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7/28/2019 CCFinalMED38.docx
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Case 14 : Cough and Hemoptysis Case 23 : acute dyspnea
-accessory m
sternocleidomastoid m.
-4. central peripheral chemoreceptor
peripheral chemoreceptor carotid bodies hypoxemia
- chemoreceptor
alkalosis HCO3
- pump failure
myasthenia gravis
-
platypnea
- h ei hei
ventilation / perfusion mismatch
- hypoxemia
. V/Q mismatch PaO2 P[A-a]O2
- e heii
dead space
-
nasopharynx
-[pneumonia] dyspnea
inflammatory exudates alveoli V/Q mismatch
- [pneumonia]
bacteria Streptococcus pneumoniae
- afferent pathway
vagus n.
-
bchi .
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-pneumocyte type II alveoli pneumocyte type I
pneumocyte type II alveolar surfactance
-. TB TB
-anti - TB drug TB high O2 , high nutrients
Isoniazid
-
N95
- cei hei histopathology
hyperplasia of mucous gland at bronchus
- cei hei
cid H cied -fiber
Case 15 : low back pain
-
weke f ibii ei . - ?
S2-S4 roots
-?
Spondylogenic causes
-?
Radicular pain
- limitation and pain on motion of back in flexion and extension?
dgeic cue
-
10cm
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-
[tension]?
L5-S1 nerve roots
- igig
w f ieeeb dic
- igig ie
igh ie e iew
- e ff ube ie
ub dihei
-14 limit
-- cm
Case 16 : Abdominal mass ..
-Which following is true regarding to transpyloric plane
tip of 9 rib
-All of the following organ lie in right upper quadrant except ?
-Which organ moving well with respiration
-In healthy thin person which organ can be palpable except ?
ovary
-Which of following is physical sign are character of enlarged liver
dull to percussion up to level of 8 rib in the midaxillary line
-Which of following is physical sign are the character of the mesenteric cyst
Move freely along right upper to left lower quadrant
-
globular mass
pretest
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right illiac fossa
right common illiac artery aneurysm
- an heavy alcoholic
drunker male have mass in epigastrium palpable not move with respirationresonant on percussion which mass most likely ?
- 46 year old lady
have hypermennorhea and fatique have pale conjuntivae . palpable mass on
suprapubic . lower edge was not palpable . any move of mass move cervix . which
mass most likely?
-29 alcoholic drunker / resonance on percussion pancreatitis
Case 17 : breast mass . . .
-
trastuzumab
-
deep vein thrombosis
-
aromatase inhibitor
-
late menopause
-
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incision and drianage-
fibroadenoma
-
colloid carcinoma
-
mammogram
Case 18 : obesity / polyuria [DM] .
-
insulin
-
metfomin
-
metformin
-
insulin
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[edema] [congestive heart failure] 10
pioglitazone
- 16
dehydration sp. gr. 1.030 sugar 4+ protein - ketone + Na=
148 K= 6.5 Cl= 92 HCO3= 5 FPG= 560
-
200 mg/dl
-
-
-
cortisol , cortisol
- metformin
- increase insulin sensitivity***
- increase insulin secretion
- decrease glucagon secretion
-
-
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Case 19 : Growth retardation
-1.
[ 80 % of ideal weight for age , 3rd 5th
percentile , weight for length , 2 major percentile ]
-
growth chart
-
- ricket osteomalacia
epiphyseal plate
- ricket
increase alkaline phosphatase
-metabolic acidosis normal gap
renal tubular acidosis
-
hypokalemia
- positive, urine pH =
RTA type RTA type I
-
bicarb reclamation
- RTA 4= hypokalemia- =bicarbonate reclaimation-Ricket osteomalacia = epiphyseal growth plate
- ricket= high ALP-Fanconi = PCT
-56.
A. Hypernatremia
B. Hypokalemia*****
C. Hyperchloremia
D. Metabolic acidosis
E. Nephrocalcinosis
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Case 20 : weight loss [ Thyroid ]
-
thyroid peroxidase
- 38 3
diffuse enlargement of thyroid gland free T4
TSH
- PTU methimazole
lactating
- 26 PTU
3
agranulocytosis
- 36 2 diffuse
thyroid enlarge with tender free T3 TSH
subacute thyroiditis
- 15
PR 56 /min BP 100/70 enlargethyroid gland and short stature , free T4 , TSH
enzymatic defects
-
increase lymphocytic infilltration
- complication
low Ca
-
subacute thyroiditis
-
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>>>>> TSH
- PE:diffuse enlargement of thyroid with tenderness
-- Thyroiditis
- low calcium
Case 21 : Oliguria / Uremia
-Which of following is correct regarding definition of uremia ?
- mGFR
inulin
-Which of following is the contribute factor in pathophysiology of tubular injury inacute tubular necrosis ?
tubular cast obstruct
-Which of following is the indication for dialysis in acute kidney injury?
serum potassium
] and tall peak T wave in EKG
- pre - renal acute kidney injury
- -
ADH
Case 22 : Hematuria / Edema
-
acute tubular necrosis
-
hepatomegaly , caput
medusae , increase jugular venous pressure
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- . 50 15
2 BP 150/80 diabetic retinopathy UA
glucose 2+ , protein 4+ , RBC 2-3 cells /hpf , granular cast 1-2 casts /lpf
- glo phagocytic activity
mesangial cell
-
-
-
[ ]
-
= =
- K
- hypoaldosterone
- aldesterone resistancde- increase of tubular flow and Na *****
- decrease of epithelial Na channel
- decrease of Na-K ATPase activity
-
hypertension,hematuria BUN=65 Cr=5 x-ray: stone U/D: hydronephrosis ddx?
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a.prerenal azotemia
b.acute intersitial neprhitis
c.acute glomerulohephritis
d.
e.posrtrenal azotemia
-
Plasma oncotic pressure
^O^
B. Venous obstruction
C. Cirrhosis
D. CHF
E. Renal failure
Case 24 : abnormal menstruation
- 1. 17
1
ueu
- 25
FSH h
-. 30 6
LH
- eue
ege , geee
-
GnRH , GnRH -uie , H uie ,
pituitary gl ,
-
secretory , proliferative , mixed , atrophic
-
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Case 25 : pelvic mass
-
- -
ficu c
- eg
hec uei c
-
nodularity uec ige
ede
- wk
dei
- i e
iid
- eg
- eg
Thbic ebizi
- ge f de ueu
eg wih uei
-29 molar pregnancy uci cuege
Thbic ebizi
Case 26 : Abnormal vaginal / urethral discharge
-1. 25 Gram stain
organism
cbciu
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- Gram stain organism
gram positive cocci , gram positive bacili , gram negative diplococci , gram negative
coccobacili -
pseudohyphae
-
organism motile with flaggella
-
Chlamydia trachomatis
-
gram stian
- [spinnbakeit ]
- 65
parabasal cell
-
estrogen
-31
>> Lactobacili
Case 27 : Chest pain
- clopidogrel
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adenosine diphosphate receptorplatelet
- isosorbide dinitrate
first pass metabolism
-
- thrombolytic drug
STEMI
-
streptokinase
-
-
thrombolytic drug
contraindication thrombolytic
- 40 year old men arrive to emergency department by onset of
severe chest pain 2 hr. He have history of hyperlipidemia treat by HMG-CoA
reductase inhibitor his BP 100/70 HR 95
EKG 12 lead
EKG elevation lead 2 , 3 , avF
acute EMI at inferior wall
- simvastatin
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cardiac remodelling
-48. E sever chest pain yperlipidemia
M-o reductse inhibitor ital sign bpm E II III a
elevation) Acute STEMI ant.wall 2. NSTEMI 3.Acute STEMI inf.wall 4. Unstable angina 5.Stable angina
cute EMI infwall
Case 28 : Hypovolumic / shock
1. distributive shock hypotension
dopamine epinephrine norepinephrine
- shock
- shock
O2
- M
keep central venous oxygen saturation > 7 %
- high cardiac output shock
PP % SBP
- obstructive shock right side
high left atrial pressure
-56. BP 70/50 HR 180 supraventricular tachycardia shock
A. Decrease end diastolic volumn
B. Decrease cardiac contractility
C. Increase venous resistance
D. Increase venous compliance
E. Increase left ventricular afterload
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Case 29 : dyspnea / orthopnea
- neurohormonal antagonist HF
digoxin
- chronic HF
digoxin
- metoclopamide chronic action
-sign + symptom evaluating HF
- peripheral pulse pulse
- chronic r I serum
on digoxin furosemide spironolactone
spironolactone
-62,.. 38 year old woman come with dyspnea on exertion, ortopnea physical examination reveal BP 130/60 bisferic
pulse, LV heaving , diastolic murmur . . . . diagnosis
a. ischemic cardiomyopathy
b. dilated cardiomyopathy
c. hypertrophic cardiomyopathy
d. chronic aortic regurgitation******
e. mitral stenosis
Case 30 : Jaundice
-enzyme chronic hepatocellular disease ALT
- chronic liver disease
gynecomastia
- dubin - johnson syndrome
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multidrug resistance protein 2
-
pernicious anemia unconjugated hyperbillirubinemia
- intrahepatic cholestasis alcohol + oral contraceptive pills
-
billiverdin reductase billiverdin billurubin
- urobillinogen
feces
- liver synthetic function
coagulation -77 Intrahepatic cholestasis
1 Alcohol
2 Contraceptive pill
3 polycystic dz
4.Hemobilia
5 1+2
Case 1 : Abdominal pain
- somatic-parietal pain
myelinated delta fiber
-
Acute pancreatitis
-visceral pain hypogastrium organ
colon-pathological process acute alcoholic pancreatitis
inflammatory process
- biliary colic
biliary colic
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-
gastric juice
- current jelly stool
intussusception- bowl sound borborygmy
small bowl obstruction
- imaging the best anatomical information
scan
- genetic acute abdominal pain
G6PD [ porphyria , sickle cell anemia , hemophilia , vasculitis]
-90. genetic abdominal pain?a.hemophillia
b.porphyria
c.G6PD
d.sickle cell
e.vasculitis
-82. visceral pain hypogastrium
A. Lower esophagus
B. Appendix
C. Stomach
D. Small intestine
E. Colon