MSC QBank – Block 8

A 36-year-old male comes to the clinic with complaints of distorted vision. He has recently immigrated to the US and doesn’t have a complete health history available. Other than the visual complaint he denies and recent trauma, headache, dizziness, change in dietary habits, pain, weakness, motor function, or sensation loss.

His vitals are below:

Height: 80”inches (203cm)

Weight: 173 lbs (78kg)

BMI: 19 kg/m²

HR: 81 beat/min

RR: 16 breath/min

BP: 126/81 mm Hg

Temp: 37°C (98.6°F)

Physical exam:

Evidence of optical lens subluxation superiorly and temporally, mild pectus carinatum and noticeable arachnodactyly.

What cardiovascular risk would he also be susceptible to?

A 68-year-old male presents to the clinic with complaints of chest pain for the past 2-3 days. He describes the pain as a sharp pain in the front of his chest. It increases with inspiration and tends to spread to the shoulder ridge. He has learned to decrease the pain by sitting with his head in his hands. The patient is on dialysis for renal failure from his insulin-dependent type 2 diabetes mellitus. He missed his last hemodialysis appointment because the procedure makes him feel weak and unwell.

Vital signs: BP: 153/96 mmHg; HR: 98 /min; RR: 18 /min; SpO2: 94% on room air

Physical examination: There is mild cognitive impairment, and an unpleasant odor on his breath. The skin shows scattered petechiae. Auscultation reveals a friction rub over the anterior chest, but no murmurs. Lung fields are clear.

The most likely cause of the patient’s findings is

A 36-year-old African Caribbean male is brought to the emergency department after he collapses at his construction job. EMTs say the patient was initially conscious, but became unable to speak. He had loss of movement in his right face and arm, with relative preservation of movement in his leg. In the ER, the patient is non-responsive.

Vital signs: normal

Physical examination: non-contributory except for

• Glasgow coma score 6
• Heart sounds reveal an apical murmur, represented in the image

CT scan shows a left middle cerebral artery stroke. Despite treatment, the patient dies 3 days later. At autopsy, there is a dilated left atrium and an abnormal mitral valve, its superior view is represented in the image.

The most likely etiology of these findings is

A 34-year-old female presents with shortness of breath and fatigue for the past week. She has known sarcoidosis and is on steroid therapy. She has been well until the onset of these new symptoms.

Vital signs: HR: 38 /min; BP: 121/68 mmHg; RR: 19 /min; Temperature: 98/1 F, SpO2: 97% on room air.

Physical examination reveals bradycardia with a regular pulse. The remainder of the exam is non-contributory.

EKG:

What is the cause of this pathophysiology?

A vascular lesion involving the area of the temporal lobe supplied by the right middle cerebral artery would produce which of these visual field defects?

A 74-year-old male with chronic hypertension presents to the emergency department due to progressive shortness of breath, persistent cough that gets worse when lying flat, noticeable swelling in his ankles, and mild weight gain. His medications are losartan, amiloride, nadolol, and hydrochlorothiazide. He stopped taking all of his medications recently because he wanted to try a pure lifestyle modification approach. The patient is admitted to the hospital for management of acute decompensated heart failure, but he is unresponsive to medical management and dies. What is most likely seen during autopsy?

A neuroradiology exam identified a meningeal tumor that was pressing on the left side of the dorsal funiculus at the T8 level of the spinal cord. Which of the following deficits would be expected in this patient?

A patient goes to the physician complaining of having a dry mouth. In addition, there was a very weak gag response noted. A lesion to which of the following could be the basis for the dry mouth?

A 63-year-old male is being evaluated 2 weeks after experiencing a transient ischemic attack. There is thickening of his carotid artery walls by ultrasound and his LDL cholesterol is 233 mg/dL. In addition to lifestyle alteration, he is placed on atorvastatin. One year later his LDL cholesterol is 164 mg/dL.

The mechanism of action by which this decrease was achieved is

A 24-year-old woman is walking to retrieve her suitcase after a flight from Milan, Italy to Minneapolis, MN, when she experiences sudden-onset shortness of breath. Her past medical history is positive for a deep vein thrombosis one year ago which was treated with anticoagulants for 6 months. The patient has a nine pack-year history of smoking. She is taking birth control pills.

Vital signs: HR: 112 /min; RR: 26 /min; BP: 122/82 mmHg; temperature: 99.5 F; SpO2: 91%.

Physical examination: tachypnea, bibasilar crackles.

The pathophysiologic parameter that most closely correlates with outcome of the most likely diagnosis is

A 66-year-old woman is seen in the clinic because she is having difficulty getting her breath when she exercises. There is no associated pain. The patient has a 64 pack-year history of cigarette smoking.

Vital signs: SaO2: 96% on room air

Physical examination: Auscultation reveals no abnormalities of heart or lungs.

Pulmonary function testing:

• FEV1: 68%
• FVC: 80% predicted
• DLCO: 58% predicted
• Residual volume : 138% predicted maximum; normal total lung capacity (by body plethysmography)

The pathophysiologic abnormality causing the increased residual volume is

A biopharmaceutical firm develops a product that blocks the function of IL-12 in tissue culture and laboratory animals.  As human trials begin, volunteers should be monitored for most increased susceptibility to which of the following?

An 18-year-old male presents to his college infirmary complaining that he is so fatigued that he can no longer keep up with classes.  He has a dry cough and low-grade fever.  He finds it difficult to keep up with an exercise regimen and feels that this has been going on for so long that he needs medical help.  A chest radiograph shows diffuse, bilateral infiltration.   The pathology associated with this presentation follows which of the following pathways?

A 26-year-old primary school teacher seeks the advice of her physician because several of her students have been diagnosed with slapped cheek fever within the past week.  She admits to her doctor that she has not informed her employer that she is 6-weeks pregnant but is now concerned with this viral outbreak.   Her physician recommends that her anti-B19 virus titers be tested promptly.  Which of the following would be the preferred result?

A 19-year-old female presents to her doctor’s office for a routine, pre-college physical.  She reveals that over the past 12 months, she has been feeling very tired and short of breath with minor exertion.  She has passed this off to her increased workload, graduation, and stress from college applications.  On review of systems, she admits that she had two episodes of dark colored urine in the morning.  On physical examination, her conjunctiva and gums appear pale.  No cardiac murmurs, rubs or gallops are appreciated, and the lungs are clear to auscultation.  She denies smoking, drinking or illicit drug use.  Her last menstrual period was 15 days ago and lasted 3 days.  Her BMI is within normal limits.  Urine dipstick shows blood in her urine, but no RBCs are appreciated on microscopy. Which of the following deficiencies is most likely in this patient?

A company is designing a new drug aimed at treating schizophrenia. The drug has a large molecular weight, is insoluble in water, and is coated in a microsphere that prevents degradation. When administered intramuscularly, its half-life is roughly 6 days. Based on the length of time it takes the drug to reach steady state, what is a potential pitfall of this new drug when used clinically?

A child with Turner syndrome is born to a normal female married to a male with hemophilia A. The child is found to have normal Factor VIII activity. What is the most likely explanation of how this occurred?

A 44-year-old male presents to his physician’s office with a one day history of a flu-like illness: fever, chills, malaise, nausea, cough, chest tightness, and dyspnea. Physical examination shows tachypnea and diffuse, fine crackles. He is reassured and supportive care is recommended. Three weeks later, he presents with the same story. He states that he had fully recovered from the previous illness before this new onset. Supportive care is recommended. Follow-up phone call one week later confirms full recovery of the patient.

Two weeks later, the patient presents with the same symptoms and findings.

Pulmonary function testing shows an FEV1 of 83% and an FVC 66% predicted.

A high resolution CT scan is ordered and seen in the image and shows ground glass infiltrates in the upper and mid lobes.

The best explanation of these findings is

A 35-year-old female comes to the emergency room with a painful knee and difficulty in walking. The radiologic exam showed a large cyst compressing structures in the popliteal fossa. Which of the following motor functions is most likely affected?