MEHLMANMEDICAL
HY USMLE REVIEW
PART IV
, MEHLMANMEDICAL.COM
YouTube
@mehlmanmedical
Instagram
@mehlman_medical
MEHLMANMEDICAL.COM 2
, MEHLMANMEDICAL.COM
HY USMLE Review – Part IV
- 72M + drooping of left side of face + decreased muscle strength and increased tendon reflexes of
both left upper and lower extremities + Babinski on left + intact sensation; what’s the most likely
explanation for this patient’s condition? à answer = lacunar infarct of internal capsule; produces
“pure motor” stroke in most cases of posterior capsule infarct; thalamic stroke produces “pure
sensory” effects; lacunar infarcts are usually due to Hx of HTN causes lipohyalinosis of lenticulostriate
arteries.
- 24M + experiment glucose injected IV in two different scenarios: 1) when food is simultaneously
consumed orally, and 2) when no food is simultaneously consumed; experiment shows that glucose is
cleared faster from circulation when food is concurrently consumed orally; Q asks, which hormone is
responsible for these findings? à answer = glucose-dependent insulinotropic peptide (GIP); secreted
in response to oral consumption of macronutrients (i.e., carbs, fats, protein); causes insulin secretion;
in other words, insulin goes up more when food is consumed orally vs merely received parenterally à
faster clearance of plasma glucose.
- 24M + receives 50g of glucose IV vs 50g of glucose orally; insulin goes up more when glucose
consumed orally; why? à answer = glucose-dependent insulinotropic peptide à greater insulin
secretion.
- 6F + finds open bottle of aspirin; which of the following findings in the patient best suggests the dose
consumed was toxic? à answer = increased respiratory rate; aspirin causes respiratory alkalosis
acutely due to upregulation of respiratory centers (high pH, low CO2, no change bicarb [too acute to
change]); after roughly 20 minutes, a mixed metabolic acidosis-respiratory alkalosis is seen (low pH,
low CO2; low bicarb); the low bicarb is not compensation for the acute respiratory alkalosis; it is
merely convenient that the salicylic acid itself is an acid and drops the bicarb; tachypnea is seen
acutely as first sign (observed by healthcare practitioner); tinnitus can be reported as first symptom
(patient-reported finding); Tx with sodium bicarb à increased excretion of aspirin via urinary
alkalinization.
- 30M + shooting groin pain + increased blood pressure + mother had surgery for thyroid cancer;
what’s most likely to establish the cause of the patient’s HTN? à answer = urinary metanephrines;
diagnosis is MEN 2A à pheochromocytoma + medullary thyroid carcinoma + primary
MEHLMANMEDICAL.COM 3
HY USMLE REVIEW
PART IV
, MEHLMANMEDICAL.COM
YouTube
@mehlmanmedical
@mehlman_medical
MEHLMANMEDICAL.COM 2
, MEHLMANMEDICAL.COM
HY USMLE Review – Part IV
- 72M + drooping of left side of face + decreased muscle strength and increased tendon reflexes of
both left upper and lower extremities + Babinski on left + intact sensation; what’s the most likely
explanation for this patient’s condition? à answer = lacunar infarct of internal capsule; produces
“pure motor” stroke in most cases of posterior capsule infarct; thalamic stroke produces “pure
sensory” effects; lacunar infarcts are usually due to Hx of HTN causes lipohyalinosis of lenticulostriate
arteries.
- 24M + experiment glucose injected IV in two different scenarios: 1) when food is simultaneously
consumed orally, and 2) when no food is simultaneously consumed; experiment shows that glucose is
cleared faster from circulation when food is concurrently consumed orally; Q asks, which hormone is
responsible for these findings? à answer = glucose-dependent insulinotropic peptide (GIP); secreted
in response to oral consumption of macronutrients (i.e., carbs, fats, protein); causes insulin secretion;
in other words, insulin goes up more when food is consumed orally vs merely received parenterally à
faster clearance of plasma glucose.
- 24M + receives 50g of glucose IV vs 50g of glucose orally; insulin goes up more when glucose
consumed orally; why? à answer = glucose-dependent insulinotropic peptide à greater insulin
secretion.
- 6F + finds open bottle of aspirin; which of the following findings in the patient best suggests the dose
consumed was toxic? à answer = increased respiratory rate; aspirin causes respiratory alkalosis
acutely due to upregulation of respiratory centers (high pH, low CO2, no change bicarb [too acute to
change]); after roughly 20 minutes, a mixed metabolic acidosis-respiratory alkalosis is seen (low pH,
low CO2; low bicarb); the low bicarb is not compensation for the acute respiratory alkalosis; it is
merely convenient that the salicylic acid itself is an acid and drops the bicarb; tachypnea is seen
acutely as first sign (observed by healthcare practitioner); tinnitus can be reported as first symptom
(patient-reported finding); Tx with sodium bicarb à increased excretion of aspirin via urinary
alkalinization.
- 30M + shooting groin pain + increased blood pressure + mother had surgery for thyroid cancer;
what’s most likely to establish the cause of the patient’s HTN? à answer = urinary metanephrines;
diagnosis is MEN 2A à pheochromocytoma + medullary thyroid carcinoma + primary
MEHLMANMEDICAL.COM 3
