CCFinalMED38.docx

7/28/2019 CCFinalMED38.docx

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pretest ( )

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= =

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Case 14 : Cough and Hemoptysis Case 23 : acute dyspnea

-accessory m

sternocleidomastoid m.

-4. central peripheral chemoreceptor

peripheral chemoreceptor carotid bodies hypoxemia

- chemoreceptor

alkalosis HCO3

- pump failure

myasthenia gravis

-

platypnea

- h ei hei

ventilation / perfusion mismatch

- hypoxemia

. V/Q mismatch PaO2 P[A-a]O2

- e heii

dead space

-

nasopharynx

-[pneumonia] dyspnea

inflammatory exudates alveoli V/Q mismatch

- [pneumonia]

bacteria Streptococcus pneumoniae

- afferent pathway

vagus n.

-

bchi .


3/19

-pneumocyte type II alveoli pneumocyte type I

pneumocyte type II alveolar surfactance

-. TB TB

-anti - TB drug TB high O2 , high nutrients

Isoniazid

-

N95

- cei hei histopathology

hyperplasia of mucous gland at bronchus

- cei hei

cid H cied -fiber

Case 15 : low back pain

-

weke f ibii ei . - ?

S2-S4 roots

-?

Spondylogenic causes

-?

Radicular pain

- limitation and pain on motion of back in flexion and extension?

dgeic cue

-

10cm


4/19

-

[tension]?

L5-S1 nerve roots

- igig

w f ieeeb dic

- igig ie

igh ie e iew

- e ff ube ie

ub dihei

-14 limit

-- cm

Case 16 : Abdominal mass ..

-Which following is true regarding to transpyloric plane

tip of 9 rib

-All of the following organ lie in right upper quadrant except ?

-Which organ moving well with respiration

-In healthy thin person which organ can be palpable except ?

ovary

-Which of following is physical sign are character of enlarged liver

dull to percussion up to level of 8 rib in the midaxillary line

-Which of following is physical sign are the character of the mesenteric cyst

Move freely along right upper to left lower quadrant

-

globular mass

pretest


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-

right illiac fossa

right common illiac artery aneurysm

- an heavy alcoholic

drunker male have mass in epigastrium palpable not move with respirationresonant on percussion which mass most likely ?

- 46 year old lady

have hypermennorhea and fatique have pale conjuntivae . palpable mass on

suprapubic . lower edge was not palpable . any move of mass move cervix . which

mass most likely?

-29 alcoholic drunker / resonance on percussion pancreatitis

Case 17 : breast mass . . .

-

trastuzumab

-

deep vein thrombosis

-

aromatase inhibitor

-

late menopause

-


6/19

-

incision and drianage-

fibroadenoma

-

colloid carcinoma

-

mammogram

Case 18 : obesity / polyuria [DM] .

-

insulin

-

metfomin

-

metformin

-

insulin


7/19

-

[edema] [congestive heart failure] 10

pioglitazone

- 16

dehydration sp. gr. 1.030 sugar 4+ protein - ketone + Na=

148 K= 6.5 Cl= 92 HCO3= 5 FPG= 560

-

200 mg/dl

-

-

-

cortisol , cortisol

- metformin

- increase insulin sensitivity***

- increase insulin secretion

- decrease glucagon secretion

-

-


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Case 19 : Growth retardation

-1.

[ 80 % of ideal weight for age , 3rd 5th

percentile , weight for length , 2 major percentile ]

-

growth chart

-

- ricket osteomalacia

epiphyseal plate

- ricket

increase alkaline phosphatase

-metabolic acidosis normal gap

renal tubular acidosis

-

hypokalemia

- positive, urine pH =

RTA type RTA type I

-

bicarb reclamation

- RTA 4= hypokalemia- =bicarbonate reclaimation-Ricket osteomalacia = epiphyseal growth plate

- ricket= high ALP-Fanconi = PCT

-56.

A. Hypernatremia

B. Hypokalemia*****

C. Hyperchloremia

D. Metabolic acidosis

E. Nephrocalcinosis


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Case 20 : weight loss [ Thyroid ]

-

thyroid peroxidase

- 38 3

diffuse enlargement of thyroid gland free T4

TSH

- PTU methimazole

lactating

- 26 PTU

3

agranulocytosis

- 36 2 diffuse

thyroid enlarge with tender free T3 TSH

subacute thyroiditis

- 15

PR 56 /min BP 100/70 enlargethyroid gland and short stature , free T4 , TSH

enzymatic defects

-

increase lymphocytic infilltration

- complication

low Ca

-

subacute thyroiditis

-


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>>>>> TSH

- PE:diffuse enlargement of thyroid with tenderness

-- Thyroiditis

- low calcium

Case 21 : Oliguria / Uremia

-Which of following is correct regarding definition of uremia ?

- mGFR

inulin

-Which of following is the contribute factor in pathophysiology of tubular injury inacute tubular necrosis ?

tubular cast obstruct

-Which of following is the indication for dialysis in acute kidney injury?

serum potassium

] and tall peak T wave in EKG

- pre - renal acute kidney injury

- -

ADH

Case 22 : Hematuria / Edema

-

acute tubular necrosis

-

hepatomegaly , caput

medusae , increase jugular venous pressure


11/19

- . 50 15

2 BP 150/80 diabetic retinopathy UA

glucose 2+ , protein 4+ , RBC 2-3 cells /hpf , granular cast 1-2 casts /lpf

- glo phagocytic activity

mesangial cell

-

-

-

[ ]

-

= =

- K

- hypoaldosterone

- aldesterone resistancde- increase of tubular flow and Na *****

- decrease of epithelial Na channel

- decrease of Na-K ATPase activity

-

hypertension,hematuria BUN=65 Cr=5 x-ray: stone U/D: hydronephrosis ddx?


12/19

a.prerenal azotemia

b.acute intersitial neprhitis

c.acute glomerulohephritis

d.

e.posrtrenal azotemia

-

Plasma oncotic pressure

^O^

B. Venous obstruction

C. Cirrhosis

D. CHF

E. Renal failure

Case 24 : abnormal menstruation

- 1. 17

1

ueu

- 25

FSH h

-. 30 6

LH

- eue

ege , geee

-

GnRH , GnRH -uie , H uie ,

pituitary gl ,

-

secretory , proliferative , mixed , atrophic

-


13/19

Case 25 : pelvic mass

-

- -

ficu c

- eg

hec uei c

-

nodularity uec ige

ede

- wk

dei

- i e

iid

- eg

- eg

Thbic ebizi

- ge f de ueu

eg wih uei

-29 molar pregnancy uci cuege

Thbic ebizi

Case 26 : Abnormal vaginal / urethral discharge

-1. 25 Gram stain

organism

cbciu


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- Gram stain organism

gram positive cocci , gram positive bacili , gram negative diplococci , gram negative

coccobacili -

pseudohyphae

-

organism motile with flaggella

-

Chlamydia trachomatis

-

gram stian

- [spinnbakeit ]

- 65

parabasal cell

-

estrogen

-31

>> Lactobacili

Case 27 : Chest pain

- clopidogrel


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adenosine diphosphate receptorplatelet

- isosorbide dinitrate

first pass metabolism

-

- thrombolytic drug

STEMI

-

streptokinase

-

-

thrombolytic drug

contraindication thrombolytic

- 40 year old men arrive to emergency department by onset of

severe chest pain 2 hr. He have history of hyperlipidemia treat by HMG-CoA

reductase inhibitor his BP 100/70 HR 95

EKG 12 lead

EKG elevation lead 2 , 3 , avF

acute EMI at inferior wall

- simvastatin


16/19

cardiac remodelling

-48. E sever chest pain yperlipidemia

M-o reductse inhibitor ital sign bpm E II III a

elevation) Acute STEMI ant.wall 2. NSTEMI 3.Acute STEMI inf.wall 4. Unstable angina 5.Stable angina

cute EMI infwall

Case 28 : Hypovolumic / shock

1. distributive shock hypotension

dopamine epinephrine norepinephrine

- shock

- shock

O2

- M

keep central venous oxygen saturation > 7 %

- high cardiac output shock

PP % SBP

- obstructive shock right side

high left atrial pressure

-56. BP 70/50 HR 180 supraventricular tachycardia shock

A. Decrease end diastolic volumn

B. Decrease cardiac contractility

C. Increase venous resistance

D. Increase venous compliance

E. Increase left ventricular afterload


17/19

Case 29 : dyspnea / orthopnea

- neurohormonal antagonist HF

digoxin

- chronic HF

digoxin

- metoclopamide chronic action

-sign + symptom evaluating HF

- peripheral pulse pulse

- chronic r I serum

on digoxin furosemide spironolactone

spironolactone

-62,.. 38 year old woman come with dyspnea on exertion, ortopnea physical examination reveal BP 130/60 bisferic

pulse, LV heaving , diastolic murmur . . . . diagnosis

a. ischemic cardiomyopathy

b. dilated cardiomyopathy

c. hypertrophic cardiomyopathy

d. chronic aortic regurgitation******

e. mitral stenosis

Case 30 : Jaundice

-enzyme chronic hepatocellular disease ALT

- chronic liver disease

gynecomastia

- dubin - johnson syndrome


18/19

multidrug resistance protein 2

-

pernicious anemia unconjugated hyperbillirubinemia

- intrahepatic cholestasis alcohol + oral contraceptive pills

-

billiverdin reductase billiverdin billurubin

- urobillinogen

feces

- liver synthetic function

coagulation -77 Intrahepatic cholestasis

1 Alcohol

2 Contraceptive pill

3 polycystic dz

4.Hemobilia

5 1+2

Case 1 : Abdominal pain

- somatic-parietal pain

myelinated delta fiber

-

Acute pancreatitis

-visceral pain hypogastrium organ

colon-pathological process acute alcoholic pancreatitis

inflammatory process

- biliary colic

biliary colic


19/19

-

gastric juice

- current jelly stool

intussusception- bowl sound borborygmy

small bowl obstruction

- imaging the best anatomical information

scan

- genetic acute abdominal pain

G6PD [ porphyria , sickle cell anemia , hemophilia , vasculitis]

-90. genetic abdominal pain?a.hemophillia

b.porphyria

c.G6PD

d.sickle cell

e.vasculitis

-82. visceral pain hypogastrium

A. Lower esophagus

B. Appendix

C. Stomach

D. Small intestine

E. Colon

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