Anatomy and Circulatory System Cases

Anatomy

• The blastocyst stage of embryonic development is when implantation into the endometrium typically occurs.
• An embryo is present as a chorionic vesicle during a spontaneous abortion in the second week of pregnancy.

Circulatory Cases

• Occlusion of the left circumflex artery can cause severe mitral regurgitation, leading to dyspnea and hypotension.
• In a right-dominant coronary vasculature, occlusion of the right coronary artery is most likely to spare the anterior interventricular septum.
• The right coronary artery commonly gives rise to the artery that supplies the SA node; therefore, blockage of this artery is a concern with arrhythmias.
• A blind sternal trauma is likely to mostly affect the right ventricle, given the ventricle's anterior location.
• Transposition of great arteries (TGA) affects the truncus arteriosus embryonic cardiac chamber.
• Tetralogy of Fallot is most likely to produce a right-to-left shunt at birth, involving unusual aorta positioning and pulmonary valve stenosis.

GIT Cases

• The small intestine is most at risk for ischemia during abdominal aortic aneurysm repair inferior to the renal arteries and extending to the bifurcation of the common iliac arteries due to anatomic considerations.
• Bleeding due to ruptured esophageal varices is related to the anastomoses between the left gastric vein and the azygos vein.
• Pain elicited when a child is placed on their left side with the right leg hyperextended is related to obturator nerve innervation.
• The colon is the most likely primary tumor location when multiple liver tumors are found during autopsy.
• A direct inguinal hernia protrudes directly through the external inguinal ring.
• Fused pelvic kidneys are prevented from ascending to their appropriate position due to the inferior mesenteric artery.
• The inferior epigastric artery lies lateral to the neck of a direct inguinal hernia sac.
• Abnormal rotation of the ventral pancreatic bud around the duodenum is a developmental abnormality that can lead to a band of tissue surrounding the descending part of the duodenum.
• Duodenal atresia is diagnosed via the double-bubble sign on ultrasound.

Endocrine & Reproductive Cases

• The right renal vein is the primary venous drainage that must first be ligated when surgically removing a mass from the right side of the body that relates to diastolic hypertension, hypokalemia, hypernatremia, decreased renin levels, and metabolic alkalosis.
• Antibodies against the pancreas are most likely present in a 10-year-old girl presenting with elevated blood glucose, decreased insulin, and elevated specific antibody levels.
• Surgical resection of a mass in the head of an organ involved in blood glucose regulation will necessitate ligation of branches from the gastroduodenal and superior mesenteric arteries.
• Severing the suspensory ligament during a hysterectomy would most severely disrupt blood flow to the ipsilateral ovary.
• The posterior pituitary gland stores the endogenous version of a hormone, which is used to help dilate the cervix during labor.
• The recurrent laryngeal nerve should be avoided during ligation of the artery supplying the lower pole of the left lobe of the thyroid gland.

Locomotor System Cases

• Ankle inversion with forward displacement of the talus most likely injures the anterior talofibular ligament.
• Fracture of the lower end of the humerus puts the flexor carpi ulnaris at risk of losing function.
• Inability to lift the arm above the head, but can lift once started by other arm, is most likely a supraspinatus injury.
• A sudden tearing sensation in the arm with inability to medially rotate it suggests injury to the subscapularis muscle.
• Injury to the anterior cruciate ligament and medial collateral ligament suggests likely injury to the medial meniscus.
• Injury to the long thoracic nerve originates at spinal levels C5, C6, and C7 after a mastectomy.
• Inability to dorsiflex or evert at the ankle with pain/numbness in the lateral leg/dorsum of the foot as well as foot drop suggests a compromised common peroneal nerve due to fracture.
• Lateral elbow pain radiating down the forearm in a tennis player is most likely related to repetitive use of the extensor carpi radialis.
• A metacarpal fracture is the most likely site of a hand fracture after punching a wall.
• A fall of the right scapula following a car accident and a tear in an important supporting ligament likely involves the coracoclavicular ligament.
• Syndactyly refers to fused digits.

CNS Cases

• Numbness over the left jaw and lower face indicates a mass compressing a cranial nerve that exits the skull through the foramen ovale.
• A lesion in the mammillary bodies is likely the cause of a patient presenting with disorientation, confusion, memory loss, nystagmus, and unsteady gait, common in chronic alcohol abuse.
• Double vision when looking to the side, with one eye not adducting and the other exhibiting horizontal movements, indicates a lesion in the medial longitudinal fasciculus.
• A mid-shaft fracture of the humerus is most associated with weakness in wrist extension due to radial nerve damage.
• Severe abdominal pain, jaundice, ascites, mental status changes, and blockage in the hepatic venous connection along with a drooping eyelid and dilated pupil indicate injury to the oculomotor nerve.
• Extra-axial fluid collection with a temporal bone fracture after a motor vehicle ejection indicates the middle meningeal artery is likely injured.
• Inability to speak/write but able to follow commands with right-sided spastic paralysis indicates a lesion involving the left inferior frontal gyrus.
• Excess CSF production would be likely due to hydrocephalus in a 3-month-old male infant with an abnormally large head and enlarged ventricles of the brain.

Respiratory & Renal Cases

• Kidney stones are most likely to cause obstruction in the ureter over the iliac vessels.
• When a child inhales a foreign body, it typically lodges in the right lower lobe.
• Oligohydramnios with wrinkled skin, deformed limbs, and abnormal facies suggests a failure in the development of the ureteric buds.

Histology

• A cell that has recently gained an acrosome and tail during spermatogenesis contains 23 chromosomes and is 1n.
• Hemosiderin-laden macrophages will be more prominent in the lung tissue of a heart transplant recipient presenting with shortness of breath and dyspnea.
• Overactivity of parathyroid chief cells can lead to fibrous tissue with hemorrhagic foci and cyst formation in bone marrow.
• Autoantibodies target the macula adherens aspect of epithelial cell junctions in a patient with skin blisters and ulcerations, with a net-like immunoglobulin deposit around keratinocytes.
• Decreased perfusion of the afferent arteriole results in renin release.
• Insufficient substance in a newborn with cyanosis, tachypnea, and dyspnea, born to a mother with gestational diabetes, disrupts liquid intermolecular forces in alveoli.

Physiology

• A drug that treats sudden-onset dizziness and chest palpitations inhibits the potassium channel.
• Severe mitral regurgitation (dyspnea, hypotension) can be the result of posterior leads ST-elevation myocardial infarction stemming from occlusion of the left circumflex artery.
• Cardiac output is related and increased by cardiac glycoside administration.
• An atrioventricular node abnormality can result in an ECG with a constant PR interval and random absence of QRS complexes.
• Dressler syndrome typically presents weeks after a myocardial infarction presenting with chest pain, dyspnea, and friction rub.
• Increased ADH is most likely elevated in a patient with chronic cough, dyspnea, hemoptysis, lethargy, weight loss, and a low serum sodium level.
• Conn syndrome is most likely the cause of hypertension, muscle cramping, elevated sodium, low potassium, and elevated bicarbonate levels.
• High dosage glucocorticoid treatment can result in the appearance of a U wave on an ECG.
• Zona glomerulosa is where a functioning hormone produced in an 18-year-old woman with hypertension, generalized weakness and hypokalemia.
• Increased secretion of cholecystokinin is responsible for postprandial pain in an overweight woman with right upper quadrant abdominal pain.
• An enlarged liver will be most likely seen at presentiation amongst other symptoms due to the presence of severe and constant right upper quadrant pain over the past two days in a polycythemia vera patient.
• Metabolic alkalosis with respiratory compensation is the acid-base disturbance occurring in a patient with severe vomiting, a pH of 7.48, a bicarbonate level of 35 mEq/L, and a partial carbon dioxide pressure of 48 mm Hg.
• Colonoscopy is the must have follow-up test for a patient with fever, acute onset of left lower quadrant abdominal pain due to Rectal bleeding with high WBC and anemia.
• Anemia of chronic disease the most likely for someone who experience history of fatigue ,Malaise ,Joint pain ,Stiffness . Also lab result show high WBC ,Low HB and Hematocrit level and normal MCV
• No change in A band; shortening of H band; shortening of I band is most likely the changes in length within each sarcomere during seizure-induced muscle contractions.

Biochemistry

• Thymidine dimers will appear in a 6-year-old boy with skin lesions all over his body, due to sensitivity from sunlight from a potential mutation in DNA.
• Protein is the first molecule produced within a cell in response to a hormone.
• Homogentisic acid oxidase defect is the most likely underlying cause of a patient presenting with arthritic pain, dark cartilage in the ears, and urine that turns black while standing.
• Muscle injury clinically similar to myositis is a common side effect of a therapy that inhibits production of mevalonic acid.
• Deficiency of uroporphyrinogen decarboxylase can be used to describe the 6-month-old child patient.
• Mutation resulting in increased absorption of dietary iron is a hereditary disorder.
• Aldose reductase most likely contributed to opacities on the lens of the eye in a 52-year-old patient with a history of poorly controlled diabetes mellitus.
• Transcription factor is the type of protein most commonly encoded that will come from Acquired mutation in the p53 gene.
• Polymerase chain reaction is considered of the following of laboratory techniques.
• Multiple sclerosis is the most likely affected.
• A patient be most likely have for other finding for 10 years old to the pediatrician with fever, facial tenderness, and a green, foul smelling nasal discharge of congenital if they have Infertility.
• The patient will going Deficiency of the anzymes of ornithine transcarbamylase.
• Biliary obstruction underlying that the Jaundice condition.
• The cardiomegaly condition will have Glucose of substances.

Pathology

• Hypertrophic obstructive cardiomyopathy (HOCM) is suspected in a 17-year-old boy who dies suddenly while playing basketball, presenting with hypertrophy and asymmetric septal enlargement due to Mutation in a sarcomere gene such as myosin-binding protein C is the underlying cause.
• Graves disease is the most likely etiology of a 42-year-old woman's disease, presenting with anxiety, palpitations, weight loss, frequent bowel movements, and a thyroid bruit, caused by autoantibody stimulation of thyroid-stimulating hormone receptors.
• Adenocarcinoma of the esophagus is a risk for a patient with burning retrosternal chest pain after meals, relieved by antacids, and an 8-cm hiatal hernia due to GERD.
• The most likely primary tumor location is in the colon that led to metastasis in a 65-year-old woman's liver.
• The tumor marker most likely to be increased in a hepatoma patient is also likely to be elevated in Yolk sac carcinoma.
• Osteosarcoma is the most likely explanation for this patient and his family since the Osteosarcoma most common which is the primary malignant bony tumor.
• Hypersensitivity pneumonitis in the following patient,An infiltration of monocytes and CD8+ lymphocytes will occur for the biopsyes.
• Bronchiectasis in the lungs which has been most likely caused by of the dilation of the airways.

Parasitology

• Schistosomiasis is the most likely disease as the farmer has been exposed and has symptoms of dysuria, pallor, abdominal pain.
• Fascioliasis is most like as the pregnant women is having vaginal bleeding in the 2nd trimester as well as blood film of eosinophilia.
• Niglaria can also is described as it has most cause of coma and water ball infection.
• Balantidium Coli mostly complaining night with vomiting, abdominal distension,tenesmus.
• heterophyes Heterophyes is more fisher man affected and complaint of diarrhea, vomiting, After consuming porry fish can occurs the disease.

Pharmacology

• Metoclopramide is the best treatment option for a 68-year-old woman with type 2 diabetes, nausea, and bloating, showing esophageal dysmotility who had problems following a meal.
• Blocking the peripheral conversion of thyroxine to triiodothyronine is one of the additional mechanisms of action of Drug .
• Decrease of prostaglandin E2 production in the afferent arterioles of the kidney is the most likely reason for a sudden renal failure to someone who take thiazide diuretics with ibuprofen.
• Warfarin is most likely prescribed long term to prevent for prevention of stroke.
• Blocks RNA synthesis causing oral contraceptive pills were ineffective.
• Block calcium channels is the mechanism of action of drugX.
• Inhibition of angiotensin II receptors the mechanism of action of the replacement drug.
• Tyrosine kinases would have induced Insulin with normal mice in researcher.

Ethics, Professionalism, & Toxicology

• Alkalinization of urine ionizes salicylate molecules, trapping them in the proximal tubule causes the emergency department physician to administer a medication that alters pH.
• Dantrolene should be administered to the patient for the treatment of muscular rigidity.
• Chlordiazepoxide drug is indicated for discomfort and anxiety.
• Deferoxamine is the best initial treatment for someone with chocolate-coated iron tablets when found in a body.
• Glucagon most appropriate to reverse the most likely cause with his condition.
• Lead poisoning is most Likely cause that will make gum as blue pigmentation .
• Addressing the patient’s concerns is the best option for someone who feels Internet is responsible for his headaches.
• Physician believes that informing the patient will be detrimental to the patient’s health for an exception.
• Marriage makes pregnant in the 17 age and has a 2 weeks recommendations for options .
• Having someone who Speaks via an interpreter .
• “I understand you are upset, but I suggest you speak directly to Dr. Smith regarding your concerns.”: the most suitable response to this patient.

Research

• The case control study starts with the case already having the disease, therefore relative risk (RR) or incidence rate (IR) cannot be measured.
• A cross-sectional study is defined as , each baseball player report regarding current and past used smokeless tobacco and alcohol use , and dentist note type and extent of lesion happened in mouth.
• Case report is used to describe of study of ear of tennitus .
• randomization . it is will be the Ensure the assign of the chance for patients.

Basic Clinical Skills

• Myocardial infarction is the SINGLE best answers for this patient with pain in jaw, and cold suiting.
• Stable angina is the SINGLE best answers for this as the pain relieved with someone is taking rest.
• B is the most Likely answer.
• Myocardial infarction more and more common during nausea and vomiting also dyspnea is a potential Symptoms.
• appendicitis is the most of signs shows as a most of the diagnosis.
• Chest X-Ray as has been Malaise with cough for couple of days a Chest X-Ray is recommended.
• Acute pancreatitis has been severely pain with chest and shock as a symptom.
• Airway management will happen first.
• B asthma is most likely happen cough and chest with tight.

Investigations in Medicine

• Diabetic ketoacidosis is less likely come features of Type 2.
• D (Above All) is more characteristics with feature.
• Serum measurements should be evaluated insulin.
• B 2 hour postprandial glucose >140.
• Fasting glucose 110-125 mg/dl precisely characterize prediabetes.
• Anemia secondary to inflammation has high serum ferritin and low total iron binding capacity.
• Free in the plasma of nonheme iron.
• . The Infection not the most cause to find in patient.

Psychiatry

• The patient being angry with the doctor is an example of negative transference.
• Anal stage is the stage of psychosexual development has this child failed to progress through.