qns

Discussion in 'Step I' started by bhuvi, Nov 18, 2005.

  1. bhuvi

    bhuvi Junior Member
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    1..A 32-year-old woman complains of a sore throat, increasing fatigue,
    and shortness of breath for the past 3 days. On physical examination,
    her temperature is 101.5 F and her heart rate is 100, with no murmurs.
    A CBC with reticulocyte count shows 1500 white blood cells/mm3. The
    platelet count is 12 x 109/L. Bone marrow aspiration and biopsy
    demonstrates cellularity less than 25%, and the corrected reticulocyte
    count is less than 1%. Which of the following is the most likely diagnosis?
    A. Anemia of chronic disease
    B. Aplastic anemia
    C. Myelodysplasia with myelofibrosis
    D. Myelophthisic anemia
    E. Pure red cell aplasia

    2..A donor liver arrives in New York from Chicago 7 hours after harvest.
    A biopsy is performed on arrival to check for ischemic injury. The
    sensitive oxidase P450 system is very susceptible to ischemia. In
    which of the following regions of the liver is this system located?
    A. Bile ducts
    B. Intermediate zone
    C. "Ito" cells
    D. Pericentral vein zone
    E. Periportal zone

    3..During a routine pediatric examination, a 12-year-old boy is noted
    to be in growth arrest. The child is obese, and multiple small bruises
    are observed on his arms and legs. The patient has difficulty rising
    from a crouching position. Measurements of blood pressure demonstrates
    hypertension when compared to age-based standards. This patient most
    likely has which of the following?
    A. Diabetes mellitus
    B. Grave's disease
    C. Hypothyroidism
    D. Parathyroid adenoma
    E. Pituitary microadenoma

    4..A 35-year-old woman dies suddenly. Autopsy findings are within
    normal limits except for the heart Which of the following is the most likely diagnosis?
    A. Acute endocarditis
    B. Calcification of the mitral anulus
    C. Marantic endocarditis
    D. Mitral valve prolapse
    E. Rheumatic valvular disease

    with explanations plzzzzz?
     
  2. BlackNDecker

    BlackNDecker Paid da cost 2 be da bo$$
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    1) This is an acute infection, therefore the WBC should be elevated...1500 wbc/mm3 is not an appropriate response. Being an acute infection, you would not see a chronic compensation so the answer can't be anemia of chronic dz. There are no peripheral blasts or characteristic "tear drop cells", so the answer can't be myelodysplastic or myelofibrosis. There are no signs and symptoms of (breast) CA so myelophthisic syndrome is not the answer. The low WBC, low platelet, and hypocellularity of the BM all suggest Aplastic Anemia.

    2) Zone 3 is most susceptible to ischemia, this was the clue(they could have mentioned ANY enzyme and the reasoning would be the same). Zone 3 surrounds the central vein and has the lowest O2 content. Ito cells are involved in fibrotic cirrhosis. You can review the relationships of the other zones for yourself...

    3) The answer is hypothyroidism. Difficulty rising from a crouched position is a buzz for myopathy/proximal thigh muscle weakness. Increased diastolic BP is also common, as is the weight gain. Iron deficiency is a typical finding in hypothyroidism as well. Type II DM would be highly unlikely in a 12 yr old, while not impossible...it still doesn't account for the myopathy, bruising, and BP. If uncontrolled Type I DM, the child would be cachectic...if controlled, the child would be otherwise normal. The description of overweight rules out Grave's Dz. The description is also not indicative of parathyroid adenomas or hypofunctioning pituitary (micro)adenomas --> the child would be underweight similar to uncontrolled Type I DM.

    4) This question kinda sux...but I'm gonna go with Mitral Valve prolapse. This is the most common cause of sudden death in Marfan syndrome. It is also more common in women. None of the others would result in sudden death due to heart abnormalaties. Murantic vegetations could embolize and cause aneurysms(& hemorrhage) but the stem of the question nullifies this arguement.

    Why do I feel like I just did your homework?

    The above information is intended for educational purposes only and should not be used to diagnose, treat, cure or prevent any disease.
     
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  3. surrender903

    Physician Classifieds Approved 10+ Year Member

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    question 4 sucks.

    acute endocarditis does nt always show up at autopsy. MVP predisposes pt to acute endocarditis.
     
  4. BlackNDecker

    BlackNDecker Paid da cost 2 be da bo$$
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    Agreed.

    Are you arguing that the answer to question 4 should be AE? If so, how would this could cause sudden death? :confused:

    MVP could cause sudden cardiac death due to the associated conduction abnormalaties which would lead to vetricular fibrillation(i.e. sudden cardiac death).

    I was expecting to get schooled on question 3...
     
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  5. surrender903

    Physician Classifieds Approved 10+ Year Member

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    i thought about saying something about question 3, but i mean they didnt say hypo, they just said pit adenoma.


    nope not arguing at all, you did a fine job. simply stating somethign i learned while at the morgue
     
  6. bhuvi

    bhuvi Junior Member
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    Thanks a lot ! :)
     
  7. bhuvi

    bhuvi Junior Member
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    i still have a doubt on 3rd qn?? :confused:

    I guess pitiutary microademona can be producing excess ACTH and hence cushing disease,which often presents with proximal myopathy, hypertesion, increase in wieght, ******ed growth etc.( Plse correct me if wrong)
     
  8. BlackNDecker

    BlackNDecker Paid da cost 2 be da bo$$
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    First, let me correct my idiocy...I was mixing up completely unrelated facts in my head. For some reason I was thinking hypertrophic cardiomyopathy(conduction defects) when I was writing MVP. I have too much info dancing around in my brain. I still think best answer to #4 is MVP...but NOT due to conduction defects :laugh:

    Yes, but it could also be producing excess GH which would cause linear and horizontal growth. The stem of the question is VERY vague and offers no lab values.

    My reasoning is that if they are describing Cushing's Sx they will most likely offer at least one of the CHARACTERISTIC findings, i.e. moon fascies, buffalo hump, or purple striae. I am not familiar with myopathy and bruising associated with Cushing's...Anybody else? I don't feel like searching this at the moment, maybe later tonight.
     
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  9. Iwy Em Hotep

    Iwy Em Hotep The Welcomer
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    I think the answer is microadenoma causing Cushing's:

    - Bruising is common in Cushing's because of poor wound healing.
    - BP is high due to catecholamine release.
    - Myopathy probably due to mobilization of glucose/protein from muscles.
    - Short stature due to bone resorption.
     

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