question from nbme 2

[drmedstudent]

1.. .Women with multiple sex partners, gets vaginal discharge, 3 sexual partners for past 6 months, tenderness with cervical motion, mucopurulent discharge, erythematous and edematous cervical os. She’s at greatest risk for infertility. What organism?


2.. .Elderly women with generalized bone pain and loss of height for last 5 yrs. Ca, PO4, Alk phos normal, protein electrophoresis normal, x ray = loss of bone density and compression at T8. Whats likely finding? Ans. Thin trabeculae w/ low osteoclastic activity


3.. .Right pupil is small and non reactive to light. Left pupil is normal. Where is lesion? Ans. Optic tract. Why?

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[IMGUSMLEStep1]

1. Chlamydia
2. Osteoporosis
3. a pupil that is non-reactive to light when light is shone on it (but reacts when light is shone on the other eye) means that there is a lesion in the afferent pathway proximal to the Lateral geniculate body. I don't know why the pupil is small or why it is an optic tract lesion in particular.

 

[IMGUSMLEStep1]

If you're using UW, search for Question 629 for osteoporosis. It has a really cool image in the explanation that once you see, you'll never forget.

 

[drmedstudent]

1. Chlamydia
2. Osteoporosis
3. a pupil that is non-reactive to light when light is shone on it (but reacts when light is shone on the other eye) means that there is a lesion in the afferent pathway proximal to the Lateral geniculate body. I don't know why the pupil is small or why it is an optic tract lesion in particular.

1. chlamydia makes sense...can u explain y it couldnt be neisseria gonorrhea, since this is more acute and chlamydia is more subacute

2. thanks ill check it out..still long ways to go with uworld bank

3. i guess that makes sense...i was thinking if its an optic tract lesion prox to LGB she'd present w/ some kind of blindness (ie. hemianopsia, etc)..but the case didnt mention any of that

 

[knuckles]

1. chlamydia makes sense...can u explain y it couldnt be neisseria gonorrhea, since this is more acute and chlamydia is more subacute

2. thanks ill check it out..still long ways to go with uworld bank

3. i guess that makes sense...i was thinking if its an optic tract lesion prox to LGB she'd present w/ some kind of blindness (ie. hemianopsia, etc)..but the case didnt mention any of that

It's a simple epidemiology question. Chlamydia is more prevalent in the United States than Gonorrhea.

 

[drmedstudent]

ok thx had more q's

1.. .15yr old girl has fever, nausea, acute abdominal pain and tenderness. Lab shows neutrophilic leukemoid rxn; laparatomy and appendectomy are done. Which histological finding will establish diagnosis of acute appendicitis? Is it follicular lymphoid hyperplasia or neutrophilic infilitrate of muscularis?
. .2. Acting bilaterally external oblique muscles produce which movement of vertebral column? Ans. Rotation. Why not flexion [Moore’s Clinical Anatomy says both flexion and rotation]?

..3. Why does pyridiostigmine cause abdominal cramping [im associating cramping with constipation]? Shouldn’t it cause diarrhea instead since it’s a indirect Ach agonist?

 

[kryptik]

cramping is not constipation, cramping is more like excessive motility

with regard to the appendicitis question i was also stuck with those two choices, because i believe RR stated that lymphoid hyperplasia was the mcc in children but i ended up going with neutrophilic infiltrate

 

[knuckles]

you should modify your DUMBBELSS to add cramping at the end. it's one of the excess ACh symptoms (eg organophosphate poisoning.)

Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation of CNS & Skeletal muscle
Lacrimation
Salivation
Sweating
Abdominal cramping