Answers with Explanations

Block I

1. A2. B3. C4. D

Block I

Alzheimer’s Disease is a deteriorating illness that affects the elderly. In recent years, it has been linked to people as early as their mid-forties because of declining amounts of acetylcholine binding to its post-synaptic receptors. There are tests that physicians can run to speculate the cause of their patient’s diminishing short- then long-term memories, but there is only one test to confirm the diagnosis of Alzheimer’s Disease. This thorough examination is an autopsy after death that will show defects, such as neurofibrillary tangles, infarcts, and tau proteins in the brain. A complete physical exam should be done to rule out other disorders that can cause memory problems, such as Hypothyroidism, as well as take a thorough past medical history and family history to learn more about genetic disorders that may be causing these issues with the patient’s memory. A Mini-Mental Status Exam should also be done to test a patient’s memory status. An MRI or CT of the head can be done to see atrophy of the decrease in size of the hemispheres of the brain, which would depict the lack of brain activity. There is no cure for Alzheimer’s Disease but there are medications that can treat the patient’s symptoms, which can help stabilize the patient’s current condition. Cholinesterase inhibitors, such as Donepezil, will prevent acetylcholinesterase, the acetylcholine enzyme, from breaking down acetylcholine in the synapse, so more acetylcholine can bind to its post-synaptic receptors.

Block II

5. B6. E7. A

Block II

Anorexia Nervosa is an eating disorder that affects girls who are trying to please their mothers. They are very thin with a Basal Metabolic Index less than 18, and they will go without eating to lose weight and stay thin. These girls do not believe they are under-weight and will go to extreme lengths to not gain any weight. This can lead to starvation and malnourishment, and the body will compensate by growing a fine layer of hair over the skin to keep the body warm. The best treatment for these patients is hospitalization and to watch each girl eat every food item on her food tray, in addition to attending counseling sessions to encourage healthy eating habits daily.

Block III

8. C9. D10. E

Block III

Asherman’s Syndrome is a disorder caused by postpartum hemorrhage of the pituitary gland. This condition will cause the hormones that are released from the pituitary to be diminished as a result of an infarct after childbirth. The mother may experience symptoms, such as cold temperature and decreased or no menstrual periods. There is no cure for this illness, but it can be treated by replenishing the body with the hormones that it can no longer produce, such as TSH and ACTH, that will make our essential hormones, like cortisol and T4 thyroid hormone.

Block IV

11. A12. B13. C14. E

Block IV

Intraductal Breast Papilloma is the most common type of breast cancer. It is not painful but what alarms the patient is the bloody discharge from her breast. The best examinations to test what the problem is to get a blood smear of the discharge to test what type of cells are growing within the specimen. An ultrasound should be down to see if there are any masses within the breast tissue, followed by a needle biopsy to test for any cancerous tissue. A mammogram is not recommended in this patient because she is too young. Her breast tissue is too dense and therefore, no masses can be visualized with a mammogram. Physicians should recommend that all women of child-bearing age take ferrous sulfate daily. This will prevent any neural tube defects that could occur if she would become pregnant unexpectedly. Monthly self-examinations are good but are inaccurate and therefore ineffective at diagnosing breast cancer.

Block V

15. C16. A17. E

Block V

Candida esophagitis is a condition that affects patients that have become immunocompromised, either from medical treatments, such as Chemotherapy and Radiation, or other medical illnesses. People present with complaints of painful swallowing of solids and liquids, as well as chest discomfort. The best treatment option is a swish and swallow method using the antifungal medication Nystatin. A follow-up examination should be done to guarantee completion of treatment and resolution of immunosuppression. If the patient is not being currently treated with medications that caused this illness, inquire about any other illnesses and test their tuberculosis and HIV status.

Block VI

18. A19. E 20. B21. A

Block VI

Women who are in their forties and are fertile, and overweight are prone to get Cholecystitis. This is a condition where gallstones get stuck in the patient’s cystic duct leaving the gallbladder, which causes right upper quadrant pain that sometimes radiates to the back in severe conditions. These large stones are composed of cholesterol that get stored in the gallbladder after eating large amounts of fatty foods over time, in which the body has not broken down. An ultrasound is the best test to confirm the diagnosis of Cholecystitis, and surgery is the best treatment to remove the gallbladder and cystic duct where the pain is derived from.

Block VII

22. A23. C24. A 25. D

Block VII

Diabetes Mellitus type I is an autoimmune disorder that affects the youth. They present with complaints of polydipsia and polyuria, as well as unexplained weight loss despite an increase in appetite. The cause of this illness is a defect in the beta cells of the

pancreas, so no insulin is being produced. The function of this insulin is to lower blood glucose levels by storing it inside of the body’s cells. The only treatment for Diabetes Mellitus type I is to give the body what it is missing, which is Insulin. There are different forms of insulin, ranging from short-acting insulins, such as Lispro to long-acting insulins, such as Detemir, which should be given to patients depending on the severity of their disease and lifestyle. There are actually two types of Diabetes Mellitus. Diabetes Mellitus type 2 is an insulin resistant disorder, whereby the insulin receptors do not respond nor allow insulin to bind to it preventing its function to lower blood glucose levels.

Block VIII

26. C27. D28. A

Block VIII

A fat embolus is a blood clot consisting of mostly fat that gets dislodged from a large bone and gets trapped in a blood vessel. With a break of a leg and hip bone, fat gets into the bloodstream and goes back to the heart and lungs preventing patients from breathing, thereby causing suffocation and then death if not treated in time. The best treatment plan for someone who has broken a large bone is to put them under 24-hour surveillance and give them anticoagulants to prevent any further clots from forming.

Block IX

29. B30. B31. D

Block IX

Osteoporosis is a bone disease that affects aging women. The most common population affected is Caucasian women with small body frames who smoke. Women produce less estrogen when they enter menopause, but there are also medications that can prevent estrogen from binding to its receptors and working properly, such as chemotherapy drugs like Tamoxifen. The lack of estrogen prevents the bones from rebuilding naturally, leaving the bone in a vulnerable state. Estrogen regulates osteoclast functions, therefore patients have bone loss and fewer cells being produced. If the cause of osteoporosis is medication-related, immediately stop using the drug. If possible substitute the treatment with another drug in its class that can do the same function without the same side effect. An example of this is substituting Tamoxifen with Raloxifen. There are other methods to decrease the risks of osteoporosis. Daily cardiovascular exercise, as well as doing weight-bearing exercises will strengthen your bones, in addition to eating healthy foods filled with anti-oxidants.

Block X

32. A33. B34. A

Block X

Tuberculosis is a lung disease that is prevalent in un-industrialized countries. Since the United States contains a lot of immigrant families or people who travel abroad, be cautious when dealing with patients who have persistent coughs, along with night sweats. First, conduct a PPD skin test and check the results within 48-72 hours. A chest X-ray should also be done to look for a Ghon complex in the lungs. If the results are

positive, quarantine the patient and begin treatment with TB medications, such as Rifampin, Ethambutol, Streptomycin, Pyrazidomide, and Isoniazid. All contacts should be tested and treated if necessary. Patients should follow-up every 2 months and have a bronchial lavage done to test the sputum for improvements of their condition. If the PPD is positive and the chest X-ray is negative, the patient does not have tuberculosis, but may have been given a BCG vaccination against tuberculosis in the past.