ifom part 4

Using of a anti micro drugs (-taxel) + a picture of a big cell? What function is disturbed? (Which cells)

Platelets

Mainly it is a picture of megacaryoctes since they depend on microtubules to complete their cell cycle and give platelets and the drug ( taxel) increase stabilization of microtubules not allowing them to depolymerize so megacaryoctes cant use them → no platelet formation

Patient with tonsillitis and fever serology done showed: erythrocyte antibody what cell secretes those antibodies?

Plasma cells

Patient has Strep Viridans presented for hematuria and red blood cell cast? Cause? ( 1-2 weeks)

Antigen-antibody complex

Mainly these are symptoms of post strep glomurelonephritis ( hematuria, red cell casts) after infection with strep the cause is the antigen antibody complex that precipitate in glomerula casing inflammation

Mechanism of action of benzodiazepines ( pam , am , chlordiazepoxide)

GABA-A receptor modulator

( facilitate GABA and increase cl- channels opening )

Enhancing the effect of GABA at the GABA-A receptor→ increase frequency of cl- channels opening

We want to know the prevalence of certain disease in population currently which study we use

Cross sectional

To determine the current prevalence of a disease in a population

after MI, which of the following mechanism of recovery of affected cardiac tissue ->

Hypertophy

Since dead cells are replaced by scar tissue so the other cells as compansetory mech to remain cardic output normal other cells contract more → hypertrophy

Pt with BPH have urine retention, pain on urination when he finish he become better, drippling, incomplete emptying, frequency what is the drug should be given

Doxazosin ( alpha 1 blocker)

Osin family

structure obstructed on middle lobe lung lateral side I sour aaleya X > what is the structure

Inferior vena cava

he is going up the stairs w byetaab degree ->

Idiopathic pulmonary ( interstitial) fibrosis

It case of exertional dyspnea ; breathlessness upon activity

A pneumonia case with chest x ray asking which lobe is affected

Right middle lobe

right heart border is blurred → right middle lobe pneumonia

Newborns lack which type of cells of immunity

Lack t cells

( adaptive immunity) / ig they have t cells but functionally immature iggggg

Obstruction in right pulmonary artey which lung side is affected

Right side

Patient with heartburn and heart enlargement or mass seen on x-ray and compressing the esophagus what is the part enlarged

Left atrial enlargement

Since left atrial enlargement leads to compression of esophagus and left recurrent laryngeal nerve causing hoarsenss

Patient with bleeding disorder found to be Gpilb defect - what are the results

Normal platelet count , normal coagulation cascade, decrease response to ADP

It is glanzman thrombocytopenia where their is Loss of GpIIb/IIIa (integrin) receptor on platelets respomsible for platetel aggregation so every thing else is normal but platelet cant aggregate

ADP activate these receptors normally leading to platelet activation but receptors are defected so decrease in response of ADP

Neonate with facial features and single ventricle in CNS - What hormone release is affected-

ADH hormone release is affected

Mainly beser fe diabetes insipidus

It is case of holoprosencephaly ( failure of forebrain to divide into 2 cerebral hemispheres → increase risk of pituitary dysfunction ( diabetes insipidus ) due to impaired ADH and GnRH release

Calculate the clearance of the drug

Clearance= rate of elimination of drug / plasma drug concentration

Cl = vd * kc ( elimination constant)

Pericardial bleeding post MI this is due to what

Ventricular free wall rupture

Due to rupture → bleeding so blood accumulates in the pericardial space causing cardiac temponade

Female patient given clomiphene then HCG, what will happen:

Maturation of eggs and proliferation of ovarian follicle

Since clomiphene blocks estrogen receptors ( antagonist on estrogen receptor) → increase in LH ,FSH → stimulation of ovulation ( proliferation of ovarian follicles and maturation of eggs)

Mode Of Action of phenylephrine

Alpa 1 adrenergic receptor agonist

Activation of alpha adrenergic receptors in nasal mucosa

It acts on vascular smooth muscle → vasoconstriction → BP increase , heart rate decrease

Epinephrine effect on receptors

It works on alpha and beta receptors

On alpha receptor: vasoconstriction → increase BP

Beta receptors in heart (B2); increase HR and contractility

On beta receptors (lung and vessles B2): bronchodilation, vasodilation

Depend od dose in low s=doses B>A → VASODILATION

In high doses A>B → vasoconstriction

Epinephrine stimulates α1, β1, β2 receptors → increases cardiac output, bronchodilation, and (dose-dependent) vasoconstriction.

Epinephrine = non-selective adrenergic agonist

• β1 → heart stimulation

• β2 → bronchodilation + vasodilation

• α1 → vasoconstriction

15.Patient cannot be exposed to sunlight (UV), Xeroderma pigmentosum. Defect in?

Nucleotide excision repair

Skin with heavy exposure to UV light. What DNA changes occurred?

Excision DNA repair

patient take testosterone supplementation what happen as adverse effect?

Increase EPO ( erythropoietin )

When EPO increase → production of RBC → polycythemia

A young female has a breast mass, non-tender, mobile, rubbery, well defined, no family, history of breast cancer diagnosis. What type of mass does she have?

Fibroadenoma

Female patient baby, yellowish fluid discharge from her umbilicus. Where is the embryologic defect?

Urachus

Normally in fetus the urachus connect urinary bladder with umbilicus but then it is obliterated to median umbilical ligamenet but if it persist → yellow discharge from the umbilicus

Failure of urorectal separation is due to defect in what

Cloaca

Patient with seminoma can cause lymphatic spread via drainage into?

Which lymph nodes does cancer in the testis spread to?

Para-aortic (lumbar) lymph nodes

Since testis drainage to para aortic lymph nodes

Patient with fake a lot of pills to suicide and glucose is 28, the initial examination shows the patient take sulfonylurea which of the following can confirm the diagnosis?

Increase in peptide C

Hypoglycemia suggest their is sulfonylurea overdose

Since this drug increase endogenous insulin and eith endogenous insulin peptide c also is released

So since peptide C increase with endogenous insulin increase not with exogenous so it is a good marker to confirm that this increase in insulin is due to overdose sulfonylurea

pregnant patient has high T4 and low TSH. Which medication should be used?

Propylthiouracil

It is a case of pregnancy hyperthyroidism

Chronic renal failure + chvostek sighn + trousseau sign

What is the diagnosis

Decreased calcium ( hypocalcemia)

Apatient with celiac disease and bone pain. What happens to PTH Calcium phosphorus?

Ca2+ decrease, phosphorus decrease, PTH increase

Pain in shoulder due to involvement of which surface of pleura?

Parietal diaphragmatic pleura

Diaphragmatic pleura and shoulder both are innervated with phrenic nerve so irritation in diaphragmatic pleura → referred pain to the shoulder

Skin is low in elasticity and full of grooves what is the deficient

Hyaluronic acid

HA for hydration, plump, smooth

If deficient:

• ↓ water retention

• skin becomes:

  • dry

  • wrinkled

  • less turgid (“grooves” appearance)

Pt went for surgery to remove a cyst what tendon can be affected

Extensor digitorum tendon

That case is referring to Lambert-Eaton myasthenic syndrome (LEMS) what is decreased

ACH.

It is case where their is antibodies attacking presynaptic voltage gated calcium channles → no release of ach

Symptoms of the case: proximal muscle weakness ( leg> arm ), hyporeflexia, autonomic symptoms (dry mouth, conctipation), improves with repeated use ( strength can be better with exercise)

If their is antibodies against presynaptic nerves what will decrease

Ach

Since these antibodies are against calcium channels in presynaptic nerves

Large size of head in comparison with limbs what is the diagnosis

Achondroplasia ( defect in endochondral ossification)

In achondroplasia ( endochondral ossification) → failure of longitudinal bone growth→ short limbs

Patient with viridians streptococci and with creatinine values that rise from 0.8 to 4 and symptoms of nephritic syndrome what is the mechanism?

Glomerulonephritis from antigen antibody Complex deposition

Decrease estrogen is cause urinary incontinence in postmenopausal why

Low estrogen levels also contribute to weaker pelvic floor muscles and reduced elasticity in your urinary tract

→ stress urinary incontinence

Child with recurrent UTI symptoms. A contrast was given into the bladder the contrast only fills the right ureter. Why?

Incomplete right ureter valve

It is case of vesicoureteral reflux ( the right vesicorectal valve is not working good since normally contrast should not return so this increase risk of recurrent UTI

Case suspected of nephrogenic diabetes insipidus. How to confirm the diagnosis?

Urine osmolarity doesn't change after water deprivation and administration of vasopressin ( no change in osmolarity)

So even if vasopressin ( ADH is given) tubules dont respond to ADH and urine remain diluted

While if it is case of diabetes insipidus urine after a vasopressor will be concentrated ( increase in osmolarity)

What is the action of Angiotensin II?

On adrenal medulla, vascular smooth muscle and renin

Adrenal medulla: increase epinephrine release

Renin : decrease renin (negative feedback on RAAS)

Vascular smooth muscle: vasoconstriction

girl with severe abdominal pain, endoscopy is normal, no diarrhea, no constipating, physical examination is normal. What is the diagnosis

Irritable bowel syndrome

It is associated with abdominal pain and other normal findings

Baby with following imaging, no left lung sounds What is the abnormality ?

Congenital diaphragmatic hernia

A patient was shot by a gun. During surgery, there was a 30-60 cm mass proximal to the liocecal valve. Meckel's diverticulum. What type of cell is found here?

Pancreas

In M.D cells are acid secreting gastric mucosa ( stomach cells) or/and pancreatic cells

Hasab l options in the question bas stomach cells > pancreatic cells

patient with COPD start having cough, chest pain.… Etc. as well as acidic taste in the mouth, why?

GERD

Gastroesophageal Reflux Disease

Patient undergoes hysterectomy. Has abdominal pain at the same side. There is an adhesion between the abdominal wall and another layer which is?

Sigmoid colon

Most common structures involved in post-gynecologic surgery adhesions:

• small bowel

• sigmoid colon (especially left-sided pain cases)

Most commonly caused by intraperitoneal adhesion ( fibrous band of scar tissue)

Patient with pleural effusion, on examination there was a pleural plaque. He was working in shipyard or other this is case of what

Asbestos

Pleural plaques are highly suggestive of:

Asbestosis exposure

Typical exposure jobs:

• Shipyard workers (MOST classic)

• Construction workers

• Insulation workers

• Old building renovation workers

Pt work in auto mechanic what will be exposed to

Asbestos

Older cars used asbestos-containing materials:

Case of kyphosis. Flattened diaphragm increased anteroposterior chest size. Result? Decrease in what occur

Decrease in vital capacity

Due to kyphosis and flattened diagram lung expansion is limited→ vital capacity decrease

Patient in the following picture. What drug to administer?

Actinic keratosis: Premalignant lesions caused by sun exposure.Small, rough, erythematous or brownish papules or plaques, Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia

Fluorouracil

Used for actinic keratosis ( Sun-exposed areas

Rough, scaly plaques, Premalignant → can progress to squamous cell carcinoma)

What can happen secondary to multiple myeloma

AL amyloidosis

Light chain in multiple myeloma are misfold and deposits as amyloid ( AL type )

How to antagonize ( reverse) warfarin: warfarin antidote

Fast reversal: fresh frozen plasma ( prothrombin complex concentrate)

Slow reversal: vitamin K

Patient get lack of empathy and other personality change which lobe is affected

Pt lost concentration, grooming, empathy which lobe is affected

Frontal lobe

Side effects of orlistat

Fecal fat

Since it decrease breakdown and absorption of dietary fats ( steatorrhea)

Patient given ACEis. Instead of improving his/her renal function, we got an increase in serum creatinine, why?

Bilateral renal stenosis

In bilateral artery stenosis→ low perfusion and blood flow→ RAAS activated and angiotensen 2 imp to maintain GFR ; when giving ACE→ decrease in angio 2 →GFR decrease and creatinine increase

. Ayoung female with hypertension, without a family history, what is the cause?

Renal artery stenosis

Renal artery stenosis leads to:

• ↓ renal blood flow (kidney “thinks” BP is low)

• ↑ Renin–angiotensin–aldosterone system

• → vasoconstriction + sodium retention

• → systemic hypertension

Pt has swelling in face and eyes these are side effects of which drug

Lisinopril ( pril ) family

They cause angioedema since they are ACE inhibitors that inhibit breakdown of bradykinin

Enalopril works on which cells

Endothelium of the lungs

They are ACE inhibitors (pril family) and ACE is present in the endothelium of the lung

Patient's uncle has long QT prolongation (long QT interval). What is the other symptom the patient may have?

Hearing loss ( sensorineural deafness)

It is congenital long QT syndrome; one of the hereditary channelopathies

It is due to mutation in k+ channels

It is jervell and lange nieisen syndrome : QT prolongation + sensorineural deafness

If without deafness→ romano ward syndrome

If left circumflex artery is blocked which part of the heart is affected

Posterior surface of left ventricle

LCA supplies posterior and lateral surface of the left ventricle

Pt has sternal chest pain an ECG is done ( ST segment elevation) what is the problem

Thrombosis

Mass in left atrial septum and left atrium what could be obstructed

Mitral valve

Patient has HTN and family has HTN, what should you advice the patient?

Exercise and dietary modification reduce the overall risk of cardiovascular diseases and HTN (not sure!!)

(Lifestyle modification + risk reduction )

Patient with family history of CAD and he is also obese, what do you tell him?

Exercise and dietary changes will help you

Main factor for staging prostate cancer? Which answer is correct

-Microscopic picture

-cytologic features

-invasion of capsule

Invasion of the capsule

Staging of prostate cancer depend on the extent of tumor spread wheater it is capsular or beyond capsular invasion

Patient given doxycycline and a fluoroquinolone (Ciprofloxacin) What food will interfere with its absorption so should be avoided?

Milk

Milk contains high calcium, so:

• Drug + calcium → non-absorbable complex

• ↓ drug absorption in the gut

• ↓ effectiveness

Aspergillus causes hepatocellular carcinoma how can it cause this

By toxin induce mutation hepatocytes

Aspergillus flavus produces aflatoxin B1, which causes p53 mutation in hepatocytes leading to HCC.

Patient has cavitary lesion in the lung containing a second lesion. Which organism is Responsible for that

Aspergillus

• Aspergillus does NOT usually invade healthy lung

• It colonizes pre-existing lung cavities, such as from:

  • Tuberculosis

  • Sarcoidosis

  • Bronchiectasis

  • Old abscess

Inside the cavity:

• fungus grows into a fungal ball (mycetoma)

• can move within the cavity → “air crescent sign”

Cavitary lung lesion + intracavitary mass = aspergilloma

Patient with MULTIPLE ring formations (appearance) within RBC on blood smear and hyper parasitemia. What is the parasite?

Plasmodium falciparum ( malaria)

Patient went to sub-Saharan Africa, and got confusion and fever, blood showed >12% parasitemia

Plasmodium falciparum ( malaria)

Asplenic patient most susceptible to which organism

Strep. Pneumonia

After kidney transplant pt more susceptible to which organism

CMV ( cytomegalovirus)

Post splenectomy, increase risk of which organism

Strep pneumonia

Which is the mechanism of action of Cyclosporine?

Inhibits calcineurin

Cyclosporine:

• Binds cyclophilin inside T cells

• The complex inhibits:
  Calcineurin
  

What is the mechanism of cyclosporine?

Decrease / inhibit cellular immunity

It binds to cyclophilin→ blocks t cell activation and inhibit calcineurin→ prevent IL2 transcription→ blocks t cell activation

Natural killers kill tumor cells via

Perforin

It makes pores in the membrance so that granzymes enter and induce apoptosis of the cell

Defect in CD18 protein ( LFA-1 : leukocyte function associated antigen 1 ) which cell is defect

Neutrophils

Dysfunctional neutrophils : high in blood but absent in infection sites

Pt with several infections by several types of organisms what is the diagnose

Severe combined immunodeficiency ( SCID )

SCID is due to defect in adenosine deaminase

When ADA is deficient:

• toxic deoxyadenosine metabolites accumulate

• toxic to lymphocytes

• especially T cells

⚠ Result

• Severe lymphopenia

• Failure of cellular and humoral immunity

Classic findings

• Recurrent severe infections

Pt with multiple disease ( infected with multiple organisms) she have SCID what enzyme is defective

Adenosine deaminase

Fever like systemic symptoms due to which tumor factor

TNF alpha

Systemic inflammatory symptoms ( symptoms related to the whole body ) : fever fatigue weakness tachycardia anorexia leukocytosis

Fever and pain are due to which factor

IL-1

You have 100 true twins. Paired twins were separated and raised in a different place. 50% of the twins got schizophrenia. What is the mode of inheritance?

Multifactorial

Someone from Greece taking sulfamethoprim and trimethoprim. He has orange urine.

Cause?

G6PD

These drugs release oxidative stress and in G6PD RBC cant neutralize oxidative stress. To this will lead to cell lysis and release of hemoglobin that will be metabolized to bilirubin and urobilin

Pt have hemolysis, anemia, bite cells what is the diagnose

G6PD deficiency

RBC with heinz bodies and bite cells

This happens due to using sulfa drugs, antimalarial, fava beans

Patient kept for 3 days without food the brain will utilize what for energy

Ketones

First 24 hours : depend on glucose

Then ketones is source of energy except for RBC that depend on glucose since it dont have mitochondria to utilize ketones

1-3 days: gluconeogenesis+ketones (mainly)

After 3 days: only ketones

Patient enter fasting training for 36 hours, and serum glucose during this fasting not change, which of the following processes maintain Glucose level?

Gluconeogenesis

Glycogen in liver is depleted after 36 h so we cant depend on glycogenolysis

Gluconeogenisis occur primary in the liver; it is formation of glucose from non carbohydratye souce

And also in kidney

Athlete is talking anabolic steriods what part of the hepatocytes is affected

Smooth endoplasmic reticulum

It contains cyp 450 enzymes that metabolize steroids so by taking steroid demand increase on SER so it proliferate so it is the organnele affected

Patient got a very high fever (40 degrees) after given isoflurane. What medication to give?

Dantlorene

Since isoflurane caused malignant hyperthermia

Patient has ulcer on left curvature of stomach. During surgery the hepatoduodenal ligament got injured. Which duct is affected?

Common bile duct

Patient undergone thyroidectomy. After the surgery she got carpopedal spasm and facial tap leads to facial muscle twisting. What test should be done?

Measure serum calcium

To check if by accident they removed the parathyroid gland

Decrease in calcium makes na+ channels open easily so nerve is easily excited causing these symptoms

In liver transplant which organ makes gluconeogenesis

Kidney

132 of 140

A 22-year-old man has a 36-hour history of pain and swelling of his left testis. One week ago he had mild dysuria and a urethral discharge. ram stein of maternal from the urethra Stows numerous neutrophile but no organisms. the most likely cause of the patients symptoms is infection with which of the Following

(A) Chlamydia trachomatis

b) CMV

C)E.coli

D) Herpesvirus

e) Mumps

Chlamydia

Since it causes urethral discharge (urethritis and it also causes epidimitis) and on urethral smear a lot of neutrophilis are seen without an organism ( no organism is seen)

Left circumflex artery is occluded which area of heart is affected

Posterior portion of left ventricle

year-old man si about to undergo resection of gastric adenocarcinoma ni the hospital. The tumor is located ni the right portion of the lesser curvature of the stomach. During the operation, the hepatoduodenal ligament si inadvertently damaged, and bile leaks into the peritoneal cavity. Which of hte folowing ducts si most likely injuredni this patient?

Common bile duct

Which of the following best explains why blood flow to the left ventricular subendocardium ceases during systole?

A) The aortic valve leaflet covers the origin of the left coronary artery

Bcoronary sinus pressure exceeds coronary arterial pressure

c) Extravascular pressure exceeds intra-arterial pressure

D) Less adenosine is released than during diastole

E) Ventricular depolarization stimulates contraction of smooth muscle of the coronary artery

C extravascular pressure exceed inta arterial pressure

During systole (contraction):

• The left ventricle muscle tightens strongly

• This squeezes the small blood vessels inside it

So the vessels get compressed shut

Key idea

The heart muscle pressure becomes higher than the blood inside its own vessels.

So:

• Outside pressure (muscle) ↑

• Inside vessel pressure ↓ relative

→ blood cannot flow

year-old woman comes to the office because of a 2-day history of blood ni her urine and stool. Two weeks ago. she was diagnosed with deep venous thrombosis of the right lower extremity. She was treated with warafin. Bteje aanda diaphoresis, pallor blab la (Emergency!!), what should she be treated with?

Fresh frozen plasma

yollow-tinged fluid draining from the umbilical stump of a newborn fetus (no other abnormalities). Impaired fevelopment of which of the following structures?

A) Abdominal wall

B) Enteric neural ganglia

c) Omphalomesenteric duct D) Umbilical vein

E) Urachus

E- urachus

investigator develops an experimental mouse model for leukocyte adhesion deficiency by deletion of the CO18 gene. To study infections, a small injection of steppyjococcus aureus given subcutaneously. compared with the mice ni the control group, mice in the intervention group would be more likely to have a deficiency of which of the following cell types at the site of infection

A) CD4+ T lymphocytes

B) cD8+ Tlymphocytes

c) Monocytes

D) Natural killer cells

E) Segmented neutrophils

E- segmented neutrophils

An 85-year-old woman comes to the physician because of a 3-month history of mild upper back pain. She appears thin Her pulse is 84imin, and blood pressure si 110/72.mmm Hg. Examination of the chest shows apronounced thoracic kyphosis, but the lungs are clear ot auscultation. Posteroanterior and lateral x-ray show an increased anteroposterior dimension to the chest, flattening of both sides of the diaphragm, and thoracic kyphosis. Which of tthe following abnormalities ni pulmonary function on si most likely ot occur ni this patient?

A) Decreased residual volume

B) Decreased respiratory rate

C) Decreased vital capacity

D) Increased tidal volume

E) Increased vital capacity

C- decreased vital capacity