TommyK 1391 - 1400

[Axon]

1391
A middle aged female patient of yours has a family history of heart disease...SO sad. Her father and mother both developed congestive heart failure and myocardial infarction from extensive coronary atherosclerosis. YOU tell her to start eating WHAT food product to reduce her risk for ischemic heart disease.

a) TASTY FISH! Fish oils diminish arachidonic acid metabolites which damage blood cells and reduce platelet aggregation.


1392
Your mother has the acute onset of dyspnea and palpitations. After you pray and cry, you do a pulmonary ventilation-perfusion scan. It indicates a high probability for a perfusion defect involving the right segmental pulmonary arterial branch. What caused this crappy dx?
Is it
1) Cirrhosis
2) irregular blood flow with stasis
3) platlet defect

a) Altered blood flow with stasis in the lung.


1393
Friends, I got info that EVERYONE got questions after the urea cycle. Right now, draw out the CYCLE from scratch paper and your memory....AT LEAST TRY FIRST.

a) Starting with Carbamoyl Phosphate coming together with the ammonium ion (IN THE MITOCHONDRIA), this complex forms CITRULINE from Ornithine. Then, in the cytosol, the citruline merges with ASPARTATE to make ARGINOSUCCINATE. Then ARGinine is formed as fumarate is split and goes back to the TCA/glycolysis. The ARGinine then THROWS OUT THE UREA before becoming Ornithine again. Ornithine, sad and lonely wanders back into the mitochondria for a friend and starts the cycle over again. THIS IS ON EVERONE'S TEST. This is how we get RID of ammonia!!


1394
REMEMBER: TOMMYK FEELS IT IS A MATTER OF TIME, AND IF YOU ARE PATIENT,
IT WILL ALL BE FINE.
BE KIND, EAT WELL, AND DON'T DO ANY SECOND JOBS OR YO' MEMORY will turn LATENT.
Here we go...you have a grandmother named Stephanie Seymour with a sudden loss of movement on part of the left side of her body. She has smoked a pack of cigarettes a day to maintain her figure and appetite for the past 50 years.
PE: T 37.1 C, P 80/minute, R 16/minute, and BP 160/100 mm Hg. A cerebral angiogram reveals occlusion of a branch of her middle cerebral artery.
Labs: Findings include a hemoglobin A1C of 9%.
Which blood lipid is most important in contributing to her disease?
1) Lipoprotein Lipase DEFiciency
2) Chylomicrons
3) LDL
4) VLDL

a) Sadly, your grandma has gotten a STROKE. The answer is LDL, which contributes to atherosclerosis.


1395
Your attending, Dr.Enrique Iglesias, tells you that atheroma formation can begin even in kids. The gross appearances of the aortas are recorded and compared with microscopic findings of atheroma formation. Which of the following is most likely to be the first visible gross evidence of an atheroma?
1) Calcification
2) Fatty streak

a) Fatty streaks!


1396
Your uncle, Robert Redford, has had increasing exercise intolerance for the past 7 years.
Labs: have shown fasting blood glucose measurements from 145 to 210 mg/dL for the past 25 years
He has not sought medical treatment.
What will likely lead to his death?
1) an MI
2) Stroke
3) Boredom

a) An MI. Diabetes predisposes to MIs.


1397
A patient comes in named Richard Nixon and dies suddenly and unexpectedly while you are the intern on staff. The immediate cause of death is found to be a hemorrhage in the right basal ganglia region.
On microscopic examination his renal artery branches have concentric endothelial cell proliferation which markedly narrows the lumen, resulting in focal ischemia and hemorrhage of the renal parenchyma.
Q) which of the following substances in his blood is most likely to be associated with these findings?
1) Elevated Troponin I
2) Renin
3) Calcium
4) Cholesterol

a) RENIN! Hyperplastic arteriolosclerosis accompanies malignant hypertension.


1398
Just KNOW that an elevated serum ammonia level is indicative of Hepatic Failure.


1399
American Idol TV show winner Carrie Underwood presents 10-year-old previously healthy child has been noted by her parents to be constantly thirsty. She is consuming large amounts of soft drinks. She is urinating often. Her diet and exercise patterns have not changed, except for an increased appetite, yet she appears cachectic and has lost 7 kg over the past 4 months. On physical examination there are no abnormal findings, other than peripheral muscle wasting and weakness. Which of the following laboratory findings would you most strongly suspect is present in this girl?
1) Increased blood insulin
2) Decreased blood glucagon
3) Ketonuria

a) Ketonuria! She has Type I diabetes. She has too much glucagon and insulin in her blood.


1400
Decades later, a patient by the name of Cindy Crawford, who exercises regularly falls down the stairs and injures her right hip. A radiograph is taken of the pelvis. There is no fracture but the radiograph reveals calcification of the small muscular arteries in the region of the pelvis. What is the probable vascular lesion which accounts for this calcification?
1) Calcific medial sclerosis
2) Metastatic calcification
3) DVT
4) Dystrophic calcification

a) Hard question...answer is Calcific medial sclerosis, VERY COMMON, hard to diagnose. The other choices involve usually larger vessels...not peripheral ones.