of cells
a. thyrotrophs. b lactotrophs. c somatotropin. d gonadotrophs. e corticotrophs
what is lactotrophs.
a prolactinoma
a previously healthy 20 year old patient is brought to the ED 15 minutes after collapsing while playing basketball. he has no history of serious illness. on arrival, he is has no pulse or respiratory effort and is declared death. Family request an autopsy. cardiac workup is likely to show
A. narrowing of the left main coronary artery B. bicuspid aortic valve C. ventricular septum defect D. symmetric thickening of the L ventricle E. systolic anterior motion of the mitral valve F. increased mean pressure gradient across the aortic valve
What is E. systolic anterior motion of the mitral valve
14 y boy with 1 month history of pain in right leg. His mother gave him Ketorolac at night, but symptoms fail to improve. PE shows tenderness along right mid femur. X-ray shows several lytic lesions in the diaphysis of the femur. biopsy of femur shows small round blue cells. What is the diagnosis ?
what is Ewing Sarcoma?
61 Y male comes to the physician because of 9 month history of progressive SOB on exertion. PE shows fine basilar end-inspiratory crackles. he has digital clubbing. FEV1/FVC of 97% and TLC of 70%. Lung biopsy shows dumbbell shaped ferruginous bodies. This patient most likely works in which of the following fields
A. shipbuilding B. aerospace manufacturing C. cattle farming D. sandblasting E. coal mining
What is A, shipbuilding
Asbestosis
A 62 year old man comes to the physician for fatigue and dyspnea for 3 months. colonoscopy shows an exophytic mass in the ascending colon. A gain of function mutation in which of the following genes is involved in the pathogenesis of this patients condition
a. DCC b. TP53 c. MLH1 d. APC e. KRAS
What is e. KRAS
54 yr woman is diagnosed with blood pressure and started on thiazide. which levels are most likely to decrease,
a. serum uric acid. b urinary calcium excretion. c urinary sodium. d serum glucose. e serum lipid levels. f urinary potassium excretion
what is urinary calcium excretion
15 Y old boy, feels well and doing well in school. no murmur appreciated, but a wide-split S2 that does not change with respiration. if left untreated, this patient is at increased risk of which of the following complications?
a. sudden cardiac death b. cerebral aneurysm c. left ventricular hypertrophy d. paradoxical embolism e. infective endocarditis
what is d. paradoxical embolism
54 yr woman comes to the physician because of painful blisters under her arms for 3 days. she also has 2 month hx of intermittent painful lesions in the mouth. PE shows erosions in buccal mucosa and lips, multiple flaccid blisters on the trunk. Skin biopsy show detachment of keratinocytes within the stratum spinosum. This patient condition is most likely caused by autoantibodies directed against components of which cell junctions?
what is Desmosomes
A. embolic occlusion of the pulmonary artery B. rupture of a subpleural bleb C. fibrosis of the pulmonary parenchyma D. infection with gram + diplococci E. Hyperresponsiveness of the bronchial system
A.
What is B, rupture of a subpleural bleb
spontaneous Pneumothorax
59 Y Woman with cirrhosis. which of the following parts of physical examination go together?
a. splenomegaly and dupuytren contracture
b. jaundice and flapping tremor
c. palmer erythema and gynecomastia
d. esophageal varies and pedal edema
e caput medusa and spider angiomata
f. testicular atrophy and abdominal dissension
what is C. Palmer erythema and gynecomastia
32 Y woman comes to the physician with 1 week hx of left flank pain and dysuria. She has had 4 episodes of urinary tract infection over the past 2 years. U/S show L-sided hydronephrosis with echogenic foci and acoustic shadow consistent with stone. urinalysis shows stones with wedge shape prisms. what is the composition of the stone.
what is calcium phosphate
47 year woman with 6 week history of fatigue presents with low grade fever. she has a bicuspid aortic valve diagnosed 10 years ago, and a history of yeast infections 1 year ago. PE shows petechiae under the fingernails and multiple tender red nodules on the fingers. A new grade 2/6 diastolic murmur is heard at the right 2nd intercostal space. what is the casual organism?
a. enterococcus faecalis b. staphylococcus epidermis c. strep pyogenes d. strep sanguinis e. strep gallolyticus f. staphy aureus e. Candida albicans
what is D strep sanguinis
African American woman comes for a routine exam. her uncle dies of metastatic melanoma 1 year ago. she works in a law firm but travels to the caribbean regularly. This woman is at risk of what type of melanoma
a. Desmoplastic b. Nodular c. Acral lentiginous d. Amelanotic e. Lentigo maligna f. Superficial spreading
what is C acral lentiginous
An 82 year old woman admitted to the hospital because of wet gangrene on her right leg. 2 days after admission she becomes increasingly confused and tachypneic. she is intubated and ventilatory supported on 100% fi02. Vitals T. 102.5F, HR 127 BP 83/47. ABG shows Pco2 of 41mmhg and PO2 of 55mmhg. Pt dies from respiratory failure despite appropriate care. further evaluation of this patient is most likely to show which of the following findings
A. hyperinflation of the lungs B. emboli in the pulmonary vasculature C. air in the pleural cavity D. nodular thickening of the interlobular septa E. abscess in the lung parenchyma F. fluid in the alveolar space
What is F, fluid in the alveolar space.
six hours after delivery, a male newborn has an episode of bilious projectile vomiting. pregnancy was complicated by polyhydramnios. Mother smoked cigarettes daily during pregnancy. X ray shows 3 distinct localized gas collection in the upper abdomen. what is the most likely diagnosis
what is jejunal atresia
Accurately interpret this ACID BASE disorder
pH 7.49 PaCO2 30 HCO3- 17
partially compensated respiratory alkalosis