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Mixed USMLE 1


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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
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.


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
Valve insufficiency
equals Regurgitation (not stenosis)
Anthrax spores
Most infectious in the Stationary phase of growth.
Wiskott-Aldrich syndrome
X-linked dz with a a triad of Thrombocytopenia, eczema & recurrent sinopulmonary infections.
Serum IgM levels are low but IgG, IgA & IgE are high.
Lack a cell wall so they are indifferent to Penicillins.
Macrolides work!
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
Direct - testing for Antigen

Indirect - testing for Ab
(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
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
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.

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