UWORLD Notes by Systems (Usmle Grassroots)

Question MainDivision Id

458

459

556

743

Pathology

Pathology

Immunology

Immunology

SubDivision

Notes

Allergy&Immunology

Skin biopsy from thigh of a child shows vascular lesions with IgA and C3 deposition. The most likely clinical presentation is *Skin rash and abdominal pain* [Henoch-Schonlein Purpura]

Allergy&Immunology

Pt is hospitalized with recent onset oliguria and a high serum creatinine level. He has been seen in clinic several times for an untranasal ulcer that has failed to heal. The pt's condition is most likely assoc with antibodies against *Neutrophils* [Wegner'sGranulamatosiswithpolyangiitis, Cytoplasmicstaining Antinuetrohilcytoplasm antibodies(c-ANCA) is pathognomonic]

Allergy&Immunology

Pt stung by a bee displaying edematous and erythematous plaque with evanescent borders and mild central pallor. This is a local allergic reaction (type 1 hypersensitivity) leading to the release of *HISTAMINE*, heparin, leukotrienes, and prostaglandins that are responisble for the increased vascular permeability leading to the presentation.

Allergy&Immunology

The classic triad of Urethritis, Conjunctivitis, and Mono- or Oligoarticular arthritis indicates "Reactive Arthritis" which is a seronegative(RF-ve) spondyloarthropathy(HLA-B27).Symptoms usually present 1-4 weeks after a primary infection causing urethritis (dysurea). Skin finding include a vesicular rash on palms & soles, circinate balanitis, and *SACROiLiiTiS* (inflammation of sacroiliac joint)

761

PathophysiologyAllergy&Immunology

23 yr old Female with migratory arthritis and skin rash exacerbated by skin exposure. Urinalysis shows moderate proteinuria and RBC casts. Serum Ab with specificity for this pts condition react with *DoublestrandedDNA* [SLE]

965

Immunology

Allergy&Immunology

We conjugate the H. Influenza capsular polysaccharide together with diptheria toxoid in the vaccine because this combination *IncreasesImmunogenicity*.

1388

Microbiology

Allergy& Immunology

Immigrant 6 year old who presents with dyspnea. He has Fever. Exam shows neck swelling, palatal paralysis and a gray pharyngeal exudate. His vaccination history is unknown. The intervention that will imrove his symptons is *Passive Immunization* (C.Diptheriainfection,exotoxin)

1389

Microbiology

Allergy& Immunology

Non pathogenic C. Diptheria become pathogenic thru *Phage conversion permiting exotoxin production*

1612

Pharmacology

Allergy& Immunology

Pt with decreased serum complement C4 and C1 esterase inhibitor levels. Drug that is contraindicated is *Captopril* [Hereditary angioedema][ ACE inhibitors make bradykinin accumulate in addition to already high bradykinin due to loss of inhibitory action of C1 esterase inhib on kalikrein which converts kinogen into bradykinin]

2068

Immunology

Allergy&Immunology

Histamineand*Tryptase*areelevated inAnaphylaxis.

2069

Immunology

Allergy&Immunology

Mast cell degranulation is triggered by *Receptor aggregation* during High affinity IgE receptor activation.

Biostatistics & Epidemiology

Early penicilin Tx of Group A strep pharyngitis is important 4 prevention of Acute Rheumatic Fever which amajor cause of CVS death in many developing nations. ARF affect mainly heart and CNS. Chronic cardiac inflammation can progres sto rheumatic heart disease, esp valvualr. (Mitral valve)and would need *Heart Surgery* Therefore, early Tx lowers need 4 Heart surgey!!

726

Pharmacology

1117

1133

1214

Pathology

Immunology

Pharmacology

Dermatology

Pt with bilateral skin lesions over his elbows. Biopsy shows very thing stratum granulosum and prominentparakeratoicstartum corneum with occasional foci of neutrophil accumulation. Most likely Dx is *Psoriasis*.

Dermatology

Pt presents with highly Pruritic (itchy) erythematous rash consisting of papules, vesicle and bulla following exposure to wilderness (Elctrician working in unmaintained woody area). Cells responsible for tissue damage are *T cells* [Poison IVY dermatitis, type 4 hypersen]

Dermatology

28 yr odl pt who has history of childhood dermatitis has been routinely applying corticosteroid cream to the flexor area of his skin for many years. A punch biopsy of area subjected to this topical therapy would most likely show *Dermal Atrophy* [corticosteroids in addition to anti-inflammatory effect, cause decreased production of extracellular matrix collagen and GAGS]

1244

Biochemistry

Dermatology

Ehlers Danlos Syndrome which presents with hyperextensible skin, easy bruising, hypermobile joints is a defect in collagen synthesis.

1245

Biochemistry

Dermatology

Ehler-Danlos Synrome can be caused by procollagen peptidase deficiency which results in impaired *cleavage of terminal propeptides* Where? --> Extracellular space.

Dermatology

Signs of scurvy such as bleeding gums , ecchymoses and corkscrew hairs implicate vit C deficiency. Vit C is required in postranslational hydroxylation of proline and lysin residues by hydroxylases in collagen synthesis. It happens in the Rough Endoplasmic reticulum

1247

Biochemistry

1313

Microbiology

Dermatology

Pt presents with skin changes. Blotches of skin on her arms appear to be of different color. She also has a tingling sensation in her hands. Exam shows patchy area of skin anesthesia and hypopigmentation on her upper extremities. Nerve biopsy shows organisms invading Schwann cells. Hiv test is negative. Most likley cause is *Myobacterium Leprae* [Tubercolid Leprosy, TH1 response. mild form compared to Lepromatousleprosy(TH20]

1314

Pathology

Dermatology

Pt that was injected with heat killed M. Leprae and developed a large indurated nodule demostrates *Increased IL-2 & IFN-gamma in skin lesions* When pt's serum is added to a mixure of cardiolipin, lecithin, and

1316

Microbiology

Dermatology

1334

Biochemistry

Dermatology

1476

Genetics

Dermatology

1553

Microbiology

Dermatology

cholestrol and extensive flocculation isThis observed, the next step is to evaluate for *Spirochetal Antibodies*. is a nonspecific treponemal serologic test known as the rapid plasma reagin test. 12 yr old is evaluated for ataxia acompanied by episodic erythematous and puritic skin lesions and loose stools. Lab shows loss of neutral aromatic amino acids in urine. The pt symptoms would most likley respond to to supplementation with *Niacin Vit B3* [Hartnup dsiease, defective intestinal and renal absorption of tryptophan. Ttryptophan is a precursor to Nicotinic acid, serotonin, andmelatonin.] [Tryptophan, phenylalanine and tyrosine are all aromatic aa][note:Pallegra?] Pt with xeroderma pigmentosum have a defect in *Endonucelease* enzyme. a unilateral vesicular rash involving a single dermatome is Shingles. The pt would siffer from *Persistent local pain* in the next 6 months

920

Pharmacology

Endocrine, Diabetes & Metabolism

A drug that activates peroxisome-proliferator activated receptor-y (a nuclear receptor and transcription factor) (such drugs are the -glitazones) results in *Decreased Insulin Resistance*

921

Pathophysiology


To diagnose Type diabetes melitus use *Fasting blood glucose level*, random glucose, or HbA1c.

922

Pathophysiology


A fetus born to a mother who had gestational diabetes would have hypoglycemia due to *Beta cell hyperplasia* [Pancreas is used to a lot of glucose from mother. After delivery, glucose suddenly stops but beta cells are still high in number and secreting insulin, resulting in hypoglycemia]

925

Pathophysiology


Amenorhea in pt involved in strenous excersie and low body wieght is caused by *HYpothalamic Suppression*


Pt with history of SLE dies at home. At her last P.E, her BP was 150/90. Clinical records show progressive truncal obesity, facial plethora, and proximal muscle weakness. Lab showed mild hyperglycemia. Evaluation of her adrenal galnds will most likely show *Bilateral cortical atrophy* [Iatrogenic cushing syndrome due to prolonged glucucorticoid use, leads to supression of of hypothalamic oituitary axis]


Pt with HTN at young age together with weakness and paresthesias (electrolye or acid-base disturbance) and low Renin levels is consisent with Primary Hyperaldostronism. His Serum level of *Na is normal, K is low, HCO3 is High* (Na is normal due to aldostrone escape)


An infant boy with recurrent vomitting (salt wasting) and poor feeding and P.E shows dehydration (salt wasting) and hypotension with labs showing low sodium (wasting) and hyperkalemia. Pt probably has Congenital Adrenal Hyperplasia 21-hyrdoxylase deficiency. There would be lowcortisol, low aldo, high ACTH, and *High 17-hydroxyprogestrone* which is a precuror to cortisol synthesis.

928

929

Pathophysiology

Pathophysiology

930

Pathophysiology

933

Endocrine, Diabetes & Pathophysiology Metabolism

934

Biochemistry


Sorbitol produced by aldolase reductase is normally metabolized to *Fructose*

981

Endocrine, Diabetes & Pathophysiology Metabolism

Pt with celiac disease will also develop vit D deficiency due to defective mucosal absorption, presenting as bone pain and weakness (Adult). Lab test would reveal *low Ca, Low PO4-, High PTH* [No vit D decreases absorption of Ca AND PO4- from GI tract]

985

Pathophysiology


In DKA there is *Increased (or normal) extracell K & Decreased Intracell K**

Pathology


Pt with elevated serum gastrin levels. Multi organ disease is suspected. Pt should be asked for a history of *MEN type 1* (MEN Type 1 has primary hyperparathyroidism, pituitary tumors, and pacnreatic tumors (esp "Gastrinomas"))

986

Symptoms of Headache, tachycardia, diaphoresis and severe HTN. THese resolve before Tx is given. Same thing happened a month ago. This is pheochromocytoma and there is *Elevated catecholamine release*

990

Physiology


Aching bones and insdeous pain in back, pelvis and lower extremities, combined with reduced sunlight exposure suggests Vit D deficiency. UV light from the sun converts *7-dehydrocholesterol* into *Cholecalciferol (Vit D3)*. Vit D3 is then converted into 25-hydroxycholecalciferol by 25-hydroxylase. 25-hydroxycholecalcifrol is then converted to 1,25-dihydroxycholecalciferol (activevitD) by 1-alpha-hydroxylase. This is the enzyme in the kidney acted on by PTH (+) and Ca2+ (-).

992

Physiology


Pt with mild hypercalcemia, borderline high PTH levels and urinary Ca that is very low and normal 25-hydroxyvit D pobably has a mutation in *Membrane-bound receptor coupled with a G-protein*

997

Biochemistry


Oxaloacetate-----> Phosphoenolpyruvate(catalyzedby PEP carboxykinase) is the 2nd commited step in gluconeogenesis which predominatesin starvation states.

998

Biochemistry


Pts with pyruvate dehydrogenase deficiency should be on a ketogenic diet. Soley Ketogenic aminoacids include *lysine* and leucine.


Insuline resistance by the pancreatic cells i sstimulated by increased ATP production. *Glucokinase* functions as a glucose sensor in pancreatic beta cells by controlling the rate of glucose entry into the glycolytic pathway. Mutations in the *glucokinase* gene are a cause of maturity-onset diabetes of the young.

1010

Biochemistry

1019

Biochemistry


Pt has absent lactate dehydrogenase activity in muscles. In this pt, strenuous exercise leads to inhibition of glycolysis in skeletal muscles due to intracellular depletion of *NAD+* Homeless pt with signs of wernicke encephalopathy after admin of glucose without thiamine supplemenation would havean impaired *Alpha ketoglutarate to Succinly CoA reaction* [Thiamine is needed for alpha ketogluyerate dehydrogenase][Also needed for other dehydrogenases and transketolase]

1021

Biochemistry


1022

Biochemistry


A direct source of energy in the TCA cycle is in the conversion of succinylcoA into Succinate thus yeilding GTP.

Biochemistry


Increasingfructose-2,6-bisphosphatepromotes glycoloysis(insulin like effect) and inhibits Gluconeogensis. Inhibiting Gluconeogenesismeans lessalanineand otherglucuneogenic substrates are converted to glucos.

Biochemistry


During fasting, maintenance of pt blood glucise is facilitated by hepatic conversion of pyruvate into glucose. The substance that is an allosteric activator of the first step of this process is *Acetyl-CoA* [Gluconeogenesis]


Pt presents with myalgias, anorexia, and skin rash. He has been consuming raw white eggs for several months. P.E shows macular dermatitis of extremities. A water soluble vit def is suspected. The biochemical conversions that most likely uses the def vit as a cofactor are *Pyruvate to Oxaloacetate* [Vit B7 (Biotin) needed as a cofactor for Carboxylases]

1031

1034

1063

Biochemistry

Pt presents with progressve lethargy. For past 3 weeks she had loss of appetite, constipation, muscle weakness, polyuria and 1065

Physiology


polydipsia. She has been taking large doses of vitamins. Exam shows she is stuporous and has dry mucus membranes. The metabolic abnormality in this pt can also be found in *Sarcoidosis* [Hypercalcemia]

869

1027

Pathophysiology

Microbiology

FemaleReproductive System & Breast

Cervical Intraepithelial neoplasia can be caused by HPV infection which can result from sexual infection due to *Lack of barrier contraception*.


Pt presents to fertility clinic. Attempting to concieve for past year, no success. She used OCP for 15 years. 7 years ago she got ceftriaxone for fever, abdominal pain, and vaginal discharge. Major contributing factor to her inability to conceive is *Insufficient antibiotic use* [PID was treated only for gonorhea, azithro was not used for coverage of chlamidya, this led to subclinical continous infection that led to scaring of fallopian tubes and subsequent infertility] Asymptomaticpt's mamogramrevealsmicrocalcifications. Biopsy

1057

1549

1560

Pathology

Pathophysiology

Physiology


shows ducts distended by pleomorphic cells with prominent central necrosis. Origin of this lesion is the *Breast Duct* [Ductal Ca in Situ]


Symptoms of primary herpes infections include inguinal lymphadenopathy,tender vesicularlesionscovering both labia majora and pernium with dysuria and itching. The infection (probably hsv-2) can lead to *Recurrent Genital Ulcers* (less sever) (HSV lies dormant in sacral dorsal root ganglia)


LH stimulates the theca interna cells of the ovarian follicle to produce androgens. Aromatase within the follicle's *Granulosa* cells subsequently converts these androgens to estradiol under FSH stumulation. The theca externa cells serve as connective tissue support structure for the follicle.

1632

Anatomy


*The suspensory ligament of ovary* must be ligated during removal of ovaries to prevent bleeding. It carries the ovarian artery. It also known as the infundibulopelvic ligament. Note that the Cardinal Ligament (transverse cervical ligament) holds the uterine artery and needs to be ligated in a hysterectomy.

1739

Anatomy


A *pudendal nerve* block is performed by injecting an anesthetic intravaginally, medial to the ischial spine, through the sacrospinous ligament. This provides anesthesia to most of the perineum.

1809

Embryology


*Vaginal Agenesis* is characterized by short vagina and rudimentary uterus and Amenorrhea with normal 2ndry sex characteristics and normal wieght and stature. It is a.k.a Mullerian Aplasia or MRKH syndrome. It often presents with urologic issues as as unilateral renal agensis.

1928

Pathology


Pt's P.E reveals a large adnexal mass. Ultrasonography reveals a large ovarian cyst. She has signs of virlization togther with clitoromegaly. Most likely Dx is *Sertoli-Leydig tumor*

1929

Microbiology


Pt with gray white fishy vaginal discharge with no inflammation that shows clue cells is characteristic of bacteril vaginosis caused by Gardnerella vaginitis which an *Anaerobic gram variable organism*

1932

Microbiology


Pt with abdominal pain, bloody vaginal discharge, orthostatic HTN and a positive preganancy test. Prior infection with *N.Gonorrhoeae* is likely responsible for her current condition. [Pt has a ruptured ectopic preganncy. Primary resik factor for Ectopic preg is tubal scaring and prior infection with Chlamidya and N. gonorrhea are major predisposing factors.]

1957

Histology


Pt with heavy and painful menstrual bleeding with uniformly enlarged uterus has Adenomyosis, which is *Endometrial tissue in theMyometrium*

Histology

*Hep B* infection causes hepatocellular cytoplasm to to fill wih surface hep b antigen. The inclusions are (finely Gastrointestinal & Nutrition granular,homogenous,pale pink),dull eosnophilic,groundglass apearance. Commonly transmitted sexually or in "IV drug users"

368

Pathology

Pt dies from profuse upper gastrointestinal hemorrhage and gross examination of liver is shown after autopsy. This resulted from Gastrointestinal & Nutrition *Fibrosis and Nodular parenchymal regenration* of the liver. Pt probably died from Liver Cirhosis that led to portal HTN and eventualGIhemorrhage.

369

Pt who presents with nausea, fatigue, anorexia who recently had surgery. Pt is weak and incteric and later dies. Liver biopsy shows PathophysiologyGastrointestinal & Nutrition shrunken liver. Pt probably had Anesthetic Induced Hepatotoxicity

367

due to Haloethane use during surgery. You would expect to also find a *Prolonged Prothrombin Time* 370

Alcohol induced hepatic steatosis is due to *Decreased Free fatty acid Oxidation*

Pathology

Gastrointestinal & Nutrition

373

Immunology

Imigrant pt who is otherwise healthy and labfinding yiled Positive Anti-Hepatiitis A IgG. He was never vaccinated against hep A. Gastrointestinal & Nutrition Thi slab finidng suggest him having an *Anicteric viral infection as a toddler*

391

63 yr old woman died of congestive heart failure. Autopsy shows a dilated heart and brownish pigmentation of the myocardium. Light microscopy of liver after prussian blue is shown. The pt's brother PathophysiologyGastrointestinal & Nutrition died of upper GI beed at age 43. Assuming this pts condition is hereditary, what contributed to her delayed onset of symptoms is *Premenaupasual menstrual bleed* [Hemochromatosis]

394

Pathology

55 yr old caucasian male whois recently diagnosed with cardiac arrhythmias is found to have mild hepatomegaly. He also complains of a dark tan despite avoiding sun exposure. Pt most Gastrointestinal & Nutrition likelysuffers from *Hemochromatosis* [Bronze diabetes, the triad of skin hyperpigmentation, DM, and pigmnetcirrhosiswith hepatomegaly]

401

Pathology

*Primary Biliary Cirrhosis is a chronic liver disease characterized by autoimmune destruction of the intrahepatic bile ducts and Gastrointestinal & Nutrition cholestasis(elevated alkaline phosphatase).The condition ismost common in middle-aged women, with severe pruritis (especially at night) one of the first symptoms reported.

402

Pt with generalized pruritus and high alkaline phosphatase along with high titers of Antimitochondrial antibodies have Primary Billary PathophysiologyGastrointestinal & Nutrition Cirrhosis.Liverautopsy wouldmorphologicallyresemble *Graft-vs-host disease*

403

Pathology

Liver biospy showing extensive lymphocyte infiltration and granulamatous destruction of interlobular bile ductis. Biopsy was Gastrointestinal & Nutrition most likely taken from a *45 yr old woman with a long history of pruritis and fatigue who has palestools and xanthelasma* [Primary Billary Cirrhosis}

405

Pathology

Pt with abdominal pain, diarhea and heme-positive stools. Stool Gastrointestinal & Nutrition cultures are negative. Biopsy of colonic mucosa reveals non-caseating granuloma. Pt most likely has *Crohn's Disease*

406

Pathology

Gastrointestinal & Nutrition inflamed and swollen terminal ilieum is probably crohns disease in which there is involvement of TH1 helper t cells.

Pathology

A finding most suggestive of Ulcerative colitis is *Continous Mucosalinvolvement* Gastrointestinal & Nutrition [Transnural inflam, rectal sparing, perianal fistula and noncaseating granuloma are allsuggestive of crohn's disease]

410

Pathology

Pt with Ulcerative Colitis who comes due to worsening pain and bloody diarrhea. He has been non compliant with his medication. He has hypotension and tachycardia. Pt is lethargic and has dry mucus membranes. There is marked abdominal distention and Gastrointestinal & Nutrition tenderness without rebound or guarding. Rectal exam shows guaiac-positive, maroon-colored, liquid stool. Best next step in pt's workup is *Plain abdominal x-ray* [Toxic Megacolon assoc with UC]

411

Pathology

A differenc bewteen sporadic colorectal carcinoma and Gastrointestinal & Nutrition colitis-associated carcinoma is that colitis associated carcinoma is *Multifical in Nature*

Pathology

Pt with abdominal pain and bloody diarrhea following a complicated surgical procedure likely has acute nonocclusive Gastrointestinal & Nutrition ischemic colitis. Primary areas affected are the Splenic flexure and the *Rectosigmoid Junction*.

421

Pathology

In the Adenoma-to-Carcinoma sequence in colon cancer, The increase in the size if the polyps that mediates the late adenoma Gastrointestinal & Nutrition part of thes sequence is a result of mutation of *K-ras* protooncogene. [APC > K-ras > p53]

426

Pathology

Gastrointestinal & Nutrition The initiating factor in acute appendicitis is *Lumen Obstruction*

427

Pathology

A pathologic finding in a polp that is associated with greatest risk Gastrointestinal & Nutrition of malignant transformation includes a *2-cm villous adenomatous polyp*

Pathology

38 year old man with colonoscopy showing ulcerative colon mass with no polyps and biopsy showing adenocarcnoma. Gene Gastrointestinal & Nutrition mutation responsible is most likely *MSH2* (Hereditary Nonpolyposis Colorectal CanceerHNPCC)

407

413

429

432

Pathology

Pt is found to have colon adenocarcinoma in the asceding colon. Pt most likely initially presented wuth *Weight loss and progressive fatigue* Gastrointestinal & Nutrition [Ascedning colon is wide and would prevent obstruction, pt usually develop anemia due to occult blood loss and non specific

434

Pathology

symptoms also occur] Pt has acute pancreatitis with normal gallbladder and common bile duct (hence due alcohol). He has a >2 AST:ALT ratio. An additional lab finding that is likely to be associated with the Gastrointestinal & Nutrition underlying cause of this pt's pancreatitis is *Mean Corpuscular Volume of 108 fl* [Alchol causes Macrocytosis (MCV >100)likely due to poor nutrition (folate def))

435

Pathology


A pancreatic psuedocyst is lined by *Fibrous and Granulation Tissue* 65 yr old man comes due to weight loss, Jaundice and anorexia. He notes his urine has been dark and his stools pale. P.E shows enlarged but nontender gallbladder. Most important risk factor

436

Pathology

Gastrointestinal & Nutrition predisposing of his condition is *Smoking* [Adneocarcinoma of the head of pancreas, Palpable nontender gall bladder + weight loss + obstructive jaubdice (assoc with priritis, dark urine, and pale stools). Smoking doubles the risk.]

1156

Pharmacology

Colichy abdominal pain, constipation, irritability and headaches, Gastrointestinal & Nutrition and works at battery factor, history of iron def anemia --> Lead posinong

1251

Biochemistry

In the duodenum, Enteropeptidase convert Trypsinogen to the Gastrointestinal & Nutrition active form trypisn. Pt with impaired enteropeptidase will fail to form *Trypsin*

1258

Pharmacology

Pt is given an opioid analgesic and develops upper abdom inal pain. P.E shows tenderness over RUQ. An adverse drug effect invlving *SMooth muscle cells* is responsible. Gastrointestinal & Nutrition [Admin of mu opioid analgesics can cause contraction of smooth muscle of the sphinctor of Oddi leading to spasm and increase in common bile duct pressure which can lead to increase pressure in

1290

Pharmacology

gallbladder and billary colid formation leading to pain] Pt with 4 week history of mucoid diarrhea with benign findings on evaluation (intermitten mild heart burn, unpleasant tase with dairy products).Pt is started on Diphenoxylate therapy. Primary target of Gastrointestinal & Nutrition this drug is *Motility* [Pt has uncomplicated diarrhea, diphenoxylate is an opoid anti-diarrhea agent structurally related to meperidine, it binds to mu opiate receptor in gi tracts and slows motility]

1358

Physiology


1396

Pathology

Pt presents with abdoinal pain and diarrhea. Recent trip to mexico.He isfebrile. Elevated leukocytes.Sigmoidoscopyshows white/yellow plaques on colonic mucosa and biopsy shows that Gastrointestinal & Nutrition plaque are composed of fibrin and inflammatory cells. Given pt'd Dx, the element likely elicited on further Hx taking regarding mexico trip is *hospitalization and antibiotics for pnemonia* [C. Deficile Colitis]

1397

Microbiology

Pt takes Clindamycin and develops C.diff Colitis. The causative Gastrointestinal & N utrition agent damages the *Cytoskeleton Integrity* of intestinal mucosal cells.

1398

Microbiology

In the absence of normal intestinal microbial flora, C.difficile can Gastrointestinal & N utrition overgrow and produce toxins. Therefore, persons with a *Preserved Intestinal MicroBiome* may not develop an infection.

A drug that inhibits primary active transports across cell membranesis*Omeprazole*

Enteric pathogen causing diarhea that can be transmitted from domestic animals to humans is *Campylobacter* 1422

1467

1475

Microbiology

Immunology

Biochemistry

Gastrointestinal & N utrition extra note: -(Curved G-ve rod that moves in corkscrw fashion) -MCC of acute gastroenteritis in kids and adults -Assoc with GBS The live attenuated oral (Sabine) poliovirus vaccine produces stronger mucosal sectretory igA immune resposne than Salk killed Gastrointestinal & Nutrition vaccine. Secretory IgA maybe refered to as *Duodenal Luminal IgA*. Remember the route of entry of the virus is thru the intestinal epithelial cells. Pt who presents with difficulty swallowing and is found to have an mass in esophagus. He is a hunter and put sodium nitrite in his meat. Analysis of biopsy sample show Cytosin Demaination. This Gastrointestinal & Nutrition damage is usually repaired (Base Excision Repair) by this enzymatic sequence; Polymerase, Ligase**Glycosylase,Endonuclease,Lyase,

1546

Physiology


Secetin, released by the *Duodenal S cells* stimulates release of bicarbonate from the pancreas.

1674

Pharmacology

Hematology & Oncology

An HIV antiviral drug that is structurally unrelated to nucleosides and is not phosphorylated intracellularly. The drug acts within the cytolplasm of infected cells to inhibit sunthesis of viral DNA from RNA template. The drug is *Nevirapine* [Non nucleaoside Reverse transcriptase Inhibitor, e.g nevirapine andefavirenz] Hypophosphorylated RB protein is likely to*Prevent G1/S cell cycle Transition* (hypophosphorylated isactive, abnormal phosphorylation results in inactivation and proceeding of cycleunchecked)

1717

Pathology


1722

Microbiology


1754

Pathology

pt being Tx for HIV. Viral strains show significant increase in POL gene. This is related to *Antiretroviral chemotherapy*


(Resistance to drugs) Benign lympph node enlargement in response to antigenic stimulation is associated with a Polyclonal proliferation of lymphocytes. A monoclonal lymphocytic proliferation of lymphocytes. A *Monoclonal lymphocytic proliferation* is a strong evidenc of malignancy.

1755

Pathology


8 year odl pt from east africa with Large tumor on Mandible with palbable regional lymphadenopathy.Biopsyshows diffuse infiltrate of lymphoid cells with numerous mitotic figures and interspersed macrophages surrounded by clear spaces (star-sky app). The gene translocated in these lymphoid cells produces a protein that is most directly responsbile for *Transcription Activation* -(Burkits lymphoma, C-myc gene, t(8:14))

1758

Pathology


bcl-2 gene normally inhibits *Cell death cascade* (inhibits apoptosis)


An example of Anaplastic tumor cells is *Brain tumor cells forming giant cells* [No resemblence to tissue of srcin. Composed of pleomorphic cells with large, hyperchromatic nuclei that grow in disorganized fashion. Anaplastic tumors may also contain numerous, abdnormal mitoses and giant tumor cells]


Pt has cancer. Genetic study shows a single nucleotide substitution causing an "activating mutation". Gene most likely involved is *KRAS* [Activating mutation indicates a proto-oncogene, like KRAS][APC, BRCA, RB, & TP53 are tumor suppressors hence are anti-oncogenes]

1759

1760

Pathology

Pathology

1761

Pathology


Pt presents with skin rash. He has history of pneumocystic pneumonia and painful ulcers. He uses Ilicit drugs frequently. P.E shows a widespread rash of lesions (image shown). Most likely cause is *Human Herpes Virus 8* [KaposiSarcoma]

1784

Pharmacology


Enoxaparin is a form of low molecular weight heparin and therefore binds to *Antithrombin 3* which once activated binds factor Xa and stops it from converting prothromin to thrombin. Pt with anemia (manifesting as fatigue), thrombocytopenia (Easy bruising), and neutropenia (recent respiratory infection), with profound reticilocytopenia, morphologically normal cells line in

1785

Pathology


eriheral smear and no splenomegaly. Bone would most likely show *Hypocellular marrow filledmarrow with fat biopsy cells and marrow stroma* [Aplastic Anemia]

1786

Pathology

Hematology & O ncology

Calculate Corrected reticulocyte count or sth.

1793

1796

1797

1816

1819

Pathology

Pathology

Pathology

Pharmacology

Pharmacology


Pt with progressive fatigue and occasional palpitations. She is post menopausal. Blood Hb level is 8.5. Peripheral blood smear shows pale microcytes. WHat should be ruled out initially in this pt *Occult blood loss* [hypochromic, microcytic anemia in setting of iron deficiency] [primary mechanism of iron def is blood loss and shud be excluded first]


Pt with hypochromic microcytic anemia who is treated with Fe supplementation. several week later her blood smear shows numerous enlarged RBC that appear blue on Wright-Giemsa stain. The bluish color on hese RBC is explained by the presence of *rRNA* [Enhance erythropoiesis and release of mature RBC's and reticulocytes, reticulocyte lacks nucleus but retain basophilic residual rRNA that appears blue on said stain)


Individuals who demonstrate increased ativity of a specific intracellular enzyme are more susceptible to developing benz(o)pyrene induced lung cancer. The enzyme that is most likely overactive in these pts is *Microsomal Monooxygenase*


Pt undergoing chemotherapy who presents with signs of hemorrhagic cystitis. Pt is probably undergoing Cyclophosphamide or ifosfamide. This could have been prevented with giving *MESNA*


Tumor cells become resistant to anticancer agents through expression of cell surface glycoprotein (P-glycoproetin, coded for by the human multi-drug resistance gene MDR1) which functions asan *ATP-dependenttransporter*

1847

Biochemistry


In an experiment where folate is deprived. Provision of *Thymidine* would reduce erythroid precuros cell apoptosis. [Folate def inhibits formation of dTMP, Thymidine supplementation can increase dTMP and hence reduce erythroid precursor cell apotosis]

1848

Pathology


Pt with Atrophic Gastritis who is given cyanocobalmin (vit B12) to treat his macrocytic anemia (penicious anemia) would have a rapid rise then fall of his *Reticulocyte count* His Hemoglobin would rise steadily but less rapidly.

1851

Pathology

Hematology & O ncology

In HUS thee is *Elevated seum indirect bilirubin*

1855

PathophysiologyHematology & On cology

Infant with hand and foot(encapsulated) syndrome (Dactylitis) with family hsitory of penumococcal sepsis probably has sickle cell disease and his *Serum Haptoglobin would be Reduced*

1873

Pathology

Angiogenesis is predominantly driven by *Fibroblast Growth Factor* and Vascular Endothelilal Growth Factor.

1877

1879


PathophysiologyHematology & On cology

Pathology


Pea d'orange is an erythematous itchy breast rash with skin texture changes analogous to an orange peel. This is the key dermatologuc presentation of inflammatory breast cancer and is caused by cancerous cells obstructing lymphatic drainage to the dermallymphaticspaces. A pt with a single amino acid substitutiion near the protein C cleavage sit in he coagulation factor V gene products. This pt is at greatestrisk for*Pulmonarythromnoembolism* [Factor V leiden, predisposes to hypercoagable state and DVT]

11728

Pharmacology


A therapy for vomiting would involve blocking of *Neurokinin 1* receptors. [Part of 5 receptors involved in vomiting, others are 5-H3, H1, M1, & D2]

11750

Pathology


55 yr old man with generalized weakness and easy fatigability. He has abdominal discomfort. Exam shows abdominal distention, and massivehepatomeglaywithspleencrossingmidline. Peripheral blood smear shows pancytopenia.Bone marrow aspiration is attempted but no marrow can be aspirated. Finding most likely to be seen in this pt is *Lymphocytes with cytoplasmic prjections* [Hairy cell luekemia, "Dry Tap" due to marrow infiltration. Splenomegaly to infiltration of red pulp]

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Pathology


Bone Metastases that is Osteoblastic (Sclerotic) on imaging can be related to *Prostate cancer* [Also small cell lung Ca and Hodgkin Lymphoma]

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11869

PathophysiologyHematology & Oncology

Pt with muscle weakness. P.E shows Gotrons papules. (image) Further evaluation wouldlikely reveal *Ovarian Adenocarcinoma* [Dermatomyositis, perimysial infiltrates. It can occur alone or as a paraneoplasticsyndrome. Mostcommonlyassociated with Ovarian,lung,colorectal and non-hodkinslymphoma]

Pathology


Paroxysmal nocturnal hemoglobinuria is due to a gene defect that leadsto uncontrolledcomplement-mediatedhemolysis.Theclassic triadincludes hemolyticanemoa(hemoglobinuria),pancytopenia, and thrombosis at atypical sites. Chronic hemolysis can cause depositionin thekidney(*Hemosiderosis*)

45

Microbiology

Infectious Diseases

A population that is universally vaccinated with recombinent HBsAg. The disease that would almost entirely disappear is *Delta Agent Infection* {Hep D causes infection only when encapsulated with HBsAg, it is a replication-defective RNA virus]

48

Microbiology

Infectious Diseases

Hepatitis that causes high incidence of fulminant hepatitis in pregnant women with high mortality (20%) is hep E which is an *unenveloped RNA virus* spread thru fecal oral route.

Infectious Diseases

Mucormycosis is an opportunistic infection caused by Rhizopus, Mucor, and Absidia. Clinical picture is paranasal involvememnt in diabetic or immunocompromised patient. Fungi form broad nonseptate hyphae at 90 degree angles!!

106

Microbiology

107

Microbiology

Infectious Diseases

Pt with on signs of diabetic ketoacidosisfacial together Black Necrotic Escha nasal cavity examination, pain,with & headache probably has "Mucormycosis" and Diagnosis can be made with *Mucosal Biopsy* to see borad-ribbon-like nonseptate hyphae with right-angle branching.

111

Microbiology

Infectious Diseases

Oral thrush (can be scaped off) in an otherwise healthy pt is suggestive of immunosuppression and HIV should be suspected. Therefore, Medical history can be focused on *Sexual Practices*

112

Immunology

InfectiousD iseases

Pt with HIV history whose "bood" cultures grow psuedohyphae producing yeast species with ability to form germtubes. This pt probably has "Cadidemia" (disseminated candida infection). Development of Candidemia is directly contributed by a *Low Neutrophil Count* Note: Superificial Candida Infection is contributed to by a "Low T-lymphocyte count"

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Pharmacology

Infectious Diseases

*Nystatin* bind Ergosterol in fungal cell membranes

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Microbiology

Microbiology

Microbiology

Infectious Diseases

Fever and Diarhea after Antibiotic adminstration suggest C. Diff infection and precaution of wearing *Nonsterile gloves and Gown* should done.

Infectious Diseases

Pt with fever and malaise. He had fever and chills which later became fatigue. He lives in easter Massachusetts. There are lung crackles and palpable splenomegaly. Peripheral blood smear shows Intraerythrocytic pleomorphic forms (Maltese Cross). Most likely source of infection is *Ixodes Tick* (Babesiosis)

Infectious Diseases

Pt who presents with febrile illness, bilateral infiltrates on x-ray, abnormal liver funcion tests, anemia, and (most importantly) *CROSS-SHAPEDIntraErythrocytic Inclusions*has Babesiiosis by the Babesia microto which is a TICK Borne infection by the IXodes Tick which also transmits the organism *BORRELIA BURGDORFERI*that causesLymedisease.

11547

Microbiology

Infectious Diseases

Pt bitten by his dog. Wound is warm, red and swollen after 24hrs. Wound culture grows g-ve coccobacilli and culture has mouse-like odor. Organism? => *Pasturella Multicoda*

11590

Pharmacology

Infectious Diseases

Pt with HLA-B*57:01 positive results is associated with *Abacavir*

Infectious Diseases

20 yr old woman comes due to vaginal pain with sex annd dysuria. She has a newboyfriend. Exam shows multiple, painful, shallow ulcers with an erythematous base on the left labia. There is no vaginal discharge. And no cervical motion tenderness. She has bilateral inguinal lymphadenopathy. Best diagnostic test for pts condition is *PCR fro viral DNA* [Genital Herpes, Tzanck smear is also possible][Syphilus is painless chancre]

Infectious Diseases

Pt presents with tonic-clonic seizure. He grew in rural Guatemala and immigrated to US 3 years ago. All other test are negative. MRI of brain reveals 2.5-centimetre cyst within the left sylvian fissure that has minimal enhancement and no associated edema. Most likely means of acquisition of infection is *Exposure to infected stool* [Neurocysticercosis by Taenia solium]

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11670

Microbiology

Microbiology

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Microbiology

Infectious Diseases

Old pt with fever and altered mental status whos urine culture grow g-ve rods that are lactos fermenting and indole-postive probably has *E. Coli* (UTI) (Indole positivity distinguishes it from Enterobacter cloacea)

11812

Microbiology

Infectious Diseases

Pt with UTI after recent cytoscopy in which urine culture shows g+ve cocci in chains most likey has Enteroccocus which shows *Gamma hemolysis on blood agar*

Infectious Diseases

Infant comes due to generalized seizure. She fever for past 12 hrs. Pt is discharged with no medication. Three days later, she has no fever but develops a maculopapular rash on her trunk. She is most likely infected with *Human Herpesvirus 6* [Roseola infantum, the seizure can happen with any febrile illness]

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11859

Microbiology

Microbiology

Infectious Diseases

Pt presents with shortness of breath, myalgias and retroorbital headaches. Pt was cleaning Animal waste at a farm. He is febrile, bronchial breath sounds are hear in right lower lung. Chest xray shows right lower and middle lobe consolidation. Lab shows thrombocytopenia elevated liver enzymes. HIV test is negative. Most likley cause isand *Coxiella Burnetii* [Q fever, has headaches and pneumonia with thrombocytopenia andelevatedthrombocytopenia]

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508

Pathology

Pharmacology

Nervous System

Pt involved in motor vehicle accident who sustains fracture of temporal bone. Bloody most likely accumulates between *Bone and Dura Mater* [Epidural Hematoma]

Nervous System

Drug interaction 2-3 weeks after New medication (e.g phenytoin)thatpresentswith cutaneousand systemicsymptoms such as diffuse erythema, generalized lymphadenopathy and facial swelling arise from DRESS (drug reaction with Eosinophila & systemic Symptoms) as the name suggests, lab finding would be *EOSINOPHILIA* Pt that presents with amenorrhea and notes that her breasts have become engorged. She is taking an antipyschotic drug. She

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566

Anatomy

Anatomy

NervousSystem

NervousSystem

probably has galactorhea in which the dopaminergic athway disturbance responsible is the the *Tuberoinfundibular*. It connects the Hypothalamus to ant pit and is responsible for dopamine-dependent prolactin tonic inhibition. The drug she is on blocks dopain in that pathway. Pancoast tumors are non-small cell lung cancers that arise near the superior sulcus. Pts may develop ipsilateral shoulder pain, upper limb parethesias and areflexic arm weakness due to involv of brachial plexus. Horner syndrome (ipsilateral partial ptosos, miosis, anhydrosis) can occur due to invlove of cervical sympathetic *Autnomic Ganglia* Young man who is aysmptomatic and found to be homozygous for the apolipoprotein E-4 allele. In the future he most likely to suffer from*Alzheimer'sdementia* [Late onset familial Alzheimer'sdisease] [Eary onset is assoc with 1) Amyloid precursor protein on chrom 21. 2) Presenilin 1 gene on chrom 14. 3) Presenilin 2 gene on chrom 1.]

591

Genetics

NervousSystem

593

Pathology

Nervous System

In alzheimer's disease, there is *Decreased acetycholine activity in the nucelus basalis*

Nervous System

Homeless man who is hospitalized and then develops acute confusion,nystagmus,abducenspalsy andopthalmoplegia probably has Chronic Thiamine Deficiency due to liver dysfunction. Thiamine is needed for Glucose metabolism and therefore *Glucose Infusion* can percipitate Wernicke Encephalopathy.

Nervous System

Wernicke syndrome manifests with opthalmoplegia, ataxia, & confusion. There is foci of hemorrhage and necrosis in the "mamillary bodies" and periaqueductal gray matter om autopsy. Diagnosisinvolvesmeasuring *Eythrocyte Transketolase activity* It occurs due to chronic Thiamine (B1) def commonly in alcoholics.

597

598

Pathology

Biochemistry

635

Anatomy

NervousSystem

Old pt with long standing HTN who presents for involuntary movements, "Threw remote control across the room" P,E shows Large amplitude flinging movements affecting proximal muscles of upper extremity. Pt most likely has injury to *Subthalamic Nucleus*

636

Pathology

NervousS ystem

Friedreichataxiaisassociatedwith*Cardiomyopathy*

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Pathology

Nervous System

Lung cancer irritating the phrenic nerve can cause dyspnea, hiccups and referred ppain to shoulder. Phrenic Neve arise from

660

Pharmacology

Nervous System

*C3-C4* Inahled anesthetic with a vey large atriovenous conc gradient shortly after begining inhalation would have a *Slow Onset of Action* (high atriovenous conc gradient means increased peripheral tissue solubility which negatively affects brain saturation)

485

Pathology

Pulmonary&CriticalCare

Pt hospitalized for abdominal pain. Lab show elevation of serum amylase and lipase. He has Hx of alcohol abuse. His condition worsens and develops severe resp distress. He dies to resp failure. Most likely finding on autopsy is *Alveolar hyaline membrane* [Pancreatitis led to ARDS][Enzymes and inflam cytokines leak into cirulation leading to infiltration of neutrophils in lung interstitium and alveolar space. Injury leads to edema & fibrin depos leading hyalinized alveoli]

486

Pathology


Pt who history of heavy alcohol use and was admitted before for acute pancreatitis. He presents with nausea vomitting and severe abdominal pain. On 2nd day he develops dyspnea, and hypoxemia. The parameter that is most likely normal in this pt is *Pulmonary Capillary Wedge pressure* [signs suggest ARDS for whch pancreatitis is major risk factor, pulmonary edema with normal PCWP]

488

Histology

Pulmonary & Critical Care

smoking induced emphysema is contributed to by neutrophils.


Pt with tickened bronchial walls, lymphocytic infiltration, mucous gland enlargement, and patchy squamous metaplasia of bronchial wall mucosa are features of Chronic Bronchitis. Smoking is a leading cause of that. Smoking is *Behavioral contributor*

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527

Histology

PathophysiologyPulmonary & C ritical Care

Young pt with paroxysmal episdoes of breathlessness and wheezing unrelated to anything. Sputum microscopy shows many granule containing cells and crystalloid masses. The sputum finding suggest the role of *IL-5* in this pts condition. [granule containing cells are eosinophils and crystalloid bodies are charocot-leyden crystalsl, a response to IL-5 released by allergen activated TH2 cells]

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531

PathophysiologyPulmonary & C ritical Care

Hypocapniaimplies*alveolahyperventilation*

Pathology


t dies from pulmonary infection. Autopsy shows a right lower lung lobe that is pale, firm and airless. Histologically, the alveoli are filled with "exudate containing neutrophils, fibrin, and some fragmented RBC's". This pt died during the *Grat Hepatization* phase of his disease.

533

Pathology


Pt with Peptosreptococcus and Fusobacterium in his lung. Predisposing factor to his condition is *Seizure disorder* [Lung abscess, caused by Oropharyngeal aspiration which can occur due to seizures (loss of consciousness)]

536

Physiology


Dust particles smaller than 2 micrometres are eliminated by macrophagesthroughphagocytosis.

552

Pathology


Hamartomas are the most common benign lung tumors. They are composed of disorganized *Cartilage, fibrous, and adipose tissue*


55 yr old woman present due to cough and recent weight loss. She doesnt smoke. P.E shows decreased breath sounds and dullness to percussion at the left lung base. Image studies show an irregular mass in the lower lobe of her left lung and left-sides pleural effusion. It malignancy is diagnosed it is most likley *Adenocarcinoma* [Most common lung cancer in general populattion]

554

Pathology

65 yr old presents due to nonproductive cough with anorexia and weight loss. He has a 50 pack year smoking history. Exam show 555

Pathology


enlarged supraclavilcular lymph node. Imaging shows a large mediastinalmasscausingtrachealdeviation.Immunohostochemical staining of mass is positive for chromogranin. Pt most likely suffers from *Small cell carcinoma*

806

Pathology


Pancreatic squamous metaplasia of the pancreas in a pt with CF (recurrent pulmonary infections, finger clubbing)is due to deficiency in *Vit A* [vit A is needed for maintenance of orderly differentiation of specialized epithelia]

877

Pathology


Black woman Pt with malaise, cough and rash wityh X-ray revealingbilateralhilar lymphadenopathyand transbronchial autopsyshowingnon-caseatinggranulomahas *SARCOIDOSIS* Pt presents with dyspnea and weakness. Mother had similar symptoms and died at age 42. Lung biopsy shows medial hypertrophy, intimal fibrosis and decreased intraluminal diameter if small branches of pulmonary artery. Pt is scheduled for lung

903

958

960

Pharmacology

Microbiology

Microbiology




transplantation.The medication indicated formanagementduring the waiting period is *Bosentan* [Pt has idiopathic pulmonary a hypertension][Bosentan is endothelin-receptor antagonist, it blocks vasoconstricting affects of endothelin] Pt with persistent cough and pulmonary infiltrate. Pt's blood shows clumping in ice but not in warm water. Organism causing condition?=> *MycoplasmaPneumonia* -(ColdAgglutinin) Heavy smoker with fever, confusion, headache, watery diarrhea and mildy productive cough. Sputum gram stain show numerous neutrophils but no bacteria. Most likely cause is *Legionella Pneumophila* [Triad of atypical pneumonia, diarrhea, and hyponatremia][poor gram stain][long smoking Hx]

961

Microbiology


Microogranism causing pneumonia isisolated and demonstrates slow growth on Buffered Carcoal Yeast Extract that is supplemented with L-cystein and Fe. It is visualized with a silver stain. Most likely cause of increased incidence of nosocomial punemonias in his hospital is *Colonization of the hospital water sysetm* (Legionella)

962

Microbiology


5 yr old boy has hugh serum level of antibodies against Polyribitol ribose phosphate(PRP). The antibodies would most likely carry protectionagainst*Epiglottitis* [Anti H. Influenza capsule antibodies]

964

Microbiology


H. influenza requires a blood agar supplemented with hematic and NAD+. Pathogenicity is related to *Capsule* Virulence factor [H.INFLU type B (HiB)]

999

Microbiology


A newborn who develops lethargy and respiratory distress. Blood cultures shows beta-hemolytic gram+ve cocci in chains that are bacitracin-resistant. The measure that could have prevented this patients condition is *Intrapartum ampicilin* [Strep Agalactiae, ie. Group B strep]

1216

Microbiology

Pulmonary& CriticalCare

Pt with sign of Tb and the observed bacterial growth is mycobacteria that grow in parallel chains (Serpentine cords). This growth correlates with bacterial *Virulence* Finding of small fibrotic focus in lower lobe of right lung and a

1221

Pathology

Pulmonary& Critical Care

calcified lymph node in the right lung hilus. This findings are most consistent with *Primary exposure to M. tuberculosis* [Ghon foucs and Ghon complex]

1233

Biostatistics


Know how to calculate Sen, Spec, PPV, NPV (QUICKLY)

Renal, Urinary Systems & Electrolytes

In the setting of low ADH, the highest osmolality is at the *Bottom of Loop of Henle*

Physiology


If animal is deprived of water, ADH will be high, high ADH promotes water reabsorption. The place with the lowest urine osmloarity (highest dilution) would be the distal convoluted tubule. Why? because its impermeable to water but continues to reabsorb electrolytes. Also, the fluid just came from the ascending limb which is also impermeable to water but reabsorps electrolytes.

1642

Pharmacology


Pt on Acyclovir who develops acute elevation of serum creatine levels. This could have been prevented with *Agressive IV Hydration* (Acyclovir Nephrotox)

1643

Pharmacology


*Foscarnet* can be used in Ganciclovir resistent CMV. Being a Ca chelator it can cause hypocalcemia. Also it induces renal wasting of Mg causing hypomagnesemia. Also reduces production of PTH further contributing to Hypocalcemia.

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1608

Physiology

1680

Anatomy


The "proximal" part of the ureter is supplied by the *Renal Artery*. The middle part is highly variable receiving supply from the gonadal artery, the common iliac, and uterine arteries. The distal part (close to bladder) is supplied by Superior Vesical artery, which is a branch of the internal iliac.

1700

Anatomy


A fracture of the elft 12th rib can cause laceration to *Left Kidney*


Neoborn who has tachypnea and hypoxia. He has a flattened nose and bilateral club feet. He dies one hour later. To be found during autopsy is *Renal Agenesis* [Potter sequence of pulmonary hypoplasia, falttened facies, and limb deformity due to Oligohydroamnios due urinary tract anomaly]

Pathology


7 yr odl with two day history of colicky abdominal pain develops bloody stools. His urine appeared red today. P.E shows palpable skin lesions on his buttocks. An additional finding consistent with his condition is *Joint Pain* [Henoch-SchonleinPurpura][Mostcommonsmallvessel vasculitis in children]

1862

Pathology


Old pt with blood in urine. Renal biospy shows rouned/polygona l cells with abundant cytoplasm. The process that acconts for abnormal appearance of cells is *Glycogen and lipid accumulation*

1913

Pathology


[C lear cell Ca of Kidney] Screening for early-stage diabetic nephropathy is done by measuring urinary concentration of *Albumin*


Ultrasound of fetus with bilaterally enlarged fetal kidneys with diffuse small cysts and oligohydroamnios has Autosomal recessive polycystic kidney disease (ARPKD) and is the oligohydroamnios can lead to Potters sequence which is Flattened facies, Limb deformity, and "Pulmnary Hypoplasia" and therefore the baby can be born with *Respiratory Disress*

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1850

1915

1989

Embryology

Embryology

Biochemistry


18 year old male with progressive skin rash. He has long standing history of intermittent burning sensation in his palms and soles that is exacerbated bt stres and fatigue. Burning is severe after exercise. He sweats very little. Lab test reveals undetectable levels of alpha-galactosidase A. Pt is at greatest risk for *Renal Failure* [Fabry Disease, X-linked alpha-galactosidase A def]

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Anatomy

15 year old boy presents with right arm numbness. He plays baseball. He has had fluctuating tingling and numbness involving the right shoulder arm and hand. Also he felt dull pain in right little Rheumatology/Orthopedics finger and hand. He has a cervical rib. Exam shows decreased & Sports sensation over emdial 2 fingers and hypothenar eminence. The structure contributing to this pts condition is *Scalene Muscle* (Thoracid outlet syndrome, compression of brachial plexus)

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Pathology

Rheumatology/Orthopedics Pt with sign of SLE would have *Low C3 and C4* & Sports

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Pathophysiology

Acute joint pain, swelling, and erythema with restricted range of Rheumatology/Orthopedics motion is consistent with synovitis. Diagnosed with *Synovial Fluid & Sports Analysis*

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Anatomy

13 yr old boy comes with right knee pain. It started as a mild ache in lower part of knee then worsened and now causes him to limp. Pain is relieved with rest and reproduced when knee is Rheumatology/Orthopedicsstraightened.Evaluation revealsavulsion of 2ndryossification & Sports center of tibia due to repetitive muscle contraction and traction of bone. Most likely insertion site of involved muscle tendon is *Tibial Tuberosity* [Osgood-Schiatter Disease]

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Pathology

Rheumatology/Orthopedics Rheeumatoid arthritis most likely affects *Cervical Spine* & Sports

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Microbiology

Pt who acquire staph infection thru hemodialysis catheters and Rheumatology/Orthopedics present with backpain could have developed osteomyelitis which & Sports can be evaluated using *MRI of the spine*

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Behavioral science

Social Sciences A pregnant minor is entitled to consent to prenatal care. Not an (Ethics/Legal/Professional) electiveterminationhowever.

10290

Behavioral science

Social Sciences The requirement for hospice care referal is *Prognosis of less or (Ethics/Legal/Professional) equal to six months*

10399

Behavioral science

Social Sciences Physicians must report impaired collegues in a timely manner. (Ethics/Legal/Professional)

11668

Behavioral science

Social Sciences a health insurance plan with low monthly premieums is *Health (Ethics/Legal/Professional) MaintenanceOrganization*

UWORLD Notes by Systems (Usmle Grassroots)

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