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  #1  
Old 07-14-2011
heights's Avatar
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Stats Heart disease prevention (free 150 spoiler)

I had a Free-150 question with a man with heart decreased left ventricle ejection fraction, sedentary lifestyle, eats a lot of red meat, drink a lot of beer, doesn't smoke, no HTN, not overweight, no atherosclerosis of coronary arteries. The question asks what he could do to decrease the risk of further damage to his heart- cut down on red meat, exercise, lose weight, stop drinking alcohol. Answer was stop drinking alcohol. Can anyone explain this? I thought it was exercise.
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Old 07-14-2011
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I think its because there is no point in exercises if r drinking beer all the time...that would also prevent him from beri beri and AFTER that if he exercises ya it wud be gud..that was my logic to it lol...the red meat was for cancer risk..
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Old 07-14-2011
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Can you pls post the original question? There must be some other clues.......
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Old 07-14-2011
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Here are a couple I would appreciate discussing:
1) A comatose 35 y/o man is admitted to after being involved in a motor vehicle accident. He is intubated and mechanically ventilated. he dies 8 weeks later. What changes would the tracheal tissue show (they showed a histology pic, but I'm having trouble adding one).
a. atrophy
b. dysplasia
c. hyperplasia
d. hypertrophy
e. metaplasia
f. neoplasia

2) A 45 y/o man has a left ventricular ejection fraction of 25% (n > 55%) with diffuse hypokinesis. He has a sedentary lifestyle, eats red meat up to 6 times weekly and drinks 4 alcoholic beverages daily. he is 6 ft tall and weighs 190 lb (BMI 25 kg/m3). His blood pressure is 90/60. Coronary arteriography shows no atherosclerosis. To prevent further heart damage, which of the following is the most appropriate recommendation
a. aerobic exercise program
b. avoidance of alcohol
c. eat more vegetables and decrease red meat intake
d. isometric/ weight training exercise
e. weight loss

3) A 6y/o boy has recurrence of an aggressive brain tumor despite treatment. The physician discusses the prognosis with the parents and recommends palliative care. The parents ask how they should talk to their son about the prognosis. The physician advises that they should be honest and follow he patient's lead during the conversation. The patient most likely has which of the following concepts of death?
a) being asleep
b) being final
c) being a long journey
d) being a temporary separation from his parents
e) no understanding of death

Please explain!
Thanks.

Last edited by heights; 07-14-2011 at 09:58 AM.
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  #5  
Old 07-14-2011
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Default I had that question, answered wrong as well

I remember that question; seen somewhere else, answered "red meat". My guess is that - Alcoholic cardiomyopathy.

Emedicine citation:


Proposed mechanisms of injury in AC include the following:
  • Inhibition of protein synthesis
  • Inhibition of oxidative phosphorylation
  • Fatty acid ester accumulation
  • Free radical damage
  • Inhibition of calcium-myofilament interaction
  • Inflammatory and immunologic factors
  • Receptor abnormalities
  • Disruption of cell membrane structure
  • Coronary vasospasm
  • Synergy with concomitant conditions
  • Activation of the renin-angiotensin system
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Old 07-14-2011
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Thanks for good questions<
1) Changes in trachea after long intubation, - should be dysplasia or athrophy...long time pressure, not sure.

For the last question, Kaplan Behavioral note (p.110) says kids up to 5 y.o do not have perception of death, and from 8-10 y.o. begin to understand universality, irreversibility etc.., so answer might be (e).
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Old 07-14-2011
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prolong intubation causes chronic irritation n tht cn cause dysplasia

the second one is reducing alcohol intake
n third is e
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Old 07-14-2011
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Quote:
Originally Posted by jahn77 View Post
Thanks for good questions<
1) Changes in trachea after long intubation, - should be dysplasia or athrophy...long time pressure, not sure.

For the last question, Kaplan Behavioral note (p.110) says kids up to 5 y.o do not have perception of death, and from 8-10 y.o. begin to understand universality, irreversibility etc.., so answer might be (e).
ya i picked e too but apparently da answer was that 6 yr old knows of death as being final (b)...
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Old 07-14-2011
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For the one with the tracheal intubation...i just looked at the histology pic and although i don't see how it relates to the vignette but if u look there is supposed to be pseudostratified ciliated columnar epithelium but instead it looks like stratified squamous epithelium (metaplasia)...maybe he was a smoker i dont see how he died 8 weeks later due to the metalplasia cud some1 plz explain that...or maybe the vignette didnt have much to do with it n we just had to look at the pic?
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Old 07-14-2011
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Default Ans. 1E, 2B, 3B

@ Mashee, you're right it is squamous metaplasia, and maybe we're supposed to be able to tell that from the histo pic. Also, I found this article http://www.ncbi.nlm.nih.gov/pubmed/1169019 so it seems that long term intubation causes squamous metaplasia (which makes sense, the ciliated epithelium is no longer necessary and a thicker epithelium is needed because of the intubation material rubbing against the trachea). I think the guy died from whatever injuries he had and it's unrelated to the question, they just said that so we know it's an autopsy section.

With regard to child development, got this from medline (crazy it's not in FA at all, and Kaplan behavioral science doesn't go into much detail.

Child's concept of death:

Death should be discussed honestly and in language that children can understand at their stage of development. A child's concept of death varies with age, and this must be taken into consideration.
Age 0 - 2 years:
  • Sees death as separation or abandonment
  • Has no cognitive understanding of death
  • Feels despair from disruption of caretaking
Age 2 - 6 years:
  • Often believes that death is reversible, temporary
  • May perceive death as a punishment
  • Engages in magical thinking that wishes come true -- may feel guilt for negative feelings toward the person who died, and think that was the cause of death
Age 6 - 11 years:
  • Shows gradual understanding of irreversibility and finality of death
  • Demonstrates concrete reasoning with ability to comprehend cause and effect relationship
Age 11 years or older:
  • Understands that death is irreversible, universal, and inevitable
  • Has abstract and philosophical thinking
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  #11  
Old 07-14-2011
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wow heights ur right....u knw that question is confusing even after reading this cuz 6 yrs is at the cutoff.. it wud have been easier to say he is 7 yrs old...but then tht's USMLE what can we do ....n that is really helpful n i'm going to copy it onto my FA thanks
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Biostatistics-Epidemiology, Free-150, US-Healthcare-

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