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  #1  
Old 11-05-2014
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Correct Answer My NBME 16 DISCUSION !!!!!!!!!!!!!!!!!!!!!!!!!!!!

I'll try as precedent form to analyse, and if do not find some answers please who took form 16 help...
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  #2  
Old 11-05-2014
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Link Pneumology

A male newborn delivered at 28 weeks gestation is tachypneic and hypoxemic. Which of the following altered structure changes in the type 2 pneumocytes is the most likely cause of this patient's condition?

Abundant rought endoplasmic reticulum wrong
Decreased numbers of lamellar bodies
Distinct junctional complexes with adjacent type 1 pneumocytes
NUmerous microvilli
Reticular fibers


I would like to say that , all this i do for myself primarily, but if someone find interesting , you are welcome...

Prior 35 weeks of gestaion, newborn have deficient surfactant secretion...
Acute respiratory distress syndrome

May be caused by trauma , sepsis , shock, gastric aspiration, uremia ,a acute pancreatitis, or amniotic fluid embolism. Diffuse alveolar damage, INcrease alveolar permeability capilary, protein rich leakage into alveoli. Resaults in formation of intra-alveolar hyaline menmbrane.
Initial damage due to release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade, and oxygen derived free radicals,...


Microvilli aren't present on terminal alveoli

I think it is Distinct junctional complexes with adjacent type 1 pneumocytes

If someone have corect answer post please....
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  #3  
Old 11-05-2014
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Correct Answer Headache

A 20 year old woman who works as a secretary comes to the physician because of an 8 year history of intermittent headaches. They begin with flashing lights in her right visual field. followed 20 minutes later by a unilateral throbbing headache accompanied by nausea and vomiting. they occur around the same time of her menses. Which of the following is the most likely diagnosis?


Cluster headache wronggg
Intracranial mass
MIgrane most posible
Tension-type headache

Quetions with headache mentioned in DIT as 5 star topic

Key words in here: intermittent headaches, unilateral lights looks like aura, throbbing, concomitent with menses.


Let's review Migrane headache.:
At least 5 attacks
Headache lasting 4-72 h
At least of the following: Location unilateral
Quality- throbbing, pulsating.
Moderate to severe intensity* inhibits or prohibits daily activity
Aggravated by routine physical activity
At least 1 of the following:

Nausea or vomiting
Photophobia or phnophobia

25% have AURA before headache starting...
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  #4  
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Fire Thread Statistics,

A 67 year old woman comes to the physician for a health maintanance examination. Her brother and mother have a history of colon cancer. The physician recommends colonoscopy, but the patient says that she would prefer only for her stool to be tested for blood. The physician explains that testing the stool for occult blood is not appropiate in this case. The physician is most likely concerned about with fo the following regarding this test?


Low sensitivity
Low specificity
Potential for a false positive result
Uncertain negative predictive value
Uncertain positive predictive value which is wrooooooooooooooooooong
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  #5  
Old 11-05-2014
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Syringe Help

Quote:
Originally Posted by sashabeliimd View Post
A 67 year old woman comes to the physician for a health maintanance examination. Her brother and mother have a history of colon cancer. The physician recommends colonoscopy, but the patient says that she would prefer only for her stool to be tested for blood. The physician explains that testing the stool for occult blood is not appropiate in this case. The physician is most likely concerned about with fo the following regarding this test?


Low sensitivity

Low specificity

Potential for a false positive result

Uncertain negative predictive value

Uncertain positive predictive value which is wrooooooooooooooooooong
Potential fo a false positive result???????

Because test may be positive also for another diseases

Causes of Blood in Stool
Blood in the stool means there is bleeding somewhere in your digestive tract. Sometimes the amount of blood is so small that it can only be detected by a fecal occult test (which checks for hidden blood in the stool). At other times it may visible on toilet tissue or in the toilet after a bowel movement as bright red blood. Bleeding that happens higher up in the digestive tract may make stool appear black and tarry.

Possible causes of blood in stool include:

Diverticular disease. Diverticula are small pouches that project from the colon wall. Usually diverticula don't cause problems, but sometimes they can bleed or become infected.


Anal fissure . A small cut or tear in the tissue lining the anus similar to the cracks that occur in chapped lips or a paper cut. Fissures are often caused by passing a large, hard stool and can be painful.

Colitis . Inflammation of the colon. Among the more common causes are infections or inflammatory bowel disease.

Angiodysplasia. A condition in which fragile, abnormal blood vessels lead to bleeding.

Peptic ulcers . An open sore in the lining of the stomach or duodenum, the upper end of the small intestine. Many peptic ulcers are caused by infection with a bacterium called Helicobacter pylori (H. pylori). Long-term use or high doses of anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen can also cause ulcers.

Polyps or cancer . Polyps are benign growths that can grow, bleed, and become cancerous. Colorectal cancer is the third most common cancer in the U.S. It often causes bleeding that is not noticeable with the naked eye.

Esophageal problems. Varicose veins of the esophagus or tears in the esophagus can lead to severe blood loss.
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  #6  
Old 11-05-2014
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Correct Answer Prostate

A 56 year old man with a palpable hard nodule on the prostate has an increased serum prostate specific antigen concentration. A fine needle biopsy specimen shows adenocarcinoma. The patient undergoes radical prostatectomy. Which of the following structures is at greatest risk for injury during removal of the prostate?

Dome of the bladder wrong
Obturator nerves
Pelvic parasympathetic nerves ?????
Penile urethra
Ureterovesical junction nooooo

Risks
Erection problems

Erection problems are one of the serious side effects of radical prostatectomy. The nerves that control a man's ability to have an erection lie next to the prostate gland. They often are damaged or removed during surgery. Sometimes these nerves can be spared during surgery to preserve erections.

About half of men are able to regain some of their ability to have erections.3 But this takes time. It can take as little as 3 months. But for most men, it will be 6 months to a year.4
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  #7  
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Liver Morphine

An 85 y.'o. woman is diagnosed with a fracture to the right femur and begins treatment with morphine by patient controlled analgesic pump. Three days later, her respirations are 6 per minut. Physical examination shows pinpoint pupils. Her serum creatinine concentration is 1.8mg d./L. Which of the following best explains this patients' clinical deterioration after the initiation of the morphine therapy?

Chronic dosing of morphine decreases its bioavailability

MOrphine bioavailability increases with chronic dosing wrooooooooooonggggg

MOrphine downregulates miu opioid receptors with chronic dosing

Morphine inhibits its own metabolism

Morphine is metabolized to actvie metabolites that accumulate
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  #8  
Old 11-05-2014
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Correct Answer Hi

Quote:
Originally Posted by sashabeliimd View Post
An 85 y.'o. woman is diagnosed with a fracture to the right femur and begins treatment with morphine by patient controlled analgesic pump. Three days later, her respirations are 6 per minut. Physical examination shows pinpoint pupils. Her serum creatinine concentration is 1.8mg d./L. Which of the following best explains this patients' clinical deterioration after the initiation of the morphine therapy?

Chronic dosing of morphine decreases its bioavailability

MOrphine bioavailability increases with chronic dosing wrooooooooooonggggg

MOrphine downregulates miu opioid receptors with chronic dosing

Morphine inhibits its own metabolism

Morphine is metabolized to actvie metabolites that accumulate THIS is corect result
Normal levels of creatinine in the blood are approximately 0.6 to 1.2 milligrams (mg) per deciliter (dL) in adult males and 0.5 to 1.1 milligrams per deciliter in adult females. (In the metric system, a milligram is a unit of weight equal to one-thousandth of a gram, and a deciliter is a unit of volume equal to one-tenth of a liter.)

Abstract

Patients with impaired renal function may experience severe and prolonged respiratory depression when treated with morphine. This has been attributed to accumulation of the drug during renal failure. Three patients are described who had classical signs of intoxication with morphine in the absence of measurable quantities of morphine in the plasma. The observed clinical effect is attributed to accumulation of the pharmacologically active metabolite morphine-6-glucuronide, which is usually renally excreted. It is concluded that morphine does not accumulate in patients with renal failure but that accumulation of metabolites does occur. The previously reported observations of morphine accumulation during renal failure probably result from the use of radioimmunoassays that cannot distinguish between morphine and morphine-6-glucuronide. Thus the apparent morphine concentration measured with these assays in fact reflects the total quantity of morphine and morphine-6-glucuronide present

Last edited by ginseng plus; 11-17-2014 at 06:52 AM.
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  #9  
Old 11-05-2014
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I disagree KIdney

During experimental study of oxygen consumption in the kideny, experimental animals are ventilated with a 100% nitrogen. Cells from which of the following areas of the kindey are most likely to show the first sign of anoxic injury?
MOst susceptible site of hypoxia

Bowman capsule
Distal convoluted tubule
Efferent arteriole
Glomerulus wronnnnnnnnnnnng
Proximal tubule
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  #10  
Old 11-05-2014
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Correct Answer Hi

Quote:
Originally Posted by sashabeliimd View Post
During experimental study of oxygen consumption in the kideny, experimental animals are ventilated with a 100% nitrogen. Cells from which of the following areas of the kindey are most likely to show the first sign of anoxic injury?
MOst susceptible site of hypoxia

Bowman capsule
Distal convoluted tubule
Efferent arteriole
Glomerulus wronnnnnnnnnnnng
Proximal tubule THIS corect
When i hear ischemia immediately comming thing about TUBULAR

Acute tubular necrosis can be caused by ischemic or nephrotic injury
Ischemic secondary to decreased renal blood flow hypotension, shock, sepsis, hemorrhage, CHF, Results in death of tubular cells that may slough into tubular lumen proximal tubule and thick ascending limb are highly susceptible to injury.

REsult that answer is Proximal tubule...
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Emergency Hypertension

A 48 yo. man is referred for evaluation of possible hypertension. ON the basis of ten measurements , the patient;s average diastolic blood pressure is 113 mm Hg, and the standard deviation is 8mm Hg. IF four rather than ten measurements of the mean blood pressure are made, Which of the following is the expected impact on the size of the 95% condifence interval about the mean blood pressure?

Change, but th direction cannot be predicted
Decrease in width
Increase in width
Remain the same wroooooooooooooooooooongggg
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Correct Answer Hi

Quote:
Originally Posted by sashabeliimd View Post
A 48 yo. man is referred for evaluation of possible hypertension. ON the basis of ten measurements , the patient;s average diastolic blood pressure is 113 mm Hg, and the standard deviation is 8mm Hg. IF four rather than ten measurements of the mean blood pressure are made, Which of the following is the expected impact on the size of the 95% condifence interval about the mean blood pressure?

Change, but th direction cannot be predicted
Decrease in width
Increase in width
Remain the same wroooooooooooooooooooongggg
Increase in width. The range is already pretty high but the more measurements you make the narrower it gets. The fewer measurements you take the wider the range becomes.

Think about you measure your patients blood pressure 10 times:
110,110,130,95,120,120,120,150,100,110... this give you a mean with a pretty wide range.

If you measure 1000 times... the mean will become something between 110-120, cause there will be less very high/very low values

If you measure 4 times:
the range increases cause the values that are out of range have a higher impact on the mean and the deviation

Always hard quetions on statistics, crazy quetions
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  #13  
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Correct Answer DRUGSq

A 38 year old woman undergoes laparascopic cholecystectomy with general anesthesia. After she awakens postoperatively, she is nauseated and vomits three times in a 20 minutes. Which of the following is the most appropiate treatment for the nausea and vomiting in this patient?

Diphenhydramine is an antihistaminic of first generation, as toxicity have sedation anti adrenergic alpha effects, and big one Antimuscarinic
Given often as premedication before anesthesia

[COLOR="rgb(255, 140, 0)"]Dronabinol[/COLOR] si typical Marijuana derivative

[COLOR="rgb(255, 140, 0)"]Loperamide[/COLOR]
Uses
This medication is used to treat sudden diarrhea (including traveler's diarrhea). It works by slowing down the movement of the gut. This decreases the number of bowel movements and makes the stool less watery. Loperamide is also used to reduce the amount of discharge in patients who have undergone an ileostomy. It is also used to treat on-going diarrhea in people with inflammatory bowel disease.

Loperamide treats only the symptoms, not the cause of the diarrhea (e.g., infection). Treatment of other symptoms and the cause of the diarrhea should be determined by your doctor.

Do not use in children younger than 6 years unless directed by your doctor. This medication should not be used in infants younger than 24 months.
If is a derivative of opiods piperidine, meperidine,
Treatment with opiods often give some effect like nausea , vomiting ithcing, seen when used in RACHIANESTHESIA AS combination...

Ondasetron
Is an antiemetic, that is used postoperatively and in patients undergoing cancer chemotherapy

Scopolamine wwwwwwronggggggggg

It episode looks like withdrawal syndrome but of which one?
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Correct Answer VItamins

A 16 year old girl with cystic fibrosi is brought to the physician because of a 3 week history of generalized weakness, numbness and tingling of her arms and legs, and difficulty walking,. She has not adhered to her medication regimen during the past 6 months. She appears alert and oriented. Her vital signs are within normal limits. Physical examination shows bilateral weakness and decreased deep tendon reflexes in the upper and lower extremities. She walks with an ataxic gait.
The most likely cause of these dindings is a deficiency of which of the folowing?

FOlic acid no
VIt a
Vit B6
Vit D wrong of course
Vit E
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  #15  
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Info Reply to this Q

Quote:
Originally Posted by sashabeliimd View Post
A 16 year old girl with cystic fibrosi is brought to the physician because of a 3 week history of generalized weakness, numbness and tingling of her arms and legs, and difficulty walking,. She has not adhered to her medication regimen during the past 6 months. She appears alert and oriented. Her vital signs are within normal limits. Physical examination shows bilateral weakness and decreased deep tendon reflexes in the upper and lower extremities. She walks with an ataxic gait.
The most likely cause of these dindings is a deficiency of which of the folowing?

FOlic acid no

VIt a just produce in deficiency blindness

Vit B6 peripheral neuropathy

Vit D wrong of course

Vit E
Produce increased fragility of erythocytes , muscle weakness, posterior column and spinocerebellar tract demyelination, is what we see on this patient.. Generaly vit E is a part of 3 antioxidants vitamins, that protect membranes from free radical damage..,
Also posterior column , as Combined degeneration of the posterior and lateral spinal columns seen in VITAMIN B 12 DEFICIENCY.. that
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  #16  
Old 11-07-2014
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Post Hi

Quote:
Originally Posted by sashabeliimd View Post
Increase in width. The range is already pretty high but the more measurements you make the narrower it gets. The fewer measurements you take the wider the range becomes.

Think about you measure your patients blood pressure 10 times:
110,110,130,95,120,120,120,150,100,110... this give you a mean with a pretty wide range.

If you measure 1000 times... the mean will become something between 110-120, cause there will be less very high/very low values

If you measure 4 times:
the range increases cause the values that are out of range have a higher impact on the mean and the deviation

Always hard quetions on statistics, crazy quetions

Recently watched videos by Doctors in training about this one, i mean Condifence Interval

it;s pretty simple if you spend a little time to understand formula that is used

CI= mean +/_ Z (SEM)

Mean in any cases is given in quetion
Z is a standard, for some standard deviations varies

1 standard deviation CI= 68%
2 standard deviation CI= 95% Z= 1.96 which is aproximately 2
3 standard deviation CI=99% Z= 2.56 which we can use as 2.5

FOr 90% CI Z= 1.67 which can use as 1.6

SEM STANDARD DEVIATION OF ERROR.

wHICH data we have?
Standard deviation 8
Mean 113
Confidence interval 95%
N of persons 1

CI=113+/- 20

Small sample size made confidence interval more broad, and contrary
big sample size narrow confidence interval...
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  #17  
Old 11-10-2014
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Heart GTP ase

A 35 y o man comes to the physician because of a 3 year history of an enlarging nose, coarsening of his facial features, musle weakness, and increased hand and foot size. Physical examination shows a large fleshy nose and prognathism. Serum studies shows an increased insulin-like growth factor 1 concentration. An MRI of the brain shows a pituitary adenoma. Morphologic analysis of a biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G alpha s, subunit of G proteins in the tumor lack GTPase activity. The tumor cells in this patient most likely have an increased activity of which of the following enzymes?

Adenylyl cyclase
Guanylyl cylcase
Janus kinase wrooooooooooong
Phospholipase C
Tyrosine kinase
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Old 11-10-2014
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Quote:
Originally Posted by sashabeliimd View Post
A 35 y o man comes to the physician because of a 3 year history of an enlarging nose, coarsening of his facial features, musle weakness, and increased hand and foot size. Physical examination shows a large fleshy nose and prognathism. Serum studies shows an increased insulin-like growth factor 1 concentration. An MRI of the brain shows a pituitary adenoma. Morphologic analysis of a biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G alpha s, subunit of G proteins in the tumor lack GTPase activity. The tumor cells in this patient most likely have an increased activity of which of the following enzymes?

Adenylyl cyclase
Guanylyl cylcase
Janus kinase wrooooooooooong
Phospholipase C
Tyrosine kinase
Adenylyl cyclase
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Old 11-10-2014
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Correct Answer hi

Quote:
Originally Posted by sashabeliimd View Post
A 35 y o man comes to the physician because of a 3 year history of an enlarging nose, coarsening of his facial features, musle weakness, and increased hand and foot size. Physical examination shows a large fleshy nose and prognathism. Serum studies shows an increased insulin-like growth factor 1 concentration. An MRI of the brain shows a pituitary adenoma. Morphologic analysis of a biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G alpha s, subunit of G proteins in the tumor lack GTPase activity. The tumor cells in this patient most likely have an increased activity of which of the following enzymes?

Adenylyl cyclase
Guanylyl cylcase
Janus kinase wrooooooooooong
Phospholipase C
Tyrosine kinase

It's very important tu understand in every NBME what they want from us to know

It's a classic features of gigantism, enlarged nose, hands, feet.
Occur in adult people, problem is with increased Growth hormone secretion,
I'am not discovering here nothing new, just try to analyze some quetions...

Insulin like peptide is increased, which work through tyrosine kinase receptor.
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  #20  
Old 11-10-2014
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Post Prader willi

A 5 year old boy with mental retardation is grossly obese and has features of prader willi syndrome. Karyotipind and fluorescent in situ hybridization studies do not show deletion in the usual site on chromosome 15. Which of the following findings is most likely to confirm PWS in this child?

DEletion in the short arm of chromosome 15
Duplication within chromosome 15
Large trinucleotide repeat expansion in the PWS area of chromosome 15
Maternal origin of both chromosome 15
Translocation in the short arm of chromosome 15
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  #21  
Old 11-10-2014
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Probability

Quote:
Originally Posted by sashabeliimd View Post
A 5 year old boy with mental retardation is grossly obese and has features of prader willi syndrome. Karyotipind and fluorescent in situ hybridization studies do not show deletion in the usual site on chromosome 15. Which of the following findings is most likely to confirm PWS in this child?

DEletion in the short arm of chromosome 15
Duplication within chromosome 15 no
Large trinucleotide repeat expansion in the PWS area of chromosome 15 no
Maternal origin of both chromosome 15, ?????? one paternal and one maternam must be????
Translocation in the short arm of chromosome 15 wrooooooooong
Prade willi syndrome
Mental retardation, hyperphagia, obesity, hypogonadism, hypotonia, and behavior like tantrum
Individual has normally inactivated maternal allele. Paternal allele should be active but is deleted.

We know diseases with trinucleotide expansion like Huntington, muscular dystrophy,Freidrich ataxia, x fragile syndrome.


DEletion in the short arm of chromosome 15??? Answer must be with deletion of Paternal chromosome 15, but may match response with just a partial deletion of chromosome too?
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  #22  
Old 11-10-2014
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Correct Answer Endocrinology

A 38 yo woman comes to the physician because of a 10 week history of epigasric pain and frequent stools. She has had two episodes of renal calculi during the past 2 years. Physical examination shows multiple superficial lipomata and mild epigastric tenderness. Upper endoscopy shows two large nonbleeding duodenal ulcers. Her gastric pH is 2.3 and serum gastrin concentration obtained immediately after the procedure is 2000pg'mL Norma less than 100. Proton pump inhibitor therapy is begun. Measurement of which of the following is the most appropiate next step in management?

Serum calcium concentration
Serum cortisol concentration
Serum tissue tranglutaminas activity
Stool alpha antitrypsin concentriation
Urine 5 hydroxyindolacetic acid concentration wronggggggg

Epigastric pain plus increased serum gastrin, and duodenal ulcers mimic Gastrinoma
Renal calculi give a sign of parathyroid gland hyperfuncion, which most common is a parathyroid adenoma, and in combination form a MEN 1 endocrine neplasia

Answer will be increased calcium
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Post Behavioral treatment :)

A 19 year old woman is brought to the physician be her mother because she has been increasingly withdrawn and isolated since graduating from high school 1 year ago. The mother reports that the patien stays in her bedroom much of the time and rarely sees friends. The patient says that she is not interested in her old friends or activities.
She has been anxious and depressed about what she has learned by listening to radio broadcasts that only she can hear. She has been spending most of her time thinking about a government scheme to control th physic pain feel. She does not dring alcohol or use ilicit drugs. She appears disheveld and is malodorous. Vital signs are within normal limits. Physical examinatino shows no abnormalities. On mental status examination, she is distracted. She has a sad mood and an anxious , sad, and blunted affect. She is oriented to person place and time. Which of the following is the most appropiate pharmacotherapy?


Buspirone wrong
Donepezil
LIthium carbonate
Risperidone
Trazodone


Please hepl to establish diagnosis for first, and wich drug can be use for this state treatment???
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Post Hi

A 9 year old boy is brought to the physician by his mother because of a 1 year history of cough productive of mucoid sputum, wheezing and shortness of breath with exertion. He has history of recurrent upper respiratory tract and sinus infections since birth. He is at the 25 percentile for height and weight. The mother says that his younger sibling is beginning to develop similar problems. Physical examination shows mild clubbing of the fingers. Laboratory studies show markedly increased sweat chloride and sodium concentration. A defect of which of the following is this patietns bronchial epithelium is most likely causing these symptoms?

Adrenoreceptors nooo
Membrane receptor
Nuclear receptor
Protein regulator wrongggg
Protein stucture

????
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  #25  
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Star Hi

Quote:
Originally Posted by sashabeliimd View Post
A 9 year old boy is brought to the physician by his mother because of a 1 year history of cough productive of mucoid sputum, wheezing and shortness of breath with exertion. He has history of recurrent upper respiratory tract and sinus infections since birth. He is at the 25 percentile for height and weight. The mother says that his younger sibling is beginning to develop similar problems. Physical examination shows mild clubbing of the fingers. Laboratory studies show markedly increased sweat chloride and sodium concentration. A defect of which of the following is this patietns bronchial epithelium is most likely causing these symptoms?

Adrenoreceptors nooo
Membrane receptor
Nuclear receptor noooo
Protein regulator wrongggg
Protein stucture

????

It's clear that diagnosis is a cystic fibrosis
BUt a pathogenesis of CF consist by an abnormal traficking of a transmembrane protein.
Mutation causes abnormal protein folding, resulting in degradation of channel before reaching cell surface.
Protein stucture May somebody verify if i deduce a corect answer???
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  #26  
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Fire Thread Neurology

A 65 year old woman comes to the physician because of a 3 month history of headache, weakness of her arms, and left flank pain, She also has had a 14 kg weght loss during this period. Physical examination shows weakness of the proximal upper and lower extremety muscles. there is augmentation of strengh with repetitive testing of the deltoid muscles. An MRI of the brain shows a single well demarcated mass surrounded by edema in the right frontal lobe. A stereotactic biopsy specimen of the lesion shows a malingnant small blue cell neoplasm thatt expresses cytokeratin chromogranin, and synaptophysin, Which of the following is the biopsy specimen is the most likely?



Anaplastic ependimoma wroooooooongggg

Extranodal primary central nervous system lymphoma

Glioblastoma multiforma

Primary cerebral neuroblastoma

Pulmonary small cell carcinoma metastatic to the brain
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  #27  
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Quote:
Originally Posted by sashabeliimd View Post
A 65 year old woman comes to the physician because of a 3 month history of headache, weakness of her arms, and left flank pain, She also has had a 14 kg weght loss during this period. Physical examination shows weakness of the proximal upper and lower extremety muscles. there is augmentation of strengh with repetitive testing of the deltoid muscles. An MRI of the brain shows a single well demarcated mass surrounded by edema in the right frontal lobe. A stereotactic biopsy specimen of the lesion shows a malingnant small blue cell neoplasm thatt expresses cytokeratin chromogranin, and synaptophysin, Which of the following is the biopsy specimen is the most likely?



Anaplastic ependimoma wroooooooongggg

Extranodal primary central nervous system lymphoma

Glioblastoma multiforma

Primary cerebral neuroblastoma

Pulmonary small cell carcinoma metastatic to the brain
Because tumor show no clasic presantation of brain tumors, but we see a blue small cell cancer metastasis
One of the often sides of metastasis from lung is BRAIN, adrenal gland,...

expresses cytokeratin chromogranin, and synaptophysin all these indicate neurosecretory type of tissue, small cell carcinoma may secrete as ACTH as ADH
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  #28  
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Post nbme

A 76 year old man with a one month history of a pulsatile abdominal mass is diagnosed with an abdominal aortic aneurysm. CT scans of the abdomen with contrast also showed an incidental finding of a horseshoe kidney, In this setting the surgical approach to repair of the aneurysm in this patient is most likely to be further complicated by the presence of which of the following?

Abnormal origin of the superior mesenteric artery
Abnormal origins of multiple renal arteries to each kidney
Friability of vascular tissue as a result of collagen synthesis abnormalities wrongggggg

Multiple wreters with abnormal courses
Tumors with malignant degeneration
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Quote:
Originally Posted by sashabeliimd View Post
A 76 year old man with a one month history of a pulsatile abdominal mass is diagnosed with an abdominal aortic aneurysm. CT scans of the abdomen with contrast also showed an incidental finding of a horseshoe kidney, In this setting the surgical approach to repair of the aneurysm in this patient is most likely to be further complicated by the presence of which of the following?

Abnormal origin of the superior mesenteric artery
Abnormal origins of multiple renal arteries to each kidney
Friability of vascular tissue as a result of collagen synthesis abnormalities wrongggggg

Multiple wreters with abnormal courses
Tumors with malignant degeneration
Short stature
Lymphedema (swelling) of the hands and feet
Broad chest (shield chest) and widely spaced nipples
Low hairline
Low-set ears
Reproductive sterility
Rudimentary ovaries gonadal streak (underdeveloped gonadal structures that later become fibrosed)
Amenorrhoea, or the absence of a menstrual period
Increased weight, obesity
Shield shaped thorax of heart
Shortened metacarpal IV
Small fingernails
Characteristic facial features
Webbed neck from cystic hygroma in infancy
Aortic valve stenosis
Coarctation of the aorta
Bicuspid aortic valve
Horseshoe kidney
Visual impairments sclera, cornea, glaucoma, etc.
Ear infections and hearing loss
High waist-to-hip ratio (the hips are not much bigger than the waist)
Attention Deficit/Hyperactivity Disorder or ADHD (problems with concentration, memory, attention with hyperactivity seen mostly in childhood and adolescence)
Nonverbal Learning Disability (problems with math, social skills and spatial relations)

Abnormal origins of multiple renal arteries to each kidney

Variant arterial supply - Bilateral renal arteries, Inferior mesenteric Artery, Arteries arising from aorta or common iliac, internal iliac, external iliac or inferior mesenteric arteries.
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Info NBME

A 4 month old boy is diagnosed with a rare autosomal recessive skeletal dysplasia involving abnormal endochondral bone formation. Genetic analysis shows null mutations on a gene for a protein that controls the traffic of vesicles into the Golgi complex. Electron microscopy of this patient;s cells will most likely show which of the following findings?

Decreased rough endoplasmic reticulum wrrrrrrrrrrrrrong
Decreased smooth endoplasmic reticulum
Dilated rough endoplasmic reticulum
Increased smooth endoplasmic reticulum
Large lysosomes
Small lysosomes
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Quote:
Originally Posted by sashabeliimd View Post
A 4 month old boy is diagnosed with a rare autosomal recessive skeletal dysplasia involving abnormal endochondral bone formation. Genetic analysis shows null mutations on a gene for a protein that controls the traffic of vesicles into the Golgi complex. Electron microscopy of this patient;s cells will most likely show which of the following findings?

Decreased rough endoplasmic reticulum wrrrrrrrrrrrrrong
Decreased smooth endoplasmic reticulum
Dilated rough endoplasmic reticulum
Increased smooth endoplasmic reticulum
Large lysosomes
Small lysosomes
I cell disease Inherited lysosomal storage disease, failure of addition of mannose 6 phosphate to lysosome proteins , enzymes are secreted outside te cell instead of being targeted to the lysosome

And i think that these substances are filled with proteins, and lysosomes will become more in size? Large lysosomes
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Mail nbme

Behavioral

A study is designed to evaluate the relationship between ambient noise and hearing loss in an automobile manufacturing plant. Different locations in the manufacturing plant have strikingly different levels of ambient noise. Each employee is given a test for hearing acuity, and then the ambient noise level is measured at his or her workstation. Which of the following best describes this study design?

Case series
Cohort
Crossover
Cross-sectional
Randomized clinical trial wrrrrrrrrrrrrong
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Quote:
Originally Posted by sashabeliimd View Post
Behavioral

A study is designed to evaluate the relationship between ambient noise and hearing loss in an automobile manufacturing plant. Different locations in the manufacturing plant have strikingly different levels of ambient noise. Each employee is given a test for hearing acuity, and then the ambient noise level is measured at his or her workstation. Which of the following best describes this study design?

Case series
Cohort
Crossover noooo
Cross-sectional noooo
Randomized clinical trial wrrrrrrrrrrrrong
Cohort study Compares a group with a given exposure or risk factor to a group without, Can be prospective or retrospective.
Looks to see if exposure increase the likelihood of disease...
Done
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Post Hi

Immunology

A 54 yo woman who works as a nurse comes to the physician for routine tuberculosis screening. A sample of her whole blood is incubated within a mixture of the synthetic peptides representing two proteins of the suspected pathogen. Three days later. supernatant is collected for evaluation. Measurement of which of the following cytokine concentration is most likely to indicate a positive result?

Granulocyte macrophage colony stimulating factor
Interferon alpha
Interferon gamma
Interleuking 4
interleukin 10
Transforming growth factorr betta
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  #35  
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Correct Answer Hi

Quote:
Originally Posted by sashabeliimd View Post
Immunology

A 54 yo woman who works as a nurse comes to the physician for routine tuberculosis screening. A sample of her whole blood is incubated within a mixture of the synthetic peptides representing two proteins of the suspected pathogen. Three days later. supernatant is collected for evaluation. Measurement of which of the following cytokine concentration is most likely to indicate a positive result?

Granulocyte macrophage colony stimulating factor
Interferon alpha
Interferon gamma
Interleuking 4
interleukin 10
Transforming growth factorr betta
What i found interesting about this blood test of TB, because is different from that injected subcutaneously...

http://www.cdc.gov/tb/publications/f...sting/igra.htm
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  #36  
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Post Hi

A 45 year old man has fever chills dysuria and tender, enlarged prostate. Which of the following is the most likely causal organism?

Adenovirus
Chlamydia tracomatis wrooooooooooong
Escherichia coli
Pseudomonas aeruginosa
Ureaplasma urealyticum
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Quote:
Originally Posted by sashabeliimd View Post
A 45 year old man has fever chills dysuria and tender, enlarged prostate. Which of the following is the most likely causal organism?

Adenovirus most common in children???
Chlamydia tracomatis wrooooooooooong
Escherichia coli
Pseudomonas aeruginosa
Ureaplasma urealyticum

What are the complications of benign prostatic hyperplasia?
The complications of benign prostatic hyperplasia may include
acute urinary retention
chronic, or long lasting, urinary retention
blood in the urine
urinary tract infections (UTIs)
bladder damage
kidney damage
bladder stones
Urinary tract infection

E.coli most common
Staph aureus
Klebsiella pneumoniae
Serratia marcescens
Enterobacter
Proteus
Pseudomonas
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Behavioral

A 62 year old man comes to the physician for a follow up examination. Two weeeeeeeeeks ago , he was discharged from the hospital after sustaining an acute myocardial infarction. He smokes 2 packs of cigarettes and drinks four 12 beers daily. His diet mostly consists of cured meats and fast food. He does not exercise. the patient tells the physician,,,, I know that i need to make some changes in how i live so that my heart can be healthier,
I just dont have the willpower to quit smoking and drinking and all that stuff ritght now.
Which of the following best describes this patients stage of behavioral change????


Precontemplation wrrrrrrrrrrrrrrong
Contemplation
preparation
Action
maintanance
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Quote:
Originally Posted by sashabeliimd View Post
Behavioral

A 62 year old man comes to the physician for a follow up examination. Two weeeeeeeeeks ago , he was discharged from the hospital after sustaining an acute myocardial infarction. He smokes 2 packs of cigarettes and drinks four 12 beers daily. His diet mostly consists of cured meats and fast food. He does not exercise. the patient tells the physician,,,, I know that i need to make some changes in how i live so that my heart can be healthier,
I just dont have the willpower to quit smoking and drinking and all that stuff ritght now.
Which of the following best describes this patients stage of behavioral change????


Precontemplation wrrrrrrrrrrrrrrong
Contemplation
preparation
Action
maintanance
Hey guys i can tell for everyone that Doctors in training is a gold for USMLE step 1, because thay accentuate more useful an Yield information, and help you memorise all during this long process of hours watching actively they video...

Stages of behavioral changes


Precontemplation ( dont think you have a problem)
Contemplation ( do think you have a problem) here you realize that problem exist
Preparation
Action
Maintanance
RElapse

Contemplation
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Post Hi

A 24 year old african american man coooooooooooomes to the physician because of a 3 month history of red bumps on his face and chin. he says that the bumps are iithcy and painful. Physical examination shows hyperpigmentated papules over the cheeks, jawline, and neck. Which of the following is the most likely diagnosis?

Acne vulgaris wroooooooooooooooooooong
Cutaneous lupus erythematosus no
Keloids nooooooo
Pseudofoliculitis barbae
Rosacea
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Quote:
Originally Posted by sashabeliimd View Post
A 24 year old african american man coooooooooooomes to the physician because of a 3 month history of red bumps on his face and chin. he says that the bumps are iithcy and painful. Physical examination shows hyperpigmentated papules over the cheeks, jawline, and neck. Which of the following is the most likely diagnosis?

Acne vulgaris wroooooooooooooooooooong
Cutaneous lupus erythematosus no
Keloids nooooooo
Pseudofoliculitis barbae
Rosacea
ONe mentioned sign is red bumps , and they location on his face specialy jawline, neck, and CHIN !!!!!!!


https://www.google.md/search?q=red+b...ulitis+barbae+
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A 5 year old boy is brought to the emergency department because of a 16 hour history of severe vomiting and increased sleepiness. His mother says that he had a flulike illness 5 days ago that she treated with aspirin. Shortly after admission, he becomes delirious and then comatose.... His prothrombin time is prolonged. Serum studies show increased ammonia and lactate concentration and increased transaminase activities. Which of the following is the most likely cause of this patients coma?

Cerebral edema
Metabolic alkalosis
Subarachnoid hemorrhage wronggggggggg
venous sinus thrombosis
viral encephallitis
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Quote:
Originally Posted by sashabeliimd View Post
A 5 year old boy is brought to the emergency department because of a 16 hour history of severe vomiting and increased sleepiness. His mother says that he had a flulike illness 5 days ago that she treated with aspirin. Shortly after admission, he becomes delirious and then comatose.... His prothrombin time is prolonged. Serum studies show increased ammonia and lactate concentration and increased transaminase activities. Which of the following is the most likely cause of this patients coma?

Cerebral edema
Metabolic alkalosis noooo
Subarachnoid hemorrhage wronggggggggg
venous sinus thrombosis
viral encephallitis
This boy have hepatitis after adminisration of ASPIRIN

Summary
Viral encephalitis is inflammation of the brain caused by a virus. The major risk from viral meningitis is permanent brain damage. Children aged one year or less and adults aged 55 years and over are more vulnerable to life threatening complications. Viruses that can cause encephalitis include enteroviruses such as poliovirus and echovirus, herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, adenovirus, rubella, measles, Murray Valley encephalitis (MVE) virus, Kunjin virus and Japanese encephalitis virus.

Symptoms

The symptoms of viral encephalitis include:
High temperature
Headache
Sensitivity to light (photophobia)
General malaise
Stiff neck
Stiff back
Vomiting
Changes to personality
Confusion
Memory loss (amnesia)
Seizures
Paralysis
Coma.
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A 24 year old woman comes to the physician for a follow up examination .SHe has an 8 year history of seizure disorder that is refractory to medication. Physical examination shows flesh colored papules in the nasolabial folds accompanied by hypopigmented ash leaf macules. An MRI of the brain shows subependymal nodules. Which of the following is the most likely cause of theese e findings?

Ehlers danlos syndrome
Fabry disease
Neurofibromatosis wroooooooooooooooooooong
Pseudoxanthoma elasticum
Tuberous sclerosis...
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  #45  
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Quote:
Originally Posted by sashabeliimd View Post
A 24 year old woman comes to the physician for a follow up examination .SHe has an 8 year history of seizure disorder that is refractory to medication. Physical examination shows flesh colored papules in the nasolabial folds accompanied by hypopigmented ash leaf macules. An MRI of the brain shows subependymal nodules. Which of the following is the most likely cause of theese e findings?

Ehlers danlos syndrome nooooooooo
Fabry disease noooooo
Neurofibromatosis wroooooooooooooooooooong
Pseudoxanthoma elasticum noooooooooo
Tuberous sclerosis...
Fabry disease
alpha galactosidase A deficiency, and accumulation of ceramide trihexoside
peripheral neuropathy of hands feet, angiokeratomas, cardiovascular and renal disease, hypohydrosis, acroparesthesia, angiokeratomas...
https://www.google.md/search?q=red+b...angiokeratomas

https://www.google.md/search?q=red+b...mas+nasolabial


Pseudoxanthoma elasticum

https://www.google.md/search?q=red+b...homa+elasticum


TUberous sclerosis:
HAMARTOMAS Hamartomas in CNS and skin
Adenoma sebaceum, cutaneous angiofibromas
Mitral valve regurgitation
ash leaf spots

https://www.google.md/search?q=red+b...sh+leaf+spots+

cardiac rabdomyoma
TUBEROUS sclEROSIS
autosomal dominant
mental retardation
renal angiomyolipoma
seizures,
shagren patches
increased incidence of subependymal astrocytomas,
ungual fibromas
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  #46  
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An increase in the amount of iron inside cultured hepatocytes leads to an increase in the amount of ferritin gene products detected by Western blotting. It does not change the amount of ferritin gene products detected by northern blotting or by the polymerase chain reaction. These results suggest that iron inceases the frequency of which of the following events?

Maturation of the ferritin gene transcript
Transcription of the ferritin gene wrong
Translation of ferritin mRNA
transport of ferritin mRNA out of the nucleus
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  #47  
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Fire Thread

Quote:
Originally Posted by sashabeliimd View Post
An increase in the amount of iron inside cultured hepatocytes leads to an increase in the amount of ferritin gene products detected by Western blotting. It does not change the amount of ferritin gene products detected by northern blotting or by the polymerase chain reaction. These results suggest that iron inceases the frequency of which of the following events?

Maturation of the ferritin gene transcript
Transcription of the ferritin gene wrong
Translation of ferritin mRNA
transport of ferritin mRNA out of the nucleus
Because all genes are synthesized in the nucleus ,fits last answer, with
transport of ferritin mRNA out of the nucleus

Please help someone to confirm this one....
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a Previously healthy........................................... .................................................. ......... A lumbar puncture is performed and the results of polymerase chain reaction testing of cerebrospinal fluid show herpes simplec virus. It is most appropiate to administer a drug that inhibits which of the following viral enzymer?


Dna polymerase
Neuraminidase
Protease
Reverse transcriptase
RNase A
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  #49  
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Quote:
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a Previously healthy........................................... .................................................. ......... A lumbar puncture is performed and the results of polymerase chain reaction testing of cerebrospinal fluid show herpes simplec virus. It is most appropiate to administer a drug that inhibits which of the following viral enzymer?


Dna polymerase
Neuraminidase
Protease
Reverse transcriptase
RNase A
Drug administered most common is Acylcovir

Mechanism of action: Monophosporylated by HSV or HZV thymidine kinase. GUanosine analog. Triphosphate formed by cellular enzymes. Preferentially inhibits viral DNA polymerase by chain termination,,,,,
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A previously healthy 67 year old woman comes to the physician because of a 3 day history of fever, shortness of breath, nonproductive cough, headache, and muscle pain. Her temperature is 38.8 The lungs are clear to auscultation. Examination shows no other abnormalities. Which of the following vaccines is most likely to have prevented these findings?

Diphteria tetanus acellular pertusis
Haemophilus influenzae type b
Hepatitis b
INactivated poliovirus
Influenza virus
Measles mumps rubella
typhoid
23 valent pneumococcal Wrong, but didt atentive about clear lung on ausculatino

varicella
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  #51  
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Correct Answer

Quote:
Originally Posted by sashabeliimd View Post
A previously healthy 67 year old woman comes to the physician because of a 3 day history of fever, shortness of breath, nonproductive cough, headache, and muscle pain. Her temperature is 38.8 The lungs are clear to auscultation. Examination shows no other abnormalities. Which of the following vaccines is most likely to have prevented these findings?

Diphteria tetanus acellular pertusis
Haemophilus influenzae type b
Hepatitis b
INactivated poliovirus
Influenza virus *****************
Measles mumps rubella
typhoid
23 valent pneumococcal Wrong, but didt atentive about clear lung on ausculatino

varicella
Senior Schedule
seniorsYou may need one or more vaccines, even if you received vaccines as a child or as a younger adult. Ask your doctor which ones are right for you. Vaccines recommended for older adults can prevent:

Influenza (Flu)
Shingles (Herpes Zoster)
Diphtheria/Tetanus
Pertussis (Whooping Cough)
Pneumococcal (Pneumonia)
Want to learn more about the vaccines you need? Use the Adult Immunization Scheduler tool to receive personalized vaccine recommendations based on your age, occupation, health status and other factors.

See the Adult Immunization Schedule to see which vaccines you may need, and talk to your provider about getting vaccinated. Donít forget if you are traveling, you may need additional vaccines. See the travelersí health page.


Influenza Virus Vaccine Safety & Availability
Influenza, also known as the flu, is a contagious respiratory disease that is caused by influenza viruses. Influenza viruses infect the respiratory tract (nose, throat, and lungs) in humans. The flu is different from a cold, mainly because the symptoms and complications are more severe. Influenza usually comes on suddenly and may include these symptoms: fever, headache, malaise (a feeling of being ill and without energy that can be extreme), cough, sore throat, nasal congestion and body aches.

A lot of the illness and death caused by the influenza virus can be prevented by a yearly influenza vaccine. Most individuals 6 months of age and older should get the influenza vaccine every year. It is especially important for people in high-risk groups and people who are in close contact with those at high risk to get an influenza vaccine every year as recommended by CDCís Advisory Committee on Immunization Practices (ACIP).

Influenza vaccine can be given to most individuals 6 months of age and older to protect against influenza. Persons who provide important community services (such as police, fire department personnel, emergency medical services) should consider getting an influenza vaccine so that those services are not disrupted during an influenza outbreak.
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Default answer

Quote:
Originally Posted by sashabeliimd View Post
A 16 year old girl with cystic fibrosi is brought to the physician because of a 3 week history of generalized weakness, numbness and tingling of her arms and legs, and difficulty walking,. She has not adhered to her medication regimen during the past 6 months. She appears alert and oriented. Her vital signs are within normal limits. Physical examination shows bilateral weakness and decreased deep tendon reflexes in the upper and lower extremities. She walks with an ataxic gait.
The most likely cause of these dindings is a deficiency of which of the folowing?

FOlic acid no
VIt a
Vit B6
Vit D wrong of course
Vit E
Remember vit E def causes something very similiar to vit B12 def (Subacute combined degeneration) pg. 467 FA2014
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  #53  
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Info

Quote:
Originally Posted by Coccidioda View Post
Remember vit E def causes something very similiar to vit B12 def (Subacute combined degeneration) pg. 467 FA2014
I found answer to these quetions, anyway thanks for reply, if you want to help try to aswer that where i'm not sure or isnt some answer....
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A 42 year old woman is brought to the emergency department 30 minutes after the sudden onset of severe headache. She has no history of major medical illness and takes no medication. ON arrival her blood pressure is 160/90 mm Hg. The right pupil is 6mm and nonreactive to light. Adduction of the right eye is impaired. Nuchal rigidity is noted. A CCCT scan of the head shows blood in the subarachnoid space. Cerebelar agiography is most likely to show an aneurysm in which of the following arteries?

ANterior cerebral wrooooooooong, realy i dont know why choise this one, maybe without to be attentive to word cerebral angiography

Internal carotid
Middle cerebral no
posterior communicating
vertebral
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Correct Answer Hi

Quote:
Originally Posted by sashabeliimd View Post
A 42 year old woman is brought to the emergency department 30 minutes after the sudden onset of severe headache. She has no history of major medical illness and takes no medication. ON arrival her blood pressure is 160/90 mm Hg. The right pupil is 6mm and nonreactive to light. Adduction of the right eye is impaired. Nuchal rigidity is noted. A CCCT scan of the head shows blood in the subarachnoid space. Cerebelar agiography is most likely to show an aneurysm in which of the following arteries?

ANterior cerebral wrooooooooong, realy i dont know why choise this one, maybe without to be attentive to word cerebral angiography

Internal carotid nooooooooooooo

Middle cerebral no

posterior communicating *************************

vertebral
Most common aneyrisms Berry which occur at the bifurcation in the circle of Willis, but here we see in quetion posterior part of circle of Willis.

Posterior communicating arteries, common site of sacular berry aneurysms, inpingement on cranial nerves. symptoms will include cranial nerve 3 palsy ocullomotor, eye is down and out. Result in ptosiss and dilated pupil
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Post NBME

A 25 year old man is brought to the emergency department because of severe abdominal pain, nausea, and vomiting for 1 hour. The pain originates in the left flank and radiates to his groin. His pulse is 100 per minut , respirations are 18 per minute, and BP is 150/mm Hg. Physical examination shows tenderness of the left flank and the left lower quadrant of the abdomen. Bowel sounds are mildly hypoactive. Test of the stool for occult blood is negative. Which of the following best explains these findings?

Colon neoplasm

Diverticulitis wrrrrrrrrrrrrong

Epididymitis

Renal infarction

Torsion of the testis

Ureteral calculus.
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Default Hi

Quote:
Originally Posted by sashabeliimd View Post
A 25 year old man is brought to the emergency department because of severe abdominal pain, nausea, and vomiting for 1 hour. The pain originates in the left flank and radiates to his groin. His pulse is 100 per minut , respirations are 18 per minute, and BP is 150/mm Hg. Physical examination shows tenderness of the left flank and the left lower quadrant of the abdomen. Bowel sounds are mildly hypoactive. Test of the stool for occult blood is negative. Which of the following best explains these findings?

Colon neoplasm nooooooooooo

Diverticulitis wrrrrrrrrrrrrong

Epididymitis nooooooooo

Renal infarction

Torsion of the testis

Ureteral calculus .
MOst often left side pain is in address to Diverticulum or from renal system, as calculi, logdet or in callices, or right in the ureter
For this reason thinks that coreect will be ureteral calculus

Symptoms of Renal infarction

The list of signs and symptoms mentioned in various sources for Renal infarction includes the 10 symptoms listed below:


Asymptomatic in minor cases
Severe upper abdominal pain
Flank pain
Fever
Nausea
Vomiting
Anorexia
Flank tenderness
Costovertebral tenderness
Abdominal pain


Symptoms of Kidney and Ureteral Stones
People often associate kidney and ureteral stones with pain. However, symptoms can vary from severe pain to no pain at all, depending on stone characteristics Ė such as the size, shape, and location of the stone in the urinary tract (Fig. 1).
Fig. 1: The urinary tract.
Fig. 1: The urinary tract.
Severe pain (renal colic)
If the stone blocks the normal urine flow through the ureter you will experience severe pain, known as renal colic. This is a sharp pain in the loin and the flank (the side of your body, from the ribs to the hip). If the stone is not in your kidney but in your ureter, you may feel pain in the groin or thigh. Men can also have pain in their testicles (Fig. 2).

Renal colic is caused by a sudden increase of pressure in the urinary tract and the ureteral wall. The pain comes in waves and does not decrease if you change positions. It is described as one of the most painful experiences, similar to giving birth.
Other symptoms that may accompany renal colic are:
Nausea
Vomiting
Blood in the urine (urine appears pink)
Painful urination
Fever
Renal colic is an emergency situation and you should contact your family doctor or nearest hospital to relieve the pain. In case of high fever you must seek medical help immediately.
Fig. 2: Area of possible renal colic pain.
Fig. 2: Area of possible renal colic pain.
Dull pain or no symptoms at all
Stones can also cause a recurrent, dull pain in the flank. This kind of pain may be a symptom of other diseases as well, so you will need to take medical tests to find out if you have kidney or ureteral stones.
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  #58  
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Post Hi

A female newborn is delivered at term to a 35 year old primigravid woman . Pregnancy was complicated by untreated maternal Graves disease. Her respirations are 66 per minut. Physical examination shows stridor, nasal flaring, intercostal retractions, and an asymmetric neck mass. Which of the following si the most likely cause of the newborn.s stridor?

Cystic hygroma

Enlarged thyroid gland wrrrrrrrrrrrrrrong

Thyroglossal duct cyst

Tracheomalacia

Vascular ring
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  #59  
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Correct Answer NBME

Quote:
Originally Posted by sashabeliimd View Post
A female newborn is delivered at term to a 35 year old primigravid woman . Pregnancy was complicated by untreated maternal Graves disease. Her respirations are 66 per minut. Physical examination shows stridor, nasal flaring, intercostal retractions, and an asymmetric neck mass. Which of the following si the most likely cause of the newborn.s stridor?

Cystic hygroma nooooo

Enlarged thyroid gland ********************************************

Thyroglossal duct cyst wrrrrrrrrrrrrrrong

Tracheomalacia may be, but History of Untreated Mother Grave's

Vascular ring no
Tracheomalacia from compressing goiter: management after thyroidectomy.
Geelhoed GW.
Author information
Abstract
Tracheomalacia may result from prolonged compression by expanding goiter, particularly within the confines of the thoracic inlet. Constriction of the upper airway by the growing goiter may be indication for operation, but the residual problem of tracheomalacia after thyroidectomy is a life-threatening postoperative complication. Examples of postoperative tracheomalacia in patients with neglected goiters endemic in the third world or recurrent goiter with airway compromise in a western medical center referral practice are described for development of management methods. Two patients with lethal postthyroidectomy tracheomalacia led me to anticipate this complication in certain identifiable high-risk patients in my own practice, and the cases of five patients are described for whom several techniques of tracheal support were attempted. One patient, for whom staged tracheoplasty was planned, opted for tracheostomy, whereas four patients have had adequate tracheal airways restored by extrinsic support. One was treated by subtotal thyroidectomy with tracheal suspension; one by staged thyroid reductions; two were treated by creation of extrinsic tracheal neo-rings constructed of surgical wire and vascular prostheses. The patient with the most dramatic airway impairment from the most extensive tracheomalacia experienced very satisfactory airway security. A second patient was also supported by the prosthetic rings but extruded one of them, possibly because of tracheostomy contamination. Until tracheal replacement or better tolerated prosthetic or biologic supports are devised, tracheomalacia will remain a vexing problem complicating thyroidectomy for long-standing or recurrent airway-compressing goiter.

Presentation
History
Infants present after a few weeks of life with expiratory stridor (also called laryngeal crow).
Expiratory stridor may worsen with supine position, crying, and respiratory infections.
Feeding difficulties are reported sometimes.
Hoarseness, aphonia, and breathing also may be reported.
Obtain history of an acquired etiology such as prolonged intubation, tracheostomy, chest trauma, recurrent tracheobronchitis, cartilage disorder (relapsing polychondritis), and lung resection.
Physical
Inspiratory retractions of supraclavicular and intercostal spaces may occur.
Thoracic deformity may be present in cases of chronic tracheomalacia, especially in younger patients.
Auscultation reveals normal inspiration but abnormal expiratory noises.
Not uncommonly, infants may demonstrate signs of growth failure.
Differential Diagnosis
The differential diagnosis of tracheomalacia includes laryngomalacia, subglottic stenosis, congenital cysts, vocal cord paralysis, and hypocalcemic tetany. Complications include problems with acute airway obstruction and perioperative morbidity and mortality.

According to a recent study by Boogaard in 2005, when pediatric pulmonologists diagnosed airway malacia (based on symptoms, history, and lung function) prior to bronchoscopy, a correct diagnosis was made in 74% of the cases. However, in 52% of the diagnoses of airway malacia, the diagnosis was not suspected prior to bronchoscopy. The children with tracheomalacia present with atypical and variable clinical features; considerable overlap occurs with features of allergic asthma

[COLOR="rgb(255, 140, 0)"]HYPOTHYROIDISM IN THE NEWBORN[/COLOR]
The most common cause of hypothyroidism in the newborn is complete absence or underdevelopment of the thyroid gland. Less commonly, the thyroid gland is present but does not produce normal amounts of thyroid hormones.

Initially, the newborn may have no symptoms. Later, the newborn may become sluggish (lethargic) and have a poor appetite, low muscle tone, constipation, a hoarse cry, and a bulging of the abdominal contents at the bellybutton (an umbilical hernia). Untreated infants will have delayed development, intellectual disability, and short stature. Eventually, the infant may develop coarse facial features and an enlarged tongue.

Because early treatment can prevent intellectual disability, all newborns receive a screening blood test in the hospital after birth to evaluate thyroid function. In affected newborns, the blood test shows an elevated level of thyroid-stimulating hormone and usually a lower level of thyroid hormone. Many newborns with hypothyroidism require thyroid hormone given by mouth for their entire life. Treatment is directed by a doctor who specializes in treating children with problems of the endocrine system (a pediatric endocrinologist).

HYPERTHYROIDISM IN THE NEWBORN
Rarely, a newborn may have hyperthyroidism, or neonatal Graves' disease. This condition usually occurs if the mother has Graves' disease during pregnancy or has been treated for it before pregnancy. In Graves' disease (see see Autoimmune Disorders During Pregnancy), the mother's body produces antibodies that stimulate the thyroid gland to produce increased amounts of thyroid hormone. These antibodies cross the placenta and similarly affect the fetus.

An affected newborn has a high metabolic rate, with rapid heart rate and breathing, irritability, and excessive appetite with poor weight gain. The newborn, like the mother, may have bulging eyes (exophthalmos). If the newborn has an enlarged thyroid gland (goiter), the gland may press against the windpipe and interfere with breathing at birth. A very rapid heart rate can lead to heart failure. Graves' disease is potentially fatal if not recognized and treated by a pediatric endocrinologist.

Doctors suspect hyperthyroidism based on the typical symptoms and confirm the diagnosis by detecting elevated levels of thyroid hormone and thyroid-stimulating antibodies from the mother in the newborn's blood. The results of a screening test of thyroid function done in all newborns may reveal hyperthyroidism.

Newborns with hyperthyroidism are treated with drugs, such as propylthiouracil, that slow the production of thyroid hormone by the thyroid gland. This treatment is needed only for a few months because the antibodies that cross the placenta from the mother eventually disappear from the infant's bloodstream.
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Emergency nbme

A 23 year old man comes to the physician because of difficulty maintaining an erection. He was involved in an automobile colission that damaged his thoracic spinal cord. Affecting motor and sensory function of the lower trunk and extremities. He is only able to obtain an erection through physical contact with his penis by his wife, and the erections does not last a long time. The best explanation for this type of erection is an intact spinal reflex arc between the sacral parasympathetic nerves and which of the following?

Genitofemural nerves

Ilioninguinal nerves

Lumbosacral trunks wrrrrrrrrrrrrroooooooooooong

Obturator nerves

Pudental nerves
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  #61  
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Cool NMBE

Quote:
Originally Posted by sashabeliimd View Post
A 23 year old man comes to the physician because of difficulty maintaining an erection. He was involved in an automobile colission that damaged his thoracic spinal cord. Affecting motor and sensory function of the lower trunk and extremities. He is only able to obtain an erection through physical contact with his penis by his wife, and the erections does not last a long time. The best explanation for this type of erection is an intact spinal reflex arc between the sacral parasympathetic nerves and which of the following?

Genitofemural nerves noooooooooooooooo

Ilioninguinal nerves noooooo

Lumbosacral trunks wrrrrrrrrrrrrroooooooooooong

Obturator nerves

Pudental nerves


Genitofemural nerves
Anatomy[edit]
The genitofemoral nerve originates from the upper L1-2 segments of the lumbar plexus. It passes downwards and emerges from the anterior surface of the psoas major muscle. The nerve continues downwards and divides into two branches, the genital branch and the femoral branch. [1] :340,343

The genital branch passes through the deep inguinal ring and enters the inguinal canal. In men, the genital branch continues down and supplies the scrotal skin. In women, the genital branch accompanies the round ligament of uterus, terminating in the skin of the mons pubis and labia majora.[1]:343

The femoral branch passes underneath the inguinal ligament, travelling adjacent to the external iliac artery, and supplying the skin of the upper, anterior thigh. [1]:34

Function
The genitofemoral nerve is responsible for both the sensory (femoral branch) and motor portions (genital branch) of the cremasteric reflex, which describes contraction of the cremasteric muscle when the skin of the superior medial part of the thigh is touched


Ilioninguinal nerves

The ilioinguinal nerve is a branch of the first lumbar nerve (L1). It separates from the first lumbar nerve along with the larger iliohypogastric nerve.

It emerges from the lateral border of the psoas major just inferior to the iliohypogastric, and passes obliquely across the quadratus lumborum and iliacus. The ilioinguinal nerve then perforates the transversus abdominis near the anterior part of the iliac crest, and communicates with the iliohypogastric nerve between the transversus and the internal oblique muscle.

It then pierces the internal oblique muscle, distributing filaments to it, and then accompanies the spermatic cord through the superficial inguinal ring. Its fibers are then distributed to the skin of the upper and medial part of the thigh, and to the following locations in the male and female:

In the male ("anterior scrotal nerve"): to the skin over the root of the penis and upper part of the scrotum.
In the female ("anterior labial nerve"): to the skin covering the mons pubis and labium majus.
Note that the ilioinguinal nerve does not pass through the deep inguinal ring, and therefore it only travels through part of the inguinal canal.

Obturator nerves

Innervation[edit]
The Obturator nerve is responsible for the sensory innervation of the skin of the medial aspect of the thigh.

It is also responsible for the motor innervation of the adductor muscles of the lower extremity (external obturator.,[2] adductor longus, adductor brevis, adductor magnus, gracilis) and the pectineus (inconstant). It is, notably, not responsible for the innervation of the obturator internus, despite the similarity in name

Function[edit]
The pudendal nerve has both motor and sensory functions. It does not carry parasympathetic fibers.[9]:1738


The pudendal nerve

The pudendal nerve supplies sensation to the penis in males and the clitoris in females, through the branches dorsal nerve of penis and dorsal nerve of clitoris.[10]:422 The posterior scrotum in males and the labia in females are also supplied, via the posterior scrotal nerves (males) or posterior labial nerves (females). The pudendal nerve is one of several nerves supplying sensation to these areas.[11] Branches also supply sensation to the anal canal.[6]:8 By providing sensation to the penis and the clitoris, the pudendal nerve is responsible for the afferent component of penile erection and clitoral erection.[12] :147

Branches also innervate muscles of the perineum and pelvic floor; namely the bulbospongiosus and ischiocavernosus muscles,[11] the levator ani muscle (including the Iliococcygeus, pubococcygeus, puborectalis and either pubovaginalis in females or pubourethralis in males),[10]:422[13] the external anal sphincter (via the inferior anal branch),[6]:7 and external urethral sphincter.
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A 4 month old boy is brought to the physician because of recurrent sinopulmonary infections since birth. Physical examination shows hypopigmentation of the skin, eyes, and hair, and numerous ecchymoses over the trunk and extremities. A peripheral blood smear shows giant granules in neutrophils and eosinophils. Which of the following is the most likely underlying cause of these findings?

Acute myeloblastic leukemia

Ataxia telangiectasia

Chediak Higashi syndrome

Leukocyte adhesion deficiency

Sezary syndrome wrrrrrrrrrrrooooooooooooooooong
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Correct Answer NBME

Quote:
Originally Posted by sashabeliimd View Post
A 4 month old boy is brought to the physician because of recurrent sinopulmonary infections since birth. Physical examination shows hypopigmentation of the skin, eyes, and hair, and numerous ecchymoses over the trunk and extremities. A peripheral blood smear shows giant granules in neutrophils and eosinophils. Which of the following is the most likely underlying cause of these findings?

Acute myeloblastic leukemia

Ataxia telangiectasia noooo

Chediak Higashi syndrome ****************************************

Leukocyte adhesion deficiency no

Sezary syndrome wrrrrrrrrrrrooooooooooooooooong
Sezary syndrome is an uncommon variant of cutaneous T-cell lymphoma (CTCL) characterized by erythroderma, pruritus, adenopathy, and circulating atypical T-lymphocytes with cerebriform nuclei. The definition of Sezary syndrome can be further refined by including only patients with a circulating peripheral blood population of clonal T-cells

Chediak Higashi syndrome FA
autosomal recessive defect in lysosomal regulator trafficking gene
Microtubule dysfunction in phagosome-lysosome fusion.
Recurrent pyogenic infections by staphylococci and streptococci,
partial albinism,
peripheral neuropathy,
neutropennia,
defective primary hemostasis,
Giant granules in neutrophils,
Large lysosomal vesicles
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Post NBME

A 3 year old boy is brought to the physician by his parents because of a 1 week history of nonproductive cough, wheezing, and nausea. Coarse bilateral crackles are heard on auscultation of the chest. Physical examination shows no other abnormalities. Stool culture shows a 1.6 cm roundworm larva. A chest x ray shows bilateral infiltration. This disease was most likely caused by ingestion of which of the following?

Feces contaminated soil

Improperly canned beans

Pork products

Raw shrimp

Undercooked meat wrrrrrrrrrrrrrrrrrong specific for E coli
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Default Hi

Quote:
Originally Posted by sashabeliimd View Post
A 3 year old boy is brought to the physician by his parents because of a 1 week history of nonproductive cough, wheezing, and nausea. Coarse bilateral crackles are heard on auscultation of the chest. Physical examination shows no other abnormalities. Stool culture shows a 1.6 cm roundworm larva. A chest x ray shows bilateral infiltration. This disease was most likely caused by ingestion of which of the following?

Feces contaminated soil ******************************************

Improperly canned beans

Pork products

Raw shrimp

Undercooked meat wrrrrrrrrrrrrrrrrrong specific for E coli
Because Ascaris Lumbricoides is most coresponding to.

Infections[edit]
Main article: Ascariasis
Infections with these parasites are more common where sanitation is poor,[7] and raw human feces are used as fertilizer.

Symptoms[edit]
Often, no symptoms are seen with an A. lumbricoides infection. However, in the case of a particularly bad infection, symptoms may include bloody sputum, cough, fever, abdominal discomfort, intestinal ulcer, passing worms, etc.[8][9] Ascariasis is also the most common cause of LŲffler's syndrome worldwide. Accompanying symptoms include pulmonary infiltration, eosinophilia, and radiographic opacities


Lifecycle[edit]
Ascaris lumbricoides, a roundworm, infects humans when an ingested fertilised egg becomes a larval worm that penetrates the wall of the duodenum and enters the blood stream. From there, it is carried to the liver and heart, and enters pulmonary circulation to break free in the alveoli, where it grows and molts. In three weeks, the larvae pass from the respiratory system to be coughed up, swallowed, and thus returned to the small intestine, where they mature to adult male and female worms. Fertilization can now occur and the female produces as many as 200,000 eggs per day for a year. These fertilized eggs become infectious after two weeks in soil; they can persist in soil for 10 years or more.[3]

The eggs have a lipid layer which makes them resistant to the effects of acids and alkalis, as well as other chemicals. This resilience helps to explain why this nematode is such a ubiquitous parasite
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Post Statistics

A screening program is instituted for detection of vaginal Chlamydia trachomatis infection among first year women college students. At the initial screening , evidence of C trachomatis infection is found in 500 of 2500 students. One year later, screening show vaginal C. trachomatis infection in an additional 200 tudents. Which of the following is the annual incidence of C trachomatis infection in this population of women students?


%%%%%%%%%%
8 wrrrrrroooooooooooooooong

10

16

20

28
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Fire Thread Please heeeeeeeeeeelp here

Quote:
Originally Posted by sashabeliimd View Post
A screening program is instituted for detection of vaginal Chlamydia trachomatis infection among first year women college students. At the initial screening , evidence of C trachomatis infection is found in 500 of 2500 students. One year later, screening show vaginal C. trachomatis infection in an additional 200 tudents. Which of the following is the annual incidence of C trachomatis infection in this population of women students?


%%%%%%%%%%
8 wrrrrrroooooooooooooooong

10

16

20

28

Incidence sound easy for start , a new cases from all number of patients or any group
Here we see 2 consecutive years
If calculate incidence just for first year where 500 of 2500 was infected incidence will be 20%
If calculate incidence just for second year of study 200 from (2500-500)
incidence will be 10%
If calculate incidence from both years together , 700 of 2500
incidence will be 28 %


??????????????????????????????????????
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Correct Answer Hi

Quote:
Originally Posted by sashabeliimd View Post
Incidence sound easy for start , a new cases from all number of patients or any group
Here we see 2 consecutive years
If calculate incidence just for first year where 500 of 2500 was infected incidence will be 20%
If calculate incidence just for second year of study 200 from (2500-500)
incidence will be 10%
If calculate incidence from both years together , 700 of 2500
incidence will be 28 %


????
If calculate incidence just for first year where 500 of 2500 was infected incidence will be 20%
A screening program is instituted for detection of vaginal Chlamydia trachomatis infection among first year women college students
Is corect this deduction?
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Save It! Hi

A 54 year old woman with terminal metastatic pancreatic cancer comes to the physician for a follow up examination . She asks the physician to prescribe her a sufficient quantity of medication to allow her to commit suicide if the pain becomes unbearable. The physician refuses to do so, but he informs the patient that he will do everything he can manage her pain. The physician's decision in this situation is most consistent with which of the following ethical principles?

Autonomy

Beneficence

Dignity

Justice

Nonmaleficence
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Correct Answer Hi

Quote:
Originally Posted by sashabeliimd View Post
A 54 year old woman with terminal metastatic pancreatic cancer comes to the physician for a follow up examination . She asks the physician to prescribe her a sufficient quantity of medication to allow her to commit suicide if the pain becomes unbearable. The physician refuses to do so, but he informs the patient that he will do everything he can manage her pain. The physician's decision in this situation is most consistent with which of the following ethical principles?

Autonomy noooo

Beneficence wrrrrrrrrrrrrrrrrrong

Dignity

Justice nooooo

Nonmaleficence ************************************************** *************************** i think most suitable
FA
Autonomy Obligation to repect patients as individuals and to honor their preferences in medical care

BEneficence Physicians have a special ethical duty to act in the patient's interest, best interest. May conflict with autonomy. If the patient can make an informed decision, ultimately the patient has the right to decide.

Nonmaleficence Do not harm. however if the benfits of an intervention outweigh the risks, a patient may make an informed decision to proceed most surgeries and medications fall into this category
Given drugs to patient for pain diminishment, but not to kill them with respiratory depression or coma...

Justice to treat persons fairly...
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Post NBME

A previously healthy 27 year oooooooooold woman comes to the physician because of a 3 week history of episodes of left sideed chest pain and tenderness. The pain radiates to the back and is exacerbated when she reaches over her head of behind her back. SHe has not had shortness of breathk , sweating, or light headedness. HEr temperature is 37 pulse 92 per minut, and BP is 130/86 mm Hg, Cardiopulmonary examination shows no abnormalities. Examination shows tenderness to palpation 2cm lateral th the midline and 10 cm below the clavicle on the left. An x ray of the chest and an ECG show no abnormalities. Which of the following is the most likely dagnosis?

Achalasia

Acute pericarditis

Costohondritis

Dissecting aortic aneurym wrrrrrrrrrrrrrroooooooooooooooooong

Gastroesophageal reflux disease

Pleurisy

Pneumothorax

Stable angina pectoris
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Default

Answer is costochondritis, note that she has tenderness to palpation which is typical in this cases.

0
Quote:
Originally Posted by sashabeliimd View Post
A previously healthy 27 year oooooooooold woman comes to the physician because of a 3 week history of episodes of left sideed chest pain and tenderness. The pain radiates to the back and is exacerbated when she reaches over her head of behind her back. SHe has not had shortness of breathk , sweating, or light headedness. HEr temperature is 37 pulse 92 per minut, and BP is 130/86 mm Hg, Cardiopulmonary examination shows no abnormalities. Examination shows tenderness to palpation 2cm lateral th the midline and 10 cm below the clavicle on the left. An x ray of the chest and an ECG show no abnormalities. Which of the following is the most likely dagnosis?

Achalasia

Acute pericarditis

Costohondritis

Dissecting aortic aneurym wrrrrrrrrrrrrrroooooooooooooooooong

Gastroesophageal reflux disease

Pleurisy

Pneumothorax

Stable angina pectoris
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Thumbs Up Hi

Quote:
Originally Posted by Coccidioda View Post
Answer is costochondritis, note that she has tenderness to palpation which is typical in this cases.

0
Yeeeeeeeah you are right, when patient say that have some pain, that might be palpated, or indicated with a single finger is a type of musculoskeletal pain, which make more considerably corect answer of costochodritis... Good job...
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  #74  
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Post Hi

44.

A previously healthy 52 year old man is brought to the physician because of a 2 month history of progressive difficulty swallowing, double vision, and slurred speech. His vital signs are within normal limits. Physical examination shows ptosisssssssssss of the eyelids and waddling gait. Muscle strength testing shows fatigable weakness of the neck. arms, hands, and fingers. Repetitive nerve stimulationn shows a 25% decrease in muscle action potential in several muscles. Which of the following mechanisms is the most likely cause of this patient's disease?


Binding of acetylcholine by an antibody

Binding of antibody to the acetylcholine receptor

Decreased acetylcholine production

Decreased release of acetylcholine from the receptor wwwwwwwwwwwwrrrrrrrrrrrrrong

Decreased reuptake of acetylcholine

Please if you aswer, just with explanation, not just make a sign to an option... thanks
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  #75  
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Correct Answer Hi

Quote:
Originally Posted by sashabeliimd View Post
44.

A previously healthy 52 year old man is brought to the physician because of a 2 month history of progressive difficulty swallowing, double vision, and slurred speech. His vital signs are within normal limits. Physical examination shows ptosisssssssssss of the eyelids and waddling gait. Muscle strength testing shows fatigable weakness of the neck. arms, hands, and fingers. Repetitive nerve stimulationn shows a 25% decrease in muscle action potential in several muscles. Which of the following mechanisms is the most likely cause of this patient's disease?


Binding of acetylcholine by an antibody

Binding of antibody to the acetylcholine receptor

Decreased acetylcholine production

Decreased release of acetylcholine from the receptor wwwwwwwwwwwwrrrrrrrrrrrrrong

Decreased reuptake of acetylcholine

Please if you aswer, just with explanation, not just make a sign to an option... thanks

It's like a Myastenia gravis, antibody against Ach receptors, and will be binding of formed antibody to the acetylcholine receptor .....
Done
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  #76  
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Post Hi

A 40 year old woman is brought to the emergency department 1 hour after sustaining a gunshot wound to the abdomen. Despite appropiate interventino, she develops ventricular fibrilation and dies 30 minutes laterrrrrrrrr. At autopsy abdominal examination shows an entry wound over the upper midline. There is 3 L of freshhhh blood in teh peritoneal cavity, the organs appear normal otherwise. Specimens of tissue from the liver and kidneys show centrilobular pallor and swelling of the hepatocytes and proximal convoluted epithelial cells, respectively. Which of the folowing mechanisms is the most likely direct cause of these renal findings?


Activatino of aspartate specific caspase ???

Binding of Fas ligand to its receptor wrrrrrrrrrrrrong

Decreased fucntion of Na K ATPase

Ribosomal disaggregation

Stimulation of phosphofructokinase
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  #77  
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Default hello

I will say its ATN due to the epithelial cells in the PCT, so my answer is decreased function of NA+/K+ Atpase, pretty sure i got it right on the test (like 90% sure)
remember when there is interruption of blood flow to the kidney you will most likely experience an ATN, as in this case.

Quote:
Originally Posted by sashabeliimd View Post
A 40 year old woman is brought to the emergency department 1 hour after sustaining a gunshot wound to the abdomen. Despite appropiate interventino, she develops ventricular fibrilation and dies 30 minutes laterrrrrrrrr. At autopsy abdominal examination shows an entry wound over the upper midline. There is 3 L of freshhhh blood in teh peritoneal cavity, the organs appear normal otherwise. Specimens of tissue from the liver and kidneys show centrilobular pallor and swelling of the hepatocytes and proximal convoluted epithelial cells, respectively. Which of the folowing mechanisms is the most likely direct cause of these renal findings?


Activatino of aspartate specific caspase ???

Binding of Fas ligand to its receptor wrrrrrrrrrrrrong

Decreased fucntion of Na K ATPase

Ribosomal disaggregation

Stimulation of phosphofructokinase
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  #78  
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Post Hi

Quote:
Originally Posted by Coccidioda View Post
I will say its ATN due to the epithelial cells in the PCT, so my answer is decreased function of NA+/K+ Atpase, pretty sure i got it right on the test (like 90% sure)
remember when there is interruption of blood flow to the kidney you will most likely experience an ATN, as in this case.
Yeaaah, i know these two things,
When is decressed blood flow like ischemia or hemorrhage will be acute tubular necrosis, i asssociate TUBULAR WITH VESSELS and when is drug toxicity, or general toxicity will be ACUTE INTERSTITIAL NEPHRITIS,

But sense here is why ATP ase decrease self function???
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  #79  
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Correct Answer

Quote:
Originally Posted by Coccidioda View Post
I will say its ATN due to the epithelial cells in the PCT, so my answer is decreased function of NA+/K+ Atpase, pretty sure i got it right on the test (like 90% sure)
remember when there is interruption of blood flow to the kidney you will most likely experience an ATN, as in this case.
Renal function and Na-K-ATPase in rats after suprarenal ligation of inferior vena cava.
Wald H, Popovtzer MM.
Abstract
To assess the effects of altered renal function on Na-K-ATPase, the following groups of rats were studied: 1. rats with suprarenal vena cava ligation (SVCL), la. DOCA-treated rats with SVCL, 2. rats with infrarenal vena cava ligation (IVCL), 3. rats with glycerol-induced acute renal failure, 4. rats with bilateral ureteric ligation, and 5. K-exalate-treated rats with SVCL. In group 1, acute renal failure with hyperkalemia developed and medullary Na-K-ATPase increased from 95 +/- 5 in control to 155 +/- 7 mumol Pi/mg prot/h, P less than 0.001, DOCA did not prevent the increase of Na-K-ATPase. In group 2, medullary Na-K-ATPase decreased from 130 +/- 10 in control to 88 +/- 7, P less than 0.01, in rats with IVCL. In group 3, cortical Na-K-ATPase decreased from 55 +/- 5 to 27 +/- 6, P less than 0.02. In group 4, Na-K-ATPase was unchanged. In group 5, maintenance of normokalemia prevented the rise in Na-K-ATPase. These experiments demonstrated a K-dependent activation of medullary Na-K-ATPase after SVCL but not in other forms of renal failure. Because SVCL diminishes drastically GFR per nephron, the present findings imply that increased loads of Na and K per nephron are not a prerequisite for an increase in medullary Na-K-ATPase. Hyperkalemia in presence of increased renal venous pressure seems to be causally related to the rise in medullary Na-K-ATPase activity.
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  #80  
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Post Hi

A 43 year old woman comes to the physician because of progressive difficulty walking during the past 3 months .Neurologic examination shows weakness and decreased muscle bulk of the lower extremities. Patellar and Achilles tendon reflexes are diminished. Sensations of joint position, pain, and temperature in the lower extremities are normal.
Which of the following is the most likely cause of the findings in this patient?

Acute peripheral neuropathy

Degeneration of motoneurons of the lumbar cord

Demyelination of the corticospinal pathways

Loss of afferent Ia axons innervating muscle spindles

Myotonic muscular dystrophy wrrrrrrrrrrrrrrrrrrrrronnnnnnnnnnnnnnng
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  #81  
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Default hi

Since it has only LMN signs, it has to be degeneration of motoneurons.
Denervation = muscle atrophy


Quote:
Originally Posted by sashabeliimd View Post
A 43 year old woman comes to the physician because of progressive difficulty walking during the past 3 months .Neurologic examination shows weakness and decreased muscle bulk of the lower extremities. Patellar and Achilles tendon reflexes are diminished. Sensations of joint position, pain, and temperature in the lower extremities are normal.
Which of the following is the most likely cause of the findings in this patient?

Acute peripheral neuropathy

Degeneration of motoneurons of the lumbar cord

Demyelination of the corticospinal pathways

Loss of afferent Ia axons innervating muscle spindles

Myotonic muscular dystrophy wrrrrrrrrrrrrrrrrrrrrronnnnnnnnnnnnnnng
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  #82  
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Post Hi

A 32 year old woman, gravida 4, para 0, aborta 3 delivers a female newborn at term with dysmorphic features and numerous organ anomalies. The mother has had multiple spontaneous abortion, and this is her first liveborn child. Which of the following is the most likely explanation for the abnormalities seen in this newborn?

AD wrong

AR

Gonadal mosaicism

Submicroscopic deletion

Unbalanced chromosome rearrangement
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  #83  
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Originally Posted by sashabeliimd View Post
Because all genes are synthesized in the nucleus ,fits last answer, with
transport of ferritin mRNA out of the nucleus

Please help someone to confirm this one....
hi the correct answer is Translation of ferritin mRNA
western blot for proteins so here only protein synth is increased....Northern blot for DNA-no change in DNA content or PCR maybe for RNA- no change in PCR either....so its due to increased translation from the already existing constant amount of ferritin mRNA
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  #84  
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Default

Quote:
Originally Posted by sashabeliimd View Post
A 32 year old woman, gravida 4, para 0, aborta 3 delivers a female newborn at term with dysmorphic features and numerous organ anomalies. The mother has had multiple spontaneous abortion, and this is her first liveborn child. Which of the following is the most likely explanation for the abnormalities seen in this newborn?

AD wrong

AR

Gonadal mosaicism

Submicroscopic deletion

Unbalanced chromosome rearrangement

the ans is unbalanced chr rearrangement...maybe trisomies..
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  #85  
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Drug Hi

Quote:
Originally Posted by anu4usmle View Post
the ans is unbalanced chr rearrangement...maybe trisomies..
MOst common abortions in first trimester are chromosome anomalies, like Down syndrome and i think you deduce corectly
thanks for you.......................
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  #86  
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Originally Posted by sashabeliimd View Post
Behavioral

A study is designed to evaluate the relationship between ambient noise and hearing loss in an automobile manufacturing plant. Different locations in the manufacturing plant have strikingly different levels of ambient noise. Each employee is given a test for hearing acuity, and then the ambient noise level is measured at his or her workstation. Which of the following best describes this study design?

Case series
Cohort
Crossover
Cross-sectional
Randomized clinical trial wrrrrrrrrrrrrong
i think its cross-sectional study..done at one point of time...
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  #87  
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Post Hi

An 80 year old woman develops fever and cloudy urine 4 days after undergoing a total knee replacement. Her temperature is 38 , Physical examination shows a bandagedd left knee and an indwelling Foley catheter. Microscopic analysis of a clean catch, spun urine specimen shows 12 WBCs per field and numerous G negative rods. Urine culture on brain heart infusion medium grows greates than 100000 bacterial colonies/ mL., with a predominant colony type that is oxidase positive and produces a diffusible green pigment. Which of the following is the most likely causal organism?

E coli

Klebsiella pneumoniae

Proteus mirabilis wrrrrrrrrrrong of course

Pseudomonas aeruginosa

Strep Pyogenes group A nooooooo
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  #88  
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Biochemistry Hi

Quote:
Originally Posted by sashabeliimd View Post
An 80 year old woman develops fever and cloudy urine 4 days after undergoing a total knee replacement. Her temperature is 38 , Physical examination shows a bandagedd left knee and an indwelling Foley catheter. Microscopic analysis of a clean catch, spun urine specimen shows 12 WBCs per field and numerous G negative rods. Urine culture on brain heart infusion medium grows greates than 100000 bacterial colonies/ mL., with a predominant colony type that is oxidase positive and produces a diffusible green pigment. Which of the following is the most likely causal organism?

E coli lactose fermenter rod G -

Klebsiella pneumoniae same lactose fermenter rod G-

Proteus mirabilis wrrrrrrrrrrong of course

Pseudomonas aeruginosa oxidase positive ********************************************

Strep Pyogenes group A is gram positive nooooooo



Hey guys i need your help, i produce a lot of mistakes on test, and really some times i don't understand why choice another incorect, when analyze same test see corect one.

And if see some uncoresponding variant, mean not classic think like is some sofisticated test???
What is your key of test solving on time and do not panic, stay calm, how you do this???? thanks

Last edited by ginseng plus; 11-13-2014 at 11:46 AM. Reason: Add images
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  #89  
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Fire Thread Microbiology

An investigator is studying strains of Streptococcus pneumoniae to monitor the effect of a conjugate polysaccharide vaccine on the expression of different capsule types. Several strains that express a capsular type previously found only in strains of Streptocuccus mitis are identified.
After laboratory incubation of a nonecapsulaaaaaaaated strain of S. Pneumoniae with the lysate from heat killed S. mitis , colonies of S pneumoniae expressing the new capsular type are identified. However no colonies of S. pneumoniae expressing this capsule are isolated after the addition of DNase to the lysate. Which of the following mechanisms is the most likely cause of the transfer of the genes encoding the new capsular type?

Bacteriophage transduction

Natural transformation

Plasmid transfer

Point mutations in the capsule genes

Slipped strand mispairing wrooooooooooongggg

Here please someone help, boring quetions like this,
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  #90  
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Default

Quote:
Originally Posted by sashabeliimd View Post
An investigator is studying strains of Streptococcus pneumoniae to monitor the effect of a conjugate polysaccharide vaccine on the expression of different capsule types. Several strains that express a capsular type previously found only in strains of Streptocuccus mitis are identified.
After laboratory incubation of a nonecapsulaaaaaaaated strain of S. Pneumoniae with the lysate from heat killed S. mitis , colonies of S pneumoniae expressing the new capsular type are identified. However no colonies of S. pneumoniae expressing this capsule are isolated after the addition of DNase to the lysate. Which of the following mechanisms is the most likely cause of the transfer of the genes encoding the new capsular type?

Bacteriophage transduction

Natural transformation

Plasmid transfer

Point mutations in the capsule genes

Slipped strand mispairing wrooooooooooongggg

Here please someone help, boring quetions like this,
hi...strep pneumo has innate ability for natural transformation...checkout FA 2014 pg no 128
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  #91  
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Unhappy

Quote:
Originally Posted by anu4usmle View Post
hi...strep pneumo has innate ability for natural transformation...checkout FA 2014 pg no 128
Thanks i found, But it is difficult to memorise or understand viral and bacterial genetics, some association do not help, for example than recombination between two chromosomes

And Transformation because their are just three bacteria mentioned like: Strep pneumonia, H. influenzae, and Neisseria ...
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  #92  
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Post Hi

A 40 year old woman comes to the emergency department because of a 1 week history of abdominal pain and watery , bloody diarrhea, She returned from a 2 week vacation in Kenya 1 month ago. Her vital signs are within normal limits. Abdominal examination shows distention and diffuse tenderness. Microscopic examination of a stool specimen shows 12 Micro m trophozoites diplayin erytrophagocytosis. Which of the following is the most likely causal organism?


Entamoeba histolytica

Leishmania donovani

Taenia saginata

Toxoplasma gondii

Trypanosoma cruzi wrrrrrrrrrrrrrrrrrrrrrrrrronnnnnnnng
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  #93  
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Default hey

erythrophagocytosis its a clue for e. hystolytica


Quote:
Originally Posted by sashabeliimd View Post
A 40 year old woman comes to the emergency department because of a 1 week history of abdominal pain and watery , bloody diarrhea, She returned from a 2 week vacation in Kenya 1 month ago. Her vital signs are within normal limits. Abdominal examination shows distention and diffuse tenderness. Microscopic examination of a stool specimen shows 12 Micro m trophozoites diplayin erytrophagocytosis. Which of the following is the most likely causal organism?


Entamoeba histolytica

Leishmania donovani

Taenia saginata

Toxoplasma gondii

Trypanosoma cruzi wrrrrrrrrrrrrrrrrrrrrrrrrronnnnnnnng
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  #94  
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Originally Posted by sashabeliimd View Post
A male newborn delivered at 28 weeks gestation is tachypneic and hypoxemic. Which of the following altered structure changes in the type 2 pneumocytes is the most likely cause of this patient's condition?

Abundant rought endoplasmic reticulum wrong
Decreased numbers of lamellar bodies
Distinct junctional complexes with adjacent type 1 pneumocytes
NUmerous microvilli
Reticular fibers


I would like to say that , all this i do for myself primarily, but if someone find interesting , you are welcome...

Prior 35 weeks of gestaion, newborn have deficient surfactant secretion...
Acute respiratory distress syndrome

May be caused by trauma , sepsis , shock, gastric aspiration, uremia ,a acute pancreatitis, or amniotic fluid embolism. Diffuse alveolar damage, INcrease alveolar permeability capilary, protein rich leakage into alveoli. Resaults in formation of intra-alveolar hyaline menmbrane.
Initial damage due to release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade, and oxygen derived free radicals,...


Microvilli aren't present on terminal alveoli

I think it is Distinct junctional complexes with adjacent type 1 pneumocytes

If someone have corect answer post please....


i think the answer is decreased number of lamellar bodies, as surfactant is stored in lamellar bodies in type 2 pneumocytes
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potential for false positive is WRONG

Quote:
Originally Posted by sashabeliimd View Post
Potential fo a false positive result???????

Because test may be positive also for another diseases

Causes of Blood in Stool
Blood in the stool means there is bleeding somewhere in your digestive tract. Sometimes the amount of blood is so small that it can only be detected by a fecal occult test (which checks for hidden blood in the stool). At other times it may visible on toilet tissue or in the toilet after a bowel movement as bright red blood. Bleeding that happens higher up in the digestive tract may make stool appear black and tarry.

Possible causes of blood in stool include:

Diverticular disease. Diverticula are small pouches that project from the colon wall. Usually diverticula don't cause problems, but sometimes they can bleed or become infected.


Anal fissure . A small cut or tear in the tissue lining the anus similar to the cracks that occur in chapped lips or a paper cut. Fissures are often caused by passing a large, hard stool and can be painful.

Colitis . Inflammation of the colon. Among the more common causes are infections or inflammatory bowel disease.

Angiodysplasia. A condition in which fragile, abnormal blood vessels lead to bleeding.

Peptic ulcers . An open sore in the lining of the stomach or duodenum, the upper end of the small intestine. Many peptic ulcers are caused by infection with a bacterium called Helicobacter pylori (H. pylori). Long-term use or high doses of anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen can also cause ulcers.

Polyps or cancer . Polyps are benign growths that can grow, bleed, and become cancerous. Colorectal cancer is the third most common cancer in the U.S. It often causes bleeding that is not noticeable with the naked eye.

Esophageal problems. Varicose veins of the esophagus or tears in the esophagus can lead to severe blood loss.
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Prade willi syndrome
Mental retardation, hyperphagia, obesity, hypogonadism, hypotonia, and behavior like tantrum
Individual has normally inactivated maternal allele. Paternal allele should be active but is deleted.

We know diseases with trinucleotide expansion like Huntington, muscular dystrophy,Freidrich ataxia, x fragile syndrome.


DEletion in the short arm of chromosome 15??? Answer must be with deletion of Paternal chromosome 15, but may match response with just a partial deletion of chromosome too?
Maternal origin of both (imprinted) chromosome 15
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  #97  
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I cell disease Inherited lysosomal storage disease, failure of addition of mannose 6 phosphate to lysosome proteins , enzymes are secreted outside te cell instead of being targeted to the lysosome

And i think that these substances are filled with proteins, and lysosomes will become more in size? Large lysosomes
large lysosomes is Wrong
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  #98  
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Angry Hi

Quote:
Originally Posted by Pikachu View Post
potential for false positive is WRONG
Hey please don't write more posts like, it's wrong, or maybe, i asked promtly to everybody who want to help,and who can help, if you know answer, with explanation of course than let's go to talk for us... If not stay away please...
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  #99  
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Correct Answer Hi

Quote:
Originally Posted by Pikachu View Post
Maternal origin of both (imprinted) chromosome 15
Prader-Willi syndrome
Prader-Willi syndrome is caused by a loss of active genes in a region of chromosome 15. This region is located on the long (q) arm of the chromosome and is designated 15q11-q13. It is the same part of chromosome 15 that is usually affected in people with Angelman syndrome, although different genes are associated with the two disorders. People can have either Prader-Willi syndrome or Angelman syndrome, but they typically cannot have both.
People normally inherit one copy of chromosome 15 from each parent. Some genes on this chromosome are turned on (active) only on the copy inherited from a person's father (the paternal copy). This parent-specific gene activation results from a phenomenon called genomic imprinting.
In about 70 percent of cases, Prader-Willi syndrome occurs when the 15q11-q13 region of the paternal chromosome 15 is deleted in each cell. A person with this chromosomal change will be missing certain critical genes in this region because the genes on the paternal copy have been deleted, and the genes on the maternal copy are turned off (inactive). Researchers are working to identify which missing genes are associated with the characteristic features of Prader-Willi syndrome.
In about 25 percent of cases, people with Prader-Willi syndrome inherit two copies of chromosome 15 from their mother instead of one copy from each parent. This phenomenon is called maternal uniparental disomy. A person with two maternal copies of chromosome 15 will have no active copies of certain genes in the 15q11-q13 region.
In a small percentage of cases, Prader-Willi syndrome is caused by a chromosomal rearrangement called a translocation. Rarely, the condition results from a mutation or other defect that abnormally inactivates genes on the paternal copy of chromosome 15.



People normally inherit one copy of chromosome 15 from each parent How can child have both copies if receive one copy from mother and another from father, and if one will be inactivated like paternal chromosome 15, he will remain just with one maternal 15 not, both ?????
Please dont write more some of this sh.............ty posts without comments to them... thanks
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Originally Posted by sashabeliimd View Post
Hey please don't write more posts like, it's wrong, or maybe, i asked promtly to everybody who want to help,and who can help, if you know answer, with explanation of course than let's go to talk for us... If not stay away please...
I mentioned them WRONG, because, i got them wrong too.....and, it might help us find the correct answer by the method of exclusion.
No problem......ready to stay away.... if you find it so disturbing
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