Case Questions Flashcards
A 32-year-old female presents with galactorrhea, frequent headaches, and decreased vision in her left eye. She has a year-long history of amenorrhea. Radiologic studies confirm a pituitary adenoma.
Overproduction of which hormone is the most likely cause of her clinical symptoms? A. prolactin B. growth hormone C. antidiuretic hormone D. follicle-stimulating hormone
A. prolactin
A 32-year-old female presents with galactorrhea, frequent headaches, and decreased vision in her left eye. She has a year-long history of amenorrhea. Radiologic studies confirm a pituitary adenoma.
Loss of vision in her left monocular visual field could be explained by damage to nerve fibers in the \_\_\_\_\_\_\_\_. A. left optic tract B. right optic tract C. right frontal lobe cortex D. left occipital lobe cortex
B. right optic tract
A 32-year-old female presents with galactorrhea, frequent headaches, and decreased vision in her left eye. She has a year-long history of amenorrhea. Radiologic studies confirm a pituitary adenoma.
The pituitary gland is located ________.
A. anterior to the lesser wings of the sphenoid
B. within the petrous portion of the temporal bone
C. superior to the cribriform plate and the crista galli
D. in the sella turcica, inferior to the diaphragma sellae
D. in the sella turcica, inferior to the diaphragma sellae
A 32-year-old female presents with galactorrhea, frequent headaches, and decreased vision in her left eye. She has a year-long history of amenorrhea. Radiologic studies confirm a pituitary adenoma.
What is the embryological origin of the cells in her tumor? A. diencephalon B. oral ectoderm C. neural crest cells D. rostral neural tube
B. oral ectoderm
Post-mortem microscopic examination of the proximal end of the left anterior descending coronary artery from a 41-year-old female reveals a thrombotic occlusion arising from an atherosclerotic plaque.
Which of the following underlying conditions most likely led to her death? A. glomerulonephritis B. portal hypertension C. calcific aortic stenosis D. type 2 diabetes mellitus
D. type 2 diabetes mellitus
Post-mortem microscopic examination of the proximal end of the left anterior descending coronary artery from a 41-year-old female reveals a thrombotic occlusion arising from an atherosclerotic plaque.
Hypercholesterolemia was implicated in the pathogenesis of her atherosclerosis. In the synthesis
of cholesterol, what is the key regulating enzyme?
A. phosphodiesterase
B. HMG-CoA reductase
C. cholesterol desmolase
D. cholesterol synthetase
B. HMG-CoA reductase
Post-mortem microscopic examination of the proximal end of the left anterior descending coronary artery from a 41-year-old female reveals a thrombotic occlusion arising from an atherosclerotic plaque.
What is the source of the left anterior descending coronary artery? A. aortic sinus B. circumflex artery C. left coronary artery D. right coronary artery
C. left coronary artery
A 3-year-old male presents with epistaxis, pain, and vomiting. Physical examination reveals generalized lymphadenopathy. Lab test results confirm a diagnosis of acute lymphoblastic leukemia.
Acute lymphoblastic leukemia is characterized by ________.
A. Bence-Jones proteins in the urine
B. decreased numbers of all types of blood cells
C. tumor masses in multiple contiguous lymph nodes
D. the presence of Reed-Sternberg cells in the bone marrow
B. decreased numbers of all types of blood cells
A 3-year-old male presents with epistaxis, pain, and vomiting. Physical examination reveals generalized lymphadenopathy. Lab test results confirm a diagnosis of acute lymphoblastic leukemia.
The follicles contained within his swollen lymph nodes are composed mostly of \_\_\_\_\_\_\_\_. A. B cells B. NK cells C. CD4+ T cells D. CD8+ T cells
A. B cells
A 3-year-old male presents with epistaxis, pain, and vomiting. Physical examination reveals generalized lymphadenopathy. Lab test results confirm a diagnosis of acute lymphoblastic leukemia.
His vomiting is initiated by stimulation of which of the following motor nerve fibers in his stomach? A. celiacganglion B. vagus nerve (CN X) C. glossopharyngeal (CN IX) D. superior hypogastric plexus
B. vagus nerve (CN X)
A 20-year-old female presents with difficulty climbing stairs and rising from a seated position. Onset was 6 months ago. Physical examination reveals a dusky red rash over her knuckles, heliotrope discoloration of her upper eyelids, and periorbital edema. She has symmetrical, proximal muscle weakness, and diminished motor strength in all extremities. Deltoid biopsy results confirm a diagnosis of dermatomyositis.
Which of the following findings is consistent with a diagnosis of dermatomyositis? A. vasculitis B. hemochromatosis C. amyloid deposition D. perifascicularhypertrophy
A. vasculitis
A 20-year-old female presents with difficulty climbing stairs and rising from a seated position. Onset was 6 months ago. Physical examination reveals a dusky red rash over her knuckles, heliotrope discoloration of her upper eyelids, and periorbital edema. She has symmetrical, proximal muscle weakness, and diminished motor strength in all extremities. Deltoid biopsy results confirm a diagnosis of dermatomyositis.
Which of the following antibodies is most likely to be elevated in her serum? A. anti-Jo-1 B. anti-Smith C. anti-centromere D. anti-DNase B
A. anti-Jo-1
A 20-year-old female presents with difficulty climbing stairs and rising from a seated position. Onset was 6 months ago. Physical examination reveals a dusky red rash over her knuckles, heliotrope discoloration of her upper eyelids, and periorbital edema. She has symmetrical, proximal muscle weakness, and diminished motor strength in all extremities. Deltoid biopsy results confirm a diagnosis of dermatomyositis.
Biopsy shows pathologic changes in the connective tissues and associated muscle tissues. Which type of connective tissue directly surrounds individual muscle fibers? A. epimysium B. epineurium C. perimysium D. endomysium
D. endomysium
A 20-year-old female presents with difficulty climbing stairs and rising from a seated position. Onset was 6 months ago. Physical examination reveals a dusky red rash over her knuckles, heliotrope discoloration of her upper eyelids, and periorbital edema. She has symmetrical, proximal muscle weakness, and diminished motor strength in all extremities. Deltoid biopsy results confirm a diagnosis of dermatomyositis.
Which of the following would most likely cause weakness in a muscle?
A. increased cytosolic calcium levels
B. decreased actin-myosin cycling rate
C. decreased activity of acetylcholinesterase
D. decreased uptake of calcium into the sarcoplasmic reticulum
B. decreased actin-myosin cycling rate
A 4-week-old male has a ventricular septal defect. Physical examination reveals a systolic murmur, but there is no evidence of cyanosis. Echocardiography shows a left-to-right shunt through a defect in the membranous part of the interventricular septum.
The membranous interventricular septum is normally formed by the \_\_\_\_\_\_\_\_. A. sinus venosus B. septum primum C. septum secundum D. endocardial cushions
D. endocardial cushions
A 4-week-old male has a ventricular septal defect. Physical examination reveals a systolic murmur, but there is no evidence of cyanosis. Echocardiography shows a left-to-right shunt through a defect in the membranous part of the interventricular septum.
How have his cardiac hemodynamics changed as a result of his left-to-right shunt?
A. heart rate is decreased
B. stroke volume is increased
C. cardiac output is decreased
D. left ventricular end diastolic volume is increased
C. cardiac output is decreased
A 4-week-old male has a ventricular septal defect. Physical examination reveals a systolic murmur, but there is no evidence of cyanosis. Echocardiography shows a left-to-right shunt through a defect in the membranous part of the interventricular septum.
If he had a right-to-left shunt, what would be the consequence? A. cyanosis B. left heart failure C. hypertrophy of the left ventricle D. re-opening of the foramen ovale
A. cyanosis
A 4-week-old male has a ventricular septal defect. Physical examination reveals a systolic murmur, but there is no evidence of cyanosis. Echocardiography shows a left-to-right shunt through a defect in the membranous part of the interventricular septum.
His condition predisposes him to infective endocarditis. One week later, he develops a fever and several septic emboli are detected in his lungs. Which pathogenic bacteria would be the most likely cause of his sepsis? A. Streptococcus viridans B. Staphylococcus aureus C. Haemophilus influenzae D. Staphylococcus epidermidis
A. Streptococcus viridans
A 22-year-old male has a history of mild, fluctuating, unconjugated hyperbilirubinemia. Lab test results indicate normal liver function. As there is no evidence of other disease processes, he is diagnosed with Gilbert syndrome.
What is the etiology of Gilbert syndrome?
A. a genetic absence of UDP-glucuronosyltransferase
B. a genetic decrease in hepatic levels of UDP-glucuronosyltransferase
C. immature hepatic processing, causing deficient conjugation of bilirubin
D. a deficiency of canalicular membrane transporters of bilirubin glucuronide
B. a genetic decrease in hepatic levels of UDP-glucuronosyltransferase
A 22-year-old male has a history of mild, fluctuating, unconjugated hyperbilirubinemia. Lab test results indicate normal liver function. As there is no evidence of other disease processes, he is diagnosed with Gilbert syndrome.
To make bilirubin more hydrophilic and facilitate its secretion into the biliary canaliculi, bilirubin is conjugated with \_\_\_\_\_\_\_\_. A. ascorbic acid B. hyaluronic acid C. glucuronic acid D. levomefolic acid
C. glucuronic acid
A 22-year-old male has a history of mild, fluctuating, unconjugated hyperbilirubinemia. Lab test results indicate normal liver function. As there is no evidence of other disease processes, he is diagnosed with Gilbert syndrome.
Bile drains directly from a bile canaliculus into a bile duct that is structurally parallel to a \_\_\_\_\_\_\_\_ in a portal triad. A. sinusoid B. cystic duct C. portal vein D. hepatic vein
C. portal vein
A 22-year-old male has a history of mild, fluctuating, unconjugated hyperbilirubinemia. Lab test results indicate normal liver function. As there is no evidence of other disease processes, he is diagnosed with Gilbert syndrome.
Normally, bilirubin is \_\_\_\_\_\_\_\_ before it is excreted from the body via the kidneys. A. converted to biliverdin B. converted to stercobilin C. neutralized by uric acid D. converted to urobilinogen
D. converted to urobilinogen
A 57-year-old male has a routine physical examination, including lab tests. His lab test results indicate significant hypercholesterolemia.
He is prescribed a cholesterol-lowering statin drug. Statin drugs affect the rate-limiting enzyme used in the biosynthesis of cholesterol. What is this rate-limiting enzyme? A. lipoprotein lipase B. HMG CoA synthase C. HMG CoA reductase D. acetyl-CoA synthetase
C. HMG CoA reductase
A 57-year-old male has a routine physical examination, including lab tests. His lab test results indicate significant hypercholesterolemia.
When evaluating his lipid levels, the physician must differentiate between the different types of lipoproteins. What is the function of VLDL?
A. transport of dietary lipids
B. transport of cholesterol to the liver
C. transport of triglycerides to the liver
D. removal of triglycerides from the liver
D. removal of triglycerides from the liver
A 57-year-old male has a routine physical examination, including lab tests. His lab test results indicate significant hypercholesterolemia.
Dietary cholesterol is transported to the liver as ________. A. LDL
B. HDL
C. VLDL
D. chylomicrons
D. chylomicrons
A 57-year-old male has a routine physical examination, including lab tests. His lab test results indicate significant hypercholesterolemia.
Hypercholesterolemia is a risk factor associated with the formation of atherosclerotic plaques. These plaques occur in which part of the vascular anatomy? A. tunica media B. tunica intima C. tunica externa D. tunica adventitia
B. tunica intima
