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Patient presents with dec. pain and temp sensation over lateral aspects of both arms.
What is the lesion?
Penlight in patient's right eye produces bilateral pupillary constriction. When moved to left eye, there is paradoxical dilatation.
Where is defect?
Atrophy of left optic nerve.
(Marcus Gunn Pupil, swinging flashlight test)
Pt describes dec prink sensation on lateral aspect of her leg and foot. A deficit in what muscular action can also be expected?
Dorsiflexion and eversion of foot (common peroneal nerve)
Elderly woman presents with arthritis and tingling over lateral digits of her right hand.
What is the diagnosis?
Carpal tunnel syndrome (median nerve compression)
20yo dancer reports dec plantar flexion and dec sensation over the back of her thigh, calf, and lateral half of her foot.
What spinal nerve is involved?
Tibial (L4-S3)
Woman involved in a motor vehicle accident cannot turn her head to the left has right shoulder droop.
What structure is damaged?
Right CN XI (runs thru jugular foramen with CN IX and X), innervating SCM and trapezius muscles.
Man presents with one wild, flailing arm.
Where is lesion?
Contralateral subthalamic nucleus (hemiballismus)
Pt with cortical lesion does not know that he has a disease.
Where is the lesion?
Right parietal lobe
Pt cannot protrude tongue toward right side (i.e. tongue deviates to left) and has a right-sided spastic paralysis.
Where is the lesion?
Left medulla, CN XII
Teen falls while rollerblading and hurts his elbow. He can't feel the medial part of the palm.
Which nerve and what injury?
Ulnar nerve due to broken medial condyle.
Field hockey player presents to the ER after falling on her arm during practice. X-ray shows midshaft break of the humerus.
Which nerve and which artery are most likely damaged?
Radial nerve and deep brachial artery, which run together.
Pt cannot blink his right eye or seal his lips and has mild ptosis on the right side.
What is the diagnosis, and which nerve is affected?
Bell's palsy; CN VII
Pt complains of pain, numbness, and a tingling sensation. On exam, she has wasting of the thenar eminence.
What is the diagnosis, and what nerve is often affected?
Carpal tunnel syndrome; median nerve
During a particular stage of sleep, man has variable blood pressure, penile tumescence, and variable EEG.
What stage of sleep is he in?
REM sleep
Person demands only the best and most famous doctor in town.
What is the personality disorder?
Narcissistic personality disorder
Nurse has episodes of hypoglycemia; blood analysis reveals no elevation in C protein.
What is the diagnosis?
Factitious disoder; self-scripted insulin.
55yo businessman complains of lack of successful sexual contacts with women and lack of ability to reach a full erection. Two years ago he had a heart attack.
What might be the cause of his problem?
Fear of sudden death during intercourse.
15yo girl of normal height and weight for her age has enlarged parotid glands but no other complaints. The mother confides that she found laxatives in the daughter's closet.
What is the diagnosis?
Women presents with headache, visual disturbance, galactorrhea, and amenorrhea.
What is the diagnosis?
43yo man experiences dizziness and tinnitus. CT shows enlarged internal acoustic meatus.
What is the diagnosis?
25yo female presents with sudden uniocular vision loss and slightly slurred speech. She has a history of weakness and paresthesias that have resolved.
What is the diagnosis?
Multiple sclerosis
10yo child "spaces out" in class (e.g. stops talking midsentence and then continues as if nothing had happened). During spells, there is slight quivering of lips.
What is the diagnosis?
Absence seizures
Man on several medications, including antidepressants and antihypertensives, has mydriasis and becomes constipated.
What is the cause of his symptoms?
Woman on MAO inhibitor has hypertensive crisis after a meal.
What did she ingest?
Tyramine (wine or cheese)
Full-term neonate of uneventful delivery becomes mentally retarded and hyperactive and has a musty odor.
What is the diagnosis?
Stressed executive comes home from work, consumes 7 or 8 martinis in rapid succession before dinner, and becomes hypoglycemic.
What is the mechanism?
NADH increase prevents gluconeogenesis by shunting pyruvate and oxaloacetate to lactate and malate.
2yo girl has an inc in abdominal girth, failure to thrive, and skin and hair depigmentation.
What is the diagnosis?
Alcoholic develops a rash, diarrhea, and altered mental status.
What is the vitamin deficiency?
Vitamin B3 (pellagra)
51yo man has black spots in his sclera and has noted that his urine turns black upon standing.
What is the diagnosis?
25yo male complains of severe chest pain and has xanthomas of his Achilles tendons.
What is the disease, and where is the defect?
Familial hypercholesterolemia; LDL receptor
Alcoholic vomits gastric contents and develops foul-smelling sputum.
What organisms are most likely?
Middle-age male presents with acute-onset monoarticular joint pain and bilateral Bell's palsy.
What is the likely disease and how did he get it?
Lyme disease; bite from Ixodes tick
Pt with Mycoplasma pneumoniae exhibits cryoagglutinins during recovery phase.
What type of immunoglobulins are reacting?
UA of patient shows WBC casts.
What is the diagnosis?
Young child presents with tetany and candidiasis. Hypocalcemia and immunosuppression are found.
What cell is deficient?
Tcell (DiGeorge)
After taking clindamycin, pt develops toxic megacolon and diarrhea.
What is the mechanism of diarrhea?
Clostridium difficile overgrowth
Pregnant woman in 3rd trimester has normal blood pressure when standing and sitting. When supine, bp drops to 90/50.
What is the diagnosis?
Compression of the IVC
35yo man has high blood pressure in his arms and low pressure in his legs.
What is the diagnosis?
Coarctation of the aorta
5yo boy presents with systolic murmur and wide, fixed split S2.
what is the diagnosis?
During a game, a young football player collapses and dies immediately.
What is the most likely type of cardiac disease?
Hypertrophic cardiomyopathy
Pt has a stroke after incurring multiple long bone fractures in trauma stemming from a motor vehicle accident.
What caused the infarct?
Fat emboli
Elderly woman presents with headache and jaw pain. Labs show elevated ESR.
What is the dx?
Temporal arteritis
80yo man presents with systolic crescendo-decrescendo murmur.
What is the most likely cause?
Aortic stenosis
Man starts medication for hyperlipidemia. He then develops a rash, pruritus, and GI upset.
What drug was it?
Pt develops cought and must discontinue captopril.
What is a good replacement drug, and why doesn't it have the same side effects?
Losartan, an ATII receptor antagonist. Does not increase bradykinin as captopril does.
Pt exhibits an extended expiratory phase.
What is the disease process?
Obstructive lung disease
Tall, thin male teenager has abrupt-onset dyspnea and left-sided chest pain. There is hyperresonant percussion on the affected side, and breath sounds are diminished.
What is the diagnosis?
Spontaneous pneumothorax
Young man concerned about his wife's inability to conceive and her recurrent URIs. She has dextrocardia.
Which of her proteins is defective?
Dynein (Kartagener's)
Baby vomits milk when fed and has a gastric air bubble.
What kind of fistula is present?
Blind esophagus with lower segment of esophagus attached to trachea.
After a stressful life event, 30yo man has diarrhea and blood per rectum; intestinal biopsy shows transmural inflammation.
What is the diagnosis?
Young man presents with mental deterioration and tremors. He has brown pigmentation in a ring around the periphery of his cornea and altered LFTs.
What treatment should he receive?
Penicillamine for Wilson's dz
20yo male presents with idiopathic hyperbilirubinemia.
What is the most common cause?
Gilbert's disease
Woman presents with diffuse goiter and hyperthyroidism.
What are the expected TSH and thyroid hormones?
High thyroid hormones
48yo female presents with progressive lethargy and extreme sensitivity to cold temperatures.
What is the diagnosis?
Pt with elevated cortisol levels undergoes a dexamethasone suppression test. 1mg of dexamethasone does not lower cortisol levels, but 8mg does.
What is the diagnosis?
Pituitary tumor
50yo man complains of diarrhea. On physical exam, his face is plethoric and a heart murmur is detected.
What is the diagnosis?
Carcinoid syndrome
Woman of short stature presents with shortened 4th and 5th metacarpals.
What endocrine disorder comes to mind?
Albright's hereditary osteodystrophy, or pseudohypoparathyroidism
Nondiabetic patient presents with hypoglycemia but low levels of C peptide.
What is the diagnosis?
Surreptitious insulin injection
24yo male develops testicular cancer.
Metastatic spread occurs by what route?
Para-aortic lymph nodes (recall descent of testes during development)
Woman with previous cesarean sectino has a scar in her lower uterus close to the opening of the os.
What is she at high risk for?
Placenta previa
Obese woman presents with hirsutism and increased levels of serum testosterone.
What is the diagnosis?
Polycystic ovarian syndrome
Pregnant woman at 16 weeks of gestation presents with an atypically large abdomen.
What is the diagnosis?
High hCG; hydatidiform mole
55yo postmenopausal woman is on tamoxifen therapy.
What is she at high risk of acquiring?
Endometrial carcinoma
Soccer player who was kicked in the leg suffered a damaged medical meniscus.
What else is likely to have been damaged?
Anterior cruciate ligament (remember the "unhappy triad")
Gymnast dislocates her shoulder anteriorly.
What nerve is most likely to have been damaged?
Axillary nerve (C5,C6)
X-ray shows bilateral hilar lymphadenopathy.
What is the diagnosis?
25yo woman presents with low-grade fever, a rash across her nose that gets worse when she is out in the sun, and widespread edema.
You are concerned about what disease?
85yo man presents with acute knee pain and swelling. Xray shows joint space without erosion.
What is the diagnosis, and what would you find on aspiration?

rhomboid calcium pyrophosphate crystals
Child has been anemic since birth.
Splenectomy would result in increased hematocrit in what disease?
Pt presents with fatigue and blood tests show a macrocytic, megaloblastic anemia.
What is the danger of giving folate alone?
Masks signs of neural damage with Vit B12 deficiency
(malpractice malpractice!)
Pt presents with anemia, hypercalcemia, and bone pain on palpation; bone marrow biopsy shows a slide pakced with cells that have a large, round, off-center nucleus.
What is the diagnosis and what would be found on urinanalysis?
Multiple myeloma (plasma cell neoplasm); Bence Jones protein (Ig light chains)
AIDS pt has just been diagnosed with cancer.
What neoplasms are associated with AIDS?
B-cell lymphoma, Kaposi's sarcoma
Pt with a new cancer diagnosis and known history of CHF is being evaluated for chemotherapy.
What chemotherapeutic agent should be avoided?
Doxorubicin (cardiotoxic)
Chromosome analysis reveals the presence of the Philadelphia chromosome, t(9;22).
What is the latest targeted therapy for this disease, and how does it work?
Imatinib (Gleevec) is used to treat CML; bcr-abl tyrosine kinase inhibitor
(NOT monoclonal antibody -- it's a 2-phenylaminopyrimidine derivative)
Pt with Mycoplasma pneumoniae exhibits cryoagglutinins during recovery phase.
What types of immunoglobulins are reacting?
UZ of patient shows WBC casts.
What is the diagnosis?
Pt presents with "rose gardener's" scenario (thorn prick with ulcers along lymphatic drainage).
What is the infectious bug?
Sporothrix schenckii
25yo medical student has a burning feeling in his gut after meals. Biopsy of gastric mucosa shows gram-negative rods.
What is the likely organism?
H. pylori
32yo male has "cauliflower" skin lesions. Tissue biopsy shows broad-based budding yeasts.
What is the likely organism?
Breast-feeding woman suddenly develops redness and swelling of her right breast. On examination, it is found to be a fluctuant mass.
What is the diagnosis?
Mastitis caused by S. aureus
Young child has recurrent lung infections and granulomatous lesions.
what is the defect in neutrophils?
NADPH oxidase (chronic granulomatous disease)
20yo college student presents with lymphadenopathy, fever, and hepatosplenomegaly. His serum agglutinates sheep RBCs.
What cell is infected?
B cell (EBV - infectious mononucleosis)
One hour after eating custard at a picnic, a whole family began to vomit. After 10 hours, they were better.
What is the organism?
S. aureus
(produces preformed enterotoxin)
Infant becomes flaccid after eating honey.
What organism is implicated, and what is the mechanism of action?
Clostridium botulinum; inhibited release of ACh
Man presents with squamous cell carcinoma of the penis.
He had exposure to what virus?
55yo man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods.
What is the diagnosis?
Legionella pneumonia
After taking clindamycin, patient develops toxic megacolon and diarrhea.
What is the mechanism of diarrhea?
Clostridium difficile overgrowth
28yo chemist presents with MPTP exposure.
What neurotransmitter is depleted?
dopamine (drug-induced parkinson's)
Woman taking tetracycline exhibits photosensitivity.
What are the clinical manifestations?
Rash on sun-exposed regions of the body.
African-American man who goes to Africa develops a hemolytic anemia after taking malarial prophylaxis.
What is the enzyme deficiency?
Glucose-6-phosphate dehydrogenase
Farmer presents with dyspnea, salivation, miosis, diarrhea, cramping, and blurry vision.
What caused this and what is the mechanism?
cause: Insecticide poisoning (organophosphates)

mechanism: Inhibition of acetylcholinesterase
27yo female with a history of psychiatric illness now has urinary retention due to a neuroleptic.
What do you treat it with?
Pt with recent kidney transplant is on cyclosporine for immunosuppression. Requires antifungal agent for candidiasis.
What antifungal drug would result in cyclosporine toxicity?
Ketoconazole (inhibits P450)
Pt is on carbamazepine.
What routine workup should always be done?
23yo female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant.
Rifampin augments estrogen metabolism in the liver, rendering it less effective.
Woman with anxiety about a gynecologic exam is told to relax and to imagine going through the steps of the exam.
What process does this exemplify.
Systematic desensitization
65yo man is diagnosed with incurable metastatic pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the patient.
What do you do?
Assess whether telling pt will negatively affect his health. If not, tell him.
Man admitted for chest pain is medicated for ventricular tachycardia. The next day he jumps out of bed and does 50 pushups to show the nurses he has not had a heart attack.
What defense mechanism is he using?
You find yourself attracted to your 26yo patient.
What do you say?
Nothing! The tone of the interview must be very professional; it is not acceptable to have any sort of romantic relationship with patients (darn it). If you feel your actions may be misinterpreted, invite a chaperone into the room.

(note: according to qbank, never choose answers where you refer your patient to someone else or dump the problem on another person/group/admin)
Large group of ppl is followed over 10 years. Every 2 years, it is determined who develops heart disease and who does not.
What type of study is this?
Cohort study
Girl can groom herself, can hop on 1 foot, and has an imaginary friend.
How old is she?
4 yo (what a cutie)
Man has flashbacks about his girlfriend's death 2 months ago following a hit-and-run accident. He often cries and wishes for the death of the culprit.
What is the diagnosis?
Normal bereavement :*(
36yo woman with a strong family history of breast cancer refuses mammogram because she heard it hurts.
What do you do?
Discuss the risks and benefits of not having a mammogram. Each patient must give her own informed consent to each procedure; if the patient refuses, you must abide by her wishes.
72yo man insists on stopping treatment for his heart condition because it makes him feel "funny."
What do you do?
Although you want to encourage the pt to take his medication, the pt has the final say in his own treatment regimen. You should investigate the "funny" feeling and determine if there are drugs available that don't elicit this particular side effect.

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