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  #1  
Old 10-12-2014
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Post My nbme 13 discussion, please hellllp !!!!!!!!!!!

Just took, nbme 13 and my result is 300(185), i know that is bad result, but want to solve every uncorrect test, to understand in what coming mistake in my answers...
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  #2  
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Post Hi

AN investigator is studying the human immune response to tumor cell antigens in malignancies, Which of the following sets of cancer types and tumor antigens is most likely to produce the highest antibody titer?
a cancer type tumor antigen
A Bcell lymphoma cd19
Bbreast cancer HER2/neu
C cervical cancer human papillomavirus type 16 e^protein
D melanoma tyrosinase
E prostate cancer prostatic acid phosphatase

I found thus aswer that: All exept human papillomavirus are self proteins that are normaly made by the body and thus will be poorly immunogenic, only HPV/E6 is an example of a foreign antigen that will induce a vigorous immune response..

Have anybody another best answer? A is incorrect
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  #3  
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Correct Answer Antilipidemics

A42 year old man comes to the physician because of a 4 week history of muscle cramping and pain. Two months ago, he began treatment with simvastatin 80 mg daily for hypercholesterolemia, After 1 month, marked improvement was noted in his serum LDL cholesterol concentration, but serum triglyceride concentration remained increased. At that time, gemfibrozil was added to his regime to decrease his triglyceride concentration. Physical examination today shows no abnormalities. This patient;s myalgia is most likely related to which of the following effects of gemfibrozil on simvastatin?

A decreased bioavailability
B increased absorption
C inhibition of cytochrome p450 metabolisem
D inhibition of hepatic glycosilation
E inhibition of hepatic sulfation


Fibrates like gemfibrosil, clofibrate, bezafibrate, fenofibrate have following effects: Decrease triglycerides, upregulate LPL and INcrease triglyceride clearance, Activate PPAR alpha to induce HDL synthesis
MYositi (increased risk with concurent Statins)
Hepatotoxicity
cholesterol gallstones if admin concuret acid resins

Explanation:Statins are p450 inducers
Gemfibrosil is P450 inhibitor,
Patient related myalgia is realted to gemfibrozil, gemfibrosil increases in the blood concentration of most statins by partially inhibiting the metabolism or glucuronidation of the statin acid product...

Done
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  #4  
Old 10-12-2014
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Correct Answer Protease inhibitor

A researcher in a pharmaceutical company designs a new protease inhibitor that inhibits replication of HIV in T lymphocytes in culture, In subsequient assays, which of the following findings is most likely to indicate that the compound is working specifically as a protease inhibitos?


a The drug prevents integration of proviral DNA into the host genome
B the RNA is partially reverse transcribed into proviral DNA
C There is a lack of a mature core
D Transcription from the HIV promoter is blocke
E the virus does not bind to CD4 in the presence of the drug

Found this explanation:
Whe viral RNA is translated into a polypeptide sequence, that sequence is assembled in a long chain that includes several individual proteins ( reverse transcriptase, protease, integrase) .Before these enzymes become functional, they must be cut from the longer polypeptide chain. Viral protease cuts the long chain into its individual enzyme component which then facilitate the production of new viruses. Inhibition leads to a lack of a mature core.


From FA:Assembly of virions depends on HIV 1 protease pol gene, which cleaves the polypeptide products of HIV nRNA into their funcional parts. THus, protease inhibitors prevent maturation of new viruses.
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  #5  
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Fire Thread Behavioral

A 43 year old man comes to the ED because of a 1-year history of low back pain. Before this examination, the patient says, "My physician is arrogant and insensitive. He never returns my phone calls, i always have to wait forever to be seen, the tests he orders are painful and unnecessary, and he can never tell me what is causing my back pain or how to treat it." Which of the following is the most appropriate response by the ED physician about this patient's complaint?


A. Reassure the patient that his physician's behavior is not unusual, and that low back pain can be difficult to assess
B. Encourage the patient to make an appointment with his physician to communicate his concerns.
...
... (not great answer choices)
E. Telephone the patient's physician to make him aware that the patient is very dissatisfied with treatment.


always advise patient to discuss issues with his physician directly.
I picked a that is incorect...
But these seemed strangely, why to apoint patient to old doctor fi him yet are in your exam room???

Please explane someone?
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  #6  
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Correct Answer Gene regulation

A 3 year old boy with a history of unexplained fever, lack of perspiration, abscence of response to noxious stimuli, and self-mutilating
behaviour is diagnosed with congenital insensitivity to pain with anhidrosis. Genetic analysis shows a missense mutation of the tyrosine kinase domain
of the TrkA gene. Assuming this is the only signaling defect in this patient, which of the following process has most likely been distrupted?

A. Binding of nerve growth factor to its receptor
B. Formation of TrkA homodimer in response to nerve growth factor
C. Phosphorylation of downstream molecules in response to nerve growth factor
D. Retrograde transport of nerve growth factor nerve terminals
E. Synthesis of nerve growth factor


http://en.wikipedia.org/wiki/TrkA_receptor
The question is essentially asking what downstream effects are prevented. The receptor component is not mutated so the ligand will interact with the receptor. Only the kinase part is mutated. The direct downstream effect of a failure to autophosphorylate is a failure of phosphorylation of downstream molecules via whatever kinase cascade is attached to this receptor

A protein kinase is a kinase enzyme that modifies other proteins by chemically adding phosphate groups to them (phosphorylation)
Done with this too...
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  #7  
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Correct Answer Embryologic derivative

A male newborn at 34 weeks; gestation is delivered vaginally. Physical examination shows no abnormalities except for a 1 cm raised, red area on the anterior section of the neck. His mother is concerned, and the physician explains that the lesion is a hemangioma, a binign growth. THis neoplas most likely originated in which of the following tissues?

Ectoderm
Endothelium
Neural crest cells
Notochord
Yolk sac

Right answer is Endothelium
Notochord and neural crest cells are part of ectoderm,
Yolk sack derivative(endodermal sinus) may be some tumors like agrressive malingnancy in ovaries, or testes if boy, and if child in a sacrococcygeal area located.
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  #8  
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Fire Thread High altitude

A previously healthy 54 yo man comes to the clinic because of lightheadedness for 6 hours. His symptoms began after skiing at a resort at an altitude of 9000 ft. he has been taking a carbonic anhydrase inhibitor since 2 days before arriving at the resort. His BP is 110/60 which sitting and 95/50 while standing. PE shows no other abnormalities. Which of the following is the most likely cause of his orthostatic hypotension?
a). High-alt. sickness
b). Hypovolemia
c). Hypoxia (wrong)
d). Impaired sympathetic nerve activity (wrong)
e). Respiratory alkalosis

Acetazolamide toxicity: Hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
High altitude sickness symptoms

Lack of appetite, nausea, or vomiting
Fatigue or weakness
Dizziness or lightheadedness
Insomnia
Pins and needles
Shortness of breath upon exertion
Nosebleed
Persistent rapid pulse
Drowsiness
Excessive flatulation[8]
General malaise
Peripheral edema (swelling of hands, feet, and face)

Remain just answer with hypovolemia, like all diuretics decrease Na as water?????? please help here
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  #9  
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Correct Answer Embriology

A 22 yo woment comes to the physician 3 months after she noticed a painless slowly enlarging mass on the left side of her neck. PE shows a freely mobile soft cystic mass with a cutaneous surface opening. the physicial explain that it is from incomplete fusion during embryo development. which of the following is the most likely location of the opening of the duct leading to the mass of the patientt?

a. ant. to the sternocleidomastoid muscle
b. midline of the neck
c. postauricular
d. pos. to the parotid gland
e. submental


A branchial cleft cyst is a congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.

Most branchial cleft fistulae are asymptomatic, but they may become infected. The cyst, however, usually presents as a smooth, slowly enlarging lateral neck mass that may increase in size after an upper respiratory tract infection
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  #10  
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Correct Answer Microbiology

A 20-year-old man comes to the physician because of cramping abdominal pain and diarrhea during the past 3 weeks; he has had a 4.5-kg (10-lb) weight loss during this period. The pain is exacerbated following meals. He went on a camping trip in upstate New York 3 weeks ago, swimming in the nearby lakes and hiking in the mountains. His vital signs are normal. Physical examination shows no abnormalities. Which of the following diagnostic tests is most likely to identify the causal organism of this patient's condition?

A) Culture of the stool for enteric bacterial pathogens
B) Electron microscopy of the stool for small round viruses
C) Microscopic examination of the stool for ova and parasites
D) Polymerase chain reaction test of the stool for Shiga toxin
E) Protoscopy and rectal biopsy

Looks like some acute infection, Traveller diarrhea, E coli
If signs and symptoms last longer than a week or bloody diarrhea occurs, the doctor may order stool cultures for microscopic examination for parasites.

Done with this
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  #11  
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Correct Answer Biochemistry

A 5-year-old boy is brought to the physician by his mother because of a 3-month history of headache, clumsiness, and fatigue. He had a generalized tonic-clonic seizure 1 month ago. His mother says that he often falls while running. Ophthalmologic examination shows ptosis of the left eye and bilateral external ophthalmoplegia. Physical examination shows weakness of the left lower extremity. Serum studies show an increased lactate concentration. Analysis of a calf muscle biopsy specimen obtained from the left lower extremity shows ragged red fibers. Which of the following metabolic processes is most likely impaired in this patient?

A) Fatty acid oxidation
B) Gluconeogenesis
C) Glycolysis
D) Oxidative phosphorylation
E) Pentose phosphate pathway
Of course when we see ragged red fibers, it's clearly about mitochondrial disease, that have a following processes defected:

Pyruvate and the citric acid cycle[edit]
Main articles: Pyruvate decarboxylation and Citric acid cycle

Heat production

Storage of calcium ions

A dominant role for the mitochondria is the production of ATP

NADH and FADH2: the electron transport chain[edit]
Main articles: Electron transport chain and Oxidative phosphorylation
https://www.studyblue.com/notes/note/n/nbme-13-random-notes/deck/6344259
I found this one, for form 13 who need..
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Correct Answer Male breast enlargement

15 yo boy brought to the physician because of painless swelling in his left breast for 1 month. Physical exam shows mild facial acne, thickening of mustache hair on face, and the presence of axillary hair. The left breast appears mildly enlarged with a palpable breast bud; the right breast is normal with no gynecomastia. His genital are Tanner stage 3. Which of the following is the most appropriate initial statement by the physician?

A. Have you tried smoking marijuana recently? That has been known to cause breast enlargement.
B. Some teenagers experiment with their parents' prescription drugs, even birth control pills. Are you?
C. This is a common condition for teenage boys and should resolve in time.
D. This may be a sign of a chromosomal problem. We need to do some genetic testing.
E. This may be a sign of a more serious condition. We'll have to do more tests to be sure.

Some gyno is normal during puberty in males due to the hormones. Its somewhere in goljan, and he mentions it in lectures.. Its one of the three times where gyno is normal in males

Goljan review book is KING really
Gynecomastia definition: benign subareolar glandular proliferation in the male breast due to estrogen more unilateral than bilateral.
Physiologic gynecomastia:
Newborns present in 70% of cases
Puberty peaks at ages 13-14 years
Elderly persons occurs between 50 an 80 years of age
in general surgery is not indicated, and can see self limiting, or dissapear lately...
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  #13  
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Correct Answer sickle cell disease

A 12 year old african american girl is brought to the emergency department by her mother because of a 6 hour history of fever and severe RIB PAIN. She has had numerous episodes in the past. Her paternal aunt and uncle have had similar symptoms since youth. Her temperaaaaaaature is 39. The lungs are clear to auscultation. Abdominal examination shows tenderness to palpation. A peripheral blood smear is shown in the photomicrograph. Which of the following is the most likely underlying cause of this patient's symptoms?


a Abnormal folding of the hemoglobin molecule caused by increased Pco2

B abnormal hydrogen bonding in the hemoglobin caused by amino acid substitution on the alpha chain wroooong

C Decreased oxygen affinity caused by an amino acid substitution in the hemoglobin alpha chain wroooooong

D Erithocyte fragility caused by an amino acid substitution in glycoproteins on the cell surface

E Polymerization of hemoglobin with hypoxic conditions due to amino acid substitution in the beta chain

It si classic sickle cell disease
Which consist in missense point mutation with substitution of valine for glutamic acid at the sixth position of the Beta globin chain
Correct answer is E

The polymerization of deoxy Hb S is the primary and indispensable event in the molecular pathogenesis of sickle cell disease [1,2]. The polymer has the form of an elongated rope-like fiber which usually aligns with other fibers, forming a fascicle, and distorting the red cell into the classic crescent or sickle shape

http://www.uptodate.com/contents/sic...nal-properties

done
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  #14  
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Fire Thread Carboxyhemoglobin

http://i.imgur.com/5CPD0.jpg


The complex is a large integral membrane protein composed of several metal prosthetic sites and 14 [1] protein subunits in mammals. In mammals, eleven subunits are nuclear in origin, and three are synthesized in the mitochondria. The complex contains two hemes, a cytochrome a and cytochrome a3, and two copper centers, the CuA and CuB centers.[2] In fact, the cytochrome a3 and CuB form a binuclear center that is the site of oxygen reduction. Cytochrome c, which is reduced by the preceding component of the respiratory chain (cytochrome bc1 complex, complex III), docks near the CuA binuclear center and passes an electron to it, being oxidized back to cytochrome c containing Fe3+. The reduced CuA binuclear center now passes an electron on to cytochrome a, which in turn passes an electron on to the cytochrome a3-CuB binuclear center. The two metal ions in this binuclear center are 4.5 Ĺ apart and coordinate a hydroxide ion in the fully oxidized state.

Crystallographic studies of cytochrome c oxidase show an unusual post-translational modification, linking C6 of Tyr(244) and the ε-N of His(240) (bovine enzyme numbering). It plays a vital role in enabling the cytochrome a3- CuB binuclear center to accept four electrons in reducing molecular oxygen to water. The mechanism of reduction was formerly thought to involve a peroxide intermediate, which was believed to lead to superoxide production. However, the currently accepted mechanism involves a rapid four-electron reduction involving immediate oxygen-oxygen bond cleavage, avoiding any intermediate likely to form superoxide.[3]


the cyt a/a3 requires 02 which CO poisoning deprives it of.
Answer guess is E, please help to make a corect answer who yet passed Form 13!!!!!!
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Correct Answer Erythromycin

A 6 year old boy is brought to the physician by his mother because of a 2 day history of fever, sore throat and occasional vomiting, His temperature is 39, Physical examination shows erythema and purulent exudate over the posterior pharyngeal wall and tonsils. The anterior cervical glands are enlarged and tender. A throat culture growth group A streptococcus, Because he is allergic to penicillin, treatment with erythomycin is begun. His condition improves during the next 2 days. The effectiveness of this antibiotic is most likely due to which of the following actions in protein synthesis?

A Causes misreading of mRNA information wrongggg
B Functions as an analog of aminoacy t RNA
C Inactivates elongation factor 2
[COLOR="rgb(255, 140, 0)"]D Interferes in aminoacyl tRNA binding[/COLOR]
E Interferes with translocation

Mechanism of action
Erythromycin displays bacteriostatic activity or inhibits growth of bacteria, especially at higher concentrations,but the mechanism is not fully understood. By binding to the 50s subunit of the bacterial 70s rRNA complex, protein synthesis and subsequent structure and function processes critical for life or replication are inhibited.[20] Erythromycin interferes with aminoacyl translocation, [COLOR="rgb(255, 140, 0)"]preventing the transfer of the tRNA bound at the A site of the rRNA complex to the P site of the rRNA complex[/COLOR]. Without this translocation, the A site remains occupied, thus the addition of an incoming tRNA and its attached amino acid to the nascent polypeptide chain is inhibited. This interferes with the production of functionally useful proteins, which is the basis of this antimicrobial action.

Result a corect answer is D???
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  #16  
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Angry Neurology

A 60 year old man comes to the physician because of progressive weakness of his hands during the past 6 months, He workd as a carpenter and has had difficulty handling his tools. He has smoked 1 pack of cigarretetes daily for 45 years. He drinks two beers daily during the workweek and approximately six beers daily on weekends. Physical examination shows no lymphadenopathy. THere is decreased strenght4/5 in the upper and lower extremities and atrophy aof the muscle of the hands. He has diffuse hyperreflexia. Fasciculations are noticed on the muscles of the hands and upper extremities. Sensory examination is normal. Over the course of this disease , which of the following findings is most likely ?


Dementia
Diffciculty swallowing
Loss of facial sensation
Loss of peripheral vibratory sensation
Nystagmus
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  #17  
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Quote:
Originally Posted by sashabeliimd View Post
A 60 year old man comes to the physician because of progressive weakness of his hands during the past 6 months, He workd as a carpenter and has had difficulty handling his tools. He has smoked 1 pack of cigarretetes daily for 45 years. He drinks two beers daily during the workweek and approximately six beers daily on weekends. Physical examination shows no lymphadenopathy. THere is decreased strenght4/5 in the upper and lower extremities and atrophy aof the muscle of the hands. He has diffuse hyperreflexia. Fasciculations are noticed on the muscles of the hands and upper extremities. Sensory examination is normal. Over the course of this disease , which of the following findings is most likely ?


Dementia
Diffciculty swallowing
Loss of facial sensation
Loss of peripheral vibratory sensation
Nystagmus


I think this DIFFICULTY SWALLOWING.

The patient is showing both UMN and LMN lesions. Typical of ALS.
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Quote:
Originally Posted by sashabeliimd View Post
A 6 year old boy is brought to the physician by his mother because of a 2 day history of fever, sore throat and occasional vomiting, His temperature is 39, Physical examination shows erythema and purulent exudate over the posterior pharyngeal wall and tonsils. The anterior cervical glands are enlarged and tender. A throat culture growth group A streptococcus, Because he is allergic to penicillin, treatment with erythomycin is begun. His condition improves during the next 2 days. The effectiveness of this antibiotic is most likely due to which of the following actions in protein synthesis?

A Causes misreading of mRNA information wrongggg
B Functions as an analog of aminoacy t RNA
C Inactivates elongation factor 2
[COLOR="rgb(255, 140, 0)"]D Interferes in aminoacyl tRNA binding[/COLOR]
E Interferes with translocation

Mechanism of action
Erythromycin displays bacteriostatic activity or inhibits growth of bacteria, especially at higher concentrations,but the mechanism is not fully understood. By binding to the 50s subunit of the bacterial 70s rRNA complex, protein synthesis and subsequent structure and function processes critical for life or replication are inhibited.[20] Erythromycin interferes with aminoacyl translocation, [COLOR="rgb(255, 140, 0)"]preventing the transfer of the tRNA bound at the A site of the rRNA complex to the P site of the rRNA complex[/COLOR]. Without this translocation, the A site remains occupied, thus the addition of an incoming tRNA and its attached amino acid to the nascent polypeptide chain is inhibited. This interferes with the production of functionally useful proteins, which is the basis of this antimicrobial action.

Result a corect answer is D???
Interferes with translocation is the right answer!
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  #19  
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Correct Answer Neurology

Quote:
Originally Posted by sashabeliimd View Post
A 60 year old man comes to the physician because of progressive weakness of his hands during the past 6 months, He workd as a carpenter and has had difficulty handling his tools. He has smoked 1 pack of cigarretetes daily for 45 years. He drinks two beers daily during the workweek and approximately six beers daily on weekends. Physical examination shows no lymphadenopathy. THere is decreased strenght4/5 in the upper and lower extremities and atrophy aof the muscle of the hands. He has diffuse hyperreflexia. Fasciculations are noticed on the muscles of the hands and upper extremities. Sensory examination is normal. Over the course of this disease , which of the following findings is most likely ?


Dementia
Diffciculty swallowing
Loss of facial sensation
Loss of peripheral vibratory sensation
Nystagmus

Correct answer is Difficulty swalowing, Disease ALS
I'll type full pathogenesis of disease for quick finding
Epidemiology :
ALS is a degenerative disease involving loss of upper and lower motor neurons.
Symptoms ussually appear between 40 and 60 years of age.
Most cases are sporadi
Pathogenesi:
Possibly due to mutated superoxide dismutase, neuron distruction by superoxide free radicals. or misfolded SOD 1 leading to apoptosis of neurons most likely mechanism

Clinical findings : [COLOR="rgb(255, 140, 0)"]Upper motor neuron [/COLOR]signs like [COLOR="rgb(255, 140, 0)"]Spasticity, babinski sign[/COLOR]
[COLOR="rgb(255, 140, 0)"] Lower motor neuron[/COLOR] signs like: [COLOR="rgb(255, 140, 0)"]Musle weakness , begins with atrophy of intrinsic muscles of the hands
Eventual paralysis of respiratory muscles[/COLOR]
No sensory changes
Preservation of bowel and bladder fuction

Diagnosis electromyography and nerve conduction studies
TReatmen: Riluzole ( glutamate antagonist)
Average survival time is 3-5 years.
From goljan rapid review
done
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  #20  
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I disagree Behavioral

A quick quetion

A 55 year old man recovered from a stroke 3 moths ago. He lives alone. He is at increased risk for which of the following psychiatric disorders???

Agoraphobia
Major depressive disorder
Obsessive - compulsive disorder
Post-traumatic stress disorder
Social phobia

After a stroke people will have of course PHOBIA of recurent appearance of a new stroke
ANSWER C is wrong , which is corect?????
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  #21  
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Quote:
Originally Posted by sashabeliimd View Post
A quick quetion

A 55 year old man recovered from a stroke 3 moths ago. He lives alone. He is at increased risk for which of the following psychiatric disorders???

Agoraphobia
Major depressive disorder
Obsessive - compulsive disorder
Post-traumatic stress disorder
Social phobia

After a stroke people will have of course PHOBIA of recurent appearance of a new stroke
ANSWER C is wrong , which is corect?????

Major Depressive disorder. He is old and lives alone. Also he just had a near death experience. Most likely.
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  #22  
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Correct Answer Neurology

Quote:
Originally Posted by sashabeliimd View Post
A quick quetion

A 55 year old man recovered from a stroke 3 moths ago. He lives alone. He is at increased risk for which of the following psychiatric disorders???

Agoraphobia
Major depressive disorder
Obsessive - compulsive disorder
Post-traumatic stress disorder
Social phobia

After a stroke people will have of course PHOBIA of recurent appearance of a new stroke
ANSWER C is wrong , which is corect?????

B... social isolation, major illness, etc... all risk factors for depression
Realy nothing else cover this quietion except for Major depressive disorder.
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  #23  
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Correct Answer Osteoporosis

A 77 year old woman dies in the hospital after a long illness. Her vertebral column, obtained , is shown in the photograph. The process shown is most likely associated with an increase in which of the following?

Calcium
Estrogen
Interleukin-1 IL-1
Monoclonal immunoglobulin Wrong
Vitamin D Wrong

GOljan rapid Review 4th edition Page 632

Pathogenesis of postmenopausal osteoporosis
Estrogen normally enhances osteoblastic activity and inhibits osteclastic activity in bone.

THIS effect on bone mass is mediated by inhibiting secretion of cytokine ( like interleukin 1, interleukin 6, TNF alpha that modulate osteoclastogenesis mean osteoclast differentiation , activation, life span, and function.)
Done
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  #24  
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Correct Answer Cardiology

A 3 year old girl is found to have a grade 4/6 loud, harsh, high pitched holosystolic murmur that radiates over the precordium and a palpable thrill at the left sternal border. Which of the following defects is most likely in this patient?


Aortic regur
Aortic stenossi
Atrial septal defect
Coarctation of the aorta
mitral regurgitation
Mitral stenosis
Patent ductus arteriosus
Pulmonic stenosis
Tricuspid regurgitation
Ventricular septal defect


Corect answer is VENTRICULAR SEPTAL DEFECT
yEEEEs this it, because Most common congenital defect, and you see on quieiton Harsh pansystolic murmur is present along the lower left sternal border.
Done
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  #25  
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Correct Answer Bevacizumab

Female with metastatoc colon cancer has maintained remission by taking bavacizumab.Ability to administer this agent despite it being foreign protein is due to ?

A)B cell dysfunction
B)T cell dysfunction
c)agent being humanized Ab
d)agent contain muramain ab molecule directed against vascular growth factor
e)immunosuppressive effect of previously administered chemotherapy

Bevacizumab is a recombinant humanized monoclonal antibody that produces angiogenesis inhibition by inhibiting vascular endothelial growth factor A
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  #26  
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Correct Answer Biochemistry

A 5-year-old girl is brought to the physician because of listlessness, fatigue, and dull pain in the right upper quadrant of the abdomen. Her height and weight are below the 25th percentile. Laboratory findings indicate that the content of her β-globin chain is 15% to 20% of normal. Sequencing of the β-globin gene shows a point mutation in a sequence 3′ to the coding region in which AATAAA is converted to AACAAA. Consequently, the amount of mRNA for β-globin is decreased to 10% of normal. Which of the following functions in mRNA synthesis and processing is most likely encoded by the sequence AATAAA?

a) capping with GTP
[COLOR="rgb(139, 0, 0)"]b) cleavage and polyadenlyation[/COLOR]
c) silencing the promoter
d) splicing of the initial mRNA transcript in the nucleus
e) transport of the mRNA out of the nucleus

first aid 2012 page 75, Kaplan 42
It is processing of eukaryotic pre messenger RNA
A poly A tail is attached to the 3 end, AAAAUAAAA, Poly A protect against rapid degradation and aids in its transport to the cytoplasm...
Done
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  #27  
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Correct Answer Interesting quietion!!!

A 19 year old woman comes to the physician because of increasingly severe pain in the right hip during the past month. She has a 4 year history of refractory inflammatory bowel disease with arthritis in the hands treated with corticosteroids for the past 2 years. An x-ray of the pelvis shows collapse of the superior half of the right femoral head with preservation of the articular cartilage. The left hip appears normal. Which of the following is the most likely cause of the hip abnormality?

Ankylosing spondylitis
Aseptic necrosis
Gouty necrosis
Multiple myeloma
Septic arthritis

Steroid big clue here, vasoconstriction and necrosis aseptic of bone, in special of some areas that are poorly perfused like a head of the femurus..
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Correct Answer Severe mental retardation

An 8 year old boy with severe mental retardation is brought to the physician because of a 1 year history of self mutilating behavior, including biting his fingers. His male cousin has similar symptoms. Physical examination shows spasticity, chorea, and mutilation of the digits. Laboratory studies are most likely to show which of the following abnormalities?

Hypercalcemia wrong
Hypercalciuria
Hyperuricemia
Hypokalemia
Hyponatremia
Hypophosphatemia

[COLOR="rgb(255, 140, 0)"]Lesch-Nyhan syndrome
Findings: Retardation, self-mutilation, aggression, hyperuricemia, gout, choreoathetosis...[/COLOR]

XXXXXX linked recessive...
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  #29  
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I disagree Behavior

A 25 year old medical student whose father had alcoholism and died of cirrhosis initially gets angry at patients with alcoholism. Over the course of training, he continues to recognize that working with these types of patients is distressing to him, but he learns methods of dealing more effectively with them. Which of the following mental mechanisms best describes his ability to effectively control his emotions?

Denial
Projection
Reaction formation
Repression wrong
Suppression

Very confused about this quietion...
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Quote:
Originally Posted by sashabeliimd View Post
A 25 year old medical student whose father had alcoholism and died of cirrhosis initially gets angry at patients with alcoholism. Over the course of training, he continues to recognize that working with these types of patients is distressing to him, but he learns methods of dealing more effectively with them. Which of the following mental mechanisms best describes his ability to effectively control his emotions?

Denial
Projection
Reaction formation
Repression wrong
Suppression

Very confused about this quietion...
It is suppression,coz repression is involuntary and it's mentioned clearly in the question that he learns methods..

And it's obvs that it can't be denial,projection or reaction formation..
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Correct Answer Behavioral

Quote:
Originally Posted by sashabeliimd View Post
A 25 year old medical student whose father had alcoholism and died of cirrhosis initially gets angry at patients with alcoholism. Over the course of training, he continues to recognize that working with these types of patients is distressing to him, but he learns methods of dealing more effectively with them. Which of the following mental mechanisms best describes his ability to effectively control his emotions?

Denial
Projection
Reaction formation
Repression wrong
Suppression

Very confused about this quietion...
Reaction formation : an unacceptable impulse is transformed into its opposite. A global reversal in which love is expressed as hate, for example: Two coworkers fight all the time because they are actually ver y attracted to each othe.

Please porpose better aswer, or explane,,,
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one small request,can u put the fonts normally?

it's so irritating to read,with diff colors and big letters.

So u thinl reaction formation is the answer?I did it offline and the answer was as given suppression.

Last edited by doctor_ind; 10-12-2014 at 10:19 AM. Reason: edit
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Quote:
Originally Posted by sashabeliimd View Post
A quick quetion

A 55 year old man recovered from a stroke 3 moths ago. He lives alone. He is at increased risk for which of the following psychiatric disorders???

Agoraphobia
Major depressive disorder
Obsessive - compulsive disorder
Post-traumatic stress disorder
Social phobia

After a stroke people will have of course PHOBIA of recurent appearance of a new stroke
ANSWER C is wrong , which is corect?????
Nope obsessive compulsive disorder is totally different
Answer is major depressive disorder.
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Correct Answer RNA

block 3 Que 13 A 60 year old man comes to the physician because of 2 year history of progressive shortness of breath with exertion his two younger siblings have similar symptoms his mother died of dilated cardiomyopathy . physical examination shows jugular venous distention and ankle edema there is hepatomegaly. inspiratory crackles are heard over both bases. a chest x-ray shows cardiomegaly and pulmonary conjestion angiography confirms dilated cardiomyopathy. an artial endocardial biopsy specimen shows abnormal sarcomeres with paracrystalline inclusion in mitocondria. sequencing of mitochondrial DNA shows G-to-A transition. this results in an added A:T base pair to the 3' end of tRNA [COLOR="rgb(255, 140, 0)"]thus shortening the C loop [/COLOR]which of the following is the most likely effect of this mutation on mitochondrial function?


A] decreased mRNA stability (wrong)
B] [COLOR="rgb(255, 140, 0)"]decreased protein synthesis[/COLOR]
C] decreased replication
D] increased mRNA stability
E] increased protein synthesis
F] increased replication

Decreased protein synthesis. You're screwing up the 3' CCA sequence on the tRNA so you're not able to properly charge tRNA with amino acids. mRNA stability is normal, but translation is decreased. and subsequently decrease protein synthesis..
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  #35  
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Correct Answer Renal stones

A 60 year old woman comes to the physician because of a 2 day history of flank pain and pain with urination. She has hypertension, recurrent urinary tract infections, and hypothyroidism. Her temperrature is 37, pulse 96, and BP 152/92mm Hg. Physical examination shows no other abnormalities. Urinalysis shows +3 blood, +1 leukocytes, and few bacteria. Ultrasonography of the abdomen shows a larsge calculus filling the entire right renal pelvis. The renal calculus in this patient is most likely composed of which of the following substances?

Calcium oxalate wrong
Cystine
Struvite
Uric acid wrong


Struvite urinary stones and crystals form readily in the urine of animals and humans that are infected with ammonia-producing organisms

Struvite stones can get large enough to fill the whole renal pelvis. Calcium oxalate stones don't get that large and aren't associated with UTIs.


Goljan source: Struvite stone ureaes producers, alkaline urine pH, ammonia smell of urine.
Magnesium ammonium phosphate
Staghorn calculus or struvite stone
Associated with urease producers like Proteus
Urine is alkaline and smells like ammonia...
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  #36  
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Info ok

Quote:
Originally Posted by doctor_ind View Post
one small request,can u put the fonts normally?

it's so irritating to read,with diff colors and big letters.

So u thinl reaction formation is the answer?I did it offline and the answer was as given suppression.
Ok, i'll try, but do this for quick view of principle or key words, because know how unwilling is to read a lot of text...
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After soloving a lot of NBME questions,I feel we can answer them by eliminating options and giving an educated guess.
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Correct Answer Antilipidemics

A 25 year old woman with obstructive sleep apnea comes to the physician because of oily, fatty bowel movements since starting a drug 1 months ago to aid in weight loss. She has lost weight during this period. Her BP is 130/80.. it was 140/85 1 month ago. PE shows no other abnormalities. Lipid studies done are shown below

Chol (total) 1 month ago = 285; now = 225
HDL-chol 1 month ago = 25; now = 28
LDL chol 1 month ago = 250; now = 150
TG 1 month ago = 300; now = 200
Which of the following drugs is the cause of steatorrhea and changes in lipid serum studies in this pt.


a. atorvastatin
b. bupropion
c. orlistat
d. phentermine
e. sibutramine

Atorvastatin was wrong answer
Bupropion used as atypical antidepressant, increase NE AND DA

Orlistat Orlistat is the saturated derivative of lipstatin, a potent natural inhibitor of pancreatic lipases isolated from the bacterium Streptomyces toxytricini.[5] However, due to its relative simplicity and stability, orlistat was chosen over lipstatin for development as an anti-obesity drug
works by inhibiting gastric and pancreatic lipases, the enzymes that break down triglycerides in the intestine. When lipase activity is blocked, triglycerides from the diet are not hydrolyzed into absorbable free fatty acids, and are excreted undigested instead. Only trace amounts of orlistat are absorbed systemically;
May be a corect , because triglycerides also are decreased after administration of the drug

phentermine Phentermine, a contraction of "phenyl-tertiary-butylamine", is a psychostimulant drug of the phenethylamine class, with pharmacology similar to amphetamine. It is used medically as an appetite suppressant.

sibutramine Sibutramine is a centrally-acting serotonin-norepinephrine reuptake inhibitor structurally related to amphetamines,
done with these too.
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  #39  
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Help Yes

Quote:
Originally Posted by doctor_ind View Post
After soloving a lot of NBME questions,I feel we can answer them by eliminating options and giving an educated guess.
Yes , it;s a good manier to learn, why not?
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Correct Answer Hydrocephalus

A 73 year old woman is brought to the physician because of a 1 month history of urinary frequency and urgency , She also has had a 3 month history of difficulties with walking, conversation, and memory. Neurologic exammination shows normal strength and sensation. Her mini-mental state examination score is 21/30. She walks with a wide-based, shuffling gait, A Ct scan of the head shows marked enalrgement of the ventricles. Which of the following is the most likely dignosis?

Atherosclerosis of the carotid artery
Dementhia, Alzheimer type wrong
Huntington disease
Normal-pressure hydrocephalus
Parkinson disease
Small vessel disease


Elderly woman, with urinary frequiencya and urgency +difficulty walking, ataxia, and memory conversation that mean cognition, >> dementia, result a Normal pressure hydrocephalus, if somebody think differently, wait your asnwer...
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  #41  
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Correct Answer Biostatistics

An epidemiologist is investigating an outbreak of diarrhea among a total of 1000 consumers of vegetables. Of those consumers, 800 people ate tomatoes and 200 people ate lettuce.A total of 400 people became ill,80 of these people ate tomatoes, and 40 people ate lettuce. Which of the following indicates the probability of having developed diarrhea in people who consumed lettuce?

0.08
0.1
0.2
0.4
0.5
What is asked???
Is asked number of having diarrhea from number of people who it lettuce
Probability of one to another divide then???
40(people who ate lettuce become ill)/200 (number of people who ate lettuce)= o.2
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  #42  
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Correct Answer INterferon

A 2 month old boy dies of meningitis despite appropiate antibiotic therapy. Culture of his cerebrospinal fluid grows Mycobacterium tuberculosis. Two of his brothers died of atypical mycobacterial infections. Which of the following immunodeficiencies most likely explains this familial history?


Complement deficiency which is wrong
Interferon gamma receptor deficiency
Leukocyte adhesion deficiency
X linked agammaglobulinemia

BIG BIG quetion


Leukocyte adhesion is excluded, because disease is seen with recurrent bacterial infections, absent pus formation, delayed separation of umbilicus,,,
a lot of neutrophils that cannot adhere transduce, and kill bacteria

X linked recessive>>> Brutons agammaglobulinemia, is a defect in BTK a tyrosine kinase gene, Blocks pro Bcell from forming Pre B cells


And last one Interferon gamma receptor deficiency, which is mostly corect because :
The human interferon-gamma receptor complex consists the heterodimer of two chains: IFNGR1 and IFNGR2.In unstimulated cells, these subunits are not preassociated with each other but rather associate through their intracellular domains with inactive forms of specific Janus family kinases ( Jak1 and Jak2). Jak1 and Jak2 constitutively associate with IFNGR1 and IFNGR2, respectively

Disease linkage
IFNGR1 deficiency is associated with the increased susceptibility to certain infectious diseases in patients, especially mycobacterial infections
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Fire Thread NExt one

A 48 year old man is brought to the emergency department because of difficulty opening his mouth and stiffness of his neck, shoulders, and back, for 4 hours. He sustained a puncture wound to his arm 1 week ago. He has received no medical care for 30 years. Physical examination shows trismus and opissthotonos. Which of the following best describes the process in this patient?

Blockade of inhibitory neurotransmitter release
Cell death in central nervous system neurons
Cell death in muscles
Cell death in peripheral nervous system neurons
Demyelinization

Key words we see are: Pucture wound , trismus, opisthotonus,

JUST clostridia tetani is coresponding here, which is an inhibitor of GABA and glycine release, that produce following symptoms like , spastic paralysis, trismus, risus sardonicus.
Answer is A , blockade of inhibitory neurotransmitter release


Excitatory neurotransmiter is Glutamate !!!
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Post E coli

A 23 year old woman comes to the physician because of t day hx of chills, nausea, and vomiting. She also has a 4 day history of flank pain, urinary frequency, and pain with urination. Her temp is 102 F pulse is 125/min, and BP 90/60. Physical examination shows right costovertebral angle tenderness. UA shows 25 WBC/hpf. A urine sample grows pink colonies on lactose-MAcConkey agar, produces a characteristic green sheen on eosin-methylene blue agar and is indole +. The production of which of the following by the bacterium aids in the virulence of the causal organism in this patient?

A- adhesins
B- antihemolytic factors
C- pyrogenic exotoxic
D- teichoic acid in the cell wall
E - thick peptidoglycan Layer

Agent pathogen is of course E coli, you see Mac COnkey agar mediu for growth, and virulence factor if related to urinary tract is PILLI, but is not directly given PILLI
but pilli help to adhere to urethra for example and farward
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Star BIo

Biostatistics, boring this object...


A study is conducted to assess the effectiveness of vitamin C in preventing common colds in children. Patients are randomly assigned to receive either vitamin C or no intervention. Otcome events common cold are reported by the parents on a monthly basis for a 1 year. Results show that those taking vitamin C have fewer colds compared with those who received no intervention (p <0.05). Which of the following raises the most concern about the validity of the conclusion that vitamin C supplements prevent the common cold?

Inadequate statistical power which is wrong
Nonrandomization
Selection bias
Variability in outcome assessment


Selection bias, is sampling bias the sample selected is not represantative of the population
example from kaplan : Predicting rates of the heart disease by gathering subjects from a local health club...

Non-randomized controlled trial
An experimental study in which people are allocated to different interventions using methods that are not random. , same method???

Confused please help here
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  #46  
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Info BEhavioral

A 21 year old african amercan man with sickle cell disease is brought to the emergency department 2 hours after the sudden onset of severe pain in his abdomen and knees,He has six similar episodes within the past 4 years , he was admitted to the hospital each time for treatment of the pain. His course has been complicated by two episodes of pneumonia adn small cerebral infarction in the past 2 years. THe patient asks the physician for extra pain medication to Kill me because i can't take it anymore. Which of the following initial actions by the physician regarding the patients request is most appropiate?


Contact the hospital ethics committee not good
Restrain the patien
Reevaluate the patient after his pain has been controlled
Administer general anethesia for sedation
COmply with the patient reques wrong


When did test , din't observe that he tell KILL ME !!! it is a suicide thoughts, and patient must be under control
Corect answer than is RESTRAIN THE PATIENT?????? WHO THINK OTHERWISE?????
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Correct Answer BEHavrioral:)

A 7 year old girl is brought to the physician by her parents because of a 3 year history of temper tantrum when her parents leave her. She refuses to sleep alone and recently would not attend her friend;s birthday slumber party. She calls to her mother if she is in another room of the house. Each morning, the patient's teacher has to carry her into school crying. Her mother recently returned to work full time and says that she is quite angry that her daughter is behaving in such a defiant way.Her father recalls that he behaved the same way when he was her age. Which of the following is the most likely explanation for this patient's behavior?


COnduct disorder
Oppositional defiant disorder
Post traumatic stress disorder
Separation anxiety disorder
Normal behavior wrong

In behavioral of this child we see a typical separation anxyety disorder...
An unrealistic and lasting worry that something bad will happen to the parent or caregiver if the child leaves
An unrealistic and lasting worry that something bad will happen to the child if he or she leaves the caregiver
Refusal to go to school in order to stay with the caregiver
Refusal to go to sleep without the caregiver being nearby or to sleep away from home
Fear of being alone
Nightmares about being separated
Bed wetting
Complaints of physical symptoms, such as headaches and stomachaches, on school days
Repeated temper tantrums or pleading


But what is hapening with father?????

Oppositional defiant disorder (ODD) is defined by the DSM-5 as a pattern of angry/irritable behavior, or vindictiveness lasting at least 6 months, and is exhibited during interaction with at least one individual that is not a sibling. Individuals must display four symptoms from one of the following categories: angry/irritable mood, argumentative/defiant behavior, or vindictiveness.


Conduct disorder (CD) is a psychological disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors."


Post traumatic stress disorder
Posttraumatic stress disorder[note 1] (PTSD) may develop after a person is exposed to one or more traumatic events, such as sexual assault, warfare, serious injury, or threats of imminent death.[1] The diagnosis may be given when a group of symptoms, such as disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal, continue for more than a month after the occurrence of a traumatic event
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Correct Answer Bence JOnes

A 54 year old woman comes to the physician because of a 5 day history of severe mid'back pain. Physical examination shows point tenderness over the T6 vertebra.
Serum studies show a calcium concentration of 13.4 mg/dL, urinalysis shows Bence JOnes proteins. Which of the following is the most likely cause of this patient;s hypercalcemia?


Excessive parathyroid hormone production
Excessive parathyroid hormone related protein production
Increased fractional calcium gastrointestinal absorption
Local interleukin 1 and tumor necrosis factor effects
Unregulater 1.25 dihydroxycholecalciferol production

Bence protein Multiple Myeloma of course disease,

Increased IL-6
Increased osteoclast activating factor RANK
Most common primary malignancy of bone
increased suscepptibility to infection
bone lytic lesions
M spike chain in urine detected
Rouleaux formation of RBCs
Hypercalcemia
Anemia
Back pain
and bone lytic lesions
Renal insuficiency
Calcium 8.8 - 10.3 mg/dL normal calcium

other name for IL-1 is osteoclast activating factor
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Correct Answer Ligaments

a 55yr old woman is scheduled to undergo transvaginal hysterectomy and oopherectomy for DUB. During the procedure the uterus must be separated from all the pelvic organs.Identification and inscission of which of the following structures that attaches to cervical region and extends posteriorly is most appropriate in this pt?

A. Mesometrium
B. Mesosalpinx
C. Mesovarium
D. Ovarian lig
E. Round lig of uterus
F. Uterosacral lig

https://www.google.md/search?q=utero...P&ved=0CBoQsAQ

A uterosacral ligament is a paired ligament of the female pelvis that runs between the uterus and the sacrum, a bone at the base of the vertebral column in the pelvis. Also known as a recto-uterine ligament, it is one of three paired peritoneal ligaments assisting in holding the uterus in place in the pelvic cavity. This ligament arises from the recto-uterine folds of the recto-uterine pouch, a space found just behind the cervix near the bottom of the uterus, and attaches to the front aspect of the sacrum.
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Quote:
Originally Posted by sashabeliimd View Post
Biostatistics, boring this object...


A study is conducted to assess the effectiveness of vitamin C in preventing common colds in children. Patients are randomly assigned to receive either vitamin C or no intervention. Otcome events common cold are reported by the parents on a monthly basis for a 1 year. Results show that those taking vitamin C have fewer colds compared with those who received no intervention (p <0.05). Which of the following raises the most concern about the validity of the conclusion that vitamin C supplements prevent the common cold?

Inadequate statistical power which is wrong
Nonrandomization
Selection bias
Variability in outcome assessment


Selection bias, is sampling bias the sample selected is not represantative of the population
example from kaplan : Predicting rates of the heart disease by gathering subjects from a local health club...

Non-randomized controlled trial
An experimental study in which people are allocated to different interventions using methods that are not random. , same method???

Confused please help here
Answer is assessment in variability outcome coz it's jus mentioned that they have fewer colds,but not exactly,the number
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Correct Answer Behavioral

A male newborn is delivered at 38 weeks gestation following an uncomplicated pregnancy. Twelve hours later, he begins sucking frantically and crying incosolably. He overreacts to stimuli around him and has a marked startle response. The symptoms slowlly resolve over the next 2-3 weeks. The most likely explanation fo these symptoms is maternal use of which of the following substances during pregnancy?

Alcohol
Heroin
LSD wrong
Marijuana
Psilocybin

It's look like withdrawal syndrome
lets detect which one is .

Heroin withdrawal>>> flu like muscle aches, nausea, or vomiting, yawning, piloerection, lacrimation, rhinorrhea, fever, insomnia, pupilary dilation


Marijuana withdrawal>>> none

LSD hallucinogen>>> none Psilocybin[nb 1] (/ˌsɪləˈsaɪbɪn/ sil-ə-sy-bin) is a naturally occurring psychedelic compound produced by more than 200 species of mushrooms, collectively known as psilocybin mushrooms.

Psilocybin Mushroom Withdrawal
There are no physiological withdrawal symptoms from psilocybin mushrooms, but habitual users may experience anxiety, depression, insomnia or cravings. A bad trip can have devastating psychological implications making deep-seated problems worse. Therapy may be needed to help deal with flashbacks. Unfortunately, these flashbacks tend to be of bad trips.

Remain only HEROIN???
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Correct Answer Coagulation

. A 22 y/o woman comes to the physician for a follow-up examination. One year ago, she was diagnosed with a[COLOR="rgb(255, 140, 0)"] pulmonary embolism.[/COLOR] Two years ago, she delivered a female stillborn at 23 weeks’ gestation. Physical exaamination today shows no abnormalities. Lab studies show normal platelet count, normal prothrombin time, and increased partial thromboplastin time. The findings in this patient are most consistent with which of the following conditions?

A) Antiphospholipid antibody syndrome ?????????
B) Factor V Leiden mutation wrong
C) Increased factor VIII (antihemophilic factor) concentration
D) Protein C deficiency (WRONG)
E) Prothrombin G20210A mutation


Antiphospholipid syndrome
(APS) is a disorder that manifests clinically as recurrent venous or arterial thrombosis and/or fetal loss. Characteristic laboratory abnormalities in APS include persistently elevated levels of antibodies directed against membrane anionic phospholipids (ie, anticardiolipin [aCL] antibody, antiphosphatidylserine) or their associated plasma proteins, predominantly beta-2 glycoprotein I (apolipoprotein H); or evidence of a circulating anticoagulant.

Multiple terms for APS exist. Unfortunately, some synonyms can be confusing. Lupus anticoagulant (LA) syndrome, for example, is misleading because patients with APS may not necessarily have systemic lupus erythematosus (SLE) and LA is associated with thrombotic rather than hemorrhagic complications. In an attempt to avoid further confusion, APS is currently the preferred term for the clinical syndrome (as described below).

Some patients with APS have no evidence of any definable associated disease, while, in other patients, APS occurs in association with SLE or another rheumatic or autoimmune disorder. Traditionally, these have been referred to as primary or secondary APS, respectively. Currently, however, the preferred terminology is APS with or without associated rheumatic disease. Although antiphospholipid (aPL) antibodies are clinically linked to APS, whether they are involved in the pathogenesis or are an epiphenomenon is unclear. (Up to 5% of healthy individuals are known to have aPL antibodies.)


Factor V leyden >>>> production of mutant factor V that cannot be degraded by protein C. Most common cause of inherited hypercoagulability

Partial thromboplastin may be increased in Von Willenbrand disease, and in Disseminated intravascular coagulation, or deficiency of others factor except for factor VII and XIII...
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Correct Answer Crest

A 64 year old woman comes to the physician because of a 6 month history of heartburn and difficutly swallowing solid and liquid. She has not had nausea or vommitting. She also has a 2 year history of pain and swelling of her wrists and hands. She has not seen a physician in 5 years. She does not smoke. She takes no medications. PE shows no wrinkles on the face and neck. He vitals are within normal limits. There is synovial thickening of the wrists bilaterally. A photograpsh of the left hand is shown. Abdominal exam shows no abnormalities. Which of the following sets of findings is most likely on the esophageal manometry?

Esophageal Peristalisis LES Tone

A. Increased Increased
B. Increased Decreased
C. Normal Increased wrong
D. Normal Decreased (wrong)
E. Decreased Increased
F. Decreased decreased

CREST syndrome >>> Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactily, Telangiectasia. Associated with antiCentromere antibody.

Goljan pathology, Diagnosis

Abnormal findings with barium swallow
Dilated aperistaltic esophgus with a beak like tapering at distal end

Abnormal findings with esophageal manometry
detects aperistalsis and failure of LES relaxation


Result both decresea tonus
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  #54  
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Correct Answer Cholesterol

An 18-year-old woman with mild mental retardation is brought to the physician because of a 3-day history of decreased ability to see in reduced light. She has a lifelong history of chronic diarrhea. Two years ago, she developed a lack of muscle control of her arms and legs, and generalized weakness. Her 16-year-old brother has had similar symptoms. Ophthalmologic examination shows bilateral retinitis pigmentosa. There is ataxia and loss of deep tendon reflexes. Laboratory studies show erythrocytes with spiny projections and a serum total cholesterol concentration of 40 mg/dL. Which of the following apolipoproteins is most likely deficient in this patient?

A) ApoA-l
B) Apo A-Il
C) ApoB
D) ApoC
E) ApoE WRONG

REmain as corect Apo B???
If symptoms show diarrhea, retinitis that indicate malbsorption of vit A, and ataxia that mean vit E , finaly all lipophilic vitamins

Apoprotein B48 in enterocytes is important in resynthesizing TGs and packaging them into chylomicrons
Apo48 si also important in transporting chylomicrons into lymphatics.
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Correct Answer Behavioral

block2-Que23 A 28 year old woman comes to the physician for a health maintance examination, she tearfully tells the physician that she and her new husband are having problems, she says that she wants to going out with friends but he does not enjoy being with people and prefer individual activity like hiking she says he seems indifferent to sexual intimacy and neither shows much emotions nor understands her feelings at all. which of the following personality styles best explaines the husband's behaviour?

A] Avoidant (wrong)
B] Narcissistic
C]Paranoid
D] Schizoid
E] Schizotypal


Avoidant extreme sensitivity to rejection, excessive shyness,strong desire acceptance,
Here patient avoid social meeting, but is in relationship
Clue is i think about No emotions in what he do.

Narcissistic is a grandiose sense of self importance, preoccupation with fantasies of unlimited wealth, power, love,


Parnoid>>> long standing, suspiciousness or mistrust of others
preocupied with issues of trust


Schizoid, is answer that looks right,

Lifelong pattern of social withdrawal, and they like it that way,
Seen by others as eccentric, isolated, withdrawan
[COLOR="rgb(255, 140, 0)"]Restricted emotional expression [/COLOR] that is a clue

Done
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  #56  
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Post Hi

It;s a good idea to insert all information about wrong answers in nbme form 13 here, because i can in any moment to review with a quick combination of CTRL + F insert needed key word from quietion and remind explanation, good luck for all who use this thread
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  #57  
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Correct Answer INfertility

A young adult couple has been unable to conceive for the past 2 years. The woman has regular menstrual cylces and takes no contraceptives, A semen analysis shows:
Quality normal range
Quantity normal range
COlor white
Fructose 5% of normal content

The most likely causes of this couple;s infertility is deficient activity of which of the following in the MAN?

Adenohypophysis
Bulbourethral glands
Prostate
Seminal vesicles
Testes
WHo provide fructose for sperme for life?

SEMINAL FLUID: The seminal fluid is secreted by the seminal vesicles. Seminal fluid is added to semen via ampulla of vas deferens.

PROPERTIES OF SEMINAL FLUID: The seminal fluid is mucoid and viscous in nature. It is neutral or slightly alkaline in reaction. It adds to the bulk of semen as it forms 60% of total semen.

FUNCTIONS OF SEMINAL FLUID:

Nutrition to sperms: When the sperms are ejaculated into the female genital tract they utilise the fructose and other nutritive substances present in seminal fluid.

Clotting of semen: As soon as semen is ejaculated the fibrinogen from seminal fluid is converted into the coagulum.

On Fertilization: The fertilization of ovum is enhanced by the prostaglandin of seminal fluid by the following processes:
Receptive capacity of cervical mucosa for sperms is increased
Causing reverse peristaltic movement of uterus and fallopian tubes which increases the rate at which the sperms are transported in female genital tract during coitus.
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Fire Thread Renal

A 4 year old girs has had PUFFY EYES for the past 3 days. She has had an upper respiratory tract infection for the past week. A urine dipstick test shows +3 protein. Urinalysis shows no red or white blood cells or casts. Which of the following mechanisms is the most likely cause of this patients condition?

Attack by antiglomerular basement membrane antibodies
Damage to the loop of Henle
Damage to the proximal renal tubule
Loss of negative glomerular charge
Presence of a posterior urethral valve

Who solve this test reply please....
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Correct Answer REnal

Quote:
Originally Posted by sashabeliimd View Post
A 4 year old girs has had PUFFY EYES for the past 3 days. She has had an upper respiratory tract infection for the past week. A urine dipstick test shows +3 protein. Urinalysis shows no red or white blood cells or casts. Which of the following mechanisms is the most likely cause of this patients condition?

Attack by antiglomerular basement membrane antibodies wrong
Damage to the loop of Henle
Damage to the proximal renal tubule
Loss of negative glomerular charge ?????
Presence of a posterior urethral valve

Who solve this test reply please....
We see here acute renal damage, Nephotic syndrome, and child, most common child nephrotic syndrome is due to minimal change disease, may be after some infection like a respiratory tract infection in this child , that responds to steroids, what is affected in minimal change disease?


T cell cytokines cause the GBM to lose its negative charge, selective proteinuria

Done
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Correct Answer Hi

A 52-year-old man comes to the physician because of a 3-month history of epigastric abdominal pain; he also has had an unintentional 6.8-kg (15-lb) weight loss during this period. He has osteoarthritis treated with naproxen as needed. He has immigrated to the UsA from Japan 6 months ago. He eats mostly traditional Japanese food prepared by his wife. He has smoked 2 packs of cigarettes daily for 30 years and drinks three to four glasses of wine daily. He is 170 cm (5 ft 7 in) tall and now weighs 82 kg (180 lb); BMI is 28 kg/m^2. Physical examination shows epigastric tenderness. Upper gastrointestinal endoscopy shows a 4-cm ulcer in the stomach.
Examination of a biopsy specimen of the lesion confirms adenocarcinoma. Which of the following is the strongest predisposing risk factor for the patient's condition?

A. Alcohol use
B. Diet
C. Ethnicity wrong
D. Naproxen
E. Tobacco use
Than b DIET, nitrosamines , special fish cooking

Done
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  #61  
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Correct Answer Confusing quietion

Twenty subjects participate in a study of cardiopulmonary physiology. The pulmonary circulation of theese subjects most likely has which of the following characteristics compared with their bronchial circulation?

Greater number of branches supplying the visceral pleura ???
[COLOR="rgb(255, 140, 0)"]Larger percentage of cardiac output[/COLOR]
Larger volume of nutrient blood to the conducting airways wrong
Lower volume., higher pressure system wrong

Pulmonary circulation have Lowest pressure highest volume circulation, for gas exchange,

Large percentage of cardiac output? may be because pulmonary as systemic cardiac output is same, indifferently from pressures

Pulmonary circulation is a high-flow, low-resistance, and low-pressure system.

BRONCHIAL CIRCULATION
The conducting airways have a separate circulation known as the bronchial circulation, which is distinct from the pulmonary circulation. The primary function of the bronchial circulation is to nourish the walls of the conducting airways and surrounding tissues by distributing blood to the supporting structures of the lungs. Under normal conditions, the bronchial circulation does not supply blood to the terminal respiratory units (respiratory bronchioles, alveolar ducts, and alveoli); they receive their blood from the pulmonary circulation. Venous return from the bronchial circulation is by two routes: bronchial veins and pulmonary veins. About half of the bronchial blood flow returns to the right atrium by way of the bronchial veins, which empty into the azygos vein. The remainder returns through small bronchopulmonary anastomoses into the pulmonary veins.
Bronchial arterial pressure is approximately the same as aortic pressure, and bronchial vascular resistance is much higher than resistance in the pulmonary circulation. Bronchial blood flow is approximately 1% to 2% of cardiac output but in certain inflammatory disorders of the airways (e.g., chronic bronchitis), it can be as high as 10% of cardiac output.
The bronchial circulation is the only portion of the circulation in the adult lung that is capable of undergoing angiogenesis, the formation of new vessels. This is extremely important in providing collateral circulation to the lung parenchyma, especially when the pulmonary circulation is compromised. When a clot or embolus obstructs pulmonary blood flow, the adjacent parenchyma is kept alive by the development of new blood vessels.

Answer B
Done
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Correct Answer Cyanosis

A male newborn delivered at 34 weeks gestation by an uncomplicated spontaneous vaginal delivery develops respiratory distress 30 minutes later. His respiration are 40/min. Physical examination shows cyanosis and lower rib retraction with respiration. Chest x rays show fine densities with a reticulogranular appearance bilaterally.
Which of the following is the most likely causes of these findings?

34 weeks, under 35 , decreased production of surfactant, fine densities with reticulogranular appearance may be ARDS???

Erythrolastosis fetalis
Extralobar sequestration Wrong
Intracranial hemorrhage bad idea
Pulmonary surfactant deficiency ?????
Situs inversus

What Causes Erythroblastosis Fetalis?
There are two main causes of erythroblastosis fetalis: Rh incompatibility and ABO incompatibility. Both are associated with blood type. There are four blood types: A, B, AB, and O. And blood can be either Rh positive or Rh negative. If a person is of blood type A and is Rh positive, he or she has A antigens and the Rh factor antigens on the red blood cell membrane surface. If a person has AB negative blood, he or she has both A and B antigens without the Rh factor antigen.

Kartagener syndrome
Further information: primary ciliary dyskinesia

Axial CT image showing dextrocardia and situs inversus in a patient with Kartagener syndrome.

Axial CT image showing situs inversus (liver and IVC on the left, spleen and aorta on the right) in a patient with Kartagener syndrome.
About 25% of individuals with situs inversus have an underlying condition known as primary ciliary dyskinesia (PCD). PCD is a dysfunction of the cilia that manifests itself during the embryologic phase of development. Normally-functioning cilia determine the position of the internal organs during early embryological development, and so embryos with PCD have a 50% chance of developing situs inversus. If they do, they are said to have Kartagener syndrome, characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. Cilia are also responsible for clearing mucus from the lung, and the dysfunction causes increased susceptibility to lung infections. Kartagener Syndrome can also manifest with male infertility as functional cilia are required for proper sperm flagella function.

Only surfactant deficiency is posible corect??? reply please
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Correct Answer Hi

31 yo woman comes to the ER with difficult breathing and muscle weakness for 10 minutes. She has a 3 year history of myasthenia gravis treated with neostigmine. The husband reports that she double her doses 2 days ago but her weakness increase since then. Which of the following event is most likely responsible for the increase of the weakness of this patient?

a. Autoimnune hyper activation of nicotinic receptors
b. autoimmune inactivation of muscarinic receptors
c[COLOR="rgb(255, 140, 0)"]. desensitization of nicotinic receptors [/COLOR]
d. excessive degradation of acetylcholine wrong
e. hyper sensitization of muscarinic receptors
f. insufficient release of acetylcholine same release

Neostigmine affect indirectly by AchE inhibiting ...
receptors got desensitized

The cause appears to be a reduction in the number of acetylcholine receptor sites as a result of disorganisation of the postsynaptic muscle membrane, which may contribute to the muscular weakness associated with the long term use of anticholinesterase agents.

Edrophonium also enhanced desensitization of the nAChR within the clinically observed range. Edrophonium desensitization of the nAChR was further increased by simultaneous exposure to other drugs known to promote desensitization of the receptor.

Done
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Fire Thread Reproductive

A 40 year old man comes to the physician because of a 6 month history of difficulty maintaining an erection during sexual intercourse. He has consumed 1/2 L of bourbon daily whisky for 15 years. His pulse is 88 per minut, and BP is 130/80. Examination shows scleral icterus and spider angiomata over the trunk. The liver span is 5-6 cm in the midclavicular line. The spleen tip is palpated 5 to 6 cm below the left costal margin. Decreased serum concentration of which of the folowing is the most likely of this patient's erectile dysfunction???


Estradiol bad idea, low estradiol for man is feel good
Estrone wrong i think
Folicle stimulating hormone
Luteinizing hormone
Testosterone

Man have problem with liver, that mean no metabolism of hormones. and their distruction... increased liver span , deduce cirrhosis hepatic...

CONCLUSIONS:
Available data suggest that in most men circulating levels of testosterone, well below the normal range, are essential for normal erection and that higher levels of serum testosterone may not have major impact on erectile function. Screening for hypogonadism in all men with ED is necessary to identify cases of severe hypogonadism and some cases of mild to moderate hypogonadism, who may benefit from testosterone treatment.

Testosterone si synthesized from cholesterol that pregnenolone hydroxypregnenolone DHEA, androstendione adrenal androgens, as well as estradiol and convertion by 5 alpha reductase to testosterone
But liver where initial convertion must occur is damaged, or malfunction...

Testosterone level decresed corect answer? have somebody another explication?
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  #65  
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Correct Answer Replication

Hologous pairing of chromosomes in prophase I is essential for which of the following normal processses?

Centromere division
Chromosome Uncoiling
Crossing over Yes crossing over between homologous chromosomes
DNA replication wrong

The centromere is the part of a chromosome that links sister chromatids. During mitosis, spindle fibers attach to the centromere via the kinetochore.[1] Centromeres were first defined as genetic loci that direct the behavior of chromosomes. Their physical role is to act as the site of assembly of the kinetochore - a highly complex multiprotein structure that is responsible for the actual events of chromosome segregation - e.g. binding microtubules and signalling to the cell cycle machinery when all chromosomes have adopted correct attachments to the spindle, so that it is safe for cell division to proceed to completion (i.e. for cells to enter anaphase).[2] There are broadly speaking two types of centromeres

MITOSIS
Although mitosis is a continuous process, it is divided into four phases for ease of understanding. The phases are: prophase, metaphase, anaphase, and telophase. Interphase, plus the four phases of mitosis, are referred to as the cell cycle. The following is a brief synopsis of the events of the four phases of mitosis (the events of interphase are described above):


Prophase -During prophase, the first phase of mitosis, the chromosomes condense (shorten) and become visible when stained and viewed under a microscope. During the latter part of prophase, the nuclear membrane disappears and the newly formed spindle fibers attach to a region of the centromere called the kinetochore.

Metaphase -During metaphase, the spindle fibers move the replicated chromosomes to the middle of
the cell where they line up in single file along the equatorial plane.

Anaphase -During anaphase, the sister chromatids are "pulled" apart (separated) and move toward
opposite poles of the cell. The separated chromatids are now called daughter
chromosomes.

Telophase -During telophase, the last phase of mitosis, the spindle apparatus disappears and nuclei reform around each set of daughter chromosomes. Cytokinesis also occurs during telophase. In animal cells, a cleavage furrow forms and eventually divides the cytoplasm in half among the two daughter cells. In plant cells, cytokinesis is accomplished with the formation of the cell plate.

http://www.upt.pitt.edu/ntress/Bio1_...nd_meiosis.htm


At the start of prophase I, the chromosomes have already duplicated. During prophase I, they coil and become shorter and thicker and visible under the light microscope.

• The duplicated homologous chromosomes pair, and crossing-over (the physical exchange of chromosome parts) occurs. Crossing-over is the process that can give rise to genetic recombination. At this point, each homologous chromosome pair is visible as a bivalent (tetrad), a tight grouping of two chromosomes, each consisting of two sister chromatids. The sites of crossing-over are seen as crisscrossed nonsister chromatids and are called chiasmata (singular: chiasma).

• The nucleolus disappears during prophase I.

http://www.phschool.com/science/biol...osis/proi.html
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Correct Answer MEN

An autopsy is done on a 46 year old woman who died of adenocarcinoma of the colon. Examinationnnn of the nech shows a 5 cm rounded mass next to the bifurcation of the carotid artery.... A section of the mass is shown i the micrograph. Immunohistochemistry of the section is positive for synaptophysin, chromogranin and neuron specific enolase. Electron microscopy shows numerous electrone dense, membrane bound meurosecretory granules. Examination of the adrenal glands shows no masses. aWHich of the following is the most likely diagnosis????

Metastatic colonic adenocarcinoma
Metastatic squamous cell carcinoma of the larynx
Papillary carcinoma of the thyroid gland is wrong answer
Paraganglioma
Parathyroid adenoma

this is multiple endocrine neoplasia like, colon adenocarcinoma, mass around bifurcation that look like a thyroid papillary carcinoma, and of course these synaptophysins, chromogranin , endocrine markers of tumor,
especialy on Suprarenal glands, but on Examinatino adrenal glands are clear


Lets review MEN neoplasia
MEN 2 is excluded because absent of pheochromocytomas
Synaptogranins >>>\
A positive immunostain for Synaptophysin indicates the presence of Medulloblastoma, a primitive neuroectoderm tumor, found in pediatric patients. It commonly seeds to the spinal cord, requiring radiation of these areas.

This gene has been implicated in X linked mental retardation

Using immunohistochemistry, synaptophysin can be demonstrated in a range of neural and neuroendocrine tissues, including cells of the adrenal medulla and pancreatic islets. As a specific marker for these tissues, it can be used to identify tumours arising from them, such as neuroblastoma, retinoblastoma, phaeochromocytoma, carcinoid, small-cell carcinoma, and medullary thyroid carcinoma, among others. Diagnostically, it is often used in combination with chromogranin A.

enolase

In recent medical experiments, enolase concentrations have been sampled in an attempt to diagnose certain conditions and their severity. For example, higher concentrations of enolase in cerebrospinal fluid more strongly correlated to low-grade astrocytoma than did other enzymes tested (aldolase, pyruvate kinase, creatine kinase, and lactate dehydrogenase).[16] The same study showed that the fastest rate of tumor growth occurred in patients with the highest levels of CSF enolase. Increased levels of enolase have also been identified in patients who have suffered a recent myocardial infarction or cerebrovascular accident. It has been inferred that levels of CSF neuron-specific enolase, serum NSE, and creatine kinase (type BB) are indicative in the prognostic assessment of cardiac arrest victims.[17] Other studies have focused on the prognostic value of NSE values in cerebrovascular accident victims.[18]

Autoantibodies to alpha-enolase are associated with the rare syndrome called Hashimoto's encephalopathy.

Metastatic colonic adenocarcinoma
https://www.google.md/search?q=Metas...w=1366&bih=643

Metastatic squamous cell carcinoma of the larynx
https://www.google.md/search?q=Metas...+of+the+larynx


Paraganglioma
https://www.google.md/search?q=Metas...=Paraganglioma

Parathyroid adenoma
https://www.google.md/search?q=Metas...hyroid+adenoma

Image on quietion looks like Pituittary adenoma,
and conclusion is MEN 1

Parathyroid tumors
Pituitary tumors
Pancreatic endocrine tumors like zollinger ellison syndrome, insulinomas, VIPomas, glucagonomas,

Done
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Correct Answer

The tracing of skeletal muscle response at different frequencies of electrical stimulation. The amount of Ca sequestered in SR is highest at which frequency? I can't post pic because I don't know if it is allowed.
a. 1 Hz
b. 3 Hz
c. 6 Hz
d. 9 Hz
e. 12 Hz

The graphs show frequency of stimulation. At the lowest frequency, the muscle will have time to pump calcium ions back into the cell. At the highest frequency, there's no time to pump calcium back into the SR, leading to its accumulation in the cytoplasm. This is what we call tetanus.

https://www.google.md/search?q=skele...ed=0CAYQ_AUoAQ

A corect, low frequency, where calcium haven't time to come back to sarcoplasmic reticulum...
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Fire Thread Behavioral

Guys really help here

A 16 year old boy has a 6 month history of type 1 diabetes mellitus and requires daily insulin injections. His blood glucose control has been poor recently, which the physician suspects may be related to the patient;s reluctance to self - administer insulin. Which of the following quetions is most appropiate to broach this issue with the patient?

Giving yourself insulin injection can be difficult. What's it like for you???

I get the feeling you have not been taking your insulin regularly, Would you like me to arrange some training for you by our nursees?

It's been my experience that most poorly controlled diabetics have trouble giving themselves insulin. Do you have this problem?

You are clearly having difficulty with insullin injections. Would you like to arrange for a family member to give you your shots?

You seem to have missed your shots. How often has this happened?

Any porpose???????
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Correct Answer answer

Quote:
Originally Posted by sashabeliimd View Post
Guys really help here

A 16 year old boy has a 6 month history of type 1 diabetes mellitus and requires daily insulin injections. His blood glucose control has been poor recently, which the physician suspects may be related to the patient;s reluctance to self - administer insulin. Which of the following quetions is most appropiate to broach this issue with the patient?

A Giving yourself insulin injection can be difficult. What's it like for you???

B I get the feeling you have not been taking your insulin regularly, Would you like me to arrange some training for you by our nursees?

C It's been my experience that most poorly controlled diabetics have trouble giving themselves insulin. Do you have this problem? wrong

D You are clearly having difficulty with insullin injections. Would you like to arrange for a family member to give you your shots?

E You seem to have missed your shots. How often has this happened?

Any porpose???????

Open ended quietion allows broad range for answer
Closed ended question limits answer, yes or no ,
Leading quetion, suggests or indicates preferred answer
Confrontation brings to the patient's attention some aspect of appearance or demeanor
Facilitation gets the patient to continue a thought talk more , e.g. tell me more about that

redirection puts quetion back to the patien
direct quetion seeeeeeks information drectly. avoid judgmental terms.
Done
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Correct Answer Voltage gated channesl

A 33 year old woman who is right-handed is brought to the physician because of a 3-day history of progressive weakness and numbness of her arms and legs. Neurologic examination shows proximal and distal weakness of the upper and lower extremities. There is areflexia. Sensation to vibration and joint position is decreased in the fingers and toes. Nerve conduction studies show a slow conduction velocity in the median, ulnar, peroneal, and tibial nerves. These electrophysiologic findings most likely indicate impaired function of which of the following ion channels?


a) neurotransmitter-gated Ca+2 channels
b) neurotransmitter-gated Na+ channels
c) neurotransmitter-gated K+ channels (WRONG )
d) Voltage-gated Ca+2 channels wrong too
e) Voltage-gated Na+ channels
f) Voltage-gated K+ channels

Amyotrophic lateral sclerosis (ALS) may not lend itself to a quick definitive diagnosis early in its presentation. Often, neurologists need many months to exclude all other possible diagnoses in a patient presenting with upper and lower motor neuron signs.

Nerve conduction studies and needle electromyography (EMG) are useful for confirming the diagnosis of ALS and for excluding peripheral conditions that resemble ALS.

Laboratory tests are performed primarily to rule out other disease processes; results generally are normal in ALS.

Biochemical markers in blood are used almost routinely to identify diseases that could mimic ALS. Examination of cerebrospinal fluid usually is not necessary unless the patient has a pure upper motor neuron (UMN) or pure lower motor neuron (LMN) presentation, in which case it can be helpful in excluding inflammatory conditions, neoplastic infiltrations, or infections.

Genetic testing
Genetic testing may be performed to identify genetic defects in some familial types of ALS, as well as other inherited motor neuron diseases. In the future, genetic testing may become more routine, given recent research showing that in some populations the C9orf72 mutation is present in a high proportion of patients with no family history of ALS.

The ethical considerations of genetic testing in patients with apparently sporadic disease have to be thought out carefully, as there are implications for family members and patients. Genetic counseling is recommended before testing is ordered.

Imaging
Imaging studies need to be tailored to the patient’s clinical presentation. Neuroimaging may include computed tomography (CT) scanning or magnetic resonance imaging (MRI) of the brain and spinal cord.

Muscle or nerve biopsy
Muscle biopsy is needed only rarely but may be considered if the presentation of ALS is atypical. The results will confirm the presence of signs of denervation and reinnervation or may lead to an alternative diagnosis.

The presence of small, angular fibers is consistent with neurogenic atrophy (denervation). Fiber-type grouping is consistent with reinnervation.

Amyotrophic lateral sclerosis from FA

Associated with both LMN and UMN signs. No sensory, cognitive or oculomotor deficits. Can be caused by defect in superoxide dismutase 1, Commonly presents as fasciculations and eventual atrophy. progressive and fatal.
Riluzole treatment modestly lenghtens survival be decreaseing presynaptic gllutamate release.
Demyelinatino of the corticospinal tract lateral...

Action potentials are most commonly initiated by excitatory postsynaptic potentials from a presynaptic neuron.[11] Typically, neurotransmitter molecules are released by the presynaptic neuron. These neurotransmitters then bind to receptors on the postsynaptic cell. This binding opens various types of ion channels. This opening has the further effect of changing the local permeability of the cell membrane and, thus, the membrane potential. If the binding increases the voltage (depolarizes the membrane), the synapse is excitatory. If, however, the binding decreases the voltage (hyperpolarizes the membrane), it is inhibitory.

Voltage gated channels, with NA sodium E corect
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  #71  
Old 10-13-2014
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Post Selenium

the prospected study was conducted to see the selinium ingestion with the gastric cancer.the investigator estimated the Relative Risk of 0.3 who were ingested the High Selenium diet (95% confident Interval 0.1-0.8)
which of the following is the most approriate interpretation

a. Selenium cause Gastric Ca
b. Seleniun does not cause gastric Ca.
c Selenium is higher risk of Gastric ca wrong
d. selenium is low risk of Gastic Ca
e. selenium is positively correlated with Gastric Ca wrong


If relative risk is less than 1, then risk of even is lower in study group than in control group. If it's higher than 1, then risk is higher in study group.
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  #72  
Old 10-13-2014
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Post Hi

http://utcomclass2015.wikispaces.com...3+OFFICIAL.pdf

aswers, but do not corespond to each number of quetion
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  #73  
Old 10-13-2014
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Correct Answer Found

Quote:
Originally Posted by sashabeliimd View Post
the prospected study was conducted to see the selinium ingestion with the gastric cancer.the investigator estimated the Relative Risk of 0.3 who were ingested the High Selenium diet (95% confident Interval 0.1-0.8)
which of the following is the most approriate interpretation

a. Selenium cause Gastric Ca
b. Seleniun does not cause gastric Ca.
c Selenium is higher risk of Gastric ca wrong
d. selenium is low risk of Gastic Ca
e. selenium is positively correlated with Gastric Ca wrong


If relative risk is less than 1, then risk of even is lower in study group than in control group. If it's higher than 1, then risk is higher in study group.

Relative risk
If RR is more then subtract 1.0 and read as percent increase, not statistically significant risk is the same, if more then 1.77 statistically significant , increased risk



If RR is less then 1.0 is read as reduction in risk.
statistical significant ( decreased risk)

Done
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  #74  
Old 10-13-2014
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Correct Answer Ribosomal proteins

An investigator studying the molecular events in the underlying causes of an autoimmune disease develops a collection of monoclonal antibodies to ribosomal proteins. One of the monoclonal antibodies is found to inhibit the ribosome peptidyl transferase. Which of the following is most likely affected in the presence of this antibody?


A) Assembly of 80S ribosomal subunits
B) Attachment of amino acids to tRNA wrong
C) Dissociation of the 80S ribosomes into 60S and 40S subunits
D) Establishment of covalent bonding between amino acids
E) Release of the mRNA from ribosomes

The Peptidyl transferase is an aminoacyltransferase (EC 2.3.2.12) as well as the primary enzymatic function of the ribosome, which forms peptide bonds between adjacent amino acids using tRNAs during the translation process of protein biosynthesis. It is not an enzymatic reaction; an enzymatic reaction implies that a protein is catalyzing the reaction, which here it is not


Yeeah form peptide bonds between adjacent amino acid,

A peptide bonds (amide bond) is a covalent chemical bond formed between two molecules when the carboxyl group of one molecule reacts with the amino group of the other molecule, causing the release of a molecule of water (H2O), hence the process is a dehydration synthesis reaction (also known as a condensation reaction), and usually occurs between amino acids. The resulting C(O)NH bond is called a peptide bond, and the resulting molecule is an amide.
Done
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  #75  
Old 10-13-2014
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Correct Answer LIsteria

A 38 yo woman at 32 weeks gestation is brought to the physician because of a two day history of fever, nausea, vomiting, and muscle aches. She appears acutely ill. Her temp is 102.2, pulse is 120/min, and respirations are 20/min. A photomicro of a gram stain of an organism recovered from a blood culture is show. Which of the floowing is the most likely causal organism?

a). Corynebacterium urealyticum (should I have heard of this before?)
b). Gardnerella vaginalis no
c). Listeria monocytogenes RIGHT
d). Rhodococcus equi (haven't heard of this one either)
e). Staph aureus wrong

Woman is pregnant

Gardnerella vaginalis is a pleomorphic gram variable rod that causes vaginosis presentig as a gray vaginal dishcarge with a fishy odor, than is not coresponding to actual symptoms

Remain Listeria
https://www.google.md/search?q=liste...ed=0CAYQ_AUoAQ

Staph look like tthat
https://www.google.md/search?q=liste...ococcus+aureus
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  #76  
Old 10-13-2014
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Thumbs Up Finished

OK guys i finished my review of wrong answers on NBME 13, make some analyses of these on right on forum, think to be helpful for others with theese explanation on each quetions , Good luck...
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  #77  
Old 12-12-2014
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Default

Quote:
Originally Posted by sashabeliimd View Post
A previously healthy 54 yo man comes to the clinic because of lightheadedness for 6 hours. His symptoms began after skiing at a resort at an altitude of 9000 ft. he has been taking a carbonic anhydrase inhibitor since 2 days before arriving at the resort. His BP is 110/60 which sitting and 95/50 while standing. PE shows no other abnormalities. Which of the following is the most likely cause of his orthostatic hypotension?
a). High-alt. sickness
b). Hypovolemia
c). Hypoxia (wrong)
d). Impaired sympathetic nerve activity (wrong)
e). Respiratory alkalosis

Acetazolamide toxicity: Hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
High altitude sickness symptoms

Lack of appetite, nausea, or vomiting
Fatigue or weakness
Dizziness or lightheadedness
Insomnia
Pins and needles
Shortness of breath upon exertion
Nosebleed
Persistent rapid pulse
Drowsiness
Excessive flatulation[8]
General malaise
Peripheral edema (swelling of hands, feet, and face)

Remain just answer with hypovolemia, like all diuretics decrease Na as water?????? please help here
yep its hypovolemia. orthostatic hypotenion is the concept they want to check here. i got this wrong too today
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  #78  
Old 12-12-2014
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Romania Hi

Quote:
Originally Posted by binav View Post
yep its hypovolemia. orthostatic hypotenion is the concept they want to check here. i got this wrong too today
Two porposes for NBME forms
Do not rush when solving

Do more nbme forms, if you havvent enough money then find offline through net
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  #79  
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Quote:
Originally Posted by sashabeliimd View Post
Two porposes for NBME forms
Do not rush when solving

Do more nbme forms, if you havvent enough money then find offline through net
yeh gave 15 and 13 rest iam gonna giv offline. u taken step1 if not wen is it?
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  #80  
Old 12-12-2014
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Romania Hi

Quote:
Originally Posted by binav View Post
yeh gave 15 and 13 rest iam gonna giv offline. u taken step1 if not wen is it?
Next week will have exam. In the last 50 meters from exam...

Forms are not so hard, but we interpreting those as some very difficult, and for this our brain make mistakes that we provoke...
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Quote:
Originally Posted by sashabeliimd View Post
Next week will have exam. In the last 50 meters from exam...

Forms are not so hard, but we interpreting those as some very difficult, and for this our brain make mistakes that we provoke...
oh yeah u are 100% right!!! man best of luck i got my step this 26th !!! but just got 228 in both 15 and 13. so thinking to shift!!
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  #82  
Old 04-05-2016
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The tracing of skeletal muscle response at different frequencies of electrical stimulation. The amount of Ca sequestered in SR is highest at which frequency? I can't post pic because I don't know if it is allowed.
a. 1 Hz
b. 3 Hz
c. 6 Hz
d. 9 Hz
e. 12 Hz

hi... what is the answer for this? isn't it option-e ??
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  #83  
Old 07-01-2016
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Quote:
Originally Posted by doctor_ind View Post
After soloving a lot of NBME questions,I feel we can answer them by eliminating options and giving an educated guess.
yes thats right
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  #84  
Old 07-15-2016
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Quote:
Originally Posted by Swethasri makam View Post
The tracing of skeletal muscle response at different frequencies of electrical stimulation. The amount of Ca sequestered in SR is highest at which frequency? I can't post pic because I don't know if it is allowed.
a. 1 Hz
b. 3 Hz
c. 6 Hz
d. 9 Hz
e. 12 Hz

hi... what is the answer for this? isn't it option-e ??
The answer is 1 Hz.

The lowest frequency would correspond to the highest sequestration of calcium in the sarcoplasmic reticulum, because high frequency stimulation will cause calcium to move out of the SR into the cytosol.
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  #85  
Old 09-15-2016
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Quote:
Originally Posted by ginseng plus View Post
An autopsy is done on a 46 year old woman who died of adenocarcinoma of the colon. Examinationnnn of the nech shows a 5 cm rounded mass next to the bifurcation of the carotid artery.... A section of the mass is shown i the micrograph. Immunohistochemistry of the section is positive for synaptophysin, chromogranin and neuron specific enolase. Electron microscopy shows numerous electrone dense, membrane bound meurosecretory granules. Examination of the adrenal glands shows no masses. aWHich of the following is the most likely diagnosis????

Metastatic colonic adenocarcinoma
Metastatic squamous cell carcinoma of the larynx
Papillary carcinoma of the thyroid gland is wrong answer
Paraganglioma
Parathyroid adenoma

this is multiple endocrine neoplasia like, colon adenocarcinoma, mass around bifurcation that look like a thyroid papillary carcinoma, and of course these synaptophysins, chromogranin , endocrine markers of tumor,
especialy on Suprarenal glands, but on Examinatino adrenal glands are clear


Lets review MEN neoplasia
MEN 2 is excluded because absent of pheochromocytomas
Synaptogranins >>>\
A positive immunostain for Synaptophysin indicates the presence of Medulloblastoma, a primitive neuroectoderm tumor, found in pediatric patients. It commonly seeds to the spinal cord, requiring radiation of these areas.

This gene has been implicated in X linked mental retardation

Using immunohistochemistry, synaptophysin can be demonstrated in a range of neural and neuroendocrine tissues, including cells of the adrenal medulla and pancreatic islets. As a specific marker for these tissues, it can be used to identify tumours arising from them, such as neuroblastoma, retinoblastoma, phaeochromocytoma, carcinoid, small-cell carcinoma, and medullary thyroid carcinoma, among others. Diagnostically, it is often used in combination with chromogranin A.

enolase

In recent medical experiments, enolase concentrations have been sampled in an attempt to diagnose certain conditions and their severity. For example, higher concentrations of enolase in cerebrospinal fluid more strongly correlated to low-grade astrocytoma than did other enzymes tested (aldolase, pyruvate kinase, creatine kinase, and lactate dehydrogenase).[16] The same study showed that the fastest rate of tumor growth occurred in patients with the highest levels of CSF enolase. Increased levels of enolase have also been identified in patients who have suffered a recent myocardial infarction or cerebrovascular accident. It has been inferred that levels of CSF neuron-specific enolase, serum NSE, and creatine kinase (type BB) are indicative in the prognostic assessment of cardiac arrest victims.[17] Other studies have focused on the prognostic value of NSE values in cerebrovascular accident victims.[18]

Autoantibodies to alpha-enolase are associated with the rare syndrome called Hashimoto's encephalopathy.

Metastatic colonic adenocarcinoma
https://www.google.md/search?q=Metas...w=1366&bih=643

Metastatic squamous cell carcinoma of the larynx
https://www.google.md/search?q=Metas...+of+the+larynx


Paraganglioma
https://www.google.md/search?q=Metas...=Paraganglioma

Parathyroid adenoma
https://www.google.md/search?q=Metas...hyroid+adenoma

Image on quietion looks like Pituittary adenoma,
and conclusion is MEN 1

Parathyroid tumors
Pituitary tumors
Pancreatic endocrine tumors like zollinger ellison syndrome, insulinomas, VIPomas, glucagonomas,

Done
The location of the tumor, the immunhistochemical profile, and the ultrastructural components are typical for tumors of neuroendocrine origin. These features are commonly seen for paraganglioma (choice D). I got Parathyroid tumors wrong
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