Anatomy Clinical Vignettes p.

68, 69

Baby vomits milk when fed

blind esophagus with lower
and has gastric air bubble.
segment of esophagus
What kind of fistula is
attached to trachea
present?

20-year old dancer with

decreased plantar flexion and
decreased sensation over the Tibial (L4 to S3)
back of her thigh, calf, and
lateral half of foot. What
spinal nerve?

Patient with decreased pain

and temp sensation over
syringomyelia
lateral aspects of both arms.
Lesion?
Penlight in patient's right eye
produces bilateral pupillary
constriction. In left eye, there atrophy of left optic nerve
is paradoxical bilateral
pupillary dilation. Defect?

Patient with decreased prick

sensation on lateral aspect of dorsiflexion and eversion of
leg and foot. A deficit in what foot (common peroneal
muscular action can also be nerve)
expected?

Elderly woman with arthritis

Carpal tunnel syndrome,
and tingling over lateral digits
median nerve compression.
of right hand. Diagnosis?

Right CN XI (runs through

Woman in car accident cannot
jugular foramen with CN IX
turn her head to the left and
and X), innervating
has right shoulder droop.
sternocleidomastoid and
What structure is damaged?
trapezius muscles)
 Man with one wild, flailing contralateral subthalamic
arm. Where is lesion? nucleus (hemiballismus)

Pregnant woman in 3rd

trimester has normal blood
pressure when standing and compression of IVC
sitting. When supine, BP
drops to 90/50. Diagnosis?

Soccer player was kicked in

anterior cruciate ligament
leg and suffered a damaged
(remember the "unhappy
medial meniscus. What else is
triad")
likely to be damaged?

Gymnast dislocates her

shoulder anteriorly. What
Axillary nerve (C5, C6)
nerve is most likely to have
been damaged?
 Patient with cortical lesion
does not know that he has a Right parietal lobe.
disease. Where is lesion?

Child presents with cleft lip.

Fusion of maxillary and
Which embryologic process
medial nasal processes.
failed?

Patient cannot protrude

tongue toward left side and
left medulla, CN XII
has right sided spastic
paralysis. Where is lesion?

Teen falls while rollerblading

and hurts his elbow. He can't Ulnar nerve due to broken
feel the medial part of his medial condyle
palm. Which nerve and what
injury?
 24-year-old male develops para-aortic lymph nodes
testicular cancer. Metastatic (recal descent of testes
spread occurs by what route? during development)

Field hockey player presents

to ER after falling on her arm
Radial nerve and deep
during practice. X-ray shows
brachial artery, which run
mid-shaft break of humerus.
together.
Which nerve and what artery
are most likely damaged?

Patient cannot blink his right

eye or seal his lips and has
mild ptosis on the right side. Bell's palsy; CNVII
What is diagnosis, and what
nerve is often affected?

Patient complains of pain,

numbness, and tingling
sensation. On exam, she has Carpal tunnel syndrome,
wasting of thenar eminence. median nerve
What is diagnosis, and what
nerve is often affected?
Behavioral Science Vignettes p. 114,115

Woman with anxiety about

gyn exam is told to relax and
imagine going through steps systematic desensitization
of exam. What process does
this exemplify?

65-year-old man is
diagnosed with incurable
Assess whether telling patient
metastatic pancreatic
will negatively affect his
adenocarcinoma. His family
health. If not, tell him.
asks you not to tell the
patient. What do you do?

Man admitted for chest pain

is medicated for ventricular
tachycardia. The next day he
jumps out of bed and does denial
50 pushups to show the
nurses he has not had a heart
attack. What defense
mechanism?

You are attracted to your 26-
year-old patient. What do you
say?
Nothing! Tone must be
professional. It is not
acceptable to have romantic
relationship with patients.
Invite a chaperone into room
if you think your actions may
be misinterpreted.

Large group of people

followed over 10 years. Every
2 years, it is determined who cohort study
develops heart disease and
who does not. What type of
study?

Girl can groom herself, can

hop on one foot, and has an
Four years old
imaginary friend. How old is
she?

Man has flashbacks about his

girlfriend's death 2 months
ago following a hit-and-run normal bereavement
accident. He often cries and
wishes for the death of the
culprit. Diagnosis?
 36-year-old woman with
Discuss risks and benefits of
strong family history of
not having mammogram.
breast cancer refuses a
Patients must give informed
mammogram because she
consent. If she refuses, you
heard it hurts. What do you
must abide by her wishes.
do?

During a particular stage of

sleep, man has variable blood
pressure, penile tumescence, REM sleep
and variable EEG. What stage
of sleep is he in?

15-year-old girl of normal

height and weight for her age
has enlarged parotid glands
but no other complaints. The bulimia
mother confides that she
found laxatives in the
daughter's closet. Diagnosis?

11-year-old girl exhibits

Tanner stage 4 development advanced stage, early
(almost full breasts and pubic development.
hair). Diagnosis?
4-year-old girl complains of
burning feeling in her
genitalia; otherwise she
behaves and sleeps normally. sexual abuse
Smear of discharge shows N.
gonorrhoeae. How was she
infected?

Although you want to

encourage him to take his
72-year-old man insists on
medication, the patient has
stopping treatment for his
the final say. You should
heart condition because it
makes him feel "funny." What investigate the "funny" feeling
and determine if there are
do you do?
drugs available that don't
elicit this side effect.

Person demands only the best

and most famous doctor in Narcissism
town. Personality disorder?

Nurse has episodes of

hypoglycemia; blood analysis Factitious disorder; self-
reveals no elevation in C scripted insulin.
protein. Diagnosis?
 55-year-old businessman
complains of lack of
successful sexual contacts
with women and lack of Fear of sudden death during
ability to reach full erection. intercourse.
Two years ago he had a heart
attack. What might be the
cause of his problem?

Biochemistry Clinical
p. 138
Vignettes

Full-term neonate of
uneventful delivery becomes
mentally retarded and PKU
hyperactive and has a musty
odor. Diagnosis?

Stressed executive comes

home from work, consumes 7 NADH increase prevents
or 8 martinis in rapid gluconeogenesis by shunting
succession before dinner, and pyruvate and oxaloacetate to
becomes hypoglycemic. lactate and malate.
Mechanism?
 2-year-old has increased
abdominal girth, failure to
Kwashiorkor
thrive, and skin and hair
depigmentation. Diagnosis?

Alcoholic develops rash,

diarrhea, and altered mental Vitamin B3 (pellagra)
status. Vitamin deficiency?

20-year-old man presents

with idiopathic
Gilbert's disease
hyperbilirubinemia. Most
common cause?

51-year-old man has black

spots in his sclera and has
noted that his urine turns Alkaptonuria
black when he is standing.
Diagnosis?
25-year-old male complains
of severe chest pain and has Familial
xanthomas of his Achilles hypercholesterolemia; LDL
tendons. What is the disease, receptor
and where is the defect?