Ob/Gyn
A 38-year-old woman, gravida 3, para 2, at about 36 weeks' gestation comes to the ED because of a 4-hour history of contractions. She has received no prenatal care but reports two uncomplicated vaginal deliveries 5 and 8 years ago. Ultrasound exam shows oligohydramnios and a full-term fetus with a large left kidney and an empty right renal fossa. Which medication is this patient likely taking?
ACE inhibitor
A study is designed to evaluate the feasibility of acupuncture in children with chronic headaches. Sixty children with chronic headaches are recruited for the study. In addition to their usual therapy, all children are treated with acupuncture three times a week for 2 months. What type of study design is this?
Case-control
A 55-year-old man who is a business executive is admitted to the hospital for evaluation of abdominal pain. He is polite to the physician but berates the nurses and other staff. The patient's wife and two of his three adult children arrive for a visit. The patient says with disgust that the missing child is and always has been worthless. This patient is most likely using which defense mechanism?
Splitting
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure during the past 2 years. She has not yet started dialysis. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause of her anemia?
Erythropoietin deficiency
A 30-year-old female presents with bloody discharge from her left breast that she has noticed intermittently for the past month. She denies any palpable breast mass, weight loss, fevers, or night sweats. She has no medical history or family history of breast cancer. The skin on her breast is normal and no breast mass is palpable. What is the most likely diagnosis?
Intraductal papilloma
A 26-year-old woman is brought to the emergency department because of an 8-hour history of severe back and abdominal pain and mild but persistent vaginal bleeding. Ultrasound of the abdomen shows a 2-cm ectopic pregnancy in the ampulla. The ampulla has ruptured into the surrounding tissue. Fluid from this rupture will most likely be found in which location?
Pouch of Douglas (recto-uterine pouch)
A group of neurologists develop a new blood test for Alzheimer's. They are optimistic about the test, as they have found that for any given patient, the test repeatedly produces very similar results. However, they find that the new test results are not necessarily consistent with the gold standard of diagnosis. How can this test be described in terms of validity and reliability?
Reliable (reproducible) and not valid (not true)
For 3 weeks following an automobile accident where she watched her child die, a 28-year-old woman reports difficulty sleeping, headaches, and an inability to concentrate. Her family reports that she suffers from nightmares and violent emotional outbursts when awake. Since the accident, she refuses to either drive or ride in a care. The symptoms presented here are most consistent with what diagnois?
Acute stress disorder (<1 month; PTSD >1 month)
A 54-year-old man comes to the physician because of episodes of fainting for 3 months. He also has had difficulty performing daily tasks because he is easily fatigued. He had a myocardial infarction 12 years ago. His pulse is 40/min, RR are 18/min and BP is 138/85. Physical exam shows evidence of cannon a waves. ECG shows a p-wave rate of 90/min and R-wave rate of 40/min with no apparent relation between the two. What is the likely diagnosis?
Third-degree atrioventricular block
A 77-year-old man becomes "senile" over a period of 3 or 4 weeks. He used to be active and made an excellent living writing fiction and movie scripts. Now he stares at the wall all day long, barely recognizes his family, and is a "completely different person". Two weeks before the mental changes began, he fell from a house but apparently sustained no serious injuries. You expect a head CT to show what?
Chronic subdural hematoma
A 17-year-old girl has never had a menstrual period. Physical exam shows a normal female body habitus, normal breast development, and normal appearing external genitalia. She has no axillary or pubic hair. What is the most likely diagnosis?
Androgen insensitivity
In a survey of 10,000 IV drug users in town A, 1,000 turn out to be infected with hepatitis. During one year follow-up, 100 IV drug uses acquire hepatitis C. What ratio is the best estimate of the annual incidence of hepatitis C infection in IV drug users in this town?
100/9,000 (incidence is # new cases/# people at risk)
A 28-year-old white male presents at a local clinic complaining of severe abdominal pain. He reports tenderness during palpation, dizziness, and difficulty concentrating. Review of the medical record shows that this is the fourth time in the past year that the patient has appeared for medical attention. On each previous occasion, no identifiable medical problem was uncovered. When confronted with this history, the patient confesses that he manufactures his symptoms before coming to the clinic. He says that he knows this is wrong, but he cannot stop himself from doing this. What is his most likely diagnosis?
Factitious disorder- conscious symptom production and unconscious motivation compared to other somatic disorders that are unconscious
A 62-year-old woman comes to the physician because of low back pain for 1 week. Menopause occurred 10 years ago. Physical exam shows localized tenderness over the lumbar spine after movement. X-rays of the spine show a compression fracture of L1-2. A DEXA scan shows decreased bone mineral density. A bisphosphonate drug is prescribed. What is the mechanism of this drug?
Decreased osteoclast activity
A 38-year-old woman is being prepared for laparoscopic gallbladder removal under general anesthesia. When she inhales halothane and is injected with succinylcholine, her temperature rises to 105 degrees F and the surgery is canceled. What is this condition called and which medication is used to treat?
A 17-year-old girl is brought to the physician by her mother because she has not had a menstrual period for 6 months. Menarche occurred at the age of 12 years, and menses has occurred at regular 28-day intervals until they became irregular 1 year ago. She is a member of her high school gymnastics team. She is 163 cm (5 ft 4 in) tall and weighs 40 kg (88lbs); BMI is 15 kg/m2. What is likely the cause of this patient's amenorrhea?
Hypogonadotropic hypogonadism
A recent study found a higher incidence of SIDS for children of mothers who smoke. If the rate for smoking mothers is 230/100,000 and the rate for nonsmoking mothers is 71/100,000, what is the relative risk for children of mothers who smoke?
3.2 (a/(a+b)) / (c/(c+d))
A 32-year-old schizophrenic patient has been taking a standard course of neuroleptic medication for the past year. This medication has been very effective at controlling his delusions and hallucinations. However, during a regular checkup the patient reports that it is hard to read because his vision is blurry, and then lapses into delirium. These symptoms are most likely produced by blockage of what receptors?
Muscarinic- (anti-cholinergic toxidrome) Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter
A 34 year-old woman presents to the emergency department with a 6- month history of recurrent epistaxis and easy bruising. She has no past medical history or surgical history and takes no medications. She has never been pregnant but notes that her menstrual periods have been "more heavy than usual" during the same 6 months. On physical exam she has diffuse areas of petechiae under her tongue and extensor surfaces of her forearms. Labs show normal PT, normal aPTT with prolonged bleeding time and normal kidney function.
Immune Thrombocytopenic Purpura (ITP)
A 32-year-old man is brought to the emergency department 30 minutes after being struck by a car while driving his motorcycle. He reports severe pelvic pain. On examination, there is bruising of the perineum and pain is elicited with motion of his pelvis. Blood is noted at the urethral meatus. A plain x-ray shows a fracture of the superior pubic ramus and retrograde urethrography is done to evaluate for a urethral disruption. Which of the following portions of the urethra would be at greatest risk for injury?
Membranous
A 40-year-old woman comes to the physician because of a 6- month history of increased facial hair growth. Her last menstrual period was 4 months ago. BMI is 26 kg/m2. Physical exam shows temporal balding and course dark hair on the upper lip. Her serum testosterone concentration is increased. Ultrasound of the pelvis shows a 12-cm ovarian mass. What is the likely pathology of the mass?
Sertoli-Leydig tumor
A survey of a popular seaside community found the local inhabitants to have unusually elevated blood pressures. In this survey, just over 95% of the population had systolic readings between 110 and 190. Assuming a normal distribution for these assessed blood pressures, the standard deviation for systolic blood pressure in this seaside community is most likely what?
20; mean is 150; 95% is two standard deviations away
A 20-year-old male is involuntarily admitted to the county psychiatric unit for psychotic behavior over the past three months. The patient's mother explained to the psychiatrist that her son had withdrawn from family and friends, appeared to have no emotions, and had delusions that he was working for the CIA. When he spoke, his sentences did not always seem to have any connection with each other. What is his current diagnosis?
Schizophreniform (1-6 months) versus brief psychotic disorder <1 month and schizophrenia >6 months
A 35-year-old women presents to her primary care physician with 2 months of severe episodes of headache, tremulousness, palpitations, and anxiety. The patient has noticed difficulty swallowing solids and on physical exam there is a palpable, nontender swelling in the front of her neck. Lab studies show hypercalcemia. An ultrasound of the neck shows irregular calcifications within a mass, and an MRI of the abdomen shows the presence of bilateral adrenal lesions. What is her likely diagnosis?
MEN 2A (parathyroid hyperplasia, medullary thyroid carcinoma, pheochromocytoma)
MEN1= 3Ps (pituitary tumor, pancreatic endocrine tumor, parathyroid adenoma) ; MEN2A= 2Ps; MEN2B= 1P (pheochromocytoma, medullary carcinoma, mucosal neuroma)
Laxative abuse- called melanosis coli, result of lipofuscin in macrophages