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Old 11-18-2010
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A 26-year-old patient presents to your office with a chief complaint of polyuria and polydipsia. He has also noticed an increase in his skin tone, but has not been outside in the sun for any extended period of time. He mentions that he has early-morning swelling in his legs and finds himself needing to sleep on two pillows to get comfortable at night; you suspect that this discomfort is due to congestive heart failure. What is the most likely diagnosis?
A Addison's disease
B Cushing's syndrome
C Diabetes mellitus
D Hemochromatosis
E Wilson's disease

????

While on the Medicine service, a third-year medical student admits a 63-year-old woman with longstanding hypertension, diabetes, and hyperlipidemia. The woman was seen in the emergency room, where she was noted to have vomiting, left–sided Horner's syndrome, and loss of facial sensation on the left, but loss of body sensation on the right. A diffusion-weighted MRI and MRA are ordered. Before the radiologic studies are performed, the team asks the medical student where the problem lies. The best explanation for this patient's stroke presentation is occlusion of which artery?
A Left middle cerebral artery
B Right middle cerebral artery
C Left anterior cerebral artery
D Right anterior cerebral artery
E Left posterior cerebral artery
F Right posterior cerebral artery
G Left posterior inferior cerebellar artery
H Right posterior inferior cerebellar artery
???

An 18-year-old female presents to your office in respiratory distress after taking a couple of aspirins for a headache. Upon further questioning her, you discover that she has a history of asthma and nasal polyps. Why did aspirin ingestion by this patient result in respiratory distress?

A Leukotrienes production
B Phospholipase A2 deficiency
C Prostacyclin production
D Prostaglandin production
E Thromboxane production

????
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Old 11-18-2010
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Q1-D
Q2-G
Q3-A
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Old 11-18-2010
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Quote:
Originally Posted by hedihav_x View Post
Q1-D
Q2-G
Q3-A
Very good Doc. You are the genius. Now, could you explain to me how did you come with this most correct answer. Just give me a brief explanation. Thank you Doc.
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Old 11-18-2010
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Q1-patient has CHF+dark skin+polydipsia &polyuria(maybe secondary to DM)
we can see these sym together in hemochromatosis
Q2-Brain stem lesion can produce ipsilateral facial sensory deficit & contralateral body sensory deficit.PICA is one of the artery that perfuse brain stem.
Q3-asprin inhibits COX enzyme so PGs & TXs can't produce but lipoxygenase overactivate & produce LTs(they play important role in asthma)
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Old 11-18-2010
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Haemochromatosis

Clinical presentation

Organs commonly affected by haemochromatosis are the liver, heart and endocrine glands.

Haemochromatosis may present with the following clinical syndromes:

Cirrhosis of the liver
Diabetes due to pancreatic islet cell failure
Cardiomyopathy
Arthritis (iron deposition in joints)
Testicular failure
Tanning of the skin


Posterior inferior cerebellar artery

Infarction of this artery due to thrombosis or stroke leads to PICA syndrome or Wallenberg syndrome, a neurological disease with characteristic, stereotyped symptoms. Occlusion of this or vertebral arteries can cause Lateral Medullary Sydrome and the descending sympathetic effects likely causeing Horner's Syndrome as well.


Aspirin Induce Asthma

The disorder is caused by an anomaly in the arachidonic acid cascade, which causes undue production of leukotrienes, a series of chemicals involved in the body's inflammatory response. When prostaglandin production (Cyclooxygenase pathway) is blocked by NSAIDS like aspirin, the cascade shunts entirely to leukotrienes (lipooxygenase pathway), causing overproduction of LT-4 and producing the severe allergy-like effects.
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