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VERSION 2 of ICM shelf

1. Alcoholic in 15 yeard hiding from his family, md student


should do what? Get permission to tell the attending
physician or quietly write in chart and sign it??
2. A 10 days old goes to milk oral formula but has
problems? Meckel’s Diverticulum
3. A lady sprained her ankle and now it’s painful and cold
–Tibial neuropathy or anterior compartment
4. Renal steone—What amino acid? Cysteine, arginie,
homocysteine?
5. Sarcoidosis—bi hilar lymphadenopathy, africal
American woman, hypercalcemia
6. Air under diaghpharm –Pilot??
7. Polycystic kidney disease saccule aneurysm, berry
aneruysm
8. Left Bundle Branch block picture –look for P2 before A2,
normally it’s A2 then P2 = paradoxical
9. Premature ventral contraction-EKG –hypokalemia or
hyperkalemia or hypocalcemia –I put hypokalemia
10. HTN & Arthritis –NSAID’s
11. Insurance doesn’t cover TSH test, they were on
lithium and now have hypothyroidisim? What do you
do? Dr. Manju said to call insurance company but
someone else said trial of levothyroxine
12. 67 Year old husband died from metastatic
carcinoma-wife is depressed—normal bereavement
13. Pain on supination –biceps tendonitis –see other files
14. Losing weight with hemoptysis –TB
15. 7 year old girl with septic arthritis –grown on chocolate
agar –n. gonorreha—she was sexually abused
16. painless mass in testes ––it doesn’t transluminate
Testicular carcinoma
17. Calcification focal –they are psammoma bodies –in
4 disease. 1. Papillary thyroid carcinoma 2. serous
cystadenocarcinomal of the ovary (asked on exam), 3.
meningioma 4. mesothelioma
18. polyartheritis nodosa-medium size arterie
vasculitis
19. broca’s –can’t speak –left frontal cortex lesion
20. A patient has myocardial infarction then dies –has
cardiac tamponase
21. Subclavian –pierce –hydrothorax
22. pneumothorax – TVF –low percussion-
hyperresonnant
23. Horner syndrome & ulna nerve problem –pancoast
tumor in LUNG
24. Lymphadenopathy –infectious mononucleosis-not
peritonsillar abscess??
25. Keratian debri-dermoid cysts—fusion –behind ear
==look up dermoid cyst
26. cervical lymph nodes –get lymph from
oropharanyx
27. leukoplakia –smoking –can’t see with KOH
associated but it’s white and can be wiped off, biopsy is
mandatory
28. Lady-complain urinary, headache, stomach
problem –Somatization disorder
29. Lady-analgersics –makes her husband do all
chores and kids do all work –takes morphine twice a
day –you have to SET A DATE FOR HER TO GO BCK TO
WORK or tell he she is using her husband/kids to get
work down (you decide )
30. Septic Shock –warm skin but cardiogenic shock
then skin is cool and clammy
31. look up acute labrinythisis, benign positional,
mennerei’s disease (EAR STUFF -2 questions)
32. picture of eye –it was right optic nerve –u shine a
light in the right eye and both of them don’t constrict
but if you shine a light in the left eye both eyes
constrict so left optic was working.
33. cotton wisp in the left eye –Ipsilateral left facial nerve
problem –left eye didn’t blink but right eye was fine
34. garage work poisoning –peripheral neuropathy, ab
pain, progressive memory loss-LEAD
35. V wave, tricuspid regurgitation-pulsatile liver (Dr.
waheeda mentioned it so many times)
36. 2mm -3mm sores with red base –Herpes
37. calf tendon pain –partial tear in the Achilles tendon
38. Basket ball player –chest pain-his blebs exploded –
pneumothorax
39. hand can’t abduct, extend –extensor radialis
longus
40. know difference between 4 & 8 month child –
standing assisted, able to grasp hand –I put 8 months,
not 4 months. But you check in brs behavioral
41. doc you are horrible I shouldn’t have come to you
–my cancer reoccurred? What do you say? I put lets
discuss treatment options I know this is an emotional
time for you. Other option was I will give you time to
think and get back to me
42. What increases or decreases as you get old,
=basal metabolic rate, Residual long volume, cardiac,
GFR?
43. A 15 year old pregnant girl says don’t tell mom? I
put I aought to tell your mom but won’t do without your
permission, other option was bring mom and her in the
same room and talk
44. dad has jaundice, his son’s friend’s at day care
had jaundice. HEP A
45. Copius white discharge –chlymdia or candida but
no abdominal tenderness
46. Increase in protein, Increase in CSF neutrophils –
TB meningitis
47. DIP Joint –pain worse with physical activity?
Osteoarthritis, RA or GOUT check first aid – I think it’s
Osteo arthritis
48. A 72 year old feell in tub, went to hospital, ct scan
fine comes home and 72 hours later unconscious and
dead—subdural bridging veins
49. A patient slow shaving, slow getting dressed?
What is it? Is it loss of dopamine, loss of 5HT, loss of
ACH, insulin. I think its myasthenia gravis so loss of Ach
but check
50. hypothenar, wasting –Ulnar nerve
51. Girl had religious experience she was hearing
colors –LSD or PCP i put LSD cuz PCP –patients get
violent I checke in first aid it was LSD
52. mass in left atrium –which feel on mitral valve
while standing –Myxoma.
53. pregnant lady heart problem –dilated
cardiomyopathy-systolic dysfunction—confirm with dr.
waheeda
54. waxy, on the chin, raised –basal cell or malignant
melanoma. Farmer –this question on icm, path, comp so
if it’s pearly –basal cell carcinoma if sand paper feel,
hard, all over hands face, trunk then actinic kearatosis
which leads to squamous cell carcinoma so know all 3
and should be good to go
55. eye problem –patient got double vision in
afternoon and diplopia –I put the one of contralateral
homonmouns hemanopia
56. Left ey can’t look right and nasal and temporal
bad on right –MS??
57. Can feel radial pulse but can’t feel femoral, popliteal
dorsal pedis –clot at aortic bifurcation?
58. know cor pumonale-heart & lung problem –a man
59. tearing chest pain –radiating to substernal –aortic
dissection
60. pulsatile abdominal mass, patient died-abdominal
aortic aneurysm
61. put hand on patient RUQ-stops during inspiration-
hurts-murphy’s sign (gallstones)-cholecystitis??
62. Cystic Fibrosis-meconium ileus (meconium plugs) –
pseudomonas aeurgunosa infection –get diabetes, CFTR
gene CHromonse 7
63. Midmenstrual cycle-LH up FSH UP estrogen UP
progesterone DOWN
64. small fine pieces in lung xray? Sandblaster
occupation or steampipe occupation
65. factor 8 deficiency –hemophilia-2 questions 1.
hemarthrosis in elbows
66. 2. PTT high check first aid for factor 8 deficiency
67. A 35 year old with lower quadrant pain left side,
fever –Diverticulitis
68. Pedigree –Mitochondrial pattern
69. Murmur at left 2nd intercostals space –pulmonic stenosis
70. herpex zoster –picture of a man with shingles on
forehead on top of eyelid it’s trigeminal V1
71. SLE-rash joint pain
th
72. 4 finger –can’t flex or extend-thickened palmar fascia
73. pregnant woman during labor bleeding she had
Sheehan syndrome --acute pituitary necrosis

path shelf spring 08


TH1  Interferon gamma
Baby retinitis –intracranial calcifications –toxoplasmosis
gondii
Alpha protein-yolk sac tumore
Aids-non hodkin’s lymphoma
Kid pesticide mom’s garden –gets parasymphatetic symptos
–parathoion & malathion is causative agent and antidote is
atrophine and 2-Pam (prolixodine)—this is pharm shelf too