Dr.Paul's Clinic

04/16/2025

Lobar Pneumonia: USMLE case

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12/24/2024

from www.supertestscores.com Introduction: Patent ductus arteriosus (PDA) is a persistence of the in utero communication between the aortic and pulmonary arteries after birth causing a left-to-right shunt. Risk factors: Maternal rubella infection; prematurity; high altitude, genetic problems such as Down syndrome Pathophysiology: In the fetal circulation, superior vena cava blood enters the right atrium and characteristically is directed across the tricuspid valve into the RV....

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from www.supertestscores.com Introduction: Patent ductus arteriosus (PDA) is a persistence of the in utero communication between the aortic and pulmonary arteries after birth causing a left-to-righ…

12/21/2024

SUPERStudy: VACTERL Association from www.supertestscores.com Introduction VACTERL association is a nonrandom constellation of congenital anomalies involving multiple organ systems. The acronym stands for: V: Vertebral anomalies A: A**l atresia C: Cardiac defects T: Tracheoesophageal fistula E: Esophageal atresia R: Renal anomalies L: Limb defects Patients often present with at least three of these anomalies, without a unifying genetic or environmental cause....

http://drpauls.org/2024/12/21/superstudy-vacterl-association/

SUPERStudy: VACTERL Association  from www.supertestscores.com Introduction VACTERL association is a nonrandom constellation of congenital anomalies involving multiple organ systems. The acrony…

12/20/2024

from www.supertestscores.com rolemia (FH) Introduction: Familial hypercholesterolemia (FH) is a group of autosomal dominant and recessive disorders of lipoprotein metabolism characterized by strikingly elevated low-density lipoprotein-cholesterol (LDL-C), the presence of xanthomas, and premature atherosclerosis. Epidemiology: Homozygous 1 in 1 million; Heterozygous 1 in 500 Pathogenesis: Pathogenic variations in the following four genes can cause FH: (1) LDLR, which encodes the LDL receptor (the most common variant; gene located on the short arm of chromosome 19) (2) …...

http://drpauls.org/2024/12/20/superstudy-familial-hypercholesterolemia/

from www.supertestscores.com rolemia (FH) Introduction: Familial hypercholesterolemia (FH) is a group of autosomal dominant and recessive disorders of lipoprotein metabolism characterized by strik…

12/17/2024

from www.supertestscores.com Purpose: Vaccinations during pregnancy aim to protect both the mother and the baby from serious infectious diseases. Maternal vaccination not only prevents complications during pregnancy but also provides passive immunity to the newborn through the placenta and breastmilk. •Vaccinations are reviewed at the first prenatal visit. Ideally, a patient will be up to date on expected vaccines prior to the initiation of pregnancy....

http://drpauls.org/2024/12/17/superstudy-vaccinations-during-pregnancy/

from www.supertestscores.com Purpose: Vaccinations during pregnancy aim to protect both the mother and the baby from serious infectious diseases. Maternal vaccination not only prevents complication…

09/12/2024

Budd Chiari syndrome

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08/22/2024

Which of the following best explains the pathology of this disease? A.Defects in erythrocytic membrane proteins such as spectrin and actin, or other RBC membrane proteins. B. A single DNA base change leads to an amino acid substitution of valine for glutamate in the sixth position on the beta-globin chain. C.hereditary disorders characterized by reduction in the synthesis of globin chains (alpha or beta)....

Which of the following best explains the pathology of this disease?  A.Defects in erythrocytic membrane proteins such as spectrin and actin, or other RBC membrane proteins.  B. A single D…

07/23/2024

A 64 year-old female, Mrs.Jane, comes to your office for her annual health checkup. For the last few months, she has been having difficulty remembering the names of her friends. She struggles to re…

07/19/2024

A 65 year-old female arrives in your office for her annual health checkup. Which of the following is true about the risk of falls in the elderly?
A.in most older individuals, men fall more often than women

B.in most older individuals, whites fall more often than Africans
C.the risk of falls is raised significantly in elderly individuals who take four or more medications
D.Living alone does not appear to be a risk factor in falls
E.Vitamin D deficiency is not associated with increased risk of falls

Correct Answer is C. Falls are a serious problem in older adults, increasing morbidity and mortality. Polypharmacy is a risk factor for falls with psychotropic medications taking the top of the list. Benzodiazepines (drowsiness, confusion, syncope, tremors), sedatives (excessive sedation), antipsychotics (postural hypotension, sedation, muscle rigidity), cholinesterase inhibitors (bradycardia), antidepressants (postural hypotension), antihypertensives (bradycardia, hypotension), diuretics (hypovolemia), hypoglycemics (acute hypoglycemia) - combination of these drug types place older patients at increased risk of falling. Physicians should take time to go over the list of current medications in each patient visit and try to reduce the dose or eliminate these medications if possible.
Incorrect Answers:
In most older individuals, women fall more often than men
Studies show that Whites fall more often than Africans, Caribbeans, Hispanics, and South Asians.
D. Living alone appears to be a risk factor in falls.
E. Vitamin D deficiency can result in muscle weakness, osteoporosis, and impaired gait patterns, resulting in increased risk of falls. For community-dwelling or long term care residents, vitamin D supplementation in doses from 700 IU/d to 1000 IU/d can reduce falls by 19% after 2-5 months of starting treatment.

Falls account for one of the most common and serious issues contributing to a disability, especially among elderly individuals. Tinetti et al. in 1988 defined a fall as an event that results in a person coming to rest on the ground or other lower-level unintentionally, which is not as a result of a....

07/17/2024

A 36 year-old male patient comes to your office seeking treatment for his opioid abuse and alcohol abuse. He is particularly interested in using naltrexone maintenance. His past medical history is …

07/15/2024

   A 16 year-old male came to your office for the evaluation of a rash on his back and an abscess on his right thigh. He is also feeling frustrated, irritable and lost interest in ac…

07/13/2024

A mother brought her 3 year-old female child to your office for a wellness pediatric physical examination. Her past medical history is significant for normal developmental milestones. Of the follow…