Anisocoria ipsilateral to compression The condition described is uncal herniation. This syndrome typically progresses in stages.

Initially, the third nerve is compressed, causing a unilaterally dilated pupil (anisocoria), of which 85% are ipsilateral to the
compression. The pupil is dilated because its resting size depends on the parasympathetic innervation to the eye, which travels on
the superficial aspect of the oculomotor nerve and so is affected initially from nerve compression.
Combined subacute degeneration This condition results from vitamin B12 deficiency, which leads to dysfunction of both the dorsal
columns and the corticospinal tracts. Patients present with a spastic ataxic gait (loss of posterior white columns leads to ataxia and
the degeneration of anterior horn cells causes spasticity)
Syringomyelia A cause of central cord syndrome, syringomyelia occurs when a fluid-filled cavity develops in the spinal cord,
commonly in the cervical region. This cavity affects the anterior commissure, which contains the decussating fibers of the
spinothalamic tract. Posterior columns are not typically affected in the early stages, so this condition produces a cape-like
distribution of pain and temperature loss with preservation of joint position sense. In addition, because of the lateral somatopic
arrangement of the sacral region inputs, there is typically sacral sparing of spinothalamic sensation.
Tabes dorsalis This condition is due to isolated degeneration of the dorsal columns resulting from long-standing syphilis infection.
Wernig-Hoffman disease This inheritable spinal muscle atrophy disorder usually presents in infancy. Degeneration of the anterior
motor horn cells occurs, producing both upper and lower motor neuron signs.
Anterior spinal artery syndrome Because the anterior spinal artery supplies approximately two-thirds of the ventral portion of the
spinal cord, occlusion of this artery (such as during abdominal aortic aneurysm repair) can lead to infarction of both the anterior
horn and spinothalamic tracts, leading to corticospinal and spinothalamic compromise below the site of ischemia. The dorsal
columns are preserved because of the separate vascular supply and, therefore, joint position sense and fine discrimination remain
unaffected.
Digoxin Digoxin is used for CHF; its side effects include visual disturbances, nausea and vomiting, headache, fatigue, and cardiac
arrhythmias. Low potassium can potentiate toxicity.
Glyburide Glyburide is used for DM2 to stimulate release of insulin from the pancreas. It may cause hypoglycemia and headache.
Hydralazine Hydralazine is used for moderate to severe HTN and CHF. It can cause a systemic lupus erythematosus (SLE)like
syndrome at chronically high doses. SVT can occur with intramuscular administration.
Hydrochlorothiazide Hydrochlorothiazide is used for hypertension. Its side effects include hypokalemia, hyperglycemia,
hyperuricemia, hyperlipidemia, and hyponatremia.
Metformin Metformin is used for DM2 to decrease hepatic glucose production and improve insulin sensitivity. It may cause lactic
acidosis, anorexia, nausea, vomiting, and rash.
Arginine Arginine is an essential amino acid, along with histidine.methionine, threonine, valine, leucine, lycine, isoleucine,
phenylalanine, and tryptophan
Enterotoxigenic E. coli Enterotoxigenic E. coli is the most common causative agent in traveler's diarrhea and causes a nonbloody
watery diarrhea.
Toxoplasmosis Toxoplasma gondii is a parasite found in cat feces and raw meat. Primary infection with T. gondiiduring pregnancy
increases the risk of congenital toxoplasmosis, which is characterized by jaundice, hydrocephalus, chorioretinitis, and intracranial
calcifications. This infection can lead to deafness, blindness, mental retardation, and seizures. You should advise your patient to
wait until she has delivered to adopt the kitten. Pregnant women who were previously infected with T. gondii are not at risk of
transmitting it to their fetuses.
The patient is experiencing malignant hyperthermia secondary to defects in a calcium-channel ryanodine receptorMalignant hyperthermia is
thought to be an autosomal inherited condition that is due to a variation/mutation in the calcium-channel ryanodine receptors in the
sarcoplasmic reticulum of skeletal muscle.
Human placental lactogen has anti-insulin properties. hPL has been implicated in gestational diabetes mellitus.
The high level of human placental lactogen in pregnancy prevents milk letdown. The high level of estrogen and progesterone prevent milk
letdown.
Progesterone and estrogen are made by corpus luteum until the fetoplacental until can take over production. The borpus luteum produces
only progesterone, not estrogen
Prolactin starts to increases after birth. Prolactin increases throughout pregnancy but milk letdown is prevented by estrogen and
progesterone.
There is a steady increase in hCG during pregnancy. The hCG level reaches its maximum at week 15 and then decreases.

A test for disease X is known to have a sensitivity of 0.95, specificity of 0.65, positive predictive value of 0.73, and negative
predictive value of 0.93. What is the false-negative rate? =0.05 do that please
Lateral edge of the rectus abdominis muscle The lateral edge of the rectus abdominis muscle, also known as the linea semilunaris,
forms the medial border of Hesselbach's triangle
46, XY This patient has androgen insensitivity syndrome, also called testicular feminization syndrome. Affected individuals have a
46, XY karyotype. They also have testicles, which may be present in the inguinal canal area or intra-abdominally. Testes should be
removed because they have a high incidence of developing cancer.D: 47, XXY [Incorrect] Patients with the 47, XXY karyotype have a
male phenotype. They typically have a very tall, eunuchoid body habitus with small testes. They may also have breast enlargement
and mild mental retardation (An 18-year-old female presents to the gynecology clinic, concerned because she has never had a

menstrual period. A physical exam reveals an absence of axillary and pubic hair. The patient has breast tissue present
bilaterally. A pelvic exam reveals the vagina ending in a blind pouch. A bimanual exam reveals an absence of cervix, uterus,
and ovaries. What is the most likely karyotype of this patient?)
Type I hypersensitivity In type I hypersensitivity, an antigen reacts with IgE bound to the surface of basophils or mast cells in tissue.
These cells then release vasoactive mediators such as histamine. This reaction can occur within minutes after exposure to the
antigenic substance
Type II hypersensitivity Type II hypersensitivity involves antibody-dependent cell-mediated cytotoxicity or complement. It is commonly
seen with warm antibody autoimmune hemolytic anemia, hemolytic disease of the newborn, Goodpasture's disease, and Grave's
disease.
Type III hypersensitivity Type III hypersensitivity involves immune complex deposition and is seen in serum sickness, arthus reaction,
polyarteritis nodosa, and lupus.
Type IV hypersensitivity Type IV hypersensitivity is a cell-mediated reaction. Common examples of type IV hypersensitivity include the
tuberculin reaction and contact dermatitis.

Estrogen is important for many different actions in the body, including the LH surge, growth of the follicle, and myometrial
excitability. Which of the following is another function of estrogen? Endometrial proliferation Estrogen is responsible for
endometrial proliferation.
Increased body temperature around ovulation Progesterone is responsible for increased body temperature around ovulation.
Production of thick cervical mucus Progesterone is responsible for the production of thick cervical mucus.
Spiral artery development in the endometrium Progesterone is responsible for spiral artery development in the endometrium.
Uterine smooth muscle relaxation Progesterone is responsible for uterine smooth muscle relaxation.
Wernicke's aphasia The patient described in this question has Wernicke's, or fluent, aphasia. With this condition, patients have
difficulty comprehending spoken language. They also have difficulty finding the right words to express themselves and talk faster
than normal
Frontal lobe syndrome Frontal lobe syndrome involves loss of initiative, difficulty adapting, and inappropriate social behavior. Also,
grasping, sucking, and groping reflexes may be present.
Damage to the corpus callosum Damage to the corpus callosum may or may not have any effect on the patient. Damage to the
splenium of the corpus callosum results in a left hemidyslexia.
Conduction aphasia Conduction aphasia is associated with good speech comprehension. The patient has difficulty repeating spoken
language.
Broca's aphasia In Broca's aphasia, also called expressive aphasia, the patient is able to comprehend spoken language. He will speak
slowly and with effort
Candidal esophagitis Candida albicans often causes esophagitis in this population. It is treated with fluconazole but can be lifethreatening. Be sure to look in everyone's mouth! You will find the typical white patches most times.
Anemia of chronic disease Anemia of chronic disease may present as macrocytic, normocytic, or microcytic red blood cells. The key
to answering this question correctly is remembering the lab abnormalities for this disease: low iron and low TIBC. This type of
anemia may be associated with chronic inflammatory states such as rheumatoid arthritis.
Thyroid-stimulating hormone and creatinine Thyroid-stimulating hormone levels would be the best way to monitor thyroid function, and
kidney function is best measured by creatinine levels. Any alteration in kidney function could lead to toxic levels of lithium, as this
drug has a very narrow therapeutic index.

S3 An S3 may be auscultated in a patient with dilated congestive heart failure. S3 occurs at the end of the rapid ventricular filling
phase of the cardiac cycle.
S4 An S4 would be an abnormal physical exam finding in this patient and is not expected. S4 is associated with a hypertrophic
ventricle, which would have been noted on the patient's echocardiogram
S2 An S2 may be auscultated on this patient, but it is a normal finding. S2 occurs with pulmonary and aortic valve closure.
S1 While an S1 may be auscultated in this patient, it is a normal physical exam finding. S1 occurs when the tricuspid and mitral
valve close
Dorsomedial medulla A lesion in the dorsomedial medulla can cause Biot's breathing, which is irregularly irregular breathing that
abruptly starts and stops
Lower pons A lesion in the lower pons can lead to apneustic breathing with excessively long inspiration
Midbrainpons junction Dysfunction of the midbrainpons junction leads to central neurogenic hyperventilation
Bilateral cerebral hemisphere Bilateral cerebral hemisphere dysfunction causes Cheyne-Stokes breathing, which is a regularly
irregular pattern of breathing with cyclic periods of apnea.
Bilateral diencephalons Bilateral diencephalons dysfunction can cause Cheyne-Stokes breathing, which is a regularly irregular pattern
of breathing with cyclic periods of apnea.

What does functional vital capacity represent? Everything except residual volume Vital capacity is the maximum inspiratory and
expiratory function that a lung can perform. VC includes every parameter (i.e., ERV, IRV, and TV) except RV, which is a fixed volume
of air in lung after maximum expiration
Type I diabetes with metabolic acidosis, elevated blood glucose levels, and electrolyte imbalance DKA occurs in type I diabetes and is
stimulated by severe insulin deficiency coupled with an absolute or relative increase in glucagon. There are increased breakdown of
adipose stores and increased levels of free fatty acids. Oxidation of the fatty acids produces ketone bodies. If the ketone bodies
exceed their metabolic breakdown rate, then ketonemia, ketonuria, and metabolic acidosis occur. Associated with ketoacidosis are
elevated blood glucose levels, electrolyte imbalance, and metabolic acidosis.
Loss of the sensory limb of the blink reflex The nerves that pass through the cavernous sinus include cranial nerves III, IV, V (V1 and V2
components), and VI. The afferent limb of the blink reflex is carried in cranial nerve V (V1 component), and the efferent limb is
carried in cranial nerve VII, which innervates the orbicularis oculi
Increased capillary pressure In heart failure, because of the heart's diminished contractility, there is increased pressure at the
capillaries applied from the vasculature.
Prominent U waves with T-wave depression The classic EKG finding in a patient with hypokalemia is prominent U waves with T-wave
depression.
Peaked T waves, flattened P waves, wide QRS complexes This is associated with hyperkalemia
Prolonged QT interval This is associated with hypocalcemia.
Shortened QT interval This is associated with hypercalcemia
Schizotypal Schizotypal patients have bizarre thoughts and appearanc
Schizoid Schizoid patients voluntarily choose to withdraw socially
Paranoid Paranoid patients characteristically have suspiciousness and are very distrustful of people around them
Borderline Borderline patients vacillate between objects and people being all good or all bad
Antisocial Antisocial patients do not care about the norms of society and will do what they please.
Osteoarthritis OA is a symmetric polyarthritis affecting the weight-bearing joints; it is characterized by pain that worsens after use. It
results from mechanical wear and tear of joints. Pain improves with rest.
Pseudogout Pseudogout is caused by a deposit of calcium pyrophosphate dihydrate crystals. Fluid analysis will show positively
birefringent rhomboid-shaped crystals. The knee is most commonly involved. Treat this condition with colchicine.

Rheumatoid arthritis RA is a symmetric polyarthritis caused by an autoimmune inflammatory disorder, eventually leading to synovial
damage. It is more common in females. The classical presentation is morning stiffness that improves with use. Systemic symptoms
can include fever, fatigue, and pleuritis.
Gout Gout most commonly affects middle-aged men and is a peripheral arthritis caused by sodium urate crystal deposition. The big
toe is the joint most often involved. Flare-ups usually occur after an alcohol binge or consumption of foods high in purines. Elevated
uric acid levels can be found in patients with gout, but note that most patients with elevated uric acid levels do not have gout.
Treatment includes NSAIDs, steroids, or colchicine. Allopurinol can be used as prophylaxis for gouty attacks.
Gonococcal arthritis This migratory arthritis is most commonly seen in sexually active young adults. Joints involved include the
hands, wrists, ankles, knees, and elbows. Patients can also have skin manifestations such as petechiae or pustules indicating a
disseminating infection.
Alprazolam This intermediate-acting benzodiazepine would effectively reduce the patient's blood pressure and calm his restlessness
and agitation. It works on the GABA receptors and would not affect the adrenergic receptors.
Zolpidem This hypnotic agent is used for insomnia
A drug interaction between fluoxetine and St. John's wort St. John's wort is an herbal product that is used to combat depression. If taken
with fluoxetine, a serotonin syndrome may precipitate. This patient presents with all the classic signs of serotonin syndrome
muscle rigidity, myoclonus, and hyperthermia
A crescendodecrescendo systolic ejection murmur beginning well after S1 The classic murmur for hypertrophic cardiomyopathy is
described
A high-pitched diastolic murmur beginning immediately after S2 A murmur of aortic or pulmonary incompetence is described.
A crescendodecrescendo systolic ejection murmur beginning immediately after S1 A murmur of aortic stenosis is described.
A continuous murmur Sudden death and an autosomal dominance point strongly to hypertrophic cardiomyopathy (HCM). HCM
classically has a systolic crescendodecrescendo ejection murmur that begins well after S1. It is often accompanied by the murmur
of mitral regurgitation, which is a high-pitched, blowing-sounding holosystolic murmur. The description for this answer choice is the
murmur of a patent ductus arteriosus
Neisseria meningitidis N. meningitidis is spread by respiratory transmission and is the most common cause of meningitis in people
who reside in close quarters, such as army recruits or college students who live in dorms. The petechial rash is diagnostic
for N. meningitidis infection. Prompt treatment with high-dose IV antibiotics is essential in decreasing the risk of neurologic
sequelae (Her CSF reveals an increase in WBC with predominant neutrophils, decreased glucose, and gram-negative

diplococci. What organism is the cause of her meningitis?

P. malariae This organism causes benign quartan malaria. When chronic, P. malariae infection is also associated with nephrotic
syndrome due to glomerulonephritis
P. ovale This organism causes benign tertian malaria. One important consideration with this parasite is that hypnozoite forms can be
present in the liver, causing relapse. For this reason, primaquine must be added to the therapy.
P. simiovale This strain infects simian species. The four human malarial species are P. falciparum, P. ovale,P. vivax, and P. malariae
P. falciparum The most feared form, it causes malignant malaria, which can manifest as cerebral malaria. Cerebral malaria can lead to coma
and is associated with a mortality rate in excess of 20%.
P. vivax This organism causes benign tertian malaria. One important consideration with this parasite is that hypnozoite forms can be
present in the liver, causing relapse. For this reason, primaquine must be added to the therapy. In addition, P. vivax can be
associated with delayed splenic ruptura
Cirrhosis This patient has no risk factors for cirrhosis, including no reports of excessive alcohol use, no hepatosplenomegaly, and
normal liver function tests.
CriglerNajjar syndrome type I In CriglerNajjar Syndrome type I, the patient has no glucuronyl transferase, kernicterus, and early
death.
CriglerNajjar syndrome type II In CriglerNajjar syndrome type II, the patient has low levels of glucoronyl transferase. Patients are
usually diagnosed early in life, with severe jaundice and a bilirubin level of 917 mg/dL.
Gilbert's syndrome Gilbert's syndrome is often found by the presence of an elevated bilirubin level on routine lab work in an
otherwise asymptomatic individual. The bilirubin level fluctuates, and may be elevated by stress, exercise, infection, or fasting.
Patients may notice scleral icterus or mild jaundice of the skin during these periods. Gilbert's syndrome affects 3% to 7% of the

population and is more common in males than in females. The hyperbilirubinemia is caused by reduced hepatic glucuronyl
transferase
Hemolytic anemia Hemolytic anemia is characterized by an elevated bilirubin level; however, the complete blood count would reveal
decreased hemoglobin and hematocrit levels. The patient would also have an elevated reticulocyte count
Decreased calcium, increased phosphate, normal alkaline phosphatase A patient with decreased calcium, increased phosphate, and
normal alkaline phosphatase would most likely present with renal insufficiency
Normal calcium, normal phosphate, increased alkaline phosphatase A patient with normal calcium, normal phosphate, and increased
alkaline phosphatase would not suggest osteoporosis.
Increased calcium, decreased phosphate, increased alkaline phosphatase A patient with increased calcium, decreased phosphate, and
increased alkaline phosphatase would not have osteoporosis but could be a candidate for hyperparathyroidism
Increased calcium, increased phosphate, normal alkaline phosphatase These lab results would not suggest osteoporosis but could
suggest vitamin D intoxication
Normal calcium, normal phosphate, normal alkaline phosphatase This patient most likely has osteoporosis; therefore, her calcium,
phosphate, and alkaline phosphatase would most likely be norma number of CD4 count and increased p24 antigen One month after
infection with HIV, patients will have decreased levels of CD4 lymphocytes; this level eventually increases two to three months after
infection. One month after infection, p24 antigen levels peak and then decrease by two months post-infection.
Increased anti-gp120 antigen Anti-gp120 antigen does not appear until 6 weeks after infection and peaks around 812 weeks postinfection
Increased anti-p24 antigen Anti-p24 antigen does not appear until 6 weeks after infection and peaks around 812 weeks post-infection.
Normal CD4 count and increased p24 antigen One month after infection with HIV, patients will have decreased levels of CD4
lymphocytes; this level eventually increases two to three months after infection. One month after infection, p24 antigen levels peak
and then decrease by two months post-infection.

antigen One month after infection with HIV, patients will have decreased levels of CD4 lymphocytes; this level eventually increases
two to three months after infection. One month after infection, p24 antigen levels peak and then decrease by two months postinfection
Cholecystokinin Cholecystokinin is responsible for these activities. It is stimulated by amino acids and fatty acids.
Gastrin Gastrin stimulates gastric motility and the secretion of pepsinogen, hydrochloric acid, and intrinsic factor.
Pepsin Pepsin is stimulated by acid and begins the process of protein digestion.
Secretin Secretin inhibits gastric acid secretion and stimulates bicarbonate secretion by the pancreas.

Vancomycin Blocks peptidoglycan synthesis.

Sulfonamides Block nucleotide synthesis

Rifampin Blocks mRNA synthesis.
Quinolones Block DNA topoisomerases
Penicillin Along with the cephalosporins, imipenem and actreonam, penicillin inhibits peptidoglycan cross-linking.
Macrolides Block protein synthesis at the 50S ribosomal subunit.
Clindamycin Blocks protein synthesis at the 50S ribosomal subunit.
Chloramphenicol Blocks protein synthesis at the 50S ribosomal subunit
Aminoglycosides Block protein synthesis at the 30S ribosomal subunit, as do the tetracyclines

Parietal cells Intrinsic factor is produced by the parietal cells in the

stomach.

Mucous cells Mucous cells produce mucus to protect the surface of the
stomach from acid.
I cells I cells are responsible for the production of cholecystokinin.
G cells G cells in the antrum of the stomach and the duodenum are
responsible for the production of gastrin.
Chief cells Chief cells are responsible for pepsinogen production.
Lunate The most commonly dislocated wrist bone is the lunate. It can
be moved into the carpel tunnel and cause symptoms of carpel tunnel
syndrome, which is what we see here.
The patient suffers from uterine fibroids. African American women have a
higher incidence of getting uterine fibroids. This patient has the
classical presentation of someone who has uterine fibroidsabnormal
uterine spotting, dysmenorrhea, and menorrhagia.
Marasmus Marasmus is caused by a deficiency of both protein and
calories. Patients with marasmus usually have loss of muscle mass as
well as subcutaneous fat and are not edematous.
a mother brings you her eight-month-old child. The child appears the size of a
four-month-old baby, has muscle wasting, but has preservation of
subcutaneous fat. The child also seems edematous. To help with diagnosis, you
do simple blood test and find that the patient has a low hemoglobin level. What
diagnosis do you make (Kwashiorkor The clinical picture above is typical
for kwashiorkor, which is caused by protein deficiency with adequate
caloric intake.)
Ablation of cranial nerve V Cranial nerve V is responsible for general
sensation of the face and mucous membranes. It also innervates the
muscles of mastication.
Ablation of cranial nerve VII Cranial nerve VII is responsible for taste
(anterior two-thirds of the tongue), salivation, lacrimation, and facial
movements.
Ablation of cranial nerve III Cranial nerve III is responsible for constriction
of the pupil, accommodation, convergence, and movement of the eye.
It innervates the medial rectus, superior rectus, inferior rectus,
inferior oblique, and levator palpebrae muscles
It is a member of the same family of viruses as the mumps virus.
Parainfluenza virus is in the Paramyxoviridae family. Also included in

this family of viruses are the respiratory syncytial, mumps, and

measles viruses.
Croup is caused by the parainfluenza virus, which is a negative singlestranded RNA virus.
(Peripheral ischemia, Great-vessel fibrosi, Pulmonary fibrosi, Pleural fibrosis,
retroperitoneal fibrosis) long-term complications of using methysergide?
Proteus mirabilis Proteus mirabilisswarm over the surface of
nonselective media. They are urease-positive, oxidasenegative, and
do not ferment lactose.
The lab reports finding a gram-negative motile rod, oxidase-positive, aerobic
organism that does not ferment lactose in the patient's sputum. Based on this
information, you determine the patient is infected with which bacterium?
(Pseudomonas aeruginosa)
He is probably experiencing a major depressive episode. To warrant a
diagnosis of a major depressive disorder, a patient must experience
symptoms for at least two weeks. These symptoms must include a
depressed mode or the inability to experience pleasure. Additionally,
the patient must have at least four of the following symptoms:
decreased or increased sleep, decreased interest, feelings of guilt,
decreased energy, inability to concentrate, change of appetite (either
increased or decreased), psychomotor agitation or retardation, or
suicidal ideation. Major depression carries a 15% risk of suicide.
He is experiencing a dysthymic disorder. This case cannot be classified as
dysthymic disorder, as that disorder requires the patient to have a
depressed mood for at least two years.
He is probably experiencing the depressive side of an underlying bipolar
disorder. To diagnose a patient as bipolar, you must be able to
document at least one manic episode. Although the patient's wife
states that he usually has energy to spare, this description does not
necessarily mean he has been experiencing mania. Mania is
characterized by a decreased need for sleep, easily distracted and
pressured speech, a grandiose view of oneself and one's abilities, and
racing thoughts.
He is probably experiencing a new onset of schizophrenia. Although new
schizophrenia can initially look like depression, it would be very
unusual for a 39-year-old male to experience a new onset of
schizophrenia. The age of onset in males is typically the early
20 sAdditionally, to warrant a diagnosis of schizophrenia, the patient

must experience the symptoms of occupational or social dysfunction

in addition to psychosis for at least six months
Uric acid Uric acid is Unseen on X ray. An abdominal X ray without contrast
shows no evidence of a stone, but he does have blood in his urine. His stone is
likely made of which of the following