TommyK posts 1401 - 1415

[Axon]

1401
A favorite patient of yours, Rita Hayworth, has had pancreatitis for the past three weeks. She is examined one morning on rounds and found to have a swollen right leg. It is tender to palpation posteriorly but is not warm. This condition is most likely to be the result of what vascular dx?
1-Venous thrombosis
2-Septic embolization
3-Congestive heart failure
4-Cellulitis
5-Infarction
6-Watching too many Star Trek reruns

A) Venous Thrombosis


1402
A young AA boy named Gary Coleman has been noted by his parents to be constantly thirsty.
He is drinking Coca Cola by the cases (Tommyk owns a lot of Coke KO stock).
He urinates 20 times a day.
He eats well, but has lost 15 pounds over the past couple of months.
On physical examination, there are no abnormal findings, other than peripheral muscle wasting and weakness.
What lab finding is likely?
Increased blood insulin, Decreased blood glucagon, Ketonuria, increased serum osmolality, Decreased plasma hydrogen ion (alkalosis) OR Decreased plasma cortisol?

a) Ketonuria. KNOW THAT increased serum osmolality is associated with Diabetes Type II.
KNOW that decreased plasma cortisol is often a SIGN FOR Addison's Dx.



1403
Your Grandmother 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?
Ulcerative atherosclerosis
Calcific medial sclerosis
Metastatic calcification, OR
Dystrophic calcification?

A) Calcific medial sclerosis. It is a benign, incidental finding most often seen in the elderly. Small arteries in pelvis and extremities are typically involved.


1404
Pt named Diana Ross has been treated in the hospital for pancreatitis for a month.
She is examined and found to have a swollen right leg. It is tender to palpation posteriorly but is not warm. This condition is the result of which of the following vascular complications?
Venous thrombosis
Congestive heart failure OR
Cellulitis?

a) Venous thrombosis


1405
A pt. named Britney Spears crashes her Ferrari and that results in severe lacerations to her lower extremities, along with blunt abdominal trauma. You must save her. In the ER she is noted to have cool skin.
She has vital signs showing T 38 C, P 105/minute, R 19/minute, and BP 60/30 mm Hg. She has decreased urine output. Which of the following laboratory findings is most likely?
Hematocrit of 70%
Glucose of 200 mg/dL
PaO2 of 20 mm Hg
Lactic acid of 4.5 mmol/L
Troponin I of 4 ng/mL

A] Lactic acidosis is the answer.


1406
Your best friend's uncle Bob has a sudden onset of severe chest pain after watching late night cable.
Vital signs: T 37 C (NORMAL),
P 101/minute,
R 20/minute,
BP 80/40 mm Hg.
An electrocardiogram demonstrates changes that are consistent with myocardial ischemia involving the left lateral ventricular free wall. You, an ER lady doc, give him thrombolytic therapy with tissue plasminogen activator (tPA). However his serum creatinine kinase is found to be 450 U/L 4 hours after this therapy. What happened at the cellular level?
Cellular regeneration
Drug-induced necrosis
Reperfusion injury
Myofiber atrophy

a) This is a biggie! The Reperfusion of damaged cells results in generation of oxygen free radicals to produce a reperfusion injury.


1407
There was a study conducted with ex-porn stars with diabetes mellitus, a they had blood glucose measurements ranging from 150 to 200 mg/dL for at least 10 years. Rectal biopsies from these patients now show that there is a form of osmotic cellular injury present in arterioles. This form of injury is most likely to be manifested by which of the following complications?
Colonic adenocarcinoma
Congestive heart failure
Impotence
Pyelonephritis

a) IMPOTENCE. (This IS an Important concept). The hyperglycemia leads to formation of sorbitol in tissues not requiring insulin for glucose uptake, resulting in osmotic cellular injury. This can occur in small vessels, retina, kidney, and nerves. The failure of erection and ejaculation results from diabetic neuropathy. My buddy Dr. Goljan told me about this.


1408
You are a nephrologist looking at the kidneys of a 48-year-old woman named Sharon Stone who died suddenly. Her kidneys are found to be of normal size. Their surfaces appear finely granular. There are small hemorrhages noted. The cortices appear pale. Microscopically, many small renal arteries and arterioles demonstrate concentric intimal thickening with marked LUMINAL narrowing. These findings are most likely to be present as a result of which of the following underlying diseases?
Amyloidosis
SLE
Scleroderma
Rheumatoid arthritis
Viral hepatitis
Diabetes mellitus
TOUGH EH?

a) Scleroderma! Hyperplastic arteriolosclerosis is typically seen with severe hypertension, which can occur with progressive systemic sclerosis (scleroderma).


1409
Upon leaving her cell, a pt named Martha Stewart, a previously healthy woman, notes that she has bruises form on her arms and legs with minor trauma. PE reveals areas of purpura from 1 to 3 cm in size over her body and extremities, but no swelling, warmth, or redness. Peripheral pulses are all palpable. Her blood pressure is 100/80 mm Hg. An ultrasound examination reveals no evidence for thrombosis. Labs: serum urea nitrogen of 20 mg/dL, LDH 300 U/L, total protein 6.9 g/dL, albumin 5.3 g/dL, alkaline phosphatase 50 U/L, AST 40 U/L, and ALT 20 U/L. Which of these labs also is most likely to be present?
Hyperglycemia
Hyper LDL
Lactic acidosis
Thrombocytopenia
Anxiety from having lost hundreds of millions of dollars in MSO stock
Anemia
(Guess first)

a) It IS thrombocytopenia. NO evidence of liver dx. The platelets are responsible for dealing with small leaks in vessels. Thrombocytopenia is marked by petechiae and purpura. She does not have evidence for peripheral vascular disease, since her circulation is good. Venous thrombosis should lead to swelling and tenderness. And MSO stock has since rebounded, so her anxiety level is decreased.


1410
Your in law Grandmother falls down the steps of YOUR house. Grandma is hospitalized for surgery to replace the broken hip she sustains and is then moved to a nursing home, but she is unable to ambulate until about a month later, when she dies suddenly. You feel guilty. Which of the following is most likely to be the immediate cause of death found at autopsy?
Squamous cell carcinoma of skin
Tuberculosis
Pulmonary embolism

a) Pulmonary embolism


1411
A pt of yours named Liz Taylor comes in with vital signs all NORMAL except BP 170/110 mm Hg. She has an abdominal ultrasound examination that shows the right kidney to be atrophic. Angiography reveals markedly reduced blood flow to the right renal artery. Which of the following laboratory findings is she most likely to have?
Serum sodium of 150 mmol/L
Serologic evidence of anti-cardiolipin antibody
Prothrombin time of 25 seconds
Plasma renin activity of 4.8 ng/mL/hr supine
Serum lactic acid of 5.5 mmol/L

a) RENIN UP...She has renal artery stenosis that is reducing renal blood flow on the right and simulating the JG cells to secrete renin to try and raise blood pressure to increase renal blood flow. Recall that anti-cardiolipin antibody is seen with the antiphospholipid syndrome, which is a cause for thrombosis. It is unlikely that the selective renal artery occlusion represents a hypercoagulable state.


1412
You are treating the best friend of Gualberto Villarroel López, President of Belize. A study of islets of Langerhans is performed. It is observed that insulitis may occur in the islets. The inflammatory infiltrate is predominantly composed of T lymphs. Which of the following is most likely to occur as a consequence of insulitis?
Cancer
Malabsorbtion
Ketoacidosis
Obesity
Sepsis

a) Ketoacidosis, TYPE I Diabetes. If you picked Malabsorption, KNOW the pancreas has an endocrine and exocrine part.


1413
Luiz Inacio Lula da Silva, President of Brazil, asks you to tend to his 21 year old son who has blunt trauma to his upper outer arm. On PE, there is a 3 x 3 cm contusion. The soft tissue bleeding stops in a few minutes, the size of the bruise does not increase. Which of the following chemical mediators is most important in this episode of hemostasis?
Leukotriene
Prostaglandin
Prostacylin
Plasminogen
Thromboxane

a) THROMBOXANE! The others vasoconstrict or dilate and prostacyclin INHIBITS platlet aggregation.


1414
Norodom Sihamoni, King of Cambodia, asks you to heal his brother, a 50 yr old. The brother feels some crushing chest pain along with numbness in his left arm after shoveling some dirt in his garden. An hour later he collapses and is taken to the ER..to YOU. Which of the following lab tests run on a blood specimen is most useful?
Glucose
Platelet count
Creatine kinase
Amylase

a) CK-MB (Creatinine)


1415
[My hands are tired, my soul is weak. Let's let Tommy take a break. MOA of drugs uses less typing, lest I get carpal tunnel syn] So...
MOA of succinyl choline?

a) Nicotinic blockade, muscle relaxant depolarizing NM blocker, binds Ach receptors and inactives. NOTE: Depolarizing blockers are NOT reversed by cholinesterase inhibitors!!! think about that!