Mixed USMLE 1
Terms
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- Previously healthy boy (not immunized) presents with sudden onset of fever, stridor and refusal to drink water. Dx?
-
Epiglottitis (H.influenzae)
- only disease where the child looks so toxic and refuses to eat/drink and may drool. Not the case with Croup (child can still eat). - ARDS - adult respiratory distress syndrome Presentation
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ARDS - charactereized by Diffuse damage to the alveolar/capillary wall.
Four most frequent causes of ARDS are:
Trauma, Sepsis, Shock, gastric aspiration.
Histo Hallmark of diffuse alveolar damage is formation of Hyaline membranes within the alveolar cavities.
- these consist of proteinaceous material of plasma origin and necortic debris from desquamated epithelium. Has a 60% mortality rate. - 2 year old with a tumor of the kidney. Distinctive feature of this lesion?
-
Wilm's tumor!
- contains embryonic glomerular and tubular structures embedded in a spindle cell stroma that may also contain smooth muscle, striated muscle, bone, cartilage, fat and fibrous tissue.
Abundant clear cells - renal cell carcinoma
Eosinophilic cells packed with mitochondria - oncocytoma
Hamartomatous blood vessels - angiomyolipoma
Necrotic bacterial forms in MCs - suggest Malakoplakia which can cause mass lesions in the kidney w/o being a true tumor. -
NMDA Rs
vs.
GABA and Glycine -
NMDA R - Ligant gate ion channel that permits the influx of Cations (Na & Ca). Cations entering the cell thru ion channels produce depolarization.
Anions entering the cell cause hyperpolariztion.
GABA and Glycine R's are inhibitory AA Receptors. They allow Cl- influx --> hyperpolarization (or membrane stabilization) thus, preventing excitation of the cell. -
6 week old infant - w/ a 10d history of coughing and choking spells. WBc is elevated with80% lymphocytes. Child is gasping for breath, exp. paroxysms of coughing.
Organisms isolated grow on Bordet-Gengou media. -
Whooping cough.
Bordetella pertussis - grame negative rod(coccoid). Encapsulated.
Grows on Bordet-Gengou media (potato agar). - Munro microabscesses
- Small collections of neutrophils in the cornified epidermis = PSORIASIS
- Alopecia aerata
-
Autoimmune attack on hair follicles.
- wide range of clinical severity.
- eg: loss of sclap hair, entire body surface etc. - SEs of Tetracycline
- Photosensitivity, pseudotumor cerebri & a variety of maculopapular rashes.
- SE's of Metronidazole
-
Development of convulsive seizures & peripheral neuropathy.
Also,produces a disulfiram-like reaction when taken with alcohol. - SE's of Fluoroquniolone
- Arthropathy, myalgias & leg cramps when given to children <18.
- Antihypertensives for pregnancy
- Mehtyldopa & Hydralazine are the safest.
- Pt with colorectal cancer develops endocarditis. Organism?
- Strep bovis
- Largest drop in BP (from the aorta to RA)
- Occurs in Arterioles (50mmHg drop)
- Agents lowering Digoxin levels
- Phenytoin & Sulfasalazine
- Drug causing Type 2 AV Block
- Metoprolol
- Valve insufficiency
- equals Regurgitation (not stenosis)
- Anthrax spores
- Most infectious in the Stationary phase of growth.
- Wiskott-Aldrich syndrome
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X-linked dz with a a triad of Thrombocytopenia, eczema & recurrent sinopulmonary infections.
Serum IgM levels are low but IgG, IgA & IgE are high. - Mycoplasma
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Lack a cell wall so they are indifferent to Penicillins.
Macrolides work! - N.meningitidis
-
Can cuase a sudden, fulminant, life-threatening meningitis or meningococcemia with a vasculitic purpura and DIC.
Can be complicated by the fatal Waterhouse-Friderichsen syndomre with coagulopathy, hypotension, adrenal cortical necrosis. - Coombs test
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Direct - testing for Antigen
Indirect - testing for Ab - Reovirus
- (rotavirus) - is ds and segmented.
- Cancer of the larynx
- Sq cell carcinoma - most frequent.
- Mucinous Cystadenoma
- Can progress to Pseudomyxoma perioteni - large amouts of gelationous, sticky, myxoid material fills the abdominal cavity and causes adhesion and obstruction of viscera.
- Edema in alcoholics. Cause?
- Decreased Plasma colloid osmotic pressure b/c the liver cant produce albumin.
- Severing of CN IX and X bilaterally
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Tachycardia with Hypertension.
Normally, IX and X firing rates increase when there is an inc in BP.
Now, cutting them sends a false signal to the medulla of the loss in BP. - Weeping, vesicular, erythematous rash in a boy a day after playing with grasses.
- Spongiotic Dermatitis - contact dermatitis (poison ivy)
- Erythema nodosum
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Chronc inflmmation in the Subcutaneous fat lobules. presents as a painful nodules often with fever and malaise.
Common with infections and drug reactions. Not with contact dermatitis. -
Bronchioalveolar carcinoma
2. Sq cell carcinoma of lung
3. Adenocarcinoma, bronchioalveiolar & large cell carcinoma -
No link to smoking.
2. Hypercalcemia
3. Coin like lesions. Adenocarcinoma also assoc with old COPD, granulomatous dz etc. - Laterally outstreched arm. Nerve injured?
- Axillary n. (Loss --> loss of deltoid function)
- Mitral valve prolapse
- Fragile X
- Ferric Fe (methemoglobinemia)
- Incapable of binding Oxygen. thus, their arterial O2 content will be low.
- Bladder rupture
- high Ammonia in peritoneal fluid
- Garlic breath
-
Arsenic poisoing
Treated with Dimercaprol or Succimer.