318406124 UWORLD Notes by Subject Main Division Usmle Grassroots

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)

11819

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]

11629

Behavioral science

If a hypertensive and diabetic patient is using herbs to lose weight, Gastrointestinal & Nutrition explain to them that these are poorly regulated and have potential health risks.

8456

Behavioral science

GeneralPrinciples

Providing care to all company employees in exchange for a set monthly fee is *Capitation*

11534

Behavioral science

Miscellaneous (Multisystem)

Pt with many diseases including neurocognitive disorder, in order to achieve drug adherence, you should *Involve a social worker in discharge planning* -Note: Checklist wont work since pt's cognition is impaired.

Behavioral science

Miscellaneous (Multisystem)

247

Behavioral science

Psychiatric/Behavioral & Substance Abuse

248

Behavioral science


11778

11550

520

Behavioral science


Pt who is becoming an outpatient and has complex medication regimens should be given a *Hospital discharge checklist* Buspirone is an nonbenzodiazepine anxiolytic used to treat Generalized Anxiety disorder. It has a SLOW ONSET. It lacks muscle relaxant or anticonvulsant properyes and carries no risk of dependence. It is a partial agonist of 5HT (1a) SSRI's & SNRI's are first line medication in generalized anxiety disorder. Benzos should be limited to short term use and for pts who respond poorly to antidepressants. Pt has been receiving treatment for mood swings and sleep problems. Now the pt has constipation, dry skin, and hair loss. Also she has weight gain despite regular diet. BP is 110/70. Pt appears tired but exam is otherwise normal. Most likely responsible drug is *Lithium* due to lithium used in bipolar disorder] [Hypothyroidism

574

Behavioral science


Following amitriptyline overdose (TCA). There is QRS widening and QTc prolongation. And Death occurs. Deat is related to *SodiumChanelinhibition* [Fast Na chanel inhibition resulting in conduction defects and arrythmias]

707

Behavioral science


Pt with painful erection for more than 4 hours. Past med history is sig for treatment-resistent depression, OCD, and insomnia. Drug most likley used is *Trazadone* [Priapism, rare side effect of trazadone] Pt smoked unknown substance. He displays uncoordinated jerky movementsofextremitiesand assualtssomeone.He appears

1165

Behavioral science


immune to pain. In the ER he has visual hallucinations and alternates between agitation and sedation. He is hyptertensive and tachycardic and has vertical nystagmus. Later, he doesnt remember anything that happened. MOA of drug is *N-Methyl-D-aspartatereceptorAntagonism*(NMDAAntagonist) [This is PCP]

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796

1466

1763

1995

Immunology

Immunology

Immunology

Immunology

Immunology

Pulmonary & Critical Care

Pt wih T cells that lack IL-12 receptor would be unable to release *IFN-Gamma* and supplementation would be needed to improve pt's recurrent respiratory infections.


African American woman presents with exertional dyspnea and dry cough. Chest xray shows bilateral hilar adenopathy and reticular pulmonary infiltrates. Serum ACE & Ca levels are elevated. PPD test is negative. Bronchoscopy is arranged. The cell type that is most likely to predominate in the lavage is *CD4+ cells* (Sarcoidosis)




Pt given an inactivated viral component vaccine. On exposure to real virus, would result in *Inhibition of viral entry into cells* (Humoral immunity and not cell mediated immunity since it is not a livevirus) 2 yr old boy Pt with sinopulmonary infections (otitis media & pneumococal pneumonia for e.g) Together with G. lamblia gastroenteritis, failure to thrive and low Serum Imunoglobulins. Flow cytometry of pts peripheral blood would show def of cell bearing *CD19* marker [X-linedAgammaglobulinemia,B cells] Infant with recurrent otitis media and bronchiolitis. He has oral candiasis. He has a Hx of chronic Diarrhea. Serum protein electrophoresis shows very low gamma globulin level. X-ray shows absent thymic shadow. Most likley Dx is *SCID* [Recurrent viral infections, Oral thrush, Persistent Diarrhea. Absent thymic shadow is due to severe T cell def. Hypogammaglobulinema is due to low Bcells. Both low humoral and cell med immunity]

2128

Immunology


*Anti IgE Antibodies* are effective add-on-therapy to severe allergic asthma patients that are already on glucucorticoids and beta-agonists.ExamplesincludeOmalizumab.

569

Immunology

Renal, Urinary Systems & Electrolytes

Hyperacute renal transplant recjection is an *Antibody-mediated hypersensitivity* (preformed Ab's against graft)


Female Pt with glomerulinephritis, photosensitive skin rash and arthralgias together witha positive trepnemal RPR but with -ve T.pallidumenzymeummunoassayandalsoprolongedaPTT probably has SLE with Antiphospholiid antibody syndrome and is therefor at risk of *Recurrent Miscarriages*

742

Immunology

747

Immunology


Pt who received emergency blood transfusion who quickly develops dyspnea, chills, chest/back pain, and hemoglobinurea probably has acute hemolytic transfusion reaction. This is a type 2 hypersensity and therefore can be due to *Complement mediated cell lysis*

750

Immunology


When it comes to handling parasites, eosinophile do it via the *Antigen-Dependent-Cell-Mediated Cytotoxicity (ADCC)*

8530

Immunology


Pt with renal cell carcinoma and given high dose IL-2. There is reduction in tumor burden. Mechanism? -> *Enhanced Activity of NK cells*

11786

Immunology


An immuno suppressant that inhibits lymphocyte proliferation by blocking interleukin-2-signal transduction is similar to *Sirolimus*

8282

680

1313

Microbiology

Microbiology

Microbiology

Cardiovascular System

The action that most likely prevents intravascular catheter-related infections is *Alcohol-based hand scrub prior to beginning the procedure*

Dermatology

Infant with diffuse skin erythema, and epidemris comes off easily with gentle pressure. This is caused by *Exotoxin-mediated skin damage* (SSSS by staph exofoliatin exotoxin)

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]

1316

Microbiology

Dermatology

When pt's serum is added to a mixure of cardiolipin, lecithin, and cholestrol and extensive flocculation is observed, the next step is to evaluate for *Spirochetal Antibodies*. This is a nonspecific treponemal serologic test known as the rapid plasma reagin test.

1553

Microbiology

Dermatology

a unilateral vesicular rash involving a single dermatome is Shingles. The pt would siffer from *Persistent local pain* in the next 6 months

Dermatology

Child of immigrants with a rash that started in face and spread rapidly down the body. Exam shows a generalized, fine pinkish, maculopapularrash andtender lymphadenopathybilateralbehind the ears. Most likely cause of this disease is a *Togavirus* [Rubella is a togavirus] [Rubeola by paramyxovirus which causes measles has no post auricular lumphadenopathy usually assoc with it]

Dermatology

Pt with animal exposure and scratch marks together with tender regional LYMPHADENOPATHY likely hasCat-Scratch Disease caused by Bartonella Henselae, a g-ve organism that also causes *BacillaryAngiomatosis*in immunocompromisedpts

Dermatology

Burn patients are susceptibe to infection with pseudomonas aeruginosa which a gram -ve rod that is oxidase positive and non-lactos fermenting. Tx can be with 4th generation cephalosporin *CeFePiMe*

Ear, Nose & Throat (ENT)

ELderely with severe pain and discharge fromgranulation ear. Touchingdiabetic pinea causes extreme pain. Otoscopy shows tissue in left ear canal with scant amount of discharge. Tymapnic membrane is clear, and no middle ear effusion. Cultures grow a g-ve rod. Characteristic best describing infecting organism is *Motile and Oxidase +ve* [PsudemonasOtitisExterna]

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1898

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8342

Microbiology

Microbiology

Microbiology

Microbiology

1027

Microbiology

FemaleReproductive System & Breast

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]

1929

Microbiology

FemaleReproductive System & Breast

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*

10401

1592

732

Microbiology

Microbiology

Microbiology

C. Difficile Infection is treated with Metronidazole, Vanco or *Fidaxomicin* The first two are first line treatments but Gastrointestinal & Nutrition *Fidaxomicin* is used in recurrent CDI and is bacteriocidal with minimalsystemicabsorption. GeneralPrinciples

Hematology & Oncology

Pt with CMV postive antibody probably had a*Mononucleosis-like illness* in the past due to CMV infection, symptoms include fever, malaisse,myalgia,atypicallymphocytosis,and elevated transaminases. PT dies from Strep Pneumo infection. He has history of motor vehicle accident that required laparatomy. The mechanism that contributed to the severeity of this pt's infection is *Systemic Bacterial Clearance* [Pt most likely had part his spleen removed after accident and became suscptible to encapsulated bacteria due to inability to clear them]

1097

Microbiology


Pt with somnolence, lethargy, and oliguria with bloody diarrhea. He has high urea, BUN and creatinine. Blood smear reveals fragmented erythrocytes, Pt has HUS which is related to the consumption of *Undercooked Beef* Mother had still bith at 18 weeks. Autopsy shows pleural effusion, pulmonary hypoplasia, and ascites. Infection with *Non-enveloped, single stranded DNA virus* is most likely etiology. [Parvovirus causing fetal hydrops]

1374

Microbiology


1722

Microbiology


45

Microbiology

Infectious Diseases

48

Microbiology

Infectious Diseases

106

Microbiology

Infectious Diseases

pt being Tx for HIV. Viral strains show significant increase in POL gene. This is related to *Antiretroviral chemotherapy* (Resistance to drugs) 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] 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. Mucormycosis is an opportunistic infection caused by Rhizopus, Mucor, and Absidia. Clinical picture is paranasal involvememnt in diabetic or immunocompromised patient. Fungi form broad

107

Microbiology

Infectious Diseases

nonseptate hyphae at 90 degree angles!! Pt with signs of diabetic ketoacidosis together with Black Necrotic Escha on nasal cavity examination, facial pain, & 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*

376

Microbiology

Infectious Diseases

Pt has fever and joint pain. He has abnormal lynphocytes on blood smear. Condition is caused by an enveloped virus containing partially-double stranded circular DNA. An enzyme packed in its virion has RNA-dependent DNA-polymerase activity. Pt is most likely infected with *Hep B virus*

532

Microbiology

Infectious Diseases

Pt presents due to fever, night sweats, weight loss and productive cough. He says his sputum is greenish and foul smelling. Chest X-ray shows a cavitary lesion in the middle lobe of right lung with air-fluid levels. Most likley cause of this cavitary lesion is *Aspiration of oropharyngeal contents* [LungAbscess]

678

Microbiology

Infectious Diseases

Youn woman with UTI. Sexually active. Culture shows catalase +ve, g+ve cocci. Organism responsible is *Novobiocin resistant* [Staph SaprophyticusUTI] Strep pyogenes (Group A)(G+ve cocci)(Beta hemolytic) (Catalse -ve) (can cuse PSGN, Acute rehumatic fever, scarlet fever, pharyngitis, & impetigo) is *Pyrrolidony Arylamidase Positive (PYR

722

Microbiology

Infectious Diseases

728

Microbiology

Infectious Diseases

+)* and Also Bacitracin sensitive. *Intravascular devices* contriubute to increase in staph bactremia thru the nation

907

Microbiology

Infectious Diseases

Signs of encephalities (fever, headache, aphasia, mental alteration) with temporal lobe lesions indicate *HSV ENCEPHALITIES*

Infectious Diseases

Neoborn presents with inability to open mouth and hands are clenched all day. P.E shows increased muscle tone, arching of the back, and dorsiflexed feet. This could ve been prevented with *Vaccination of pregnant woman* (Neonatal tetanus)

Infectious Diseases

Ulcer with central black eschar surrounded by edema suggest Bacillus Anthracis. Helping in making a diagnosis would be *Occupation* [exposure to animal or animal products, if no risk of occupational exposure then there is potential of bioterrorism]

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971

Microbiology

Microbiology

1007

Microbiology

InfectiousD iseases

Pt with asymmetric polyarthritis (knee, elbow, wrist)with synovial fluid analysis showing neutrophilic predominanc and intracellular organisms most likey has "Neusseria Gonorrhoeae". *Condom use could ve prevented it*

1026

Microbiology

InfectiousD iseases

Tx of Neisseria Gonorrhea does not appear to provide lasting protective immunity due to *High variability of microbial antigenic structure* and hence recurrent infections occur. 6 year old of recently immigrant family comes due to sore throat

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1095

Microbiology

Microbiology

InfectiousD iseases

InfectiousD iseases

and fever. Exam shows mild tonsilar erythema with exudates. Microscopy shows clumped, gram +ve bacteria with polar granules that stain deeply with aniline dyes. The pathogenicity of the organism likely causing this condition is *Impairment of protein Synthesis* (Diptheia toxin, ADP-ribosylation of EF-2) 6 yr old with fever and sore throat. Non immunized. P.E shows a grey pharyngeal exudate and gram stains shows g+ve organisms. The culture type that facilitate teh growth of this organism is *Cystein-tellurite agar* [C.DIPTHERIA] [Bordet-Gengou medium is for pertusis, thayer martin for gonorrhea, mcConkey is for enterics]

11524

Microbiology

Infectious Diseases

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

11540

Microbiology

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*

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]

11604

Microbiology

Pt presents with tonic-clonic seizure. He grew in rural Guatemala and immigrated to US 3 years ago. All other test are negative. MRI 11670

Microbiology

Infectious Diseases

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]

11766

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]

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 and elevated liver enzymes. HIV test is negative. Most likley cause is *Coxiella Burnetii* [Q fever, has headaches and pneumonia with thrombocytopenia andelevatedthrombocytopenia]

NervousS ystem

HIV pt infected with organism stained with india ink in CSF showing spherical yeast with thick capsules (C.neoformans). Most likely primary foucs is *Lungs* [found in pigeon droppings and soil, enters thru resp route]

11822

11859

113

Microbiology

Microbiology

Microbiology

1667

1677

Microbiology

Microbiology

Pulmonary& CriticalCare

Child with upper-respiratory tract symptoms "followed" by brassy (barking) cough and difficulty breathing probbaly has parainfluenza virus Croup whichis a *Paramyxovirus*


Mycoplasma hominis is a genus that includes Ureaplasma urealyticum and those have no cell walls. They are therefore resistent to cell wall synthesis inhibitors. We tend to use anti-ribosomalagents(macrolides,tetracyclies)

1679

Microbiology


Pt with persistent coughm low-grade fever and malaise. Chest xray shows pulmonary infiltrates more severe than would be expected based on clinical status. Causative agent required cholestrol enriched medium to grow. This is walking pneumonia caused by *Mycoplasma Pneumonia*

9989

Microbiology


*Klebsiella Pneumoniae* is a g -ve rod that grows pink-colored (lactose fermenting) mucoid colonies on MacConkey agar. It is encapsulated and casues community acquired pnemonia in Alcholicpateints.

646

Microbiology

*Staph Aureus* is the most commin cause of Acute Hematogenous Rheumatology/Orthopedicsosteomeylitis in children (10 year old for eg) characterized by pain & Sports over long bones (tibia, femur)with high fever and chills. Possible soft tissue swelling. Vague symptoms.

845

Microbiology

Rheumatology/Orthopedicsrash with slapped cheek appearance is of Erythema infectiosum & Sports caused by parvo virus B19, disease is also called Fifth disease.

Microbiology

Pt who has recently been to a resort presents with ithcy rash. Exam shows diffuse, pruritic, papuloppustular rash on trunk and Rheumatology/Orthopedicsextremities. Analysis of fluid shows oxidase +ve grame -ve rods & Sports that prodcuces a pigment on culture medium. Most likely source of this infection is *Pool water* (Psuedomonashottubfolliculitis)

1101

Microbiology

Pt present with sore on his right hand. He is in Wool business. Was recently in Asia. P.E shows an ulcer with black eschar and siginificant surrounding edema. The toxin causing the edema Rheumatology/Orthopedics around the ulcer has a MOA similar to a toxin produced by & Sports *Bordetella Pertussis* (Bacillus Anthracis, anthrax exotoxin edema factor similar to adenylate cyclase toxin of bordetella pertusis)

1394

Microbiology

Crepitus on physical and radiographic visualization of gas in Rheumatology/Orthopedics tissues esuggests Gas gangrene by C. Perfringes which also & Sports

Microbiology

causes Transient Watery Diarrhea and Abdominal Discomfort. 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*

974

11868

458

459

Pathology

Pathology

Allergy&Immunology

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] Pt is hospitalized with recent onset oliguria and a high serum creatinine level. He has beenseen 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]

39

Pathology


Pt with chest pt shows near-toal-occlusion of LAD artery. The absence of myocardial necrosis and scarring despite vessel occlusion in this pt is explained by the *Slow Growth Rate* of the occluding plaque. (arterial collaterals have developed around point of occlusion)

41

Pathology


Light Microscopic changes of ischemic myocyte after 12 days is *Granulationtissuewithneovascularization*

43

Pathology


Pt with dyspnea and chronic exertional angina is evaluated for coronary revascularization. His Echho shows Hypokinesia of the anterior wall of the left ventricle and a left ventricular ejection fraction (LVEF) of 35%. The pt undergoes coronary artery bypass grafting. Repeat eccho 10 days later shows that hypokinesia is no longer evident and LVEF increased to 50%. The best explanation for the changes in cardiac contractility is *Hibernating Myocardium* [Due to chronic ischemia

73

Pathology


MI in the setting of normal coronary arteries. Mitral valve thickening with vegetations is noted. Pt cardiac condition is most likely associated with *SLE* (Libman-sacks endocarditis (verucous endocarditis) occurs in 25& of sle pts. SlE may cause acute coronary syndrome at young age even with normal coronary arteries) Pt comes in with fatigue and shortness of breat. Recently he noticed bilateral leg swelling and abdominal distention. Pt dies despite Tx. Autopsy shows significant endocardial thickening with dense fibrous deposits around the tricuspid and pulmonary valves as well as moderate pulmonary valve stenosis. The left sided cardiac chambers and valves are normal. Measuring levels of *Urinary 5-hydroxyindoleacetic acid* would vehelped in diagnosing pt [Carcinoid Sydnrome]

74

Pathology


82

Pathology


MCC of sudden cardiac deaths in young persons is *Hypertrophic cardiomyopathy*


Presentation of "Sudden Cardiac Death" in young pt with family history of SCD and autopsy finding of septal hypertrophy suggest Hypertrophic CardioMyopathy which is Autosomal Dominant in whcih there are mutations in sarcomere genes. These include *Beta-Myosin Heavy Chain* and Myosin-binding protein C.

83

Pathology

84

Pathology


Young pt with an episode of syncope that was not provoked by any activity. No significant past medical history and no medications. ECG shows QT-interval prolongation. Assuming this is an inherited condition, the relevant mutations likely affects *Membrane Potassiumchannelproteins* [sudden cardiac arrhythmia, QT interval reflects cardiac myocyte action potential duration which is determined in part by K+ current]

91

Pathology


6 year old pt with Long QT interval and with family histo of sudden death probably has congenital long QT syndrome and can have an associated*Neurosensory deafness*

94

Pathology


Localized amyloid in the atria of heart is amyloid derived from Naturiretic peptide.

97

Pathology


Acute-onset, mid-chest pleuritic pain of that decreases on sitting up and leaning forward is characteristic acute pericarditis. Fibrinous or serofibrinous pericarditis is the most common form. Pericardial *Friction Rub* is the most striking physical finding.

1875

Pathology


In the event of an interruption of blood flow secondary to arterial occlusion of left atrium. The organ that would be least vulnerable to infarction is the *LIVER* [Has dual blood supply][The exception is during liver transplant and there is hepatic artery thrombosis. This becuase during the transplant the collateral supply is severed]

1882

Pathology


Transient myocardial ischemia causes myocardial hypertrophy is due to *Inttracellular Ca2+ accumulation*

8296

Pathology


Pt complains of worsening dyspnea. Also low grade fever and weight loss, also syncopal episodes when lying down. Auscultation shows low-pitched mid-diastolic rumble at cardiac apex. ECG shows left atrial enlargement and echo shows large pedunclated mass attached to the left atrium. Histology of mass will likley show *Scattered cell within a mucopolysaccharide strome* [Atrial Myxoma]

8458

104

467

Pathology

Pathology

Pathology


Most common cause of death a lightening strike is *Cardiac Arrythmia* and Respiratory failure.

Dermatology

Pt with skin rash. He noticed it while in beach resort. He is works in hot humid areas. Skin finding is shown (image). Most likely cause is *Malassezia globoss* [Pityriasis versicolor]

Dermatology

Pt with small bluish lesion under the nail of her right index finger. It is extremely tender to touch. If the lesion is a tumor, its cells of srcin are likely to have a function of *Thermoregulation* [This could be a glomangioma or a melanoma, since pigmentation is not in answer choice, it must be a glomangioma][A glomangioma is a tumor of modified smooth muscle cells of a glomus body. Glomusbodiesareinvolvedin thermoregulation]

876

Pathology

Dermatology

3 year old presents with recurrent skin rashes. He develops erythematous itching rash on his cheeks, trunk, and arms abut 5 or 6 times a year. Mother says eruptions seem to be related to consumption of certain foods. The pt's condition is most likely associatedwith*Astham* [Atopic Dermatitis or Eczema]

1042

Pathology

Dermatology

In shingles, affected are would have *Multinucleated cells with Intranuclear inclusions* [VZV]

Dermatology

Pt comes for routine up and you notice several subcutaneous bumpscheck attached to Achilles tendons. Best initial test is *Blood Cholestrol* Pt has tendinous xanthomas (yellow nodules composed of "lipid" laiden histiocytes in the dermis) -Associatedwith(FamilialHypercholestrolemia) Pt presents with pruritic skin rash over elbows and knees. He also hasprolongedabdominaldiscomfort,faltulenceandvoluminous greasy stools. The finding most likely to be seen in this pt is *IncreasedIntestinalintraepitheliallymphocytes* [Pt has Dematitis Herpetiform which is associated with celiac disease that has increased intraepithelial lymphocytes]

1108

Pathology

1111

Pathology

Dermatology

1113

Pathology

Dermatology

1114

Pathology

Dermatology

Highest risk of metastasis in a malignant melanoma is *Active Vertical Growth* BiopsyofUrticariawouldshow*DermalEdema*

Pathology

Pt presents with abdominal discomfort, greasy stool, and weight loss. He has been treated for joint pain with Ibupropfen. Intestinal biopsy shows multiple macrophages loaded with PAS-positive Gastrointestinal & Nutrition granules in the lamina propria. This pt shud be Tx with *Antibiotics* [Wipple disease caused by g+ve actinomycete Tropheryma whippelii]

132

Pathology

The *Glycoprotein* in cell walls of actinomycete Tropheryma whippeli colors magenta with PAS and is diastase-resistant, Gastrointestinal & Nutrition making this stain an excellent choice for evaluating tissue for whippledisease.

135

Pathology

Gastrointestinal & Nu trition The NF-kB factor pathway stimulates *Cytokine Production*

131

Pt with sharp pain and bright red rectal bleeding on defecation 255

257

Pathology

Gastrointestinal & Nutrition suggest an Anal Fissure. Which is at the *Posterior midline Distal to the Dentate line*

Pathology

65 yr old man with iron def anemia. He has weight loss and anorexia. He has no change in bower habits. Rectal exam shows guaiac-positive brown stool. A 3cm mass is found on colonoscopy. Biopsy shows pleomorphic cells with large, dark nuclei forming Gastrointestinal & Nutrition irregular, crowded glands, some of which contain mucus. Studis show multiple mass lesions in the liver and lungs. Pt's neoplasm most likely srcinated from *Ascending colon* [Right sided colon Cancer] Alcoholicmale presentswith hematemesis.Endoscopyshows longitudinal mucosal tears at the gastroesophageal junction. This pt Gastrointestinal & Nutrition condition is most likely related to *Intraabdominal pressure* [Mallory-Weiss syndrome] Pt presents with anatcid resistant severe Heart Burn. P.E shows scattered Telangiectasias on face, several ulcers at tip of fingers, and small Ca deposits on hands and elbows. Most likely cause of pt heart burn is *Fibrous Replacement of the muscularis in the Gastrointestinal & Nutrition loweresophagus* [CRESTsyndrome, Calcinossi,RaynaudPhenomenon, Esophagealdysmotility,Sclerodactly,Telangiectasia] [Esophageal dysmoti is result of atrophy and "Fibrous replacement" of muscularis in lower esoph]

281

Pathology

284

Pathology

290

Pathology

Gastrointestinal & Nutrition

304

Pathology

with paraital hyperplasia (Zollinger-Ellison) causing visible Gastrointestinal & Nutrition Pt enlargement ofcell gastric folds. The stimuli that caused this probably *Gastrin*

305

Pathology

Erosions are defined as mucosal defects that do not fully extend thru the *Muscularis Mucosa*

A pt with distal ulcer and high-normal gastrin levels that rise in response to secretin adminstration are suggestive of Zollinger-Ellison Syndrome. The is caused by gastrin-secreting Gastrointestinal & Nutrition tumors (Gastrinomas) which is a *Neoplasia* Usually secretin inhibits gastrin production.

326 327

Pathology Pathology

Gastrointestinal & Nu trition Celiac disease is diagnosed with *Small intestine Biopsy* Infant with poor weight gain since birth. He has bulky and greasy stools. Jejunal Biopsy (Image) shows foamy or clear cytoplasm of Gastrointestinal & Nutrition enterocytes with normal mucosal structure. Dx is *Abetalipoproteinemia*

Pathology

Pt who recently travelled to south america. His liver biopsy shows spotty hepatocyte necrosis and inflammatory cell infiltration. Most likely clinical presentation of this pt is *Fever, Anorexia, and Gastrointestinal & Nutrition dar-colored urine* [Acute Hep A infection] [Dark color urine is due to increased conjugated bilirubin levels]

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.

370

Pathology


Pathology

acid Oxidation* 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]

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.

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


366

394

401

407

Pathology

Alcohol induced hepatic steatosis is due to *Decreased Free fatty

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

A finding most suggestive of Ulcerative colitis is *Continous Mucosalinvolvement* Gastrointestinal & Nutrition [Transnural inflam, rectal sparing, perianal fistula and

410

Pathology

noncaseating granuloma are allsuggestive of crohn's disease] 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* Pt with abdominal pain and bloody diarrhea following a

413

Pathology

Gastrointestinal & Nutrition complicated surgical procedure likely has acute nonocclusive 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*

429

432

Pathology

Pathology

434

Pathology

435

Pathology

436

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) 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 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)) A pancreatic psuedocyst is lined by *Fibrous and Granulation Gastrointestinal & Nutrition 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 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.] 23 year old is hospitalized with acute pancreatitis that resolves rapidly with fasting. Pt does not consume alcohol. One of the tests

440

Pathology

Gastrointestinal & Nutrition that sould be considered during the workup is *Serum Triglycerides* [Hypertriglyceridemia can cause acute pancreatitis] [Two main causes however are gallstones and alcoholism]

881

Pathology

6 yr old is brough tdue to confusion and intractable vomiting. Mother says he had a febrile illness w t o dasy ago and she gave him "Some over-the-counter pills and it helped his fever. While you Gastrointestinal & Nutrition talk to mother, the boy lapses into a coma. Light microscopy of his liverwillreval *Microvesicularsteatosis* [Rye Sydnrome, hepatic encephalopathy due to aspirin intake after a viral illness in kids]

1143

Pathology


Infection with Shigella Sonnei though food. The cells primarily responsible for uptake of bacteria are *Microfold (M) cells*

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]

1783

Pathology

Pt with abdominal pain, diarrhea, and tender abdomen without Gastrointestinal & Nutrition guarding. There is a draining fistula near her coccyx. Most likley Dx is *Crohn Disease* Pt recently went to mexico. He presents with low grade fever, anorexia, dark colored urine and RUQ tenderness. Liver biopsy

1863

Pathology

Gastrointestinal & Nutrition mostlikelyshows *Hepatocye Swelling* [Acute viral hepatitis, most likely by Hep A virus] [Hall mark is hepatocyte necrosis which characterized by swelling]

1927

Pathology

IV drug used wuth fever, jaundice and anorexia. Liver biopsy showsmononuclearinfiltrates,hepatocyte swelling and acidophilic Gastrointestinal & Nutrition bodies. Formation of acidophilic bodies is the result of *Apoptosis* [viralhepatitis]

7710

Pathology


Pathology

HIV pt with multople hemorrhagic polypoidal lesions on colonoscopy. Biopsy reveals spindle cells with surrounding blood Gastrointestinal & Nutrition vesselproliferation. Most likely cause is *Kaposi's Sarcoma* [HHV-8]

Pathology

Infant with abdominal distention, vomiting and blood streaked stools. She was born out of preterm delivery. Abdominal x-rays Gastrointestinal & Nutrition shows curvilinear areas of lucency that parallel the bowel wall lumen. Most likely Dx is*Necrotizing Enterocolitis*

Pathology

Renal transplant pt who presents with worsening retrosternal chest pain, dysphagia, and odynophagia. An esophagogastroduodenosopy shows linear shallow ulceraion on Gastrointestinal & Nutrition lower esophagus. Likely finding on esophageal biopsy is *Enlarged cells with Intranuclear inclusions* (CMVesophagitis)

8290

9920

11548

Pt with duodenal ulcer. H. Pylori can be found in *Prepyloric area* [Antrum of stomach]

Pt dies from liver disease. Both changed and unchanged hepatocytesdomonstrate foreign DNA Fragmentsintegrated into 58

Pathology


341

Pathology


Backpain that is constant (i.e not relieved by rest or positional changes) and that is worst at night is suggestive of *Neoplasm* as inspinalmetastasis.


55 year caucasian male is found on colonoscopy to have a solitary mass in his sigmoid colon. Biopsy shows colon cancer. The feature that carries the worst prognosis is *Tumor Penetration into the Muscularis Propria* (Tumor staging, more imp than grade)

423

615

Pathology

Pathology


their fragments likely belong to *Hep Band virus* [Hepgenome. C is RNAThese virus and has no reverse transciptatse does not integrate into host genome]

Child who presents with headaches and gait instability. MRI shows tumor in the cerebellum wtih both cystic and solid components (white and dark). Most likely Dx is *Pilocytic Astrocytoma* (Medulloblastoma is only solid, ie dark)

1580

1630

1717

1754

Pathology

Pathology

Pathology

Pathology


Pancreatic calcification with abdominal pain and finding of low hemoglobin and high MCV suggest Macrocytic anemia. The pts probably has Chronic pancreatitis due to ethanol abuse. The anemia is due to folic acid def or b12 def and is causing impaired DNA synthesis leading to *diminished thymidine synthesis*


IV drug used with HIV infection. He comes due abdominal distention and anorexia. CT scan shows ascites and large mass surrounding small intestine. Biopsy of mass shows unifrom, round, medium-sized tumor cells with basophilic cytoplasm and proliferation fraction of >99%. Agent assoc is *EBV* [Burkitt Lymphoma, t(8:14) involving c-myc] [Kaposi sarcoma (hhv8) would shows large cells, big nuclei, and prominent nucleoli]


Hypophosphorylated RB protein is likely to*Prevent G1/S cell cycle Transition* (hypophosphorylated isactive, abnormal phosphorylation results in inactivation and proceeding of cycleunchecked)


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. 8 year odl pt from east africa with Large tumor on Mandible with palbable regional lymphadenopathy.Biopsy showsdiffuse infiltrate of lymphoid cells with numerous mitotic figures and interspersed

1755

Pathology


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]


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]

1759

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1761

Pathology

Pathology

Pathology

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))

1785

Pathology


Pt with anemia (manifesting as fatigue), thrombocytopenia (Easy bruising), and neutropenia (recent respiratory infection), with profound reticilocytopenia, morphologically normal cells line in eriheral smear and no splenomegaly. Bone marrow biopsy would most likely show *Hypocellular marrow filled with fat cells and marrow stroma* [Aplastic Anemia]

1786

Pathology

Hematology & O ncology

Calculate Corrected reticulocyte count or sth.

1793

1796

1797

Pathology

Pathology

Pathology


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*

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*

1873

Pathology


1879

Pathology


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

1880

Pathology


Pt with chest tightness and dyspnea, with chest CT showing a saddle pulmonary embolus. Pt has history of cancer, smoking and age (70). This places him at risk of developing a vebous thromboembolism. A factor that contrinutes to this a *Hypercoagulable state* (Virchow's triad: endothelial injury, venous stasis, and hypercoagulable state)

1953

Pathology


Hemophilia is an X-linked cogulopathy that presents with after intramuscular hemorrhage, hemarthroses, delayedbleed procedure.Labresults showprolongedPartialThromboplastin Time.


Pt has epistaxis, ecchymoses, and marked thrombocytopenia. SHe has a normal hematocrit, leukocyte count and differential, frinogen and PT. She takes no medication, and there is no hepatosplenomegaly on P.E. These findings suggest an isolated acquired thrombocytopenia. Most likely mechanism in this pt is *Immune destruction of platelets* like "Immune thrombocytopenic purpura"

1954

Pathology

The finding of a high peak in gamma-globulin region on serum protein electrophoresis (SPEP) usually represents an M protein 1964

Pathology


consisting of anoverproduced immunoglobin. myeloma causes an M proteinmonoclonal peak on SPEK as well as Multiple anemia (weakness), lytic bone lesions (back pain, pathologic fractures) and renal insufficiency (related to amyloid deposition and hypercalcemia). *Multiple myeloma is *Plasma cell neoplasm**

2084

Pathology


Pt with signs of sickle cell disease (african american, recurrent back pain, bony tenderness, low Hb). Histopathologic evaluation of his spleen would show *Fibrosis and Atrophy*

2093

Pathology


Breast cells that over express 185kD glycoprotein and that have intracellular tyrosine kinase activity are probably the HER2/neu oncogenes that *Accelerates Cell Proliferation*

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]

11754

Pathology


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

11869

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*)

390

Pathology

Infectious Diseases

The most common outcome in HBV-Infected adults is acute hepatitis with mild or subclinical symptoms that eventually *completely resolve*

472

Pathology

Infectious Diseases

Pt with aortic regurg murmur (diastolic) in the presence of mediastinalwidening.FTA-ABSpsotive(syphilus).Thepathologic process responsible starts at *Vasa Vasoum Obliteration* [Teriary Syphilus causing aortic aneyrysm, which beigns with vasa vasorum endarteritis and obliteration resulting in inflam, ischemia and weakening of adventitia.]

651

Pathology

InfectiousD iseases

TertiarySyphilusgenitallesionsarecalled*Gummas*

Infectious Diseases

An unvaccinated infant is brought with a rash. Three days ago, she developed fever, along with cough, congestion, and red eyes. Rash appeared on face and spread to trunk and arms. The def assoc with increased complications from this pt condition is *Vit A* [Measles virus]

1045

Pathology

1138

Pathology

Infectious Diseases

Pt recently went to south america presents with fever, headache, abdominal pain and 1 week history of watery diarrhea that has recently become bloody. He is febrile and P.E shows hepatosplenomegalyandseveralfainterythematousmaculopapular lesions on chest and abdomen. Most likely cause is *Salmonella Typhi* [Typhoid Fever]

1958

Pathology

Infectious Diseases

Bacterial Vaginosis can be Tx with *Clindamycin* or Metronidazole.

624

Pathology

MaleReproductiveSystem

Pt presents with a painless scrotal nass. He also has increased sweating and heat intolerance. P.E shows an enlarged nontender right testicle. Lab shows increased serum T4 and T3. The constellation of findings seen in this pt most likley suggest an elevation of serum *hCG* [Testicular malignancy releases hCG which has a similar structure to TSH and can bind and activate thyroid to produce ParaneoplasticHyperthyroidism.]

8325

485

486

531

Pathology

Pathology

Pathology

Pathology

Pregnancy, Childbirth & Puerperium

Neoborn with a palpable swelling of neck. He is comfortable only when held sideways. The child favors looking toward right and cries when his head is turned to left. Most likely condition present prenatallyis*Intrauterine Malposition* [Congenitaltorticollis,sternocleidomastoidmuscle injuryand fibrosis]

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]


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]


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*

533

Pathology


phase of his disease. 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)]

552

Pathology


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

554

555

565

648

Pathology

Pathology

Pathology

Pathology



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


Pt presents with cough and headaches and dyspnea. He complains of a puffy face. P.E shows facial swelling and conjunctival edema. Dilated vessels are seen over his neck and upper trunk. The pts condition is most likely caused by a *Mediastinal Mass* [SuperiorVenecavasyndrome]


Pt with shoulder pain (pain under scapula and in right arm). Pain is associ with numbness on his right forearm and tips of fingers. He has Hemoptysis. He smoked 2 packs/day for 40 years. Most likey cause is *Superior Sulcus Tumor* (Pancoast Tumor)

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* [C lear cell Ca of Kidney]

1913

Pathology


Screening for early-stage diabetic nephropathy is done by measuring urinary concentration of *Albumin*

2131

Pathology


Proteinurea with serum containing IgG4 antobodies to phospholipase A2 receptor (PLA2R) suggests idiopathic *Membranious Nephropathy*

340

Pathology

Pt with recurrent nonpitting edema of hands, raynaud phen, and Rheumatology/Orthopedics retrosternal burning has CREST syndrome which would find & Sports *Anti-centromere* Antobodoes.

Pathology

Pt with multi system systems and history IV drug use. His muscle biopsy shows transmural inflammation of mid-sized arteries with areas of homogeneous, eosinophilic arterial wall necrosis (i.e Rheumatology/Orthopedics fibrinoid necrosis). Areas of internal elastic lamina disruption are & Sports also present. Most likely predisposing factor to this pt's current condition is *Viral Hepatitis* [Polyarteritis Nodosa]

Pathology

Pt with persistent headache and pain in the jaw when chewing Rheumatology/Orthopedicsfood. Artery biopsy shows multinuclear giant cells and internal & Sports elastuc membrane "fragmentation". Pt has Giant cell arteritis and treatment reduces risk of *Ischemic optic Neuropathy*

Pathology

Eosiniphilic granulomatosis with polyangiitis (Churg-Strauss) is a small to medium vessel vasculitis characterized by late-onset Rheumatology/Orthopedicsasthma,rhinosinusitis,andeosinophilia.Mononueritismultiplexdue & Sports to involvement of the epineural vessels of peripheral nerve is common. The finidning of antibodies against neutrophil myeloperoxidase is also common.

1850

457

461

667

702

Pathology

Pt with blue sclera and easily fractured bones probably has Rheumatology/Orthopedicsosteogenesis imperfecta due to defect in type 1 collagen which is & Sports

the primary collagen in bone. Therefore, the primary impairement is *Bone Matrix Formation*

721

Pathology

Child with fever and malaise. He parents say he refrains from using his right leg. Passive range of motion does not elicit pain and Rheumatology/Orthopedicsno joint effusion is seen. However, the pt refuses to bear weight & Sports with his right lower extremity. Scintigraphy is most likely to reveal increased focal radiotracer uptake in the *Long Bone Metaphysis* [Hematogenous Osteomyelitis]

820

Pathology

Rheumatology/OrthopedicsDigital Clubbing can be caused by Lung Disease. E.g: & Sports Bronchiectasis

914

Pathology

Elderly woman with jaw pain during chewing (Jaw claudication) , Rheumatology/OrthopedicsAn episode of vision loss in one eye that resolved (amaurosis & Sports fugax). Best initial test is *Erythrocyte Sed Rate* [Giant cell Arteritis][C-reactive protein is also indicated]

855

Pharmacology

Nervous System

Pt with fever and muscle rigidity soon after surgey. He has high BP and high HR. P.E shows muscle stiffness and cyanotic skin mottling. Most approprate treatments affects *Intracell Ca release inskeletalMuscles* (Pt has Malignant Hyperthermia, Treated with Dantrolene, a muscle relaxant that acts on ryandoine receptor and prevents further release of Ca)

856

Pharmacology

Nervous System

The cause of rapid plasma decay of thiopental was not metabolism of the drug but rather *redistribution of the drug to other tissues* throughout the body.

866

Pharmacology

Nervous System

Child with High fever and seizures has febrile seizures and shud be given *Acetominophen* (Antipyretic, never give aspirin to a

1322

Pharmacology

Nervous System

child) ST-Segment elevation in inferior leads tells you its Inferior MI. Inf MI is due to blockage of right coronary artery which supplies SA & AV nodes. Thus, inf MI's Often present with bradycardia. Treating bradycardia with ATROPINE thru blocking vagal influence on nodes thus increasing HR. Side effect of Atropine in the eye is GLAUCOMA. So pts complains of severe right sided eye pain.

1360

Pharmacology

Nervous System

Receptor that when stimulated causes immediate change in transmembrane Ca, Na, and potassium secondary to opening of receptor channel is *Nicotinic Cholinergic Receptor*

Nervous System

A drug that causes less uterine contractions (i.e uterine relaxation) and Eye Midryasis is *Alpha and beta-adrenergic agonist* [B2 stimulation in uterus causes relaxation while Alpha 1 stimulation in eyes causes mydriyasis (the basis of using phenylephrine befor eye exams)]

Nervous System

If pt is on warfarin and a new drug was added and pt developed thrombotic event, then the new drug lowered efficacy of anticoagulation property of warfarin through the induction of CYP450, which is how Warfarin is metablized. One such drug is Phenobarbital.

Nervous System

Pt with a hand tremor. It is most prominent in activity such drinking from a glass. She says alcohol improves the tremor. Family Hx is significant for similar problems. Best Tx for this pt is *Propranolol* [Essential Tremor, nonselective beta blockers lessens it via CNS effects]

1368

1777

1946

Pharmacology

Pharmacology

Pharmacology

2000

Pharmacology

Nervous System

Pt that presents chest and and has history of HTN, Diabetesm, and with asthma. Txpain is given chest pain disappears but he now develops dyspnea. Pt was most likey given beta blockers to relieve chest pain (B-1 block) and develoved bronchoconstriction (B-2 block) which caused the dyspnea. B-blockers work by *Inhibiting the neurostransmitter-receptor interaction in adrenergic synapses*

2089

Pharmacology

Nervous System

Treat serotonin syndrome with *Cyproheptadine* (a first gen. antihistamine that has nonspecific 5-HT & 5-HT2 receptor antagonism)

8476

11458

Pharmacology

Pharmacology

Nervous System

Nervous System

Woman who presents with a migrain who is given a medication to be used immediately during an attack. Medication most likely affect *Postsynapticserotoninreceptorstimulation* (Triptans, e.g sumatriptan, serotonin agononist 5-HT 1B & 1D) Pt with MS who has spastic paraparesis. Most effective monotherapy for this pts spasms is *Baclofen* (agaonist at GABA-B receptor) (Tizanidine is also effective)

1665

8266

Physiology

ATP helps release *Myosin head from Actin binding site*, and thus Rheumatology/Orthopedics lack of ATP leads to persistance of myosin-actin cross bridge & Sports (Rigormortis)

Physiology

Wieght lifter who raises wieght above head and then his arms Rheumatology/Orthopedicssuddenly and involuntarily give away and he drops the wieght to & Sports ground. The structure that was most likley responsible for the suddent muscle relaxation is *Golgi tendon organ*

318406124 UWORLD Notes by Subject Main Division Usmle Grassroots

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