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  #1  
Old 08-29-2014
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Save It! Nbme 7 discussion!!!

Some quietions make more interest to discuss together, because cannot find a realy right answer, all who resolved this NBME form are welcome for this one...
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  #2  
Old 08-29-2014
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Default Pharmacology

a 75 year old woman begins treatment with several drugs for osteoporosis. Two weeks later, she develops a burning sensation in her chest and throat daily approximately two hourss after taking her medication. Which of the following medication is the most likely cause of the development of the burning sensation in this patient?

Alendronate
Calcitonin
Raloxifene
Sodium fluoride
vitamin D

i Choiced raloxifene, but wasnt corret, Alendronat? and why?
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  #3  
Old 08-29-2014
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Post Calcium channel blocker

A 33 year old woman with hypertension is treated with a calcium channel blocccker that i known to slow conduction through the atrioventricular node. Which of the following components of an ECG will be affected most by this drug?


PR interval
QRS amplitude
QRS width
QT interval
Sinus rate

i answered Sinus rate which is incorrect/ if conduction through atrioventricular interval answer is PR INTERVAL?????
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  #4  
Old 08-29-2014
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Default Pharmacology

A 25 year old man is brought to the emergency department because of confusion and stupor for 1 hour. He is nurse. This is his fourth similar episode within the past 4 month, he is asymptomatic between the episodes, which are not related to meals. Physical examination shows no abnormalities. Laboratory studies show a serum glucose concentration of 30 mg/dL. serum glucose concentration during his previous episodes have ranged from 20 to 40 mg/dL. Dextrose resolved the symptoms during his previous visits. in addition to stabilizing the patient , which o the following is the most appropiate next step in establishing a diagnosis?


24 hour urine collection for measurement of ACTH
Measurement of serum c peptide concentration
Measurement of serum cortisol concentration
CT scan of the pancreas
Prednisone therapy


I think diagnosis is INsulinoma, and what is the best choice to detect this one?
C- peptide to see that is any endogenous insulin secretino, or CT scan of pancreas that will detect it?
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Old 08-29-2014
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Post renin angiotensin pathway

Please someone help to solve this tests, it; very important to understad mistakes during this process



during an experiment , the following data are obtained from an anesthetized dog:
Mean glomerular capillary hydrostatic pressure HP GC 45 mm Hg
mean bowman space hydrostatic pressure HP BS 12 mm Hg
meag dlomerular capillary oncotic pressure 23 mm HG
mean bowman space oncotic pressure 0 mm HG
coefficient of filtratino (3.0 mL/min)/mm Hg
renal blood flow 200 mL /min
Hematocrit 40%
filtration fraction 25%

An intravenous infusion of angiotensin 2 is administered for 60 minutes, Which of the following is most likely in this animal after the infusion?



Increased filtration fraction
increased HP BS
increased K I
decreased mean ONcotic GC
decreased renal blood flow

??? if increased hydrostatic pressure is incorect? than which is correct? angiotensin 2 produce vasoconstriction and may be a secondary effect to decrease in blood flow to kidney???
please help someone who yet solve this form
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Old 08-29-2014
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Bisphosphonates( including alendronate) can cause osteonecrosis of the jaw.
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Old 08-29-2014
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Default NBME form 7

Quote:
Originally Posted by sashabeliimd View Post
Some quietions make more interest to discuss together, because cannot find a realy right answer, all who resolved this NBME form are welcome for this one...
Just today took NBME got bull **** score - 217, send you personal message let's discuss it over Skype;
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Old 09-14-2014
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Any of you guys want to discuss NBME 7 qs?
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Old 09-15-2014
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Save It! HI

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Originally Posted by qirkergaard View Post
Any of you guys want to discuss NBME 7 qs?
Let discuss, just give me a sign, my skype is sashabeliimdamc.
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Old 09-15-2014
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Quote:
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Let discuss, just give me a sign, my skype is sashabeliimdamc.
Just added you.
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  #11  
Old 09-18-2014
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Post HI

A 44 year old man comes to the physician to discuss the results of electromyography conducted 1 week ago. He has had progressive muscle wasting, frequent muscle twitches at rest, mild difficulty swallowing, and a 6,8 kg weight loss during the past 3 months, He has been concerned that this might represent a a serious illness. Physical examination shows atrophy of the muscle of the right upper extremity and left lower extremity, and brisk deep tendon reflexes. The results of the EMG are compatible with amyotrophic lateral sclerosis. Which of the following is the most appropiate way to initiate a discussion about these results with this patient?

A i'd like to talk to you about your EMG, but i want to wait until your wife can be present. Can you return later this week with her?


B You do have a very serious muscle disease called ALS. This cannot be cured, but i will be here to help you with everything i can, Have you heard of ALS?

C you seem to have a significant muscle disease , and I am going to start you on medication right away, Have you thought about a living will or power of attorney for medical affairs?

D your EMG shows diffuse denervation and four extremity increaseed amplitude, which confirms our worst suspicions, You have ALS

E your EMG shows diffuse muscle disease, and i will refer you to a specialist, in the meantime, I"D like to provide you with a web site that offers lots of helpful advice about living with the disease.
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  #12  
Old 09-18-2014
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Quote:
Originally Posted by sashabeliimd View Post
A 44 year old man comes to the physician to discuss the results of electromyography conducted 1 week ago. He has had progressive muscle wasting, frequent muscle twitches at rest, mild difficulty swallowing, and a 6,8 kg weight loss during the past 3 months, He has been concerned that this might represent a a serious illness. Physical examination shows atrophy of the muscle of the right upper extremity and left lower extremity, and brisk deep tendon reflexes. The results of the EMG are compatible with amyotrophic lateral sclerosis. Which of the following is the most appropiate way to initiate a discussion about these results with this patient?

A i'd like to talk to you about your EMG, but i want to wait until your wife can be present. Can you return later this week with her?


B You do have a very serious muscle disease called ALS. This cannot be cured, but i will be here to help you with everything i can, Have you heard of ALS?

C you seem to have a significant muscle disease , and I am going to start you on medication right away, Have you thought about a living will or power of attorney for medical affairs?

D your EMG shows diffuse denervation and four extremity increaseed amplitude, which confirms our worst suspicions, You have ALS

E your EMG shows diffuse muscle disease, and i will refer you to a specialist, in the meantime, I"D like to provide you with a web site that offers lots of helpful advice about living with the disease.
ANSWER E is incorect

And a corect answer i think is B, because you may tell everything to patient and ask if him know anything about diseases that him may have, please replay and give a porpose for this quietion....
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  #13  
Old 09-18-2014
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Post hi

A 20 month old boy is brought to the physician by his mother because she is concerned about his language development. HIS MOTHER says, ( i don;t understand, His 4 year old sister had no problems with speech when she was his age). He is able to make some sounds, including B and P spontaneously, but he seems slow to imitate words the parents say. He is active ,able to run a few steps, and can recongnize shapes and do simple puzzles. He is at the 60th percentile for lenght and weight, and 75th percentile for head circumference. He is friendly and cooperative and has a good eye contact. Physical examination shows no abnormalities. Which of the following is the most appropiate initial statement by the physician?

A I recommend that he undergo a hearing screening as soon as possible

B i wouldn't worry.Boys often speak later than girls do

C i'm going to schedule him for an MRI of the brain to exclude hydrocephlus

D you should give him things only if he attempts to ask for them

E you should have him evaluated by a child psychologist for a possible autistic disorder


I think aswer is D it's like positive reinforment method? but which is definitively correct? please help
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  #14  
Old 09-18-2014
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Post Hi

An investigator is conducting a study of a possible link between the developlment of breast cancer and an environmental toxin in a particular community. Over a 1 year period, all of the women with established breast cancer in a certain zip code are identified. Which of the following best describes this measurement?

A Attack rate

B Cumulative incidence

C incidence

D period prevalence

E point prevalence


E incorect, it is a prospective study? and if is just development of breast cancer it might be incidence, then answer B is???

Last edited by ginseng plus; 09-18-2014 at 11:06 AM.
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  #15  
Old 09-18-2014
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Post Hi

I know that a lot of people solve this form and is one of the predictable, please contribue to this and help with some quietions


A 69 year old man with Parkinson disease has a progression of his tremor that is unresponsive to medications.A stereotactic operation is scheduled.To alleviate the tremor, the needle should be placed in which of the following?


A cerebellar hemisphere


B frontal lobe of the cortex

C Globus pallidus

D inferior olivary nucleus


E substantia nigra that is incorrect anwer !!!
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  #16  
Old 09-18-2014
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Quote:
Originally Posted by sashabeliimd View Post
I know that a lot of people solve this form and is one of the predictable, please contribue to this and help with some quietions


A 69 year old man with Parkinson disease has a progression of his tremor that is unresponsive to medications.A stereotactic operation is scheduled.To alleviate the tremor, the needle should be placed in which of the following?


A cerebellar hemisphere


B frontal lobe of the cortex

C Globus pallidus

D inferior olivary nucleus


E substantia nigra that is incorrect anwer !!!
Posteroventral pallidotomy and deep brain stimulation (DBS) in various basal ganglia targets have been the most used surgical procedures during the last year that makes the later C the best choice

find in UW forum that basal ganglia
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  #17  
Old 09-18-2014
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Post Hi


A healthy 21-year-old man is undergoing initial screening for intestinal polyps. Sigmoidoscopy shows multiple sessile and pedunculated polyps throughout the rectum and sigmoid colon. Physical examination shows poor dentition and several osteomas in the mandible and skull. Which of the following is the most likely diagnosis?


A Cowden disease

B Cronkhite-Canada syndrome

C Gardner syndrome

D Inflammatory mucosal polyps

E Juvenile polyposis

F Peutz-Jeghers syndrome
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  #18  
Old 09-18-2014
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Quote:
Originally Posted by sashabeliimd View Post

A healthy 21-year-old man is undergoing initial screening for intestinal polyps. Sigmoidoscopy shows multiple sessile and pedunculated polyps throughout the rectum and sigmoid colon. Physical examination shows poor dentition and several osteomas in the mandible and skull. Which of the following is the most likely diagnosis?


A Cowden disease

B Cronkhite-Canada syndrome

C Gardner syndrome

D Inflammatory mucosal polyps

E Juvenile polyposis

F Peutz-Jeghers syndrome


From Pathoma course as high yield and realy it's a high yield if is meeting on this form, and answer is Gardner syndrome : FAP ( familial adenomatous polyposis) + fibromatosis + osteomas( in this case you see several osteomas in the mandible and skull.)
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  #19  
Old 10-21-2014
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Hi everyone ! i did nbme 7 today and i have quite a few doubts. Hope we can help each other out here !
- in the question with the picture of the removed appendix, which type of inflammation is it?
-25 yr old woman, severe pain in right hip, running on uneven ground, pain exacerbated on flexion and int rotation and on direct palpation of lateral aspect of hip, which bursa is involved?
-in the diagram of aa biosynthesis which aminoacids is he talking about ? is it the phenylalanine, tyrosine, dopa, dopamine, ne, epi thing?
-in uncompensated respiratory acidosis, is the HCO3- normal or decreased??
-How does COX2 increase the risk of mi and stroke?

more questions to come

Last edited by zh3298; 10-21-2014 at 01:48 AM.
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Old 10-21-2014
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Quote:
Originally Posted by sashabeliimd View Post
A 25 year old man is brought to the emergency department because of confusion and stupor for 1 hour. He is nurse. This is his fourth similar episode within the past 4 month, he is asymptomatic between the episodes, which are not related to meals. Physical examination shows no abnormalities. Laboratory studies show a serum glucose concentration of 30 mg/dL. serum glucose concentration during his previous episodes have ranged from 20 to 40 mg/dL. Dextrose resolved the symptoms during his previous visits. in addition to stabilizing the patient , which o the following is the most appropiate next step in establishing a diagnosis?


24 hour urine collection for measurement of ACTH
Measurement of serum c peptide concentration
Measurement of serum cortisol concentration
CT scan of the pancreas
Prednisone therapy


I think diagnosis is INsulinoma, and what is the best choice to detect this one?
C- peptide to see that is any endogenous insulin secretino, or CT scan of pancreas that will detect it?
the thing here is to differentiate if its endogenous insulin or exogenous. in insulinoma since it is endogenous insulin c peptide level will increase. if it was malingering, in which case he would consume exogenous insulin, c peptide wont increase
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Old 10-21-2014
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Quote:
Originally Posted by sashabeliimd View Post
A 20 month old boy is brought to the physician by his mother because she is concerned about his language development. HIS MOTHER says, ( i don;t understand, His 4 year old sister had no problems with speech when she was his age). He is able to make some sounds, including B and P spontaneously, but he seems slow to imitate words the parents say. He is active ,able to run a few steps, and can recongnize shapes and do simple puzzles. He is at the 60th percentile for lenght and weight, and 75th percentile for head circumference. He is friendly and cooperative and has a good eye contact. Physical examination shows no abnormalities. Which of the following is the most appropiate initial statement by the physician?

A I recommend that he undergo a hearing screening as soon as possible

B i wouldn't worry.Boys often speak later than girls do

C i'm going to schedule him for an MRI of the brain to exclude hydrocephlus

D you should give him things only if he attempts to ask for them

E you should have him evaluated by a child psychologist for a possible autistic disorder


I think aswer is D it's like positive reinforment method? but which is definitively correct? please help
my key says the answer is B. And i agree. the mothers problem is that the child is not speaking well enough. if it were hearing problem the mother would have complained that the child is not responding to her calls.
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Old 10-21-2014
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Quote:
Originally Posted by sashabeliimd View Post
An investigator is conducting a study of a possible link between the developlment of breast cancer and an environmental toxin in a particular community. Over a 1 year period, all of the women with established breast cancer in a certain zip code are identified. Which of the following best describes this measurement?

A Attack rate

B Cumulative incidence

C incidence

D period prevalence

E point prevalence


E incorect, it is a prospective study? and if is just development of breast cancer it might be incidence, then answer B is???
i have no idea about this question either my key says it is C
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Old 10-21-2014
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Default need help on this one

A 76yr old man, comes with shorttness of breath for 3 weeks. 20 yr history of htn. temp normal, pulse 118/min, rr 22/min, BP 108/52. B/L crackles +. S1 S2 normal. S3 heard. point of maximal impulse is located at 6th intercostal space at anterior axillary line. which of the options is correct?

LV stroke volume LA pressure Peripheral vasc resistance
A. dec dec dec
B. dec dec inc
C. dec inc inc
D. inc dec dec
E. inc dec inc
F. inc inc dec

The answer is given as C. can someone pls explain..
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Old 10-21-2014
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Quote:
Originally Posted by sashabeliimd View Post
a 75 year old woman begins treatment with several drugs for osteoporosis. Two weeks later, she develops a burning sensation in her chest and throat daily approximately two hourss after taking her medication. Which of the following medication is the most likely cause of the development of the burning sensation in this patient?

Alendronate
Calcitonin
Raloxifene
Sodium fluoride
vitamin D

i Choiced raloxifene, but wasnt corret, Alendronat? and why?
Bisphosphonates like Alendronate are caustic to the esophagus. so after taking drug stay upright for atleast 30mins before lying down, to prevent reflux. they also cause osteonecrosis of jaw and also excreted unchanged in urine, so use carefully in renal failure pts.
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  #25  
Old 10-21-2014
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Correct Answer Deletion gene

A 4 year old boy has progressive muscle weakness and markedly increased serum creatine kinase activity. Additional laboratory studies show deletion of the gene for Dystrophin. Which of the following patterns of inheritance should be explained during a counseling session?

Autosomal dominant
Autosomal recessive
Mitochondrial
X-linked dominant
X-linked recessive


Duchenne's muscular dystrophy
X linked frame shift mutation
Deletion of dystrophin gene
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  #26  
Old 10-21-2014
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Correct Answer THalasemias

A 15-month-old girl is brought to the physician because of a 6-month history of progressive weakness and fatigue. Physical examination shows tachycardia, scleral icterus, pallor, and hepatosplenomegaly. Her hemoglobin concentration is 5.6 g/dL (N=11.5–14.5), and serum indirect bilirubin concentration is 3 mg/dL. A peripheral blood smear shows severe hypochromia, nucleated erythrocytes, and microcytosis. DNA analysis shows an A→G point mutation within the TATA box of the β-globin gene promoter. Which of the following sets of additional laboratory findings is most likely in this patient?

Hemoglobin F

HemoglobinA2:Hemoglobin A Ratio

Reticulocyte Count

all with up down arrows


Point mutation in splice sites and promoter sequences, result in decreased B globin synthesis..
Diagnosis of Betta thalasemia minor :
B chain is underproduced, mean decreased HbA normal adult Hb is decreased, but HbA2 is more than 3.5%
B thalasemia major is monozygotic, and is more severe anemia , where b chain is absent completely, requiring often blood transfusion with some complications like hemochromatosis

In both major and minor thalasemias HbF is increased, which result in answer A where all are increased ( HbA2, HbF, and reticulocyte count.)
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Old 10-21-2014
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Info Man with Parkinson disease

A 69 year old man with Parkinson disease has a progression of his tremor that is unresponsive to medications. A stereotactic operation is scheduled, To alleviate the tremor the needle should be placed in which of the followiing locations???

Cerebellar hemisphere

Frontal lobe of the cortex Bad idea

Globus pallidus Remain on of the best aswer

Inferior olivary nucleus I think no because it is need for more precise movements

Substantia nigra which is wrong


Let's review every answer, and for what is responding each location in the brain...

Cerebellar hemisphere: Intention tremor, limb ataxia, damage to the cerebellum results in ipsilateral deficits, fall toward side of lesion

Frontal lobe if is lesioned: Disinhibition and deficits in concetration, orientation, judgment, may have reemergence of primitive reflexes, personality changes.

Globus pallidus :The globus pallidus (Latin for "pale globe") also known as paleostriatum, is a sub-cortical structure of the brain. It is part of the telencephalon, but retains close functional ties with the subthalamus - both of which are part of the extrapyramidal motor system.[1] The globus pallidus is a major component of the basal ganglia core along with the striatum and its direct target, the substantia nigra. The latter are made up of similar neuronal elements, have similar afferents from the dorsal striatum, and have a similar synaptology; neither receives cortical afferents.

Function[edit]
The globus pallidus is a structure in the brain involved in the regulation of voluntary movement. It is part of the basal ganglia, which, among many other things, regulate movements that occur on the subconscious level. If the globus pallidus is damaged, it can cause movement disorders, as its regulatory function will be impaired. There may be cases in which damage is deliberately induced, as in a procedure known as a pallidotomy, in which a lesion is created to reduce involuntary muscle tremors

Globus pallidus is a part of BASAL GANGLIA
Globus pallidus
Substantia nigrum

Striatum Function
It is closely associated with the cerebellum, meaning that it is involved in control and coordination of movements,[1] sensory processing and cognitive tasks likely by encoding the timing of sensory input independently of attention or awareness .[2][3] [4] Lesions to the inferior olive have been associated with a decreased ability to perfect highly specialized motor tasks, such as improving one's accuracy in hitting a target with a ball.[5] There is some evidence that it is stimulated by ghrelin
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Old 10-21-2014
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Correct Answer Dislocation of the hips

A 2 month old girl is brought to the physician by her mother because she is concerned that her daughter has not looked normal since birth. Physical examination shows coarse facial features, dislocation of the hip, an inguinal hernaia, and generalized hypotonia. Serum studies show increased activities of lysosomal enzymes. Urine studies show no mucopolysaccharides. Microscopic examination of cultured skin fibroblasts shows dense inclusion bodies and deficient lysosomal enzymes. the most likely cause of this patient;s disorder is a defect that occurs in which of the following?

Golgi complex
MItochondria
Polyribosome
RER
SER

Last phrase about dense inclusions give some signs of Lysosomal disorder

I cell disease ( inclusion cell disease)
INherited lysosomal storage disorder, failure of addition of mannose 6 phosphate to lyysosome proteins.( Enzymes are secreted outside the cell instead of being targeted to the lysosome.) Results in coarse facial features, clouded corneas. restricted joint movement, and high plasma levels of lysosomal enzymes. Often fatal in childhood.
Skeletal abnormalities, severe psychomotor impairmant.
Golgi complex here is a problem for sure.
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Old 10-21-2014
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Fire Thread Boring statistics

Two programs for the treatment of patients with newly detected hypercholesterolemia were tried in a community. Program A was used in one district of the community, and Program B was used in another. After four years, 40% of the 110 patients on Programe A and 53% of the 95 patients on Programe B had been successfully treated for hypercholesterolemia. The p- value for the difference was 0.3. Based on these data , the health officials decide not to change to program B in the first district. Which of the following best explains this decision?

They attributed the difference in success rates to chance alone
THey distinguished between statistical significance and clinical significance >>>>>>>wrong
They felt the power was too high to justify a decision in favor of Programe B
They felt the p-value was too small to justify a decision in favor of Programe B
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Old 10-21-2014
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Fire Thread Review, please help here

Quote:
Originally Posted by sashabeliimd View Post
Two programs for the treatment of patients with newly detected hypercholesterolemia were tried in a community. Program A was used in one district of the community, and Program B was used in another. After four years, 40% of the 110 patients on Programe A and 53% of the 95 patients on Programe B had been successfully treated for hypercholesterolemia. The p- value for the difference was 0.3. Based on these data , the health officials decide not to change to program B in the first district. Which of the following best explains this decision?

They attributed the difference in success rates to chance alone
THey distinguished between statistical significance and clinical significance >>>>>>>wrong
They felt the power was too high to justify a decision in favor of Programe B Wrong too
They felt the p-value was too small to justify a decision in favor of Programe B

Let's review some statistical errors, and mean of the P value
Error types
TYpe 1 error alpha false - positive error
Stating that there is an effect or difference when none exists To mistakenly accept the experimental hypothesiss and reject the null hypothesis
P= probability of making type 1 error, P is judged against a preset level of significance usually less than 0.05
If P is less than 0.05 then there is less than a 5% chance that data will show something that is not really there. you saw difference that did not exist.


But here we can see another p value that is more than 0.05 ( 0.3 )

If P> 0.05 do not reject the null hypothesis has not reached statistical power.

Decide that the drug does not work

STATISTICAL POWER IS DIRECTLY RELATED TO TYPE 2 ERROR, 1-B= POWER

??? A is correct , and why ,explane please anybody
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Correct Answer Behavioral

A 42 year old woman comes to the physician fo a follow up examination after she received two increased blood pressure readings on different days. Her blood pressure now is 140/90 mm Hg , Physical examination shows no other abnormalities. In addition to considering pharmacotherapy, the physician recommends a low sodium diet. Which of the following initial statements is the most appropiate aproach to educating this patient about decreasing her sodium intake???

The internet is a great way to learn about methods to decrease sodium in your diet

Do you know what kind of foods are high in sodium?

I will send you a brochure outlining th low sodium diet you will need to follow

You must see nutritionist to discuss decreasing your sodium intake wronggggg

You need to lower your intake to fewer than three grams of sodium daily

I think second answer, because you it must be directly asked , to seek which information patient know, And avoid judgmental terms.

???
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Correct Answer GIT

A 58 year old man comes to the physician because of a 6 month history of a gurgling noise in his throat as he eats, which often requires repeated coughing and throat clearing to eradicate. He occasionaly regurgitates undigested food 1 hour after eating. He has a 2 year history of well controlled type 2 diabetes mellitus and a 6 month history of intermittent mild dysphagia and prgressive halitosis. He has not had any weight loss. His vital signs are within normal limits. Physical examination shows no abnormalities.
Which of the following is the most likely diagnosis?

Barrett esophagus
Diffuse esophageal spasm
Esophageal cancer, which is wrong
Gastroesophageal reflux disease
Zenker diverticulum

Barrett esophagus >>>>>refers to an abnormal change (metaplasia) in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by simple columnar epithelium with goblet cells (which are usually found lower in the gastrointestinal tract).

Signs and symptoms:
The change from normal to premalignant cells that indicate Barrett's esophagus does not cause any particular symptoms. Barrett's esophagus, however, is associated with these symptoms:

frequent and longstanding heartburn
trouble swallowing (dysphagia)
vomiting blood (hematemesis)
pain under the sternum where the esophagus meets the stomach
unintentional weight loss because eating is painful


Diffuse esophageal spasm>>>>>>Diffuse esophageal spasm (DES) is a condition in which uncoordinated contractions of the esophagus occur. It is thought to result from motility disorders of the esophagus. These spasms do not propel food effectively to the stomach. It can cause dysphagia, regurgitation and chest pain.

Gastroesophageal reflux disease>>>>>Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease is a chronic symptom of mucosal damage caused by stomach acid coming up from the stomach into the esophagus.[1]

GERD is usually caused by changes in the barrier between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which normally holds the top of the stomach closed, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. These changes may be permanent or temporary.


Zenker diverticulum>>>>>Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, also hypopharyngeal diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a false diverticulum (not involving all layers of the esophageal wall).
Mechanisms and manifestations[edit]
In simple words, when there is excessive pressure within the lower pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter.

More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (known as Killian's triangle, located superior to the cricopharyngeus muscle and inferior to the inferior constrictor muscles). The result is an outpouching of the posterior pharyngeal wall, just above the esophagus, specifically just above the cricopharyngeal muscle.[3]

While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as dysphagia (difficulty swallowing), and sense of a lump in the neck; moreover, it may fill up with food, [COLOR="rgb(255, 140, 0)"]causing regurgitation [/COLOR](reappearance of ingested food in the mouth), cough (as some food may be regurgitated into the airways),[COLOR="rgb(255, 140, 0)"] halitosis ([/COLOR]smelly breath, as stagnant food is digested by microorganisms), potential infection of the pharyngeal areas due to food stuck, and involuntary gurgling noises when swallowing. It rarely, if ever, causes any pain.

Cervical webs are seen associated in 50% of patients with this condition.

Rarer forms of cervical esophageal diverticula are the Killian's diverticulum and the Laimer's diverticulum. Killian's diverticulum is formed in the Killian-Jamiseon triangle (located inferior to the cricopharyngeus on both sides of this muscle's insertion into the cricoid cartilage). Laimer's diverticulum is formed in Laimer's triangle (located inferior to the cricopharyngeus in the posterior midline above the confluence of the longitudinal layer of esophageal muscle). Laimer's triangle is covered only by the circular layer of esophageal muscle.

Zenker diverticulum best answer here...
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Correct Answer Interesting one

An 8 year old boy is brought to the physician by his parents because of a 3 month history of episodes of unusual behavior that interfere with his performance at school. His teacher told the parents that he suddenly stops what he is doing for a few seconds and stares into space, The episodes start and end abruptly. Physical adn neurologic examinations show no abnormalities. Which of the following mechanisms is the most likely cause of these episodes?

A Cortical inhibition of thalamic neurons wrong was
B Decreased dopaminergic inputs to cortical neurons
C IMpaired activity of pontine neurons
D Spreading depression of cortical neurons
E Synchronized discharge of the thalamocortical neurons

Diagnosis looks like abcense..
Absence seizures occur in idiopathic and symptomatic generalized epilepsies.[4] Among the idiopathic generalized epilepsies, absence seizures are seen in childhood absence epilepsy (pyknolepsy), juvenile absence epilepsy, and juvenile myoclonic epilepsy (impulsive petit mal).[5] The seizures in these conditions are called typical absence seizures and are usually associated with generalized 3-4 Hz spike-and-slow-wave complexes on EEG.[6]

In childhood absence epilepsy, seizures are frequent and brief, lasting just a few seconds (pyknoleptic). Some children can have many such seizures per day. In other epilepsies, particularly those with an older age of onset, the seizures can last several seconds to minutes and may occur only a few times a day; these are called nonpyknoleptic or spanioleptic absence seizures.

Myoclonic and tonic-clonic seizures may also be present, especially in syndromes with an older age of onset.

In the cryptogenic or symptomatic generalized epilepsies, absence seizures are often associated with slow spike-wave complexes of 1.5-2.5 Hz[5] ; these are also called sharp-and-slow-wave complexes. These seizures may be associated with loss of axial tone and head nodding; a fall may occur. Increased tone, autonomic features, and automatisms may also be seen. Absence seizures associated with slow spike-wave complexes are called atypical absence seizures.[7]

See Epilepsy and Seizures for a general overview of these topics.

Classification
The International League Against Epilepsy (ILAE) Commission on Classification and Terminology revised the concepts, terminology, and approaches for classifying seizures and epilepsy.[8]

The classification of absence seizures has been simplified as follows:

Absence seizures - Typical or atypical.
Absence with special features - Includes myoclonic absence and eyelid myoclonia

The current understanding of the pathogenesis of absence seizures is based on animal models that generate generalised spike-and-wave discharges on EEG. A reverberating circuit between the thalamus and cortex is the basis for this model, with the hypothesis being that aberrant rhythmic oscillations are generated in the circuit, analogous to a mechanism that generates normal sleep spindles. The reticulothalamic nucleus of the thalamus has been particularly implicated and contains a predominance of inhibitory GABA-containing interneurons. In this case, GABA-mediated activity may trigger absence seizures by inducing prolonged hyperpolarisation and activating low-threshold Ca^2+ currents. [22] [23] The concept of 't-type' or 'low-threshold' calcium channels playing a role in absence seizures is supported by the responsiveness of typical absence seizures to medicines such as ethosuximide, which is known to block these channels.

Multiple studies have been done in the attempt to identify a single gene locus for childhood absence epilepsy (CAE), juvenile myoclonic epilepsy (JME), or even the idiopathic generalised epilepsies (IGE) in general. Most identified genes associated with IGE involving absence seizures are for different types of ion channels (channelopathies). A gene for a component of GABA^A receptor has been implicated in a large family of JME with autosomal dominant inheritance. [24] To date, CAE has been associated with defects in gamma-aminobutyric acid (GABA)^A receptor gamma2 subunit and voltage-gated Ca^2+ channel alpha-1A subunit (CACNA1A) among others. [23] [25] Mutations in a gene that encodes voltage-gated chloride channel CLC-2 has been associated with CAE, juvenile absence epilepsy (JAE), and JME. [26] There have been multiple studies demonstrating a locus that may predispose to JME on chromosome 6p as well as 15q; the latter maps to the alpha-7 subunit of the neuronal nicotinic acetylcholine receptor (CHRNA7). [25] Recently, some cases of early-onset absence epilepsy have been attributed to mutations in the GLUT1 glucose transporter. [27


A reverberating circuit between the thalamus and cortex is the basis for this model

E is corect
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Correct Answer COX

A 55 yo man comes to the emergency department 2 hours after he fell on his right wrist. He has a 1 year history of coronary artery disease and a 2 year history of heartburn. Examination of the right wrist shows exquisite tenderness to palpation and swelling. The patient asks ( Do you think you could prescribe celecoxib for the pain?) I've heard that it won't upset my stomach like aspirin does. The physician is reluctant to prescribe this drug because other drugs in the same category have been associated with increased risk for myocardial infarction. This increased risk is most likely caused by Which of the following mechanisms of action?
Greater inhibition of cyclooxygenase ! than cox2 wrong
INhibition of cox 2 enzyme in gastric epithelial cells, that is unspecific for stomach

INhibition of lipoxygenase preventing the formation of leukotriene D and C which is action of Zileuton, not a Cox inhibitors

Inhibition of prostacyclin I2 formation without inhibition of thromboxane A2 in platelets No because Celecoxib bypass stomach, in stomach are just a few COX 2 Enzymes,
Inhibition of prostaglandin E2 formation,, for sure both COX1,2 inhibit formation of prostaglandin, which have a vasodilating effect, and prevent formation of thrombi,
Last one is correct
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Correct Answer Simple quetion but

A 71 year old man comes to the physician because of a 4 month history of decreased force and size of his urine stream. Rectal examination shows a diffusely enlarged prostate. Urinalysis shows microscopic blood. Cytoscopy shows hypertrophy and thickening of the bladder wall. Without treatment, this patient is at greatest risk for which of the following?


Bladder transitional cell carcinoma is wronggggggggg
Renal papillary necrosis
Urethal diverticulum bad idea
Urethral stricture bad idea
Urinary tract infection


Complications
By Mayo Clinic Staff
Prostate gland enlargement becomes a serious problem when it severely interferes with your ability to empty your bladder. If this is the case, you'll probably need surgery. Complications of enlarged prostate include:

Acute urinary retention. Acute urinary retention is a sudden, painful inability to urinate. This may occur after you've taken an over-the-counter decongestant medication for allergies or a cold. When you are unable to urinate at all, your doctor may thread a tube (catheter) through your urethra into your bladder. Or, your doctor may put in a suprapubic tube — a catheter that drains your bladder through the lower abdomen. The type of catheter you need will depend on your particular circumstances. Some men with an enlarged prostate require surgery or other procedures to relieve urinary retention.
Urinary tract infections (UTIs). Some men with an enlarged prostate end up having surgery to remove part of the prostate to prevent frequent urinary tract infections.
Bladder stones. These are mineral deposits that can cause infection, bladder irritation, blood in the urine and obstruction of urine flow and are generally caused by the inability to completely empty the bladder.
Bladder damage. This occurs when the bladder hasn't emptied completely over a long period of time. The muscular wall of the bladder stretches and weakens and no longer contracts properly. Often, symptoms of bladder damage improve after prostate surgery or other treatment, but not always.
Kidney damage. This is caused by high pressure in the bladder due to urinary retention. This high pressure can directly damage the kidneys or allow bladder infections to reach the kidneys. When an enlarged prostate causes obstruction of the kidneys, a condition called hydronephrosis — a swelling of the urine-collecting structures in one or both kidneys — may result.
Most men with an enlarged prostate don't develop these complications. However, acute urinary retention and kidney damage in particular can be serious health threats when they do occur.

Also answer divine very clearly that is infection of urinary tract, from stasis of urine...
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Correct Answer Neurology

A 50 yo man with schizophrenia develops fever, catatonia, and muscle rigidity 48 hours after starting treatment with chlorpromazine. his temperature is 39.2 .Laboratory studies show myoglobinemia and an increased serum creatine kinase activity. Which of the following is the most likely diagnosis?


Acute dystonia
Akathisia
Neuroleptic malignant syndrome right answer
Parkinsonian syndrome
tardive dyskinesia

Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures.[1] The movements may resemble a tremor. Dystonia is often initiated or worsened by voluntary movements, and symptoms may “overflow” into adjacent muscles.[2]

The disorder may be hereditary or caused by other factors such as birth-related or other physical trauma, infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical drugs, particularly neuroleptics.[1] Treatment must be highly customized to the needs of the individual and may include oral medications, botulinum neurotoxin injections, physical therapy and/or other supportive therapies, and/or surgical procedures such as deep brain stimulation.

Akathisia, or acathisia (from Greek καθίζειν kathízein - "to sit", a- indicating negation or absence, lit. "inability to sit") is a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting. People with akathisia are unable to sit or keep still, complain of restlessness, fidget, rock from foot to foot, and pace



Neuroleptic malignant syndrome>>> rigidity, myoglobinuria, autonomic instability, hyperpyrexia


tardive dyskinesia>>>>> Stereotypic oral-facial movements due to long term antipsychotic use, often reversible
Tardive dyskinesia /ˈtɑrdɨv ˌdɪskɨˈniːʒə/ is a difficult-to-treat and often incurable form of dyskinesia, a disorder resulting in involuntary, repetitive body movements.



Parkinson disease
Signs and symptoms
Black and white picture of male with PD stooping forward as he walks. He is viewed from the left side and there is a chair behind him.
A man with Parkinson's disease displaying a flexed walking posture pictured in 1892. Photo appeared in Nouvelle Iconographie de la Salpètrière, vol. 5.
First line of text is "Catherine Metzger" Second line of text is "13 Octobre 1869" (13 October 1869; in French).
Handwriting of a person affected by PD in Lectures on the diseases of the nervous system by Charcot (1879). The original description of the text states "The strokes forming the letters are very irregular and sinuous, whilst the irregularities and sinuosities are of a very limited width. (...) the down-strokes are all, with the exception of the first letter, made with comparative firmness and are, in fact, nearly normal — the finer up-strokes, on the contrary, are all tremulous in appearance (...)."
Main article: Signs and symptoms of Parkinson's disease
Parkinson's disease affects movement, producing motor symptoms.[5] Non-motor symptoms, which include autonomic dysfunction, neuropsychiatric problems (mood, cognition, behavior or thought alterations), and sensory and sleep difficulties, are also common. Some of these non-motor symptoms are often present at the time of diagnosis and can precede motor symptoms.[5]

Motor
Further information: Parkinsonian gait
Four motor symptoms are considered cardinal in PD: tremor, rigidity, slowness of movement, and postural instability.[5]

Tremor is the most apparent and well-known symptom.[5] It is the most common; though around 30% of individuals with PD do not have tremor at disease onset, most develop it as the disease progresses.[5] It is usually a rest tremor: maximal when the limb is at rest and disappearing with voluntary movement and sleep.[5] It affects to a greater extent the most distal part of the limb and at onset typically appears in only a single arm or leg, becoming bilateral later.[5] Frequency of PD tremor is between 4 and 6 hertz (cycles per second). A feature of tremor is pill-rolling, the tendency of the index finger of the hand to get into contact with the thumb and perform together a circular movement.[5][13] The term derives from the similarity between the movement in people with PD and the earlier pharmaceutical technique of manually making pills.[13]

Bradykinesia (slowness of movement) is another characteristic feature of PD, and is associated with difficulties along the whole course of the movement process, from planning to initiation and finally execution of a movement.[5] Performance of sequential and simultaneous movement is hindered.[5] Bradykinesia is commonly a very disabling symptom in the early stages of the disease.[6] Initial manifestations are problems when performing daily tasks which require fine motor control such as writing, sewing or getting dressed.[5] Clinical evaluation is based in similar tasks such as alternating movements between both hands or both feet.[6] Bradykinesia is not equal for all movements or times. It is modified by the activity or emotional state of the subject, to the point that some people are barely able to walk yet can still ride a bicycle.[5] Generally people with PD have less difficulty when some sort of external cue is provided.[5][14]

Rigidity is stiffness and resistance to limb movement caused by increased muscle tone, an excessive and continuous contraction of muscles.[5] In parkinsonism the rigidity can be uniform (lead-pipe rigidity) or ratchety (cogwheel rigidity).[5][6][15][16] The combination of tremor and increased tone is considered to be at the origin of cogwheel rigidity.[17] Rigidity may be associated with joint pain; such pain being a frequent initial manifestation of the disease.[5] In early stages of Parkinson's disease, rigidity is often asymmetrical and it tends to affect the neck and shoulder muscles prior to the muscles of the face and extremities.[18] With the progression of the disease, rigidity typically affects the whole body and reduces the ability to move.

Postural instability is typical in the late stages of the disease, leading to impaired balance and frequent falls,[19] and secondarily to bone fractures.[5] Instability is often absent in the initial stages, especially in younger people.[6] Up to 40% may experience falls and around 10% may have falls weekly, with number of falls being related to the severity of PD.[5]

Other recognized motor signs and symptoms include gait and posture disturbances such as festination (rapid shuffling steps and a forward-flexed posture when walking),[5] speech and swallowing disturbances including voice disorders,[20] mask-like face expression or small handwriting, although the range of possible motor problems that can appear is large.[5]

Neuropsychiatric
Parkinson's disease can cause neuropsychiatric disturbances which can range from mild to severe. This includes disorders of speech, cognition, mood, behaviour, and thought.[5]

Cognitive disturbances can occur in the initial stages of the disease and sometimes prior to diagnosis, and increase in prevalence with duration of the disease.[5][21] The most common cognitive deficit in affected individuals is executive dysfunction, which can include problems with planning, cognitive flexibility, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information. Fluctuations in attention and slowed cognitive speed are among other cognitive difficulties. Memory is affected, specifically in recalling learned information. Nevertheless, improvement appears when recall is aided by cues. Visuospatial difficulties are also part of the disease, seen for example when the individual is asked to perform tests of facial recognition and perception of the orientation of drawn lines.[21]

A person with PD has two to six times the risk of dementia compared to the general population.[5][21] The prevalence of dementia increases with duration of the disease.[21] Dementia is associated with a reduced quality of life in people with PD and their caregivers, increased mortality, and a higher probability of needing nursing home care.[21]

Behavior and mood alterations are more common in PD without cognitive impairment than in the general population, and are usually present in PD with dementia. The most frequent mood difficulties are depression, apathy and anxiety.[5] Establishing the diagnosis of depression is complicated by symptoms that often occur in Parkinson's including dementia, decreased facial expression, decreased movement, a state of indifference, and quiet speech.[22] Impulse control behaviors such as medication overuse and craving, binge eating, hypersexuality, or pathological gambling can appear in PD and have been related to the medications used to manage the disease.[5][23] Psychotic symptoms—hallucinations or delusions—occur in 4% of people with PD, and it is assumed that the main precipitant of psychotic phenomena in Parkinson’s disease is dopaminergic excess secondary to treatment; it therefore becomes more common with increasing age and levodopa intake.[24][25]

Other
In addition to cognitive and motor symptoms, PD can impair other body functions. Sleep problems are a feature of the disease and can be worsened by medications.[5] Symptoms can manifest as daytime drowsiness, disturbances in REM sleep, or insomnia.[5] Alterations in the autonomic nervous system can lead to orthostatic hypotension (low blood pressure upon standing), oily skin and excessive sweating, urinary incontinence and altered sexual function.[5] Constipation and gastric dysmotility can be severe enough to cause discomfort and even endanger health.[26] PD is related to several eye and vision abnormalities such as decreased blink rate, dry eyes, deficient ocular pursuit (eye tracking) and saccadic movements (fast automatic movements of both eyes in the same direction), difficulties in directing gaze upward, and blurred or double vision.[5][27] Changes in perception may include an impaired sense of smell, sensation of pain and paresthesia (skin tingling and numbness).[5] All of these symptoms can occur years before diagnosis of the disease.[5]
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Fire Thread Anatomy

A 60 year old man with metastatic prostate cancer has difficulty speaking and swallowing. He has weakness of elevation of the right side of the palate and weakness and atrophy of the right sternocleidomastoid and trapezius muscles.
These findings are most likely to be caused by a lesion in which of the following structures?

Foramen ovale
Foramen rotundum
Hypoglosal canal
Jugular foramen
stylomastoid foramen wrong....

??? some suggestions
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Correct Answer

Quote:
Originally Posted by sashabeliimd View Post
A 60 year old man with metastatic prostate cancer has difficulty speaking and swallowing. He has weakness of elevation of the right side of the palate and weakness and atrophy of the right sternocleidomastoid and trapezius muscles.
These findings are most likely to be caused by a lesion in which of the following structures?

Foramen ovale
Foramen rotundum
Hypoglosal canal
Jugular foramen
stylomastoid foramen wrong....

??? some suggestions
MUst detect which nerves are damaged, and through which foramen they pass,

Foramen ovale CN V 3 mandibular division , mastication, general sense of the anterior two thirds of the tongue NOOOOOO


Foramen rotundum CN V2 maxillar branch of trigeminal nerve, nothing common with inervation of SCM or trapezius nerves

Hypoglosal canal CN XII hypoglos which inervate tongue, specially movement

Jugular foramen CN IX X XI jugular vein, all pass through this channel,
CN XI Accesory, head turning, shoulder shrugging, inervates SCM and trapezius muscles
This is a corect answer
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Fire Thread Small cell carcinnoma

A 67 year old man with small cell carcinoma of the lung develops antibodies directed against the P/Q type calcium channel. He is at increased risk for developing a neurologic syndrome that most closely resembles that produced by which of the following toxins?

Botulinum
Diphtheria
Organophosphate
Strychnine incorect
Tetanus
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Correct Answer HHHHh

Quote:
Originally Posted by sashabeliimd View Post
A 67 year old man with small cell carcinoma of the lung develops antibodies directed against the P/Q type calcium channel. He is at increased risk for developing a neurologic syndrome that most closely resembles that produced by which of the following toxins?

Botulinum *******************************
Diphtheria
Organophosphate
Strychnine incorect
Tetanus
It's so simple

Small cell carcinoma of the lung may be associated with a Lambert Eaton syndrome which is a Antibodies to presynaptic Calcium channel results in decrese of ACh release ,leading to proximal muscle weakness. Symptoms impove with muscle use.
Prevent Ach release....
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Fire Thread Odd behavioral science

Sometimes boring subject of study, sometimes interesting informatino may be studied from this subject


A 23 year old woman with schizophrenia is brought to the emergency department from an inpatient psychiatric facility 30 miniutes after she accidentally burned her leg with boiling water while cooking. Physical examination shows an 8 cm area of erythema and blistering on the anterior section of the right thigh. The patient refuses treatment. She says I know i have a thougt problem i take medication for , but i never know who to trust. I want to wait until my parents get here. I know that my leg cauld get infected if i wait too long, but i dont think it is going to kill me if i wait a few hours. Which of the following initial actions be the physician is most appropiate at this time?

Do not proceed with treatment and determine if her parents are on their way

Do not proceed with treatment until a court order can be obtained ordering therapy bad idea, because doctors must solve problems without court, most desirable way
Do not proceed with treatment until a psychiatric evaluation is completed

Proceed with treatmen because she admits that she has a psychiatric disorder wrong, do not treat schyzophrenics, they have odd behavior, but counsciousness is saved wrong aswer

Proceed with treatment because she has been placed in a psychiatric facility
Proceeed with treatment because she is showing signs of paranoia which proves her to be incompetent

??????? some ideas
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Correct Answer I want to wait until my parents get here.

Quote:
Originally Posted by sashabeliimd View Post
Sometimes boring subject of study, sometimes interesting informatino may be studied from this subject


A 23 year old woman with schizophrenia is brought to the emergency department from an inpatient psychiatric facility 30 miniutes after she accidentally burned her leg with boiling water while cooking. Physical examination shows an 8 cm area of erythema and blistering on the anterior section of the right thigh. The patient refuses treatment. She says I know i have a thougt problem i take medication for , but i never know who to trust. I want to wait until my parents get here. I know that my leg cauld get infected if i wait too long, but i dont think it is going to kill me if i wait a few hours. Which of the following initial actions be the physician is most appropiate at this time?

Do not proceed with treatment and determine if her parents are on their way

Do not proceed with treatment until a court order can be obtained ordering therapy bad idea, because doctors must solve problems without court, most desirable way
Do not proceed with treatment until a psychiatric evaluation is completed

Proceed with treatmen because she admits that she has a psychiatric disorder wrong, do not treat schyzophrenics, they have odd behavior, but counsciousness is saved wrong aswer

Proceed with treatment because she has been placed in a psychiatric facility
Proceeed with treatment because she is showing signs of paranoia which proves her to be incompetent

??????? some ideas

I want to wait until my parents get here.
It's the patient desire, about to wait parents to arrive for first??? reply please
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Correct Answer Anatomy

A 28 year old man who is a construction worker is brought to the emergency department after his left arm was injured. An x ray of the left upper extremity shows a comminuted spiral fracture of the humerus. Which of the following additional deficits is most likely in this patient?

Ishemia of the forearm
Loss of function of muscles innervated by the radial nerve
Rupture of the biceps muscle wrongggg
Sensory loss on the palmar surface of the index finger
Sensory loss on the plamar surface of the small finger

A humerus fracture can be classified by the location of the humerus involved: the upper end, the shaft, or the lower end.

Certain lesions are commonly associated with fractures to specific areas of the humerus. At the upper end, the surgical neck of the humerus[1] and anatomical neck of humerus[2] can both be involved, though fractures of the surgical neck are more common. The axillary nerve can be damaged in fractures of this type. Mid-shaft fractures may damage the radial nerve, which traverses the lateral aspect of the humerus closely associated with the radial groove. The median nerve is vulnerable to damage in the supracondylar area, and the ulnar nerve is vulnerable near the medial epicondyle, around which it curves to enter the forearm.

2 most common nerves are injured , axial and radial

Answer is B radial nerve lesion...
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Fire Thread Respiratory

A healthy 40 year old woman inhales to total lung capacity and then exhales focefully. The rate of expiratory airflow is highest at total lung capacity and decreases linearly as exahalation continues. Which of the following is the most likely cause of the observed decrease in expiratory airflow?

Airway compression
Decreased expiratory effort
Decreased intrapleural pressure wrong
DOming of the diaphragm
INcreased elastic recoil
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Correct Answer

Quote:
Originally Posted by sashabeliimd View Post
A healthy 40 year old woman inhales to total lung capacity and then exhales focefully. The rate of expiratory airflow is highest at total lung capacity and decreases linearly as exahalation continues. Which of the following is the most likely cause of the observed decrease in expiratory airflow?

Airway compression
Decreased expiratory effort
Decreased intrapleural pressure wrong
DOming of the diaphragm
INcreased elastic recoil
So the correct answer is A
As the intrapleural pressure increases it will compress the airways and decreases the flow rates. It's called "dynamic compression of the airways". This mechanism is also responsible for the fact that we can only exhale 80% of our vital capacity and we cannot empty the whole lung because compression of the upper airways is more than the lower airway and it will reach a point where it closes off the system and no more exhalation is possible.

This mean that some air in upper airway partion of the lung is like trapped and produce and compression of the air from count of quit force aplicated to the lung
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Correct Answer ACTH

A 52 year old woman has had slowly progressive weakness and weight loss of a 9 kg for 4 months. She has never traveled outside of the USA. Her blood pressure is 82/50 mm hg. Her skin shows diffuse hyperpigmentation. Plasma concentration of ACTH is markedly increased, and serum concentration of cortisol is decreased. CT scan of the chest and abdomen disclose no mass lesions. Which of the following is the most likely etiology of this patient's disease?

Autoimmune Right answer
Congenital
INfectious wrong
Metabolic
Neoplastic

It's looks like Addison disease, hyperpigmentation, increased ACTH,deficiency of aldosterone and cortisol, causing hypotension

Addison's disease, chronic first adrenal insufficiency due to adrenal atrophy or destruction by disease like ( autoimmune, TB, metastasis,)
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Correct Answer Fructose

A 3 month old boy is brought to the physician because of a 2 month history of frequent crying and tremulousness that usually occur 3 to 4 hours after feeding. He has been breast fed since birth. Physical examination shows fat cheeks, massive hepatomegaly, and thin extremities. After a 4 hour fast serum studies show metabolic acidosis, a decreased glucose concentration, and increased concentrations of lactic acid, uric acid, triglycerides, and cholesterol. Deficiency of which of the following hepatic enzymes is the most likely cause of the disorder in this patient?

Fructose 1 phosphate aldolase >>>>>>>>>>>>>>>>>>>>>
Galactose 1 phosphate uridyltransferase
Glucose 6 phosphatase
Hepatic lipase
Medium chain acyl CoA dehydrogenase

Just for review of two important diseases

Aldolase B or Fructose 1 p aldolase activity deficiency:
LEthargy, vomiting
LIver damage
Hyperbilirubinemia
Hypoglycemia
Hyperuricemia
Renal proximal tubule defect Fanconi


Galactose 1 p uridyltransferase deficiency:
Cataracts early in life
Vomiting diarrhea following lactose ingestion
Lethargy
Liver damage, hyperbilirubinemia
Mental retardation
feed intolerance
Hypoglycemia
Bleeding problems
Accumulates in brain
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Correct Answer Microbiology

A 32 year old man comes to the physician because of a chronic skin lesion that developed shortly before he was discharged from active military duty in Iraq 6 weeks ago. The lesion began as a painless red papule on his right arm that gradually became nodular, it now is growing larger. PHysical examination shows a 4*5 cm crusting lesion with an irregular but sharp border on the right upper extremity. A Giemsa stain of a biopsy specimen shows multiple 1.3 to 3 Micro M inclusions within histiocytes. Which of the following is the most likely causal organism?
Histoplasma capsulatum wrongggggggg
Leismania major *********************************************
Plasmodium vivax
Strongyloides stercorales
Toxoplasma gondii

Histoplasma capsulatum causes often pneumonia, and is found in Missisipii river valeys

Leismania major
Leishmania major is a species of protozoa found in the genus Leishmania, and is associated with the disease zoonotic cutaneous leishmaniasis (also known as "Aleppo boil," "Baghdad boil," "Bay sore," "Biskra button," "Chiclero ulcer," "Delhi boil," "Kandahar sore," "Lahore sore," "Oriental sore," "Pian bois," and "Uta").[1] L. major is an intracellular pathogen which infects the macrophages and dendritic cells of the immune system.[2] Though Leishmania species are found on every continent aside from Antarctica, Leishmania major is found only in the Eastern Hemisphere, specifically in Northern Africa,[3] the Middle East, Northwestern China, and Northwestern India.
L. major is an intracellular pathogen which infects the macrophages and dendritic cells of the immune system

Strongyloides stercoralis Larvae in soil penetrate the skin intestinal infection, causes vomiting, diarrhea, and anemia,, Rhabdiform larva in the stool


Toxoplasma gondii
Brain abscess in HIV( seen as ring enhancing brain lesions on CT MRI) congenital toxoplasmosis= classic triad, Chorioretinitis, hydrocephalus, and intracranial calcifications.
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Correct Answer Neurology

A 56 year old man who is right handed comes to the physician because of a 2 moonth history of progressive clumsiness in the right hand and difficulty finding words. Neurologic examination shows upper motoneuron weakness of the right extremity, and difficulty with naming and repetition. An MRi of the brain shows and infiltratin left frontal mass. Analysis of a stereotaxic biopsy specimen shows a grade 2 astrocytoma. Impaired activity of which of the following proteins is the most likeyly cause of this lesions?

Cyclin D
P 53
Ras **********************
Ret
Tyrosine kinase A


Cyclin D
Role in cancer

Given that many human cancers happen in response to errors in cell cycle regulation and in growth factor dependent intracellular pathways, involvement of cyclin D in cell cycle control and growth factor signaling makes it a possible oncogene. In normal cells overproduction of cyclin D shortens the duration of G1 phase only, and considering the importance of cyclin D in growth factor signaling, defects in its regulation could be responsible for absence of growth regulation in cancer cells. Uncontrolled production of cyclin D affects amounts of cyclin D-Cdk4 complex being formed, which can drive the cell through the G0/S checkpoint, even when the growth factors are not present.

Overexpression can happen in one of three ways: as a result of gene amplification, impaired protein degradation, or chromosomal translocation. Gene amplification is responsible for overproduction of cyclin D protein in bladder cancer and esophageal carcinoma, among others.[5]

In cases of sarcomas, colorectal cancers and melanomas, cyclin D overproduction is noted, however, without the amplification of the chromosomal region that encodes it (chromosome 11q13, putative oncogene PRAD1, which has been identified as a translocation event in case of mantle cell lymphoma[14]). In parathyroid adenoma, cyclin D hyper-production is caused by chromosomal translocation, which would place expression of cyclin D (more specifically, cyclin D1) under an inappropriate promoter, leading to overexpression. In this case, cyclin D gene has been translocated to the parathyroid hormone gene, and this event caused abnormal levels of cyclin D.[5] The same mechanisms of overexpression of cyclin D is observed in some tumors of the antibody-producing B cells. Likewise, overexpression of cyclin D protein due to gene translocation is observed in human breast cancer.[5][15]

Additionally, the development of cancer is also enhanced by the fact that retinoblastoma tumor suppressor protein (Rb), one of the key substrates of cyclin D-Cdk 4/6 complex, is quite frequently mutated in human tumors. In its active form, Rb prevents crossing of the G1 checkpoint by blocking transcription of genes responsible for advances in cell cycle. Cyclin D/Cdk4 complex phosphorylates Rb, which inactivates it and allows for the cell to go through the checkpoint. In the event of abnormal inactivation of Rb, in cancer cells, an important regulator of cell cycle progression is lost. When Rb is mutated, levels of cyclin D and p16INK4 are normal.[5]

Another regulator of passage through G1 restriction point is Cdk inhibitor p16, which is encoded by INK4 gene. P16 functions in inactivating cyclin D/Cdk 4 complex. Thus, blocking transcription of INK4 gene would increase cyclin D/Cdk4 activity, which would in turn result in abnormal inactivation of Rb. On the other hand, in case of cyclin D in cancer cells (or loss of p16INK4) wild-type Rb is retained. Due to the importance of p16INK/cyclin D/Cdk4 or 6/Rb pathway in growth factor signaling, mutations in any of the players involved can give rise to cancer

p53
Tumor protein p53, also known as p53, cellular tumor antigen p53, phosphoprotein p53, or tumor suppressor p53, is a protein that in humans is encoded by the TP53 gene. The p53 protein is crucial in multicellular organisms, where it regulates the cell cycle and, thus, functions as a tumor suppressor, preventing cancer.

Ret Multiple endocrine neoplasia types A and B where thyroid gland is implicated.

Ras colon carcinoma, melanomas, lymphomas

Tyrosine kinase

Function[edit]
The term kinase describes a large family of enzymes that are responsible for catalyzing the transfer of a phosphoryl group from a nucleoside triphosphate donor, such as ATP, to an acceptor molecule.[2] Tyrosine kinases catalyze the phosphorylation of tyrosine residues in proteins.[2] The phosphorylation of tyrosine residues in turn causes a change in the function of the protein that they are contained in.[2]

Phosphorylation at tyrosine residues controls a wide range of properties in proteins such as enzyme activity, subcellular localization, and interaction between molecules.[3] Furthermore, tyrosine kinases function in many signal transduction cascades wherein extracellular signals are transmitted through the cell membrane to the cytoplasm and often to the nucleus, where gene expression may be modified.[3] Finally mutations can cause some tyrosine kinases to become constitutively active, a nonstop functional state that may contribute to initiation or progression of cancer.

Astrocytomas
Genes involved and Proteins

Note
Alteration of genes involved in cell-cycle control:
it is known that the progression of the-cell cycle is controled by positive and negative regulators; some autors report alteration in cell-cycle gene expression in human brain tumors
the p16 gene and the p15 gene are located in 9p21, a chromosome region commonly deleted in astrocytomas; expression of p16 gene is frequently altered in these tumors: in 33-68% of primary glioblastomas and 25% of anaplastic astrocytomas
the Rb gene located on13q chromosome plays an important role in the malignant progression of gliomas
the p53 gene is a tumor suppressor gene located on chromosome 17p13.1; loss or mutation of p53 gene has been detected in many types of gliomas and represents an early genetic event in these tumors
overexpression of MDM2 is also seen in primary glioblastomas
others oncogenes have been found to be amplified in a few cases of astrocytomas : oncogenes Gli, MYC, MYCN, MET and N-Ras
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  #50  
Old 10-22-2014
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Fire Thread ????

A 52 year old woman comes to the physician because of nausea, intermittent bloating, and diarrhea for 5 days. She underwent a gastric bypass operation 1 month ago and has had a 9 kg weight loss since then. Abdominal examination shows mild distention. which of the following is the most likely cause of this patients's symptoms?

Absence of functional parasympathetic ganglia in the large bowel
Hypersecretion of acid NO acid because of gastrectemy
Rapid emptying of hyperosmolar chyme into the small bowel
Spasm of the pyloric sphincter
Surgical interruption of vagal fibers to the stomach wrong
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  #51  
Old 10-22-2014
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Correct Answer

Quote:
Originally Posted by sashabeliimd View Post
A 52 year old woman comes to the physician because of nausea, intermittent bloating, and diarrhea for 5 days. She underwent a gastric bypass operation 1 month ago and has had a 9 kg weight loss since then. Abdominal examination shows mild distention. which of the following is the most likely cause of this patients's symptoms?

Absence of functional parasympathetic ganglia in the large bowel
Hypersecretion of acid NO acid because of gastrectemy
Rapid emptying of hyperosmolar chyme into the small bowel
Spasm of the pyloric sphincter
Surgical interruption of vagal fibers to the stomach wrong
It is dumpind syndrome, post gastric ectomy surgery

Pathophysiology, diagnosis and management of postoperative dumping syndrome.

Jan Tack
Jan Tack
Joris Arts
Joris Arts
Philip Caenepeel
Philip Caenepeel
Dominiek De Wulf
Dominiek De Wulf
Raf Bisschops
Raf Bisschops
Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
Nature Reviews Gastroenterology &#38 Hepatology (Impact Factor: 10.43). 10/2009; 6(10):583-90. DOI: 10.1038/nrgastro.2009.148
Source: PubMed
ABSTRACT Dumping syndrome is a frequent complication of esophageal, gastric or bariatric surgery. Rapid gastric emptying, with the delivery to the small intestine of a significant proportion of solid food as large particles that are difficult to digest, is a key event in the pathogenesis of this syndrome. This occurrence causes a shift of fluid from the intravascular component to the intestinal lumen, which results in cardiovascular symptoms, release of several gastrointestinal and pancreatic hormones and late postprandial hypoglycemia. Early dumping symptoms comprise both gastrointestinal and vasomotor symptoms. Late dumping symptoms are the result of reactive hypoglycemia. Besides the assessment of clinical alertness and endoscopic or radiological imaging, a modified oral glucose tolerance test might help to establish a diagnosis. The first step in treating dumping syndrome is the introduction of dietary measures. Acarbose can be added to these measures for patients with hypoglycemia, whereas several studies advocate guar gum or pectin to slow gastric emptying. Somatostatin analogs are the most effective medical therapy for dumping syndrome, and a slow-release preparation is the treatment of choice. In patients with treatment-refractory dumping syndrome, surgical reintervention or continuous enteral feeding can be considered, but the outcomes of such approaches are variable.
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  #52  
Old 10-22-2014
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Fire Thread Brain

A 60 year old man is brought to the emergency department because of a severe headache and weakness on the left 3 hours after falling from a ladder and hitting his head on the sidewalk. He briefly lost consciousness but is awake on arrival at the eemergenecy department. He is alert and oriented. His temperature is 36 pulse 65, respiration 12, and blood pressure is 160/100 mm Hg. Neurologic examination shows a dilated pupil on the right and a normal pupil on the left. He has mild weakness of his left upper and lower extremities. Which of the following findings is most likely on a CT scan of the head?

Brain stem hemorrhage
Herniation of the cerebellar tonsils
Herniation of the cingulate gyrus
Herniation of the uncus
Subarachnoid hemorrhage wrooooooooooooong
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  #53  
Old 10-22-2014
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Correct Answer Review

Quote:
Originally Posted by sashabeliimd View Post
A 60 year old man is brought to the emergency department because of a severe headache and weakness on the left 3 hours after falling from a ladder and hitting his head on the sidewalk. He briefly lost consciousness but is awake on arrival at the eemergenecy department. He is alert and oriented. His temperature is 36 pulse 65, respiration 12, and blood pressure is 160/100 mm Hg. Neurologic examination shows a dilated pupil on the right and a normal pupil on the left. He has mild weakness of his left upper and lower extremities. Which of the following findings is most likely on a CT scan of the head?

Brain stem hemorrhage
Herniation of the cerebellar tonsils
Herniation of the cingulate gyrus
Herniation of the uncus
Subarachnoid hemorrhage wrooooooooooooong
dilated pupil on the right and a normal pupil on the left it is Ocullomotor nerve damage,

The uncus is an anterior extremity of the Parahippocampal gyrus. It is separated from the apex of the temporal lobe by a slight fissure called the incisura temporalis.

Although superficially continuous with the hippocampal gyrus, the uncus forms morphologically a part of the rhinencephalon

Clinical significance[edit]
The part of the olfactory cortex that is on the temporal lobe covers the area of the uncus, which leads into the two significant clinical aspects of the uncus: uncinate fits and uncal herniations.

Seizures, often preceded by hallucinations of disagreeable odors, often originate in the uncus.
In situations of tumor, hemorrhage, or edema, increased pressure within the cranial cavity, especially if the mass is in the middle fossa, can push the uncus over the tentorial notch against the brainstem and its corresponding cranial nerves. If the uncus becomes herniated the structure lying just medial to it, cranial nerve III, can become compressed. This causes problems associated with a non-functional or problematic CN III - the pupil on the ipsilateral side fails to constrict to light and absence of medial/superior movement of the orbit, resulting in a fixed, dilated pupil and an eye with a characteristic "down and out" position due to dominance of the abducens and trochlear nerves. Further pressure on the midbrain results in progressive lethargy, coma and death due to compression of the mesencephalic reticular activating system. Brainstem damage is typically ipsilateral to the herniation, although the contralateral cerebral peduncle may be pushed against the tentorial notch, resulting in a characteristic indentation known as Kernohan's notch and ipsilateral hemiparesis, since fibers running in the cerebral peduncle decussate (cross over) in the lower medulla to control muscle groups on the opposite side of the body.
The landmark that helps you find the amygdala on a coronal section of the brain.

If the uncus becomes herniated the structure lying just medial to it, cranial nerve III, can become compressed
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  #54  
Old 10-22-2014
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Drug ARDS

a 50 year old man comes to the physician for a follow up examination. ONe year ago, he was admitted to the hospital for treatment of acute respiratory distress syndrome associated with acute pancreatitis. Which of the following is most likely to be found in this patient with resolved ARDS?

Decreased alveolar dead space : tidal volume
Decreased concentrations of surfactant protein D
Decreased diffusing capacity for carbon monoxide
Increased concentrations of neutrophils in bronchoalveolar lavage fluid Wrongggggggggggggggggg
Increased concentrations of surfactant protein D
Increased pulmonary capillary blood volume.

Please give some explanation someone ?!!!?@
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  #55  
Old 10-22-2014
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Correct Answer

Quote:
Originally Posted by sashabeliimd View Post
a 50 year old man comes to the physician for a follow up examination. ONe year ago, he was admitted to the hospital for treatment of acute respiratory distress syndrome associated with acute pancreatitis. Which of the following is most likely to be found in this patient with resolved ARDS?

Decreased alveolar dead space : tidal volume
Decreased concentrations of surfactant protein D
Decreased diffusing capacity for carbon monoxide
Increased concentrations of neutrophils in bronchoalveolar lavage fluid Wrongggggggggggggggggg
Increased concentrations of surfactant protein D
Increased pulmonary capillary blood volume.

Please give some explanation someone ?!!!?@

Decreased diffusing capacity for carbon monoxide


ARDS is an acute injury to the lungs that results in alveolar flooding, atelectasis and a severe oxygenation defect, but is not due to heart failure. In its early stages, it can cause shortness of breath (dyspnea), increased rate of breathing (tachypnea), and low oxygen saturation (hypoxemia).[1][2]

ARDS is characterized by the following criteria:[3][4]

lung injury of acute onset, within 1 week of an apparent clinical insult and with progression of respiratory symptoms
bilateral opacities on chest imaging not explained by other pulmonary pathology (e.g. pleural effusion, pneumothorax, or nodules)
respiratory failure not explained by heart failure or volume overload
decreased arterial PaO
2/FiO
2 ratio:
mild ARDS: ratio is 201 - 300 mmHg (≤ 39.9 kPa)
moderate ARDS: 101 - 200 mmHg (≤ 26.6 kPa)
severe ARDS: ≤ 100 mmHg (≤ 13.3 kPa)
(a minimum PEEP of 5 cmH
2O is required; it may be delivered noninvasively with CPAP to diagnose mild ARDS). A decreased PaO
2/FiO
2 ratio indicates reduced arterial oxygen content relative to that of the inhaled gas, indicating a failure of the lung to transport oxygen into the blood.

The above characteristics are the "Berlin criteria" of 2012 by the European Society of Intensive Care Medicine, endorsed by the American Thoracic Society and the Society of Critical Care Medicine. They are a modification of the previously used criteria:[5][6]

Acute onset
Bilateral infiltrates on chest radiograph sparing costophrenic angles
Pulmonary artery wedge pressure < 18 mmHg (obtained by pulmonary artery catheterization), if this information is available; if unavailable, then lack of clinical evidence of left atrial hypertension
if PaO
2:FiO
2 < 300 mmHg (40 kPa) acute lung injury (ALI) is considered to be present
if PaO
2:FiO
2 < 200 mmHg (26.7 kPa) acute respiratory distress syndrome (ARDS) is considered to be present
Cause[edit]
The predisposing factors of ARDS are numerous and varied. Sepsis, multiple blood transfusions, pulmonary contusion, aspiration of gastric contents and drug abuse or overdose are common.[2] Also, burns, pancreatitis, smoke inhalation, pneumonia and near drowning can cause this condition. The inhalation of irritants, chemical warfare agents such as Phosgene, Chlorine Gas and such can also cause ARDS.

Some cases of ARDS are linked to large volumes of fluid used during post-trauma resuscitation.[7] Other causes include shock, near-drowning and inhalation of irritants or toxic fumes that damage the alveolar epithelium.

The list of predisposing factors is extensive and some do not necessarily seem to have anything to do with injuring the lungs. Therefore, this syndrome is best diagnosed and managed on its criteria first, with retrospective management on whatever conditions may have precipitated it.

ARDS is a clinical syndrome associated with pathological findings including pneumonia, eosinophilic pneumonia, cryptogenic organizing pneumonia, acute fibrinous organizing pneumonia, and diffuse alveolar damage

Diffusion capacity is decreased, and exchange between o2 and CO2
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Quote:
Originally Posted by sashabeliimd View Post
A 20 month old boy is brought to the physician by his mother because she is concerned about his language development. HIS MOTHER says, ( i don;t understand, His 4 year old sister had no problems with speech when she was his age). He is able to make some sounds, including B and P spontaneously, but he seems slow to imitate words the parents say. He is active ,able to run a few steps, and can recongnize shapes and do simple puzzles. He is at the 60th percentile for lenght and weight, and 75th percentile for head circumference. He is friendly and cooperative and has a good eye contact. Physical examination shows no abnormalities. Which of the following is the most appropiate initial statement by the physician?

A I recommend that he undergo a hearing screening as soon as possible

B i wouldn't worry.Boys often speak later than girls do

C i'm going to schedule him for an MRI of the brain to exclude hydrocephlus

D you should give him things only if he attempts to ask for them

E you should have him evaluated by a child psychologist for a possible autistic disorder


I think aswer is D it's like positive reinforment method? but which is definitively correct? please help
I chose B but it is incorrect
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A 55 yo man comes to the emergency department 2 hours after he fell on his right wrist. He has a 1 year history of coronary artery disease and a 2 year history of heartburn. Examination of the right wrist shows exquisite tenderness to palpation and swelling. The patient asks ( Do you think you could prescribe celecoxib for the pain?) I've heard that it won't upset my stomach like aspirin does. The physician is reluctant to prescribe this drug because other drugs in the same category have been associated with increased risk for myocardial infarction. This increased risk is most likely caused by Which of the following mechanisms of action?
Greater inhibition of cyclooxygenase ! than cox2 wrong
INhibition of cox 2 enzyme in gastric epithelial cells, that is unspecific for stomach

INhibition of lipoxygenase preventing the formation of leukotriene D and C which is action of Zileuton, not a Cox inhibitors

Inhibition of prostacyclin I2 formation without inhibition of thromboxane A2 in platelets No because Celecoxib bypass stomach, in stomach are just a few COX 2 Enzymes,
Inhibition of prostaglandin E2 formation,, for sure both COX1,2 inhibit formation of prostaglandin, which have a vasodilating effect, and prevent formation of thrombi,
Last one is correct
it is asking about why there is an INCREASED RISK, not just mechanism of action, therefore....answer is...inhibition of prostacyclin formation without inhibition of thromboxane A2 in platelets.

nonselective NSAIDS inhibit COX1 in platelets causing inhibition of thromboxane A2 which promotes platelet aggregation and vasoconstriction, they also inhibit prostacyclins which inhibit platelet aggregation and cause vasodilation

selective COX2 inhibitors do NOT work on thromboxane, but do on prostacyclins....therefore there is an increase risk of thrombosis and MI
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  #58  
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Quote:
Originally Posted by ginseng plus View Post
A 55 yo man comes to the emergency department 2 hours after he fell on his right wrist. He has a 1 year history of coronary artery disease and a 2 year history of heartburn. Examination of the right wrist shows exquisite tenderness to palpation and swelling. The patient asks ( Do you think you could prescribe celecoxib for the pain?) I've heard that it won't upset my stomach like aspirin does. The physician is reluctant to prescribe this drug because other drugs in the same category have been associated with increased risk for myocardial infarction. This increased risk is most likely caused by Which of the following mechanisms of action?
Greater inhibition of cyclooxygenase ! than cox2 wrong
INhibition of cox 2 enzyme in gastric epithelial cells, that is unspecific for stomach

INhibition of lipoxygenase preventing the formation of leukotriene D and C which is action of Zileuton, not a Cox inhibitors

Inhibition of prostacyclin I2 formation without inhibition of thromboxane A2 in platelets No because Celecoxib bypass stomach, in stomach are just a few COX 2 Enzymes,
Inhibition of prostaglandin E2 formation,, for sure both COX1,2 inhibit formation of prostaglandin, which have a vasodilating effect, and prevent formation of thrombi,
Last one is correct



it is asking about why there is an INCREASED RISK, not just mechanism of action, therefore....answer is...inhibition of prostacyclin formation without inhibition of thromboxane A2 in platelets.

nonselective NSAIDS inhibit COX1 in platelets causing inhibition of thromboxane A2 which promotes platelet aggregation and vasoconstriction, they also inhibit prostacyclins which inhibit platelet aggregation and cause vasodilation

selective COX2 inhibitors do NOT work on thromboxane, but do on prostacyclins....therefore there is an increase risk of thrombosis and MI
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