USMLE Vignette Flashcards: Micro, Path and Pharm -Sidebyside

8/7/2019 USMLE Vignette Flashcards: Micro, Path and Pharm -Sidebyside

1/18

Microbiology Vignettes p174

An alcoholic vomits gastriccontents and has foul

smelling sputum. Whatorganisms are most likely?

Anaerobes

Middle-age man has acutemonoarticular joint pain andbilateral Bell's palsy. What

disease and how?

Lyme, Ixodes tick

Pt with Mycoplasmapneumoniae, cryoagglutinins.

What Ig types?

IgM


2/18

U/A with WBC casts. Dx? Pyelonephritis

Young child with tetany,candidiasis, hypocalcemia,and immunosuppression.

What cell is deficient?

Tcell (DiGeorge)

Pt with "rosegardener's" (thorn prick,

ulcers along lymph drainage).What bug?

Sporothrix schenckii

25yr old med student has"burning" gut after meals.Gram negative rods in Bx.

What organism?

H. pylori


3/18

32yr old man w/ "cauliflower"skin lesions. Bx shows broad-

based budding yeasts.

Organism?

Blastomyces

Breast feeding woman w/

redness & swelling of rightbreast. Fluctuant mass. Dx?

Mastitis by S. aureus

Young child w/ recurrent lunginfxns & granulomatouslesions. What defect in

neutrophils?

NADPH oxidase (chronicgranulomatous disease)

20yr old college student w/lymphadenopathy, fever,

hepatosplenomegaly. Serumagglutinates sheep RBCs.

What cell infected?

B-cell (EBV; infectiousmononucleosis)


4/18

Microbiology Vignettes p175

1hr after eating custard at apicnic, whole family vomits.

After 10hrs all better.Organism?

S. aureus(producespreformed enterotoxin)

Infant eats honey -> flaccid.Organism? Mechanism?

Clostridium botulinum;inhibited release of Ach

Man w/ squamous cellcarcinoma, penis. what virus?

HPV


5/18

Pt w/ endocarditis 3wks afterprosthetic heart valve.

Organism?

S. aureus or S. epidermis

Pathology Vignettes p220

Woman w/ previous C-section has scar in lower

uterus close to opening of theos. Risk for what?

Placenta previa

35yr old man w/ hi BP inarms. Low in legs. Dx?

Coarctation of Aorta


6/18

Woman w/ difuse goiter andhyperthyroidism. Values of

TSH and thyroid hormones?

Low TSH, and high thyroidhormones

Pt w/ extended expiratoryphase. Disease process? Obstructive Lung Disease

Woman w/ headache, visualdisturbance, galactorrhea,

amenorrhea. Dx?

Prolactinoma

Baby has foul smelling stooland recurrent pulmonary

infxns. Dx? Test to confirm?

Cystic fibrosis. Chloride sweattest.


7/18

Obese woman w/ hirsutismand hi serum testosterone.

Dx?

Polycyctic ovarian syndrome

Man w/ pain and swelling inknees, subcutaneous nodules

around the joints and

Achilles, exquisite pain in themetatarsophalangeal join of

right big toe. Bx showsneedle-like crystals. Dx?

Gouty arthritis

48yr old female w/progressive lethargy and

extreme sensitivity to coldtemp. Dx?

Hypothyroidism

Pt w/ elevated serum cortisollevels undergoes

dexamethasone supp. test.1mg doesn't lower cortisol.

8mgs does. Dx?

Pituitary tumor.


8/18

During a football game,player collapses/dies

immediately. Likely Cardiac

disease?

Hypertrophic cardiomyopathy


Child anemic since birth.Splenectomy -> increased

Hct in what disease.

Spherocytosis

43yr old man experiencesdizziness/tinnitus. CT shows

enlarged internal acousticmeatus. Dx?

Schwannoma


9/18

Child exhibits weakness andenlarges calves. Disease? How

inherited?

Duchenne's musculardystrophy, X-linked

recessive.

25yr old female w/ suddenuniocular vision loss and

slightly slurred speech. Hx ofweakness and pareshesias

that have resolved. Dx?

Multiple Sclerosis

Teenager w/ nephriticsyndrome & hearing loss. Dx?

Alport's syndrome

Tall thin male teenager w/abrupt-onset dyspnea & left-

sided chest pain.Hyperresonant percussion on

the afected side &diminished breath sounds.

Dx?

Pneumothorax


10/18

Young man concerned aboutwife's URIs and inability to

conceive. Also dextrocardia.

What protein?

Dynein (Kartagener's)

55yr old man who smokes &drinks has cough & flu-like

Sx. Gram stain showsnothing. Silver shows gram-

neg rods. Dx?

Legionellapneumonia

Pt has stoke after incurringmultiple long bone fractures

in trauma stemming fromMVA. Cause?

Fat emboli.

25yr old woman w/ a lowgrade fever, rash across nosefrom sun, widespread edema.Should be concerned about

what disease?

SLE


11/18


50yr old man w/ diarrhea, PE

reveals plethoric face andheart murmur. Dx?

Carcinoid syndrome

Elderly woman w/ a headacheand jaw pain. Elevated ESR.

Dx?

Temporal arteritis.

Pregnant woman @16wks w/an atypically large abdomen.

Blood test abnormality?Disorder?

High hCG, hydatidiform mole


12/18

80yr old man w/ a systoliccrescendo-decrescendo

murmur. Most likely cause?

Aortic stenosis

Woman of short stature w/short 4th and 5th

metacarpals. Endocrinedisorder?

Albright's hereditary

osteodystrophy orpseudohypoparathyroidism

After stressful event, 30yr oldman w/ diarrhea and blood

per rectum. Intestinal bxshows transmural inflamm.

Dx?

Crohn's

Young man w' mentaldeterioration and tremors.

Brown pigmentation in a ringaround periphery of cornea

and altered LFTs. Tx?

Penicillamine for Wilson'sdisease.


13/18

Pt w/ fatigue, blood testsshow macrocytic,

megaloblastic anemia. Why

danger to give folate alone?

Masks signs of neuraldamage w/ vitamin B12

deficiency

10yr old "spaces out" in class(stops talking midsentence

and then continues as ifnothing had happened).

During spells, quivering oflips. Dx?

Absence seizure.

85yr old man w/ knee painand swelling. X-ray showsincreased joint space w/oerosion. Dx? What does

aspirate show?

Pseudogout. Rhomboidcalcium pyrophosphate

crystals.



14/18

X-ray shows bilateral hilarlymphadenopathy. Dx?

Sarcoidosis.

5yr old boy w/ systolic

murmur and a wide, fixedsplit S2. Dx?

ASD

Pharmacology Vignettes p286

28yr old chemist w/ MPTPexposure. Neurotransmitter

depleted?

Dopamine


15/18

Woman taking tetracycline isphotosensitive. Clinical

manifestations?

Rash on sun-exposed regionsof body

Non-diabetic pt has

hypoglycemia but low C-peptide. Dx?

Surreptitious insulin injection

African-american man whogoes to Africa develops a

hemolytic anemia after takingmalarial prophylaxis. Enzyme

deficiency?

Glucose-6-PhosphateDehydrogenase

27yr old female w/ hx ofpsych illness now has urinary

retention due to aneuroleptic. Tx?

Bethanechol


16/18

Farmer presents w/ dyspnea,salivation, miosis, diarrhea,

cramping, blurry vision.

Cause & mechanism?

Insecticide poisioning;inhibition of AChE

Pt w/ recent kidney transplantis on cyclosporine forimmunosuppression.

Requires antifungal agent forcandidiasis. What antifungal -

> cyclosporine toxicity?

Ketoconazole

Man on several medsincluding antidepressants and

antihypertensives, hasmydriasis and becomes

constipated. Cause?

TCA

55yr old postmenopausalwoman is on tamoxifen

therapy. Risk?

Endometrial carcinoma


17/18

Woman on MAO inh hashypertensive crisis after a

meal. What did she eat?

Tyramine (wine/cheese)

After taking clindamycin, pt

dev toxic megacolon anddiarrhea. Mechanism?

Clostridiumdicileovergrowth

Pharmacology Vignettes p287

Man starts meds forhyperlipidemia. Then rash,

pruritus, and upset GI. Drug?

Niacin


18/18

Pt on carbamazepine. Whatroutine workup should always

be done?

LFTs

23yr old female who is onrifampin for TB prophylaxis

and on birth control(estrogen) gets pregnant.

Why?

Rifampin augments estrogen

metabolism in the liver,rendering it less efective.

Pt develops cough and mustdiscontinue captopril. What isa good replacement? Why not

same side efects?

Losartan, an angiotensin IIreceptor antagonist, does not

increase bradykinin ascaptopril does.

USMLE Vignette Flashcards: Micro, Path and Pharm -Sidebyside

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