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#1
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Nbme 11 discussion!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!

Hey lets us discuss some interesting and difficult quetions here from NBME 11...

#2
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hi

Have anyone full list of answers to this form, to make faster work with detecting mistakes??? Not to look at every test in part and verify through a lot of forums? Thanks
#3
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hi

looks simple but , so amazing forum , where you can find anything else you cannot find...

http://www.usmleforum.com/files/forum/2012/1/664277.php

#4
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370

10. A 28-year-old woman wants to lose weight. She is 160 cm (5 ft 3 in) tall and weighs 81.5 kg (180 Ib); BMI is 32 kg/m2. She consumes 1800 calories daily and has a sedentary lifes tyle. Assume that there are 3500 calories per pound and that brisk walking consumes 500 calories per hour. Which of the following regimens is most likely to help her lose 0.9 kg (2 Ib) weekly?

----Calories Per Day--------Brisk Walking Daily
A) Decrease by 100------------- 1/2 hour
B) Decrease by 100------------- 1 hour
C) Decrease by 500------------- 1/2 hour
D) Decrease by 500------------- 1 hours
E) No change ------------------- 1 hour
F) No change ------------------- 1/2 hours
#5
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hi

Quote:
 Originally Posted by sashabeliimd 10. A 28-year-old woman wants to lose weight. She is 160 cm (5 ft 3 in) tall and weighs 81.5 kg (180 ib); bmi is 32 kg/m2. She consumes 1800 calories daily and has a sedentary lifes tyle. Assume that there are 3500 calories per pound and that brisk walking consumes 500 calories per hour. Which of the following regimens is most likely to help her lose 0.9 kg (2 ib) weekly? ----calories per day--------brisk walking daily a) decrease by 100------------- 1/2 hour b) decrease by 100------------- 1 hour c) decrease by 500------------- 1/2 hour d) decrease by 500------------- 1 hours e) no change ------------------- 1 hour f) no change ------------------- 1/2 hours

1 lb fat=3500 cal

to lose 1 lb/week=lose 500cal/day (1week=7days)

brisk walk 1 hour=lose 500 cal daily

brisk walk 7 hour=lose 3500 cal weekly=1 pound

answer d
#6
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370

A previously healthy 71-year-old man comes to the physician because of a 1-dy history of pain and swelling of his right leg. Physical examination shows diffuse edema of the right lower extremity and calf tenderness. Doppler USG shows a DVT in the right lower extremity. After starting heparin therapy immediately, it is most appropriate to initiate a 6-months course of a medication with which of the following mechanisms of action?
A. Binds to the active site on the thrombin molecule
B. Interferes with the carboxylation of coagulation factors
C. Irreversibly inactivates cyclooxygenase
D. Potentiates the action of antithrombin 3
E. Selectively inhibits factor 10a.

Hey i just add here to help another, some test in file where i downloaded show that answers are wrong, but in reality did right...
#7
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hi

Quote:
 Originally Posted by sashabeliimd A previously healthy 71-year-old man comes to the physician because of a 1-dy history of pain and swelling of his right leg. Physical examination shows diffuse edema of the right lower extremity and calf tenderness. Doppler USG shows a DVT in the right lower extremity. After starting heparin therapy immediately, it is most appropriate to initiate a 6-months course of a medication with which of the following mechanisms of action? A. Binds to the active site on the thrombin molecule B. Interferes with the carboxylation of coagulation factors C. Irreversibly inactivates cyclooxygenase D. Potentiates the action of antithrombin 3 E. Selectively inhibits factor 10a. Hey i just add here to help another, some test in file where i downloaded show that answers are wrong, but in reality did right...

B..Warfarin..is an appropriate treatment for 6 months ,so its mechanism of action is Interferes with the carboxylation of coagulation factors
#8
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hi

Quetion is about zona fasciculata, but which point is in graph?? B??
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#9
12-05-2014
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Which of the following is the most likely effect of trinucleotide repeats on transcription of FMR1 mRNA?

a- alteration of mRNA splicing
b- decreased transcription
c- incorporation of CGG repeats into mRNA
d- increased binding of RNA polymerase
#10
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370

Quote:
 Originally Posted by sashabeliimd Which of the following is the most likely effect of trinucleotide repeats on transcription of FMR1 mRNA? a- alteration of mRNA splicing b- decreased transcription c- incorporation of CGG repeats into mRNA d- increased binding of RNA polymerase

B

Transcription defects induced by repeat expansion: fragile X syndrome, FRAXE mental retardation, progressive myoclonus epilepsy type 1, and Friedreich ataxia.
Greene E1, Handa V, Kumari D, Usdin K.
Author information
Abstract
Fragile X mental retardation syndrome, FRAXE mental retardation, Progressive myoclonus epilepsy Type I, and Friedreich ataxia are members of a larger group of genetic disorders known as the Repeat Expansion Diseases. Unlike other members of this group, these four disorders all result from a primary defect in the initiation or elongation of transcription. In this review, we discuss current models for the relationship between the expanded repeat and the disease symptoms.
Copyright 2003 S. Karger AG, Basel
#11
12-05-2014
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25yr old dude w/ type I diabetes comes to you cuz of poor diabetic control for 3 months. He has ketones in his urine, and his blood glucose conc. has been in 200-400 mg/dl range, particularly after exercise. he has been receiving 2 injections of insulin daily. Physical exam shows no abnormalities. His HA1C is 12%. After exercising on treadmill for 45 minutes, that patient has a increase in serum glucose from 175 to 225 mg/dl. Which of the following hepatic enzymes is most likely elevated initially by exercise in this patient?

A. Debranching ezyme
B. Phopholicpase C
C. Phosphorylase kinase
D. Portein Kinase B
#12
12-05-2014
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Quote:
 Originally Posted by sashabeliimd 25yr old dude w/ type I diabetes comes to you cuz of poor diabetic control for 3 months. He has ketones in his urine, and his blood glucose conc. has been in 200-400 mg/dl range, particularly after exercise. he has been receiving 2 injections of insulin daily. Physical exam shows no abnormalities. His HA1C is 12%. After exercising on treadmill for 45 minutes, that patient has a increase in serum glucose from 175 to 225 mg/dl. Which of the following hepatic enzymes is most likely elevated initially by exercise in this patient? A. Debranching ezyme B. Phopholicpase C C. Phosphorylase kinase D. Portein Kinase B
debranching enzyme only breaks the 1,6 glucosidic bonds (at the branch points), whereas muscle phosphorylase is the rate limiting enzyme of glycogenolysis that releases G-1-P by breaking a 1.4 glycosidic linkages.
#13
12-05-2014
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The graph shows the response elicited by different concentrations of drug X in a system containing spare receptors in the absence (solid curve) and presence (dashed curves) of two different concentrations of drug Y. Drug Y alone has no effect.

[​IMG]
Which of the following best describes drug Y?
A. Competitive reversible antagonist
B. Full agonist
C. Inverse agonist
D. Noncompetitive antagonist
E. Partial agonist
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#14
12-05-2014
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Quote:
 Originally Posted by sashabeliimd The graph shows the response elicited by different concentrations of drug X in a system containing spare receptors in the absence (solid curve) and presence (dashed curves) of two different concentrations of drug Y. Drug Y alone has no effect. ​ [​IMG] Which of the following best describes drug Y? A. Competitive reversible antagonist B. Full agonist C. Inverse agonist D. Noncompetitive antagonist E. Partial agonist
Answer is D
#15
12-05-2014
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Tricky quetion

a investigator is developing a new drug, X to protect health care workers after accidental inoculation with blood containing HIV. the drug is designed to block viral entry into the cell. which of the following is the most appropriate target for Drug X?
CD8
Chemokine receptor
Fc receptor
HIV protease
Integrase
IL2 receptor
reverse transcriptase
Tat protein

#16
12-05-2014
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Hi

Quote:
 Originally Posted by sashabeliimd a investigator is developing a new drug, X to protect health care workers after accidental inoculation with blood containing HIV. the drug is designed to block viral entry into the cell. which of the following is the most appropriate target for Drug X? CD8 Chemokine receptor Fc receptor HIV protease Integrase IL2 receptor reverse transcriptase Tat protein
C-C chemokine receptor type 5, also known as CCR5 or CD195, is a protein on the surface of white blood cells that is involved in the immune system as it acts as a receptor for chemokines. This is the process by which T cells are attracted to specific tissue and organ targets. Many forms of HIV, the virus that causes AIDS, initially use CCR5 to enter and infect host cells. A few individuals carry a mutation known as CCR5-Δ32 in the CCR5 gene, protecting them against these strains of HIV.

In humans, the CCR5 gene that encodes the CCR5 protein is located on the short (p) arm at position 21 on chromosome 3. Certain populations have inherited the Delta 32 mutation resulting in the genetic deletion of a portion of the CCR5 gene. Homozygous carriers of this mutation are resistant to M-tropic strains of HIV-1 infection
#17
12-05-2014
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Hi

3) A 10 year old boy is brought to physician by his parents for a follow up examination because of mental retardation and pigmentary anomalies. He underwent an operation at the age of 3 years to correct syndactyly between the middle and ring fingers bilaterally. Physical examination shows streaky hyperpigmentation. Chromosomal analysis shows 46, XY in 15 cells and 69 XXY in 5 cells. Which of the following is the most likely explanation of the karyotype findings?
a) deletion
b) duplication
c) inversion
d) mosaicism
e) ring chromosome
f) translocation

I think and choice MOSAICISM,
#18
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hi

Quote:
 Originally Posted by sashabeliimd 3) A 10 year old boy is brought to physician by his parents for a follow up examination because of mental retardation and pigmentary anomalies. He underwent an operation at the age of 3 years to correct syndactyly between the middle and ring fingers bilaterally. Physical examination shows streaky hyperpigmentation. Chromosomal analysis shows 46, XY in 15 cells and 69 XXY in 5 cells. Which of the following is the most likely explanation of the karyotype findings? a) deletion b) duplication c) inversion d) mosaicism e) ring chromosome f) translocation I think and choice MOSAICISM,
Presence of different pairs of chromosomes in some cells...
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#19
12-05-2014
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Hi quizzes for nbme 11

Methotrexate anticancer effects? Inhibition of Thymidilate Synthase
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Optimal diagnostic cut point for results of test need to include all of the "infected"
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Best likelihood of survival of colorectal carcinoma? Poorly differentiated carcinoma confined to mucosa
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-PPD skin test, predominance of what cell types? Macrophages
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-High thyroid during pregnancy due to what? Estrogen
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-Histology of Type I DM pancreas? cell necrosis with inflammatory infiltrate
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-Decreased amniotic fluid and normal size fetal kidney, bladder and ureter distended, what is the problem? posterior urethral valves
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CSF gram stain shows spore forming, gram+ bacilli, widening of mediastinum, what is the virulence factor that enable to avoid phagocytosis? polyglutamic acid (Anthrax)
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Why do mitochondrial have their own tRNA? Because they use non-standard genetic code
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Bicylclist with back program and erectile dysfunction, has back tenderness and hemorrhoids. What cause erectile dysfunction? Damaged blood and nerve supply to erectile tissues
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CHF patient has pleural effusions, pleural fluid: 80 glucose, 2 protein, 25 LDH, 500 nucleated cell ct. What is cause? Increased hydrostatic pressure
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-What causes the contraction of skin after several weeks of healing? Myofibroblast activity
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Parkinson's disease with history of major depressive disorder, treated with fluoxetine. What antiparkinsonian drug is contraindicated? Selegiline (MAO Inhibitor)
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-Withdrawal symptoms and yawn a lot, dilated pupil? Heroin withdrawal
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-Secretin increase what? Pancreatic bicarb
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Diabetic patient with poor glycemic control, what is activated early when he goes exercising? Phosphorylase kinase
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-left eyelid drooping, weakness on right side. what is diagnosis? Lower midbrain lesion (Weber syndrome)
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Drug Y at 1 um decrease potency but doesn't decrease Vmax, Drug Y at 10um decrease potency AND Vmax, Drug Y by itself has no effect, what is Drug Y to X Noncompetitive antagonist
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2 day history of progressive confusion, fever, when he speaks, he enunciate clearly. Words uttered made no sense. Does not follow commands, what is diagnosis? Meningococcal meningitis
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-Surgical neck fracture, what is cutaneous problem? Lateral aspect of arm lose sensation (axillary nerve)
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Drug X is to design blocking HIV entry into cell. What is the appropriate target for Drug X? Chemokine receptor (CCR4, CXCR5)
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Jaundice, with blood regurgitation, elevated ALP (AST and ALT normal). What GI pathology? Esophageal varices
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Fluid in abdominal cavity has specific gravity greater than 1.020, numerous leukocytes, cellular debris. what describe the fluid? Transudate
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-Levofloxacin resistance, how? mutation of gene encoding topoisomerase II
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Painless jaundice, dark urine and pale stool, CT has large poorly defined soft tissue density at head of pancreas. what causes jaundice? Common bile duct obstruction
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10 year old boy, 46 XY in 15 cells and 69XXY in 5 cells, what is explanation of the finding? Mosaicism
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-HTN and Raynauds disease, what antihypertensive drug will help both? Nifedipine
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-diaper rash and swelling of hands and feet, face and lips are red, conjunctivae injected, bilateral cervical lymphadenopathy, S3 gallop no murmur, edema and erythema of hands and feet, what pathological process will be found? Acute arteritis with aneurysm in coronary arteries (Kawasaki disease)
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Central california, mild eosinophilia, patchy bronchopneumonia. Culture grow mold show in picture, what is problem? Coccioides immitis
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-Treatment of precocious puberty Leuperlide
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Gradual onset of fatigue, fever, pain in muscle during past 3 weeks, lost 8 lbs, takes no medication, fever, BP 140/95, trunks and extremities has areas of raised, reticular, cyanotic discoloration consistent with lived reticularis. left foot drop. Has p-ANCA. what is diagnosis? Vasculitis
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-What best to classify N. meningitides into serogroup? Antibodies to capsular polysaccharide
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-Long face, prominent ears, large testes, has 800 CGG repeat. What is the effect of the repeats on transcription of FMR1 mRNA? Decrease transcription
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-Cuase of PSGN? Strep Pyogenes (Group A strep)
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3 week old newborn brought to physician because recurrent vomiting after feeding. Eager to feed even after vomiting. Abdomen with 1-2 cm mobile mass in epigastrium to right of midline. If condition have lower threshold of liability in males than females, which relative have greatest risk to also develop this disorder? Brother, if newborn is Female
(??)
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2 month old boy with failure to thrive and poor feeding. Jaundice, cataracts, hepatomegaly. Decreased glucose concentration. Urine has positive reaction to copper reduction test, negative reaction to glucose oxidase. Deficiency of what enzyme? Galactose-1-phosphate uridultransferase (Classic galactossemia)
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-What stimulate VEGF in tumor mass? Decreased PO2
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Cleft lip cause? Failure of maxillary and nasal prominences to fuse
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Decarease NE effect, decrease Phenylephrine effect, what drug is it? Prazosin
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Swollen, itchy eyes, runny nose, sneezing for past week. What history is important to establish diagnosis? New pet in threshold (allergy)
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-Bosentan, blockade of what? Endothelin recepotrs
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Mom thinks kids are lazy and fight with each other, she is poor and uses portable heater. kids have headache and dizzy. What is initial action? Need to assess possibility of CO poisoning
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Husband call to find out diagnosis for wife, what should you say? I am sorry, but i cannot tell you anything about your wife's diagnosis without her permission
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-Polio vaccine, what does it do? Increase neutralizing antibodies in circulation
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Rapidly progressive degenerative neurologic disease at Pacific Ocena island. Infected cells have RNA dependent DNA polymerase activity. What is the virus? HIV
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Infection with Staph Aureus, Serum electrophoresis show what pattern? normal albumin. Elevated alpha, beta1, beta2. Low gamma.
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76 year old women with severe back pain for past 2 weeks. Taking prednisone for RA for 6 months and has HRT with estrogen for 15 years. X ray show vertebral fracture. Cuase? Decreased bone formation due to inhibition of osteoblast differentiation
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-Hypersalivation, fever, confusion, right arm weakness, tingling, numbness. what animal? Bat (rabies)
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Lyme disease picture. The likely cause of this patient's infection is taxonomicaly and morphologically most similar to infection agent of which condition? Letpospirosis (because this is also a spirochete)
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50 year old with menopause symptoms. Has atrophic vaginal mucosa. Pap smear with increased paranasal epithelia cells with no dysplasia. Due to decrease production of what? Steroid hormones by ovarian follicles
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-Kidney venous PO2 is higher than others, why? Ratio of oxygen consumption to blood flow is lower in kidney than in other organs
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-Mycoplasma. DOC? Azithromycin (Macrolide)
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500 worker with bladder cancer, 200 without bladder cancer. Bladder cancer: 250 has exposure. No bladder cancer: 50 have exposure. What is odds ratio? 3.0 (OR= De Hne / Dne He)
-De=disease exposed
-Hne=healthy not exposed
-Dne=disease not exposed
-He=healthy exposed
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-Gastric band surgery, needs to pass through what? Lesser omentum
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X-ray of chest. Where is the valve replacement Tricuspid (show on the middle right behind sternum)
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-Panic disorder, drug activates benzodiazepine binding sites on GABA. what is the drug? Alprazolam
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Men with purulent urethral discharge and dysuria. Found Gonorrhea, treated with ceftriaxone. Symptoms go away for 2 days, but discharge come back. Why? Has infection with both N. gonorrhea and chlamydia
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-Cuase of bacteria vaginosis Gardnerella vaginosis
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E coli has resistance. Carried by plasmid. What observation best support the hypothesis? Transfer require cell to cell contact
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-What is most useless tendon that can be used to fix others? palmaris longus
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-Anticough drug other than codeine? Dextromethorphan
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Drug that act as D2 receptor agonist. what is drug? Ropinirole
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-Neutrophil chemotaxis and oxidative metabolism are defective due to increase activity of which enzymes? Adenylyl cyclase
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-Sign of irreversible cell injury? Disruption of plasma membrane
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Female infant dies at 12 days. Autopsy shown, what is the infant most likely infected by? Hyperbilirubinemia
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After open carpal tunnel release operation, new numbness of right thenar eminence. Has shock like sensation radiating to affected area. Which nerve injury during operation? Palmer cutaneous branch of median nerve
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-AST and ALT high, no other risk factors except for fat and HTN with thiazide. Why high AST and ALT? Nonalcoholic steatohepatitis
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-HIV patient has dysarthria for 3 months, homonymous heminopia. Has enhancing lesion in cortex. Diagnosis? Lymphoma
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Gene product of CMV cause translocation of nascent MHC I from endoplasmic reticulum into cytosol. What will occur regarding to MHC I? Degradation by proteosome
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Women with Crohns disease has radio labeled laculose. She execrate more lactulose than normal subject. What inflammation associated changes in integrity of what epithelial structure? Tight junctions (zona occludens)
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-Adipocyte play important role in maintaining homeostasis when fasting. how? Glucagon activate hormone sensitive lipase
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-Invasive melanoma with regression. Why regression? T lymphocyte mediated cytotoxicity
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-NNRTI mechanism? block replication of HIV genome in host cells
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Need to reach involved vessels that feed leiomyoma, what is most direct course of catheter after entering femoral artery? External iliac artery->internal iliac artery->uterine artery
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Treat oral candidiasis? Nystatin
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-Cause of renal cell carincoma. Risk factor? 2- napthylamine exposure
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Tingling and numbness of his hands. Has NHL. What medication cause this finding? Vincristine
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-Albuterol MOA? beta 2 agonist->increase cAMP in smooth muscle
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Biopsy of lung shows anapestic, biphasic neoplasm that express calretinin, cytokeratin but not carcinoembryonic antigen. What additional structure in lung tissue?
-Work as insulation installer Ferruginuous bodies (Asebetos!)
 The above post was thanked by: anoopreddy27 (10-30-2015), avid_learner (02-13-2016), Drsouheyla (12-23-2014)
#20
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Pancreatic obstruction quetion

Bile duct obstructionShare on facebookShare on twitterBookmark & SharePrinter-friendly version
Bile duct obstruction is a blockage in the tubes that carry bile from the liver to the gallbladder and small intestine.

Related topics include:

Acute cholecystitis
Choledocholithiasis
Gallstones
Causes
Bile is a liquid released by the liver. It contains cholesterol, bile salts, and waste products such as bilirubin. Bile salts help your body break down (digest) fats. Bile passes out of the liver through the bile ducts and is stored in the gallbladder. After a meal, it is released into the small intestine.

When the bile ducts become blocked, bile builds up in the liver, and jaundice (yellow color of the skin) develops due to the increasing levels of bilirubin in the blood.

The possible causes of a blocked bile duct include:

Cysts of the common bile duct
Enlarged lymph nodes in the porta hepatis
Gallstones
Inflammation of the bile ducts
Narrowing of the bile ducts from scarring
Injury from gallbladder surgery
Tumors of the bile ducts or pancreas
Tumors that have spread to the biliary system
Liver and bile duct worms (flukes)
The risk factors include:

History of gallstones, chronic pancreatitis, or pancreatic cancer
Injury to the abdominal area
Recent biliary surgery
Recent biliary cancer (such as bile duct cancer)
The blockage can also be caused by infections. This is more common in persons with weakened immune systems.

Symptoms

Abdominal pain in the upper right side
Dark urine
Fever
Itching
Jaundice (yellow skin color)
Nausea and vomiting
Pale-colored stools
Exams and Tests
Your doctor or nurse will examine you and feel your belly.

The following blood test results could be due to a possible blockage:

Increased bilirubin level
Increased alkaline phosphatase level
Increased liver enzymes
The following tests may be used to investigate a possible blocked bile duct:

Abdominal ultrasound
Abdominal CT scan
Endoscopic retrograde cholangiopancreatography (ERCP)
Percutaneous transhepatic cholangiogram (PTCA)
Magnetic resonance cholangiopancreatography (MRCP)
A blocked bile duct may also alter the results of the following tests:

Amylase blood test
Gallbladder radionuclide scan
Lipase blood test
Prothrombin time (PT)
Urine bilirubin
Treatment
The goal of treatment is to relieve the blockage. Stones may be removed using an endoscope during an ERCP.

In some cases, surgery is required to bypass the blockage. The gallbladder will usually be surgically removed if the blockage is caused by gallstones. Your health care provider may prescribe antibiotics if an infection is suspected.

If the blockage is caused by cancer, the duct may need to be widened. This procedure is called endoscope or percutaneous (through the skin next to the liver) dilation. A tube may need to be placed to allow drainage.
#21
12-05-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hi

Done with first block ,40/50 corect anwers, going to second....
#22
12-06-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hi

Question had a CXR with major stuff in the L chest and the stem gave a "anaplastic, biphasic neoplasm that expresses calretinin and cytokeratin but not carcinoembryonic antigen"

I got that question wrong too, but a quick search on google seems to indicate that cytokeratin and calretinin are associated with mesothelioma. Biphasic is also a histological subtype of mesothelioma. CEA would be positive in lung adenocarcinoma, so they were probably just trying to say that it wasn't an adenocarcinoma. The mesothelioma was associated with asbestos as you mentioned, so they were looking for ferruginous bodies.
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#23
12-06-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370

During a study of the response of renal tubular cells to ischemic injury, the blood supply to the kidneys in experimental animals is interrupted for variable lengths of time. The renal tubular cells then are examined by light and electron microscopy. The presence of which of the following features would definitively indicate irreversible injury to the renal tubular cells?

Blunting of microvilli
Cellular swelling
Disaggregation of ribosomes
Disruption of the plasma membrane
Loosening of intercellular attachments
#24
12-06-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370

Quote:
 Originally Posted by sashabeliimd During a study of the response of renal tubular cells to ischemic injury, the blood supply to the kidneys in experimental animals is interrupted for variable lengths of time. The renal tubular cells then are examined by light and electron microscopy. The presence of which of the following features would definitively indicate irreversible injury to the renal tubular cells? Blunting of microvilli Cellular swelling Disaggregation of ribosomes Disruption of the plasma membrane Loosening of intercellular attachments
Disruption of plasma membrane indicate irreversible damage...
#25
12-06-2014
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A 62-year-old man is brought to the physician by his wife because of increasing confusion during the past 6 months. His wife says that he has become lost twice in the past month when going to work, even though he has been going to the same office for 12 years. She adds that he often has difficulty finding objects such as his glasses and keys, sometimes
cannot recall his grandchildren’s names, and has become very critical of her cooking, which he used to enjoy. When asked, he can name only the current president and none of the candidates for an upcoming presidential election, although he and his wife watch the television news together each night. Neurologic examination shows no motor or sensory abnormalities. His Mini-Mental State Examination score is 19/30. Treatment with a cholinesterase inhibitor is most likely to improve this patient’s memory because of its ability to target synaptic connections between which of the following structures?

A) The basal forebrain and neurons in the cerebral cortex
B) The dentate nucleus and the thalamus
C) The fornix and neurons in the mammillary bodies
D) The substantia nigra and the neurons of the globus pallidus
E) The thalamus and neurons in layer 4 of the cerebral cortex

#26
12-06-2014
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Quote:
 Originally Posted by sashabeliimd A 62-year-old man is brought to the physician by his wife because of increasing confusion during the past 6 months. His wife says that he has become lost twice in the past month when going to work, even though he has been going to the same office for 12 years. She adds that he often has difficulty finding objects such as his glasses and keys, sometimes cannot recall his grandchildren’s names, and has become very critical of her cooking, which he used to enjoy. When asked, he can name only the current president and none of the candidates for an upcoming presidential election, although he and his wife watch the television news together each night. Neurologic examination shows no motor or sensory abnormalities. His Mini-Mental State Examination score is 19/30. Treatment with a cholinesterase inhibitor is most likely to improve this patient’s memory because of its ability to target synaptic connections between which of the following structures? A) The basal forebrain and neurons in the cerebral cortex B) The dentate nucleus and the thalamus C) The fornix and neurons in the mammillary bodies D) The substantia nigra and the neurons of the globus pallidus E) The thalamus and neurons in layer 4 of the cerebral cortex
Alheimer disease, and affected basal forebrain

http://en.wikipedia.org/wiki/Nucleus_basalis_of_Meynert

Function
The primary concentration of cholinergic neurons/cell bodies that project to the neocortex are in the basal nucleus of Meynert which is located in the substantia innominata of the anterior perforated substance. These cholinergic neurons have a number of important functions in particular with respect to modulating the ratio of reality and virtual reality components of visual perception.[2] Experimental evidence has shown that normal visual perception has two components.[2] The first (A) is a bottom-up component in which the input to the higher visual cortex (where conscious perception takes place) comes from the retina via the lateral geniculate body and V1. This carries information about what is actually outside. The second (B) is a top-down component in which the input to the higher visual cortex comes from other areas of the cortex. This carries information about what the brain computes is most probably outside. In normal vision, what is seen at the center of attention is carried by A, and material at the periphery of attention is carried mainly by B. When a new potentially important stimulus is received, the Nucleus Basalis is activated. The axons it sends to the visual cortex provide collaterals to pyramidal cells in layer IV (the input layer for retinal fibres) where they activate excitatory nicotinic receptors and thus potentiate retinal activation of V1.[3] The cholinergic axons then proceed to layers 1-11 (the input layer for cortico-cortical fibers) where they activate inhibitory muscarinic receptors of pyramidal cells, and thus inhibit cortico-cortical conduction.[3] In this way activation of Nucleus Basalis promotes (A) and inhibits (B) thus allowing full attention to be paid to the new stimulus. Goard and Dan,[4] and Kuo et al.[5] report similar findings. Gerrard Reopit, in 1984, confirmed the reported findings in his research.
#27
12-06-2014
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A ring-enhancing lesion is an abnormal radiologic sign on MRI or CT scans obtained using radiocontrast. On the image, there is an area of decreased density (see radiodensity) surrounded by a bright rim from concentration of the enhancing contrast dye. This can be a finding in numerous disease states. In the brain, it can occur with an early brain abscess as well as in Nocardia infections associated with lung cavitary lesions. In patients with HIV, the major differential is between CNS lymphoma and CNS toxoplasmosis. The ring enhancing lesions tend to be multiple in number and cerebral and basal in location in CNS toxoplasmosis.

MAGIC DR is an acronym for causation.

HIV is related to brain tumors like lymphomas, specific...
#28
12-06-2014
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Hi

6 weeks after undergoing open carpal tunnel release operation, 44 yr old woman comes to doc with new sx of numbness in the right hand. when asked about the exact location of these sx, she points to area over the right thenar eminence. percussion of the area between the flexor carpi radialis and palmaris longus tendons at the distal palmar wrist crease produces a painful shock like sensation radiating into the affected area of the palm. an intraoperative nerve injury is suspected. which of the following nerves is likely injured in this pt?

a) dorsal sensory branch of the ulnar n
b) lateral cutaneous nerve of the forearm
c) palmar cutaneous branch of the median n
d) recurrent motor branch of the median n
e) sensory branch of the radial n
#29
12-06-2014
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Quote:
 Originally Posted by sashabeliimd 6 weeks after undergoing open carpal tunnel release operation, 44 yr old woman comes to doc with new sx of numbness in the right hand. when asked about the exact location of these sx, she points to area over the right thenar eminence. percussion of the area between the flexor carpi radialis and palmaris longus tendons at the distal palmar wrist crease produces a painful shock like sensation radiating into the affected area of the palm. an intraoperative nerve injury is suspected. which of the following nerves is likely injured in this pt? a) dorsal sensory branch of the ulnar n b) lateral cutaneous nerve of the forearm c) palmar cutaneous branch of the median n d) recurrent motor branch of the median n e) sensory branch of the radial n

It's Palmar Cutaneous branch of Median, which supplies SENSORY to the thenar/palmar area upto the base of the lateral 3 digits. Sensory to the lateral 3 .5 digits is Common Palmar Digital branch of the Median. The Recurrent MOTOR branch of the Median n supplies motor innervation to the 3 thenar muscles.
#30
12-06-2014
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tendon of flesor carpi radialis injury

http://www.orthobullets.com/hand/603...endon-injuries

25 year old man is brought to the emergency department 4 hours after receiving a gunshot wound to his forarm during a hunting accident. An exploratory operation shows that the tendon of the flexor carpi radialis is severed, and there is a comminuted fracture of the distal radius; all other structures are intact. Due to the extent of the injury, an attempt to suture the severed ends of the carpi radialis tendon is unsuccessful. The tendon of which of the following muscles is most likely to be used to surgically bridge the gap between the severed ends of the injured tendon because functional loss would be insignificant?
a. flexor carpi ulnaris
b. flexor digitorum profundus
c.flexor digitorum superficialis
d. Palmaris longus
e. pronator teres

Can anybody give a short explanation?
Attached Thumbnails

#31
12-06-2014
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Hi

60 yr/old man develops pain,erythemia,and swelling of the right great toe, Serum urine concentration is 3 times normal. Which of the following finding is most common in pt with this condition?

a..Absence of Aminotransferase
b..Absence of glucose 6 phosphatase
c..Absence of glutatione peroxidase
d..Absence of HPGRT
e..No specific enzyme or renal effect
#32
12-06-2014
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Quote:
 Originally Posted by sashabeliimd 60 yr/old man develops pain,erythemia,and swelling of the right great toe, Serum urine concentration is 3 times normal. Which of the following finding is most common in pt with this condition? a..Absence of Aminotransferase nooo http://www.clinchem.org/content/43/9/1665.full b..Absence of glucose 6 phosphatase nooooooo c..Absence of glutatione peroxidase nooo d..Absence of HPGRT e..No specific enzyme or renal effect nooo

Hypoxanthine-guanine phosphoribosyl transferase (HPRT) normally plays a key role in the recycling of the purine bases, hypoxanthine and guanine, into the purine nucleotide pools (see the image below).

Purine metabolic pathways.
Purine metabolic pathways.
In the absence of HPRT, these purine bases cannot be salvaged; instead, they are degraded and excreted as uric acid. In addition to the failure of purine recycling, the synthetic rate for purines is accelerated, presumably to compensate for purines lost by the failure of the salvage process. The failure of recycling together with the increased synthesis of purines is the basis for the overproduction of uric acid.[2]

The increased production of uric acid leads to hyperuricemia. Since uric acid is near its physiologic limit of solubility in the body, the persistent hyperuricemia increases the risk of uric acid crystal precipitation in the tissues to form tophi. Uric acid crystal deposition in the joints produces an inflammatory reaction and gouty arthritis. The kidneys respond to the hyperuricemia by increasing its excretion into the urogenital system, increasing the risk of forming urate stones in the urinary collecting system. These stones may be passed as a sandy sludge or as larger particles that may obstruct urine flow and increase the risk of hematuria and urinary tract infections.

The pathogenesis of the neurologic and behavioral features is incompletely understood.[5] Neurochemical and neuroimaging studies have demonstrated significant abnormalities of dopamine neuron function in the basal ganglia that might account for the abnormal extrapyramidal neurologic signs and many of the behavioral anomalies. Neuropathologic studies suggest a neurodevelopmental defect, with no signs of a degenerative process.[3] However, the mechanism by which HPRT deficiency influences the basal ganglia, and particularly the dopamine systems, remains unknown.
#33
12-06-2014
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Hi

Seventy nine year old woman with dementia, DMII, and HTN brought in for chest pain and agitation for 4 hours. Smoked 2 packs a day until 70, when she quit. Pulse 120, RR 32, BP 180/100. Crackles are heard in both lung bases, with a systolic ejection murmur at the apex of the heart and regular rhythm. ECG shows ST-elevation in anterolateral leads. Chest X-ray shows mildly enlarged cardiac silhouette.

A. Acute Coronary Syndrom
B. Cerebrovascular Event
C. Acute Pericarditis
D. Bilateral Pneumonia
E. Pulmonary Embolism
#34
12-06-2014
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Hi

Quote:
 Originally Posted by sashabeliimd Seventy nine year old woman with dementia, DMII, and HTN brought in for chest pain and agitation for 4 hours. Smoked 2 packs a day until 70, when she quit. Pulse 120, RR 32, BP 180/100. Crackles are heard in both lung bases, with a systolic ejection murmur at the apex of the heart and regular rhythm. ECG shows ST-elevation in anterolateral leads. Chest X-ray shows mildly enlarged cardiac silhouette. A. Acute Coronary Syndrom B. Cerebrovascular Event C. Acute Pericarditis D. Bilateral Pneumonia E. Pulmonary Embolism
Chronic increased blood pressure, ,ejection murmur can give a sign of aortic stenosis, rythm is normal... Hypertrophy of the left ventricle will result with increased needs for O2 and nutrients, but because wall is too thick may occur some ischemia of the myocardium....
#35
12-06-2014
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Hi

a full-term 1 day old male newborn undergoes hearing screening. The newborn has no visible malformation or abnormalities. Results of otoacoustic emissions testing are abnormal. A subsequent diagnostic brain stem auditory evoked response is also abnormal. Which of the following is the most compelling reason for the newborn screening program?

a. although congenital hearing loss occurs infrequently, screening is cost-effective.
b. early diagnosis and treatment of hearing loss will prevent delay in motor development
c. identification and treatment of hearing loss before the age of 6 months will allow for better prognosis of speech and language development
d. newborn screening allows for more time to prepare hearing aids so the newborn can be fitted with them when he or she reaches the age of 1 year
e. newborn screening will identify these children who will require a cochlear implant after the age of 5 years

#36
12-06-2014
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Quote:
 Originally Posted by sashabeliimd a full-term 1 day old male newborn undergoes hearing screening. The newborn has no visible malformation or abnormalities. Results of otoacoustic emissions testing are abnormal. A subsequent diagnostic brain stem auditory evoked response is also abnormal. Which of the following is the most compelling reason for the newborn screening program? a. although congenital hearing loss occurs infrequently, screening is cost-effective. b. early diagnosis and treatment of hearing loss will prevent delay in motor development c. identification and treatment of hearing loss before the age of 6 months will allow for better prognosis of speech and language development d. newborn screening allows for more time to prepare hearing aids so the newborn can be fitted with them when he or she reaches the age of 1 year e. newborn screening will identify these children who will require a cochlear implant after the age of 5 years

This recommendation is based on studies that have shown that children identified with hearing loss prior to 6 months of age have a better chance of developing skills equivalent to their peers by the time they enter kindergarten. Children not identified until later (for example, it is very common to first identify hearing impaired children at age 2 to 3 years) may ultimately suffer from irreversible and permanent impairments in speech, language, and cognitive abilities when compared to their peers.
#37
12-06-2014
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Multidrug resistance E.coli is being investigated.the determinants of antibiotic resistance are tought to be carried on a plasmid that has been transferred among different bacterial strains
which of the following obsevations from in vitro studies best support this hypothesis?

1.Lysogeney must precede transfer
2.transfer is susceptible to DNase
3.Transfer requires a bacteriophage
4.Transfer reqires cell to cell contacts
5.Transfer reqires transformation competent receipent strain
#38
12-06-2014
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Quote:
 Originally Posted by sashabeliimd Multidrug resistance E.coli is being investigated.the determinants of antibiotic resistance are tought to be carried on a plasmid that has been transferred among different bacterial strains which of the following obsevations from in vitro studies best support this hypothesis? 1.Lysogeney must precede transfer 2.transfer is susceptible to DNase 3.Transfer requires a bacteriophage 4.Transfer reqires cell to cell contacts 5.Transfer reqires transformation competent receipent strain
That plasmid transfer between bacterias needs cell to cell contact through conjugation.And E coli is notorious for that.

Bacterial conjugation is the transfer of genetic material (plasmid) between bacterial cells by direct cell-to-cell contact or by a bridge-like connection between two cells.[1] Discovered in 1946 by Joshua Lederberg and Edward Tatum,[2] conjugation is a mechanism of horizontal gene transfer as are transformation and transduction although these two other mechanisms do not involve cell-to-cell contact.[3]

Bacterial conjugation is often regarded as the bacterial equivalent of sexual reproduction or mating since it involves the exchange of genetic material. During conjugation the donor cell provides a conjugative or mobilizable genetic element that is most often a plasmid or transposon.[4][5] Most conjugative plasmids have systems ensuring that the recipient cell does not already contain a similar element.

The genetic information transferred is often beneficial to the recipient. Benefits may include antibiotic resistance, xenobiotic tolerance or the ability to use new metabolites.[6] Such beneficial plasmids may be considered bacterial endosymbionts. Other elements, however, may be viewed as bacterial parasites and conjugation as a mechanism evolved by them to allow for their spread.

http://en.wikipedia.org/wiki/Bacterial_conjugation
#39
12-06-2014
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During experiment the us11 gene product of cytomegalovirus is expressed constitutively after stable transfection in an experiment tumoer cell line.it is found that this gene product causes translocation of nascent class 1 mhc molecules from the endoplasmic reticulum into cytosol.which of the following is most likely to occur regarding the class 1 mhc product??

a . association with invariant chain

b.binding of peptide from the endocytic pathway

c.degradation by the proteasome

d.formaton of class1mhc/mhc2 mhc hybrid molecules

e.interaction with the T lymphocyte receptor
#40
12-06-2014
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Quote:
 Originally Posted by sashabeliimd During experiment the us11 gene product of cytomegalovirus is expressed constitutively after stable transfection in an experiment tumoer cell line.it is found that this gene product causes translocation of nascent class 1 mhc molecules from the endoplasmic reticulum into cytosol.which of the following is most likely to occur regarding the class 1 mhc product?? a . association with invariant chain b.binding of peptide from the endocytic pathway c.degradation by the proteasome d.formaton of class1mhc/mhc2 mhc hybrid molecules e.interaction with the T lymphocyte receptor

for a second disregard the Cytomegali virus...... and think of the concept... mhc1 and mhc2

mhc 1 is associated with cytotoxic t cells = associated with endogenous viral infections
mhc 2 is associated with t helper cells [th1 and th2] = associated with exogenous bacterial infection

mhc 1 is found within the ER and encounters virus in small pieces [viral peptides or self peptide] within the cytoplasm after virus is broken down via TAP and then sent to CM for recognition

mhc 2 is within the cytoplasm from the beginning and gets its invariant chain degraded via the ↓ in PH than attaches to the bacteria and gets sent to Cell membrane for recognition

if the virus causes a translocation from the ER to cytosol that would mean that the MHC 1 molecule can't function normally like its suppose to and recognize endogenous viral proteins thus acting like a MHC 2 molecule.... but u see this molecule does not have a invariant chain therefore i assume it would attach to the bacteria without any effect from the PH so i would say either it forms a MHC HYBRID molecule [d] or be degraded by PROTEASOMES [c] and IN SUCH SCENARIO NATURAL KILLER CELLS WOULD TAKE OVER THE ACTION Where u have the absent of MHC 1 molecule.........

Class I MHC molecules bind peptides generated mainly from degradation of cytosolic proteins by the proteasome

Function
Class I MHC molecules bind peptides generated mainly from degradation of cytosolic proteins by the proteasome. The MHC Ieptide complex is then inserted into the plasma membrane of the cell. The peptide is bound to the extracellular part of the class I MHC molecule. Thus, the function of the class I MHC is to display intracellular proteins to cytotoxic T cells (CTLs). However, class I MHC can also present peptides generated from exogenous proteins, in a process known as cross-presentation.

A normal cell will display peptides from normal cellular protein turnover on its class I MHC, and CTLs will not be activated in response to them due to central and peripheral tolerance mechanisms. When a cell expresses foreign proteins, such as after viral infection, a fraction of the class I MHC will display these peptides on the cell surface. Consequently, CTLs specific for the MHCeptide complex will recognize and kill the presenting cell.

Alternatively, class I MHC itself can serve as an inhibitory ligand for natural killer cells (NKs). Reduction in the normal levels of surface class I MHC, a mechanism employed by some viruses during immune evasion or in certain tumors, will activate NK cell killing.
#41
12-06-2014
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Hi

Finished with second part of NBME 12...
#42
12-10-2014
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A 5-year-old girl is brought to a new physician by her mother for an examination prior to attending kindergarten. Her mother says, "My daughter has a murmur, but I was told that she'd grow out of it." The patient has no history of major medical illness. She is at the 50th percentile for height and weight. A grade 2/6 systolic murmur is heard over the left sternal border. Cardiac catheterization shows:
Location Pressure (mm Hg) O2 Saturation
Aorta 105/60 98%
Vena cava 7/2 75%
Pulmonary artery 25/9 85%
Right atrium 4 75%
Left atrium 8 98%
Right ventricle 25/4 83%
Left ventricle 105/8 98%

The failure of which of the following during embryonic development best explains this patient's condition?

A
)
Closure of the ductus venosus

B
)
Closure of the foramen ovale

C
)
Development of the septum secundum

D
)
Fusion of the interventricular septum with endocardial cushions

E
)
Reabsorption of the septum primum

VSD most common, and is heard a murmur along the left sternal border...
#43
12-10-2014
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A 2-month-old boy is brought to the phvsician because of failure to thrive
and poorfeeding since birth He was recentlv adopted from Romania and has
been fed cow's milk. He is below the 5th percentile for length and weight.
Physical examination shows jaundice. cataracts. and hepatomegaly. Serum
studies show a decreased glucose concentration. The urine shows a positive
reaction to a copper reduction test and a negative reaction to a test
agent that contains glucose oxidase.Deficiency of which of the following
hepatic enzymes is the most likely cause of the disorder in this patient?

A.Fructokinase
B.Fructose-1.6-bisphosphate aldolase
C.Galactokinase
D.Galactose-1-phosphate uridyltransferase
E.Glucose-6-phosphatase
#44
12-10-2014
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Quote:
 Originally Posted by sashabeliimd A 2-month-old boy is brought to the phvsician because of failure to thrive and poorfeeding since birth He was recentlv adopted from Romania and has been fed cow's milk. He is below the 5th percentile for length and weight. Physical examination shows jaundice. cataracts. and hepatomegaly. Serum studies show a decreased glucose concentration. The urine shows a positive reaction to a copper reduction test and a negative reaction to a test agent that contains glucose oxidase.Deficiency of which of the following hepatic enzymes is the most likely cause of the disorder in this patient? A.Fructokinase B.Fructose-1.6-bisphosphate aldolase C.Galactokinase D.Galactose-1-phosphate uridyltransferase >>>>>>>>>>>>>>>>>>>>>>>>>>>>>> E.Glucose-6-phosphatase
Cataracts>>>>>>>>>> galactose deficiency, and because is mostly severe form it will be galactose 1 phosphate uridyltransferase deficiency...
#45
12-10-2014
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Hi

A 3 yr old is brought to ER because he ingested his grandpa 's "heart pills" . ECG shows 3rd degree heart block with ventricular escape rhythm that resolves after giving Atropine. What drug did he ingest?

a) captopril
b)Digoxin
c) Hydrocholorthiazide
d)Isosorbide dinitrate(wrong)

#46
12-10-2014
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Quote:
 Originally Posted by sashabeliimd A 3 yr old is brought to ER because he ingested his grandpa 's "heart pills" . ECG shows 3rd degree heart block with ventricular escape rhythm that resolves after giving Atropine. What drug did he ingest? a) captopril b)Digoxin c) Hydrocholorthiazide d)Isosorbide dinitrate(wrong)
Signs and symptoms
Digitalis toxicity produces CNS, visual, GI, and cardiac manifestations. Nausea, vomiting, and drowsiness are among the most common extracardiac manifestations.

CNS symptoms of digitalis toxicity include the following:

Drowsiness
Lethargy
Fatigue
Neuralgia
Headache
Dizziness
Confusion or giddiness
Hallucinations
Seizures (rare)
Paresthesias and neuropathic pain
Visual aberration often is an early indication of digitalis toxicity. Yellow-green distortion is most common, but red, brown, blue, and white distortions also occur. Drug intoxication also may cause the following:

Snowy vision
Photophobia
Photopsia
Decreased visual acuity
Yellow halos around lights (xanthopsia)
Transient amblyopia or scotomata
GI symptoms in acute or chronic toxicity include the following:

Anorexia
Weight loss
Failure to thrive (in pediatric patients)
Nausea
Vomiting
Abdominal pain
Diarrhea
Mesenteric ischemia (a rare complication of rapid IV infusion)
Cardiac symptoms
Cardiac symptoms include the following:

Palpitations
Shortness of breath
Syncope
Swelling of lower extremities
Bradycardia
Hypotension
Dyspnea
See Clinical Presentation for more detail.

Diagnosis
Studies in patients with possible digitalis toxicity include the following:

Serum digoxin level
Electrolytes
Renal function studies
ECG
Serum digoxin level

Therapeutic levels are 0.6-1.3 to 2.6 ng/mL
levels associated with toxicity overlap between therapeutic and toxic ranges
False-negative assay results may occur with acute ingestion of nondigoxin cardiac glycosides (eg, foxglove or oleander)
levels determined less than 6-8 hours after an acute ingestion do not necessarily predict toxicity
The best way to guide therapy is to follow the digoxin level and correlate it with serum potassium concentrations and the patient's clinical and ECG findings.
Electrolytes

In acute toxicity, hyperkalemia is common
Chronic toxicity is often accompanied by hypokalemia and hypomagnesemia
Electrocardiography

Digoxin toxicity may cause almost any dysrhythmia
Classically, dysrhythmias associated with increased automaticity and decreased AV conduction occur
Sinus bradycardia and AV conduction blocks are the most common ECG changes in the pediatric population, while ventricular ectopy is more common in adults
Nonparoxysmal atrial tachycardia with heart block and bidirectional ventricular tachycardia are particularly characteristic of severe digitalis toxicity
#47
12-10-2014
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Hi

A 76-year-old woman comes to the physician because of severe back pain for the past 2 weeks. She has no history of smoking. She has been taking prednisone (30 mg/day) for rheumatoid arthritis for the past 6 months and has received hormone replacement therapy with estrogen and progesterone for the past 15 years. Calcium and vitamin D intake are adequate. X-rays of the spine show a vertebral fracture. Which of the following is the most likely cause of the fracture?​

A. Decreased bone formation due to decreased calcium absorption
B. Decreased bone formation due to inhibition of osteoblast differentiation
C. Increased bone resorption due to decreased calcium absorption
D. Increased bone resorption due to decreased serum parathyroid hormone concentration
E. Increased bone resorption due to estrogen receptor defect
#48
12-10-2014
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Hi

Quote:
 Originally Posted by sashabeliimd A 76-year-old woman comes to the physician because of severe back pain for the past 2 weeks. She has no history of smoking. She has been taking prednisone (30 mg/day) for rheumatoid arthritis for the past 6 months and has received hormone replacement therapy with estrogen and progesterone for the past 15 years. Calcium and vitamin D intake are adequate. X-rays of the spine show a vertebral fracture. Which of the following is the most likely cause of the fracture?​ A. Decreased bone formation due to decreased calcium absorption B. Decreased bone formation due to inhibition of osteoblast differentiation C. Increased bone resorption due to decreased calcium absorption D. Increased bone resorption due to decreased serum parathyroid hormone concentration E. Increased bone resorption due to estrogen receptor defect
Osteoporosis is one of the most serious adverse effects experienced by patients receiving long term corticosteroid therapy. Bone loss occurs soon after corticosteroid therapy is initiated and results from a complex mechanism involving osteoblastic suppression and increased bone resorption. There are a number of factors that may increase the risk of corticosteroid-induced osteoporosis [smoking, excessive alcohol (ethanol) consumption, amenorrhoea, relative immobilisation, chronic obstructive pulmonary disease, inflammatory bowel disease, hypogonadism in men, organ transplantation]. The initial assessment of patients about to start taking corticosteroids should include measurement of spinal bone density, urinary calcium level and plasma calcifediol (25-hydroxycholecalciferol) level; serum testosterone levels should also be measured when hypogonadism is suspected. Many different drugs have been used to prevent osteoporosis in patients receiving long-term corticosteroid therapy, including thiazide diuretics, cholecalciferol (vitamin D) metabolites, bisphosphonates, calcitonin, fluoride, estrogens, anabolic steroids and progesterone. At present, however, published studies have failed to demonstrate a reduction in the rate of fracture using different preventive pharmacological therapies in patients being treated with corticosteroids on a continuous basis. Among the drugs studied, bisphosphonates (pamidronic acid and etidronic acid) and calcitonin appear to be effective in increasing bone density. Cholecalciferol preparations have been reported to be effective in some, but not all, studies. Limited data have shown positive results with thiazide diuretics, estrogen, progesterone and nandrolone. When treating patients with corticosteroids, the lowest effective dose should be used, with topical corticosteroids used whenever possible. Auranofin may be considered in patients with corticosteroid-dependent asthma. Patients should take as much physical activity as possible, maintain an adequate daily intake of calcium (1000 mg/day0 and cholecalciferol (400 to 800 U/day), stop smoking and avoid excessive alcohol intake. It is important to detect and treat hypogonadism in men, if present, and to replace gonadal hormones in postmenopausal women or amenorrhoeic premenopausal women, and to detect and correct cholecalciferol deficiency. A thiazide diuretic should be considered if hypercalciuria is present (urinary calcium excretion in excess of 4 mg/kg/day). High-risk patients and those with established osteoporosis should be treated with bisphosphonates (cyclical etidronic acid or intravenous pamidronic acid), nasal calcitonin, or calcifediol or calcitriol. Patients receiving cholecalciferol preparations should be carefully monitored for hypercalciuria and hypecalcaemia.
#49
12-10-2014
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in an epidemiol study of workers in the aniline dye industry, 500 workers with bladder cancer and200 workers without baldder cancer are selected .the investig obtain a history of exposure to aniline dyes in the groups. among workers with bladder cancer, 250 have an exposure to aniline dyes and among the 200 without bladder cancer, 50 have a history of exposure . which of the following is the odds ratio for the v exposure variable?

A 0.33
B 0.5
C 1.0
D 1.5
E 2.0A wrong
F 3.0
#50
12-10-2014
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Quote:
 Originally Posted by sashabeliimd in an epidemiol study of workers in the aniline dye industry, 500 workers with bladder cancer and200 workers without baldder cancer are selected .the investig obtain a history of exposure to aniline dyes in the groups. Among workers with bladder cancer, 250 have an exposure to aniline dyes and among the 200 without bladder cancer, 50 have a history of exposure . Which of the following is the odds ratio for the v exposure variable? A 0.33 b 0.5 c 1.0 d 1.5 e 2.0a wrong f 3.0
or= ( disease+/disease-) in exposure + /( disease+/disease-) in nonexposure
or= 250/50 / 250/150 = 250*150/250*50=3
#51
12-10-2014
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Hi

This question is testing the concept and not the exact question. Look away if you don't want to see it before you attempt the exam.

Which of the following is the common feature between Inactivated Polio virus vaccine(Salk) and Attenuated Polio virus vaccine (Sabin)?

a) Activated CD8 cytotoxic lymphocytes effectors in the circulation
b) Activated CD8 cytotoxic lymphocytes effectors in the gut
c) Neutralizing antibodies in the circulation
d) Neutralizing secretory IgA antibodies in the gut
#52
12-10-2014
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Quote:
 Originally Posted by sashabeliimd This question is testing the concept and not the exact question. Look away if you don't want to see it before you attempt the exam. Which of the following is the common feature between Inactivated Polio virus vaccine(Salk) and Attenuated Polio virus vaccine (Sabin)? a) Activated CD8 cytotoxic lymphocytes effectors in the circulation b) Activated CD8 cytotoxic lymphocytes effectors in the gut c) Neutralizing antibodies in the circulation d) Neutralizing secretory IgA antibodies in the gut
http://www.who.int/immunization/docu...immunology.pdf
Attached Thumbnails

#53
12-10-2014
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Hi

A 30 year old woman comes to the physician for an initial evaluation. She has a history of illicit intravenous drug use and is now completing a methadone maintenance program. Physical exam shows scars in the antecubital fossae. A chest x-ray shows small nodules in the perihilar lung fields. A biopsy specimen from the perihilar regions will most likely show small foreign particles surrounded by which of the following?

A. Granulation Tissue

B. Granulomatous Inflammation

C. Hemosiderin-laden macrophages

D. Neutrophilic abscess

E. Proliferated capillaries.
#54
12-10-2014
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Quote:
 Originally Posted by sashabeliimd A 30 year old woman comes to the physician for an initial evaluation. She has a history of illicit intravenous drug use and is now completing a methadone maintenance program. Physical exam shows scars in the antecubital fossae. A chest x-ray shows small nodules in the perihilar lung fields. A biopsy specimen from the perihilar regions will most likely show small foreign particles surrounded by which of the following? A. Granulation Tissue B. Granulomatous Inflammation C. Hemosiderin-laden macrophages D. Neutrophilic abscess E. Proliferated capillaries.

Figure 1 A 28-year-old woman with a history of heroin use was admitted for increasing dyspnea. A chest radiograph (Panel A) showed diffuse bilateral pulmonary infiltrates that were predominantly interstitial. An open-lung biopsy was performed. Histologic analysis showed medial hypertrophy of medium-sized pulmonary arteries indicative of pulmonary hypertension, as well as occasional foreign-body granulomas. Polarized light microscopy (Panel B) revealed refractile particles in the outer portion of the wall of a pulmonary artery (hematoxylin and eosin, ×40). Electron microscopy of lung tissue showed the ultrastructural aspects of the embolized microcrystalline material in an alveolar septum (arrow in Panel C, ×2100; Panel D, ×6600). In intravenous drug users, pulmonary granulomatosis is due to the repeated formation of microemboli of foreign material resulting from the injection of suspensions of crushed tablets or the contents of capsules intended for oral consumption. The foreign material consists of insoluble microcrystals (cellulose, talc, or starch) used as inert filler substances in oral pharmaceutical preparations such as methadone and barbiturates. There is no specific treatment for granulomatous lung disease related to intravenous drug use.
Attached Thumbnails

#55
12-10-2014
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Hi

Quote:
 Originally Posted by sashabeliimd Quetion is about zona fasciculata, but which point is in graph?? B??
A is capsula
B zona GLomerulosa
C zona Fasciculata
D zona Reticularis
E probably is the medulary part of the adrenal gland...
#56
12-11-2014
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Hi

One day after a total abdominal hysterectomy with salpingo-oophorectomy for stage Ill cervical cancer, a 42-year-old woman has abdominal distention. She has passed only 200 mL of urine since the operation. Ultrasonography shows an accumulation of fluid in the abdominal cavity; the physician suspects that the fluid is urine. This patient most likely sustained injury to the ureter during intraoperative ligation of which of the following arteries?
A) Internal iliac artery
B) Ovarian artery
C) Pudendal artery
D) Superior vescicle arteries
E) Ureteric branches of the renal artery

(I guess this should be B) ovarian artery in the infundibulo-pelvic ligament)
#57
12-11-2014
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Quote:
 Originally Posted by sashabeliimd One day after a total abdominal hysterectomy with salpingo-oophorectomy for stage Ill cervical cancer, a 42-year-old woman has abdominal distention. She has passed only 200 mL of urine since the operation. Ultrasonography shows an accumulation of fluid in the abdominal cavity; the physician suspects that the fluid is urine. This patient most likely sustained injury to the ureter during intraoperative ligation of which of the following arteries? A) Internal iliac artery B) Ovarian artery C) Pudendal artery D) Superior vescicle arteries E) Ureteric branches of the renal artery (I guess this should be B) ovarian artery in the infundibulo-pelvic ligament)

Laparoscopic surgery has many advantages over traditional abdominal methods, including smaller incisions, less postoperative pain, less blood loss, lower infection rates, shorter hospital stays, faster recovery time, and faster return to work. Increasing use of laparoscopic surgery has led to reports of increasing numbers of urinary tract complications after such procedures. Most important among these injuries are those involving the ureter. With the increasing use of laparoscopic surgery, particularly laparoscopic hysterectomies, a concomitant increase has occurred in ureteral injuries reported to happen during this procedure.1 However, laparoscopic salpingo-oophorectomy is a procedure that also places the ureter at risk and is performed much more frequently than laparoscopic hysterectomy. The case detailed below is an example of such an occurrence. Interestingly, it is only the second case of this type of injury occurring specifying use of the Harmonic scalpel that could be found after an English literature review utilizing PubMed and Ovid databases from 1995 through 2008. This particular case also illustrates the advantages and potential disadvantages of the use of this instrument and energy source in gynecologic endoscopic surgery.
#58
12-11-2014
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Hi

lady with a baby with minimal fetal movement. no congenital anomoly family hx. ultrasound shows decreased amniotic fluid and normal sized fetal kidneys but the fetal bladder and ureters bilaterally are markedly distended. fetus is male. what is the abormaluty?
penile hypospadias
placental insuff.
PCKD
posterior urehtral valve
prostatic nodular hyperplasia
#59
12-11-2014
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Quote:
 Originally Posted by sashabeliimd lady with a baby with minimal fetal movement. no congenital anomoly family hx. ultrasound shows decreased amniotic fluid and normal sized fetal kidneys but the fetal bladder and ureters bilaterally are markedly distended. fetus is male. what is the abormaluty? penile hypospadias placental insuff. PCKD posterior urehtral valve prostatic nodular hyperplasia
Posterior Urethral Valves
What are posterior urethral valves (PUV)?
PUV is an abnormality of the urethra, which is the tube that drains urine from the bladder to the outside of the body for elimination. The abnormality occurs when the urethral valves, which are small leaflets of tissue, have a narrow, slit-like opening that partially impedes urine outflow. Reverse flow occurs and can affect all of the urinary tract organs including the urethra, bladder, ureters, and kidneys. The organs of the urinary tract become engorged with urine and swell, causing tissue and cell damage. The degree of urinary outflow obstruction will determine the severity of the urinary tract problems.

What causes posterior urethral valves?
PUV is the most common cause of severe types of urinary tract obstruction in children. It is thought to develop in the early stages of fetal development. The abnormality affects only males and occurs in about one in 8,000 births. This disorder is usually sporadic (occurs by chance). However, some cases have been seen in twins and siblings, suggesting a genetic component.

What are the symptoms of posterior urethral valves?
The syndrome may occur in varying degrees from mild to severe. The following are the most common symptoms of posterior urethral valves. However, each child may experience symptoms differently. Symptoms may include:

An enlarged bladder that may be detectable through the abdomen as a large mass

Urinary tract infection (usually uncommon in children younger than age 5 and unlikely in boys at any age, unless an obstruction is present)

Painful urination

Weak urine stream

Urinary frequency

Bedwetting or wetting pants after the child has been toilet trained

Poor weight gain

Difficulty with urination

The symptoms of PUV may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How are posterior urethral valves diagnosed?
The severity of the obstruction often determines how a diagnosis is made. Often, PUV is diagnosed by fetal ultrasound while a woman is still pregnant. Children who are diagnosed later often have developed urinary tract infections that require evaluation by a doctor. This may prompt your doctor to perform further diagnostic tests, which may include:

Abdominal ultrasound. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Voiding cystourethrogram (VCUG). A specific X-ray that examines the urinary tract. A catheter (hollow tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body) and the bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.

Endoscopy. A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the urinary tract. Tissue samples from inside the urinary tract may also be taken for examination and testing.

Blood test. A blood test may be ordered to assess your child's electrolytes and to determine kidney function.

http://www.stanfordchildrens.org/en/...ves--90-P03110
#60
12-11-2014
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Hi

A 37-year-old man comes to the emergency department because of a 10-day history of yellow skin, vague abdominal discomfort, and fatigue. His vital signs are within normal limits. Physical examination shows generalized icterus. Serum studies show:[/LEFT]
AST: 320 U/L
ALT: 340 U/L
Hepatitis B surface antigen(HBsAg): positiveIgM
anti-hepatitis B core antigen(HBcAg): positive
Anti-hepatitis D virus: negative

Direct damage to infected hepatocytes in this patient is most likely mediated predominantly by which of the following?​
A. Antibody against HBcAg
B. Antibody against HBsAg
C. Complement via the alternate pathway
D. Cytotoxic T lymphocytes -> pathogenesis of HVB -> Immunesystems kills our cells..
E. Viral cytopathic effect
#61
12-11-2014
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Hi

A 32-year-old woman comes to the physician because of intermittent
abdominal cramps and diarrhea. alternating with constipation. The stools
are loose and brown: there is no blood or mucus. She has had these
symptoms for 15 years. but they have become more frequent during the past
3 months. She has not had fever orweight loss. Colonoscopy 3 years ago
showed no abnormalities. She recently was promoted to a management
position at her company. She is 160 cm (5 ft 3 in] tall and weighs 75 kg
(165 lb]: BMI is 29 kg./m2. Her temperature is 37°C (98.6°F]. pulse is
72/'min. respirations are 16/min. and blood pressure is 130/76 mm Hg.
Examination shows no abnormalities. Test of the stool for occult blood is
negative. Which of the following is the most likely diagnosis?

A.Colon cancer
B.lnflamatory bowel disease
C.lrritable bowel syndrorne When you hear diarrhea, constipation, alternating, women, and examination shows nothing wrong suspect IBS.
D.Pancreatic insufficiency (Wrong)
E.Peptic ulcer disease
No blood and mucus rules out choices B&E with A as no wt loss BMI 29/kg. That leaves us two choices Was not sure of irritable bowel syn therefore I left the choice considering blood and mucus may precipitate as the name suggest. kindly explain with the correct answers.
#62
12-11-2014
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Sudden Death from ventricular hypertrophy...

Sudden and unexpected death is the most devastating and unpredictable complication of HCM, but only a minority of patients are actually at risk. Sudden death in HCM may occur without warning signs and is caused by lethal heart rhythm disturbances (called ventricular tachycardia and ventricular fibrillation) that probably originate from the disorganized heart muscle structure or from small scars. Patients are rarely aware of rhythm abnormalities that may precede sudden death; however, fluttering, pounding, or skipped beats (palpitations), as well as dizziness and fainting, should always be reported to the cardiologist.

While sudden death occurs most commonly in children and young adults, the risk extends into mid-life and beyond (although less frequently). Reaching a particular age does not therefore confer immunity from sudden death. Sometimes sudden collapse occurs with vigorous exertion on the athletic field; athletes with HCM should be disqualified from most organized sports to reduce their risk.

A number of risk factors for sudden death have been identified, although most patients will never experience a life-threatening rhythm. HCM patients should have a clinical risk assessment with history and physical examination, echocardiography, 24-hour ECG recording (Holter monitor), and exercise testing, and should be routinely evaluated by a cardiologist about every 12 months.
#63
12-11-2014
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Hi

6. 45 yo man has partial colectomy for carcinome. Which of the following indicated highest likelihood for survival for 5 years after the resection of the lesion.

Moderately diferentiated carcinoma invading the muscularis

mucin producing carcinome invasive to the serosal surface

mucrin producing carcinome metastatic to regional nodes

poorly differentiated carcinoma confined to mucosa

well differentiated carcinome with hepatic metastasis
#64
12-11-2014
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Quote:
 Originally Posted by sashabeliimd 6. 45 yo man has partial colectomy for carcinome. Which of the following indicated highest likelihood for survival for 5 years after the resection of the lesion. Moderately diferentiated carcinoma invading the muscularis mucin producing carcinome invasive to the serosal surface mucrin producing carcinome metastatic to regional nodes poorly differentiated carcinoma confined to mucosa well differentiated carcinome with hepatic metastasis
Grade and Differentiation

The grade of a tumor refers to its biologic aggressiveness.6 For carcinoid tumors and PNET, the grading system is based on the rate of proliferation, which is defined by the number of mitoses per 10 high-power microscopic fields or per 2 mm2 (mitotic rate), or as the percentage of tumor cells that immunolabel positively for the Ki-67 antigen (Ki-67 index).6 Mitotic rate and Ki-67 index are listed by tumor grade in Table 1. Briefly, low-grade tumors are characterized by low proliferative indices and are considered indolent in nature.7 High-grade tumors tend to be poorly differentiated, have high proliferative indices, and are thus very aggressive.7

http://www.carcinoid.com/health-care...62121348333814
#65
12-11-2014
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Hi

A 56 year old woman has recently diagnosed carcinoma of the breast. X-ray shows a tumor next to the right side of the heart. An enhanced CT scan with the tumor invading the pericardium is shown. Which of the following structures is most likely involved?

A) Coronary sinus
B) Greater splanchnic vein
C) Right phrenic nerve
D) Right vagus nerve
E) Thoracic duct
#66
12-11-2014
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Hi

Quote:
 Originally Posted by sashabeliimd A 56 year old woman has recently diagnosed carcinoma of the breast. X-ray shows a tumor next to the right side of the heart. An enhanced CT scan with the tumor invading the pericardium is shown. Which of the following structures is most likely involved? A) Coronary sinus B) Greater splanchnic vein noooooooooo C) Right phrenic nerve D) Right vagus nerve E) Thoracic duct
Anybody remember corect answer?
We see that opacity on the right side of the lateraly to the heart, but?
Attached Thumbnails

#67
12-11-2014
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Prenatal Diagnosis for Congenital Malformations and Genetic Disorders

Congenital abnormalities account for 20-25% of perinatal deaths. Many genetic disorders can be detected early in pregnancy using various noninvasive and invasive techniques. These techniques are outlined below.

Noninvasive techniques
Fetal visualization
Ultrasound
Fetal echocardiography
Magnetic resonance imaging (MRI)
Radiography
Screening for neural tube defects (NTDs) - Measuring maternal serum alpha-fetoprotein (MSAFP)
Screening for fetal Down syndrome
Measuring MSAFP
Measuring maternal unconjugated estriol
Measuring maternal serum beta-human chorionic gonadotropin (HCG)
Measuring inhibin
Separation of fetal cells from the mother's blood
Assessment of fetal-specific DNA methylation ratio[1]
Invasive techniques
Fetal visualization
Embryoscopy
Fetoscopy
Fetal tissue sampling
Amniocentesis
Chorionic villus sampling (CVS)
Percutaneous umbilical blood sampling (PUBS)
Percutaneous skin biopsy
Other organ biopsies, including muscle and liver biopsy
Preimplantation biopsy of blastocysts obtained by in vitro fertilization
Cytogenetic investigations
Detection of chromosomal aberrations
Fluorescent in situ hybridization
Molecular genetic techniques
Linkage analysis using microsatellite markers
Restriction fragment length polymorphisms (RFLPs)
Single nucleotide polymorphisms (SNPs) - DNA chip, dynamic allele-specific hybridization (DASH)
#68
12-11-2014
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A 45-year-old man with recently diagnosed early-onset Parkinson disease comes to the physician for a follow-up examination. He has a long history of major depressive disorder successfully treated with fluoxetine. Treatment with which of the following antiparkinsonian drugs is contraindicated in this patient?​
A. Amantadine
B. Benztropine
C. Levodopa
D. Ropinirole
E. Selegiline
#69
12-11-2014
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Quote:
 Originally Posted by sashabeliimd A 45-year-old man with recently diagnosed early-onset Parkinson disease comes to the physician for a follow-up examination. He has a long history of major depressive disorder successfully treated with fluoxetine. Treatment with which of the following antiparkinsonian drugs is contraindicated in this patient?​ A. Amantadine B. Benztropine C. Levodopa D. Ropinirole E. Selegiline
>>>>>>>>>>>>>>>>>>>>>

MAO plus SSRI is contraindicated..

Selective serotonin reuptake inhibitors (SSRIs), widely prescribed medications for the treatment of depression, obsessive-compulsive disorder, bulimia, anorexia nervosa, panic disorder, anxiety, and social phobia, have a high therapeutic to toxicity ratio. However, although they are associated with less toxicity than tricyclic antidepressants (TCAs), they are often involved in co-ingestions that can precipitate the potentially lethal serotonin syndrome (SS). (See Etiology.)

SS represents a constellation of signs and symptoms that manifest in the neuromuscular, autonomic nervous, and gastrointestinal systems, in which concentrations of serotonin receptors are the highest. SS represents the most severe end of a spectrum of serotonin excess and is characterized by mental status changes, neuromuscular hyperactivity, and autonomic instability. (See Prognosis and Presentation.)[1, 2]

The majority of all antidepressants prescribed in the United States are from the SSRI family.[3, 4] Commonly prescribed SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox). SSRI toxicity and other adverse drug reactions can occur with overdose, in combination with other medications, or, infrequently, at therapeutic doses. (See Etiology.)

SS is often caused by combinations of SSRIs with other proserotonergic agents, including the following:

Monoamine oxidase inhibitors (MAOIs)
TCAs
Trazodone (Desyrel)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Norepinephrine-dopamine reuptake inhibitors
Lithium
Opioids

Amphetamine/stimulants - Including methylphenidate (Ritalin); 3,4 methylenedioxymethamphetamine (MDMA, Ecstasy); cocaine; and herbal dietary supplements or nutraceuticals (St. John's wort, ginseng, and S-adenosyl-methionine)
All of these affect the production, release, or breakdown of serotonin at the presynaptic cleft, thereby increasing its levels and toxicity. Less frequently, SS can be precipitated by an overdose of a single SSRI.

Venlafaxine (Effexor) and duloxetine (Cymbalta) are serotonin-norepinephrine reuptake inhibitors (SNRIs) that are also associated with serotonin toxicity, as is the tetracyclic drug mirtazapine (Remeron), an alpha-2 adrenergic heteroreceptor blocking agent that causes increased norepinephrine and serotonin release in addition to blocking serotonin receptors.

Trazodone is a tetracyclic drug that blocks serotonin reuptake and also has an antagonistic effect at the serotonin 5HT2 receptor site.

Bupropion (Wellbutrin), a norepinephrine-dopamine reuptake inhibitor classified as neither an SSRI nor a TCA, is another commonly prescribed antidepressant that can precipitate SS; it is commonly involved in fatal antidepressant overdoses.

Several opioids are serotonergic and have been associated with SS. These include meperidine (Demerol), tramadol (Ultram), dextromethorphan, and pentazocine.

Numerous reports have described serotonin syndrome precipitated by combination of serotonergic drugs with the antimicrobial agent linezolid, which exhibits monoamine oxidase (MAO)-type effects.[5]

Pharmacokinetics
SSRIs are metabolized in the liver by cytochrome P-450 mixed function oxidase (MFO) microsomal enzymes. They are highly bound to plasma proteins and have a large volume of distribution. Peak plasma levels are reached in 2-10 hours. Half-lives for SSRIs are variable, but most have a half-life of 20-24 hours.[6] A notable exception is fluoxetine (Prozac) and its active metabolite, norfluoxetine, which have half-lives of 2-4 days and 8-9 days, respectively.

Hence, addition of serotonergic medications to a patient's regimen must not occur until 2-3 weeks after discontinuation of an SSRI. Some recommend a 5-week "wash-out" period for fluoxetine prior to initiation of an MAOI. (See Treatment.)[7, 8]

Complications
Complications of SSRI toxicity can include the following (see Prognosis):

Seizures
Arrhythmia
Rhabdomyolysis
Disseminated intravascular coagulation
Acute renal failure
Respiratory failure
#70
12-11-2014
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Hi

A randomized cohort study of drug X administered to subjects after a
myocardial infarction found that overall there was no decrease in
mortality compared with administration of a placebo after a myocardial
infarction. However. on review of the data. there were statistically fewer
deaths among drug X subjects in
the subgroup with nontransmural myocardial infarction than in the placebo
group. A retrospective assessment of the database available for drug X
supported the observation. Which of the following is the most appropriate
next step?

A.Cross-sectional population study of administration of drug X vs. placebo
after nontransmural myocardial infarction

B.Prospective. randomized. controlled study of administration of drug Xvs.
placebo after nontransmural myocardial infarction >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >

C.Treatment of all patients with drug X after myocardial infarction F

D.Treatment of only patients with nontransmural myocardial infarction with
drug X (wrong)

E.Treatment of only patients with transmural myocardial infarction with
drug X
#71
12-11-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Quetion with old man that have Alzheimer disease

Alzheimer's disease and the basal forebrain cholinergic system: relations to beta-amyloid peptides, cognition, and treatment strategies.
Auld DS1, Kornecook TJ, Bastianetto S, Quirion R.
Author information
Abstract

Alzheimer's disease (AD) is the most common form of degenerative dementia and is characterized by progressive impairment in cognitive function during mid- to late-adult life.

Brains from AD patients show several distinct neuropathological features, including extracellular beta-amyloid-containing plaques, intracellular neurofibrillary tangles composed of abnormally phosphorylated tau, and degeneration of cholinergic neurons of the basal forebrain. In this review, we will present evidence implicating involvement of the basal forebrain cholinergic system in AD pathogenesis and its accompanying cognitive deficits. We will initially discuss recent results indicating a link between cholinergic mechanisms and the pathogenic events that characterize AD, notably amyloid-beta peptides. Following this, animal models of dementia will be discussed in light of the relationship between basal forebrain cholinergic hypofunction and cognitive impairments in AD. Finally, past, present, and future treatment strategies aimed at alleviating the cognitive symptomatology of AD by improving basal forebrain cholinergic function will be addressed.
Copyright 2002 Elsevier Science Ltd.
#72
12-11-2014
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Hi

Hey i finished review and solving of nbme 11, think to be helpful for others in finding of some quetions, good luck for everyone...
#73
12-23-2014
 USMLE Forums Scout Steps History: Not yet Posts: 15 Threads: 1 Thanked 1 Time in 1 Post Reputation: 11
Still confused

I didn't get this Q yet. Isn't asking about to lose 2lb? How about answer C: 500 cal in 1/2h? That will be; If 500cal in 1/2h, so 1000 cal in h, so 7000cal(2lb) in 7h, 1h x day x week. Am I wrong?

Quote:
 Originally Posted by sashabeliimd 1 lb fat=3500 cal to lose 1 lb/week=lose 500cal/day (1week=7days) brisk walk 1 hour=lose 500 cal daily brisk walk 7 hour=lose 3500 cal weekly=1 pound answer d
#74
12-23-2014
 USMLE Forums Scout Steps History: Not yet Posts: 15 Threads: 1 Thanked 1 Time in 1 Post Reputation: 11
Answer B

Quote:
 Originally Posted by sashabeliimd Quetion is about zona fasciculata, but which point is in graph?? B??
Yes, answer b A - Capsule
B- Glomerulose - Aldos (Mineraloc)
C- Fasciculata - Cortis (Corticost)
D- Reticularis - Andro (Sex Horm)
E- Medulla

"The deeper you go the sweeter it gets"
 The above post was thanked by: ginseng plus (12-24-2014)
#75
12-23-2014
 USMLE Forums Master Steps History: 1+CK+CS+3 Posts: 1,109 Threads: 31 Thanked 521 Times in 394 Posts Reputation: 540

Quote:
 Originally Posted by WillyGarcia I didn't get this Q yet. Isn't asking about to lose 2lb? How about answer C: 500 cal in 1/2h? That will be; If 500cal in 1/2h, so 1000 cal in h, so 7000cal(2lb) in 7h, 1h x day x week. Am I wrong?
[QUOTE]10. A 28-year-old woman wants to lose weight. She is 160 cm (5 ft 3 in) tall and weighs 81.5 kg (180 ib); bmi is 32 kg/m2. She consumes 1800 calories daily and has a sedentary lifes tyle. Assume that there are 3500 calories per pound and that brisk walking consumes 500 calories per hour. Which of the following regimens is most likely to help her lose 0.9 kg (2 ib) weekly?

----calories per day--------brisk walking daily
a) decrease by 100------------- 1/2 hour
b) decrease by 100------------- 1 hour
c) decrease by 500------------- 1/2 hour
d) decrease by 500------------- 1 hours
e) no change ------------------- 1 hour
f) no change ------------------- 1/2 hours

1 lb fat=3500 cal

to lose 1 lb/week=lose 500cal/day (1week=7days)

brisk walk 1 hour=lose 500 cal daily

brisk walk 7 hour=lose 3500 cal weekly=1 pound

answer d[QUOTE]

Well I still think the answer is D though he didn't calculate it well.

Your objective is to loose 0.9kg or 2ib in a week (7days)

But we are told that 3500 calories is per 1ib
So 2ib is 7000 calories

So our goal is to loose 7000 in 7 days

Let's start.
If we decrease our daily calorie intake daily by 500 then we will loose 500x7= 3500 in a week.
Then also if we walk briskly for one hour daily then we will loose 500x7= 3500

So in all we would have lost 3500+3500=7000 in a week
So answer is D
__________________
In USMLE, “Any fool can know. The point is to understand.”
#76
12-23-2014
 USMLE Forums Scout Steps History: Not yet Posts: 15 Threads: 1 Thanked 1 Time in 1 Post Reputation: 11
Though is E

I answered D, and was incorrect. I think the Q. is directed to ask about Gout in a patient of this age and conditions, even when generally speaking the absence of HPRT as cause of uremia, could provoke Gout, I still think the "MOST COMMON IN PATIENTS WITH THIS CONDITION" should conduce us to Answer E

Quote:
 Originally Posted by sashabeliimd Hypoxanthine-guanine phosphoribosyl transferase (HPRT) normally plays a key role in the recycling of the purine bases, hypoxanthine and guanine, into the purine nucleotide pools (see the image below). Purine metabolic pathways. Purine metabolic pathways. In the absence of HPRT, these purine bases cannot be salvaged; instead, they are degraded and excreted as uric acid. In addition to the failure of purine recycling, the synthetic rate for purines is accelerated, presumably to compensate for purines lost by the failure of the salvage process. The failure of recycling together with the increased synthesis of purines is the basis for the overproduction of uric acid.[2] The increased production of uric acid leads to hyperuricemia. Since uric acid is near its physiologic limit of solubility in the body, the persistent hyperuricemia increases the risk of uric acid crystal precipitation in the tissues to form tophi. Uric acid crystal deposition in the joints produces an inflammatory reaction and gouty arthritis. The kidneys respond to the hyperuricemia by increasing its excretion into the urogenital system, increasing the risk of forming urate stones in the urinary collecting system. These stones may be passed as a sandy sludge or as larger particles that may obstruct urine flow and increase the risk of hematuria and urinary tract infections. The pathogenesis of the neurologic and behavioral features is incompletely understood.[5] Neurochemical and neuroimaging studies have demonstrated significant abnormalities of dopamine neuron function in the basal ganglia that might account for the abnormal extrapyramidal neurologic signs and many of the behavioral anomalies. Neuropathologic studies suggest a neurodevelopmental defect, with no signs of a degenerative process.[3] However, the mechanism by which HPRT deficiency influences the basal ganglia, and particularly the dopamine systems, remains unknown.
#77
12-24-2014
 USMLE Forums Master Steps History: --- Posts: 868 Threads: 78 Thanked 360 Times in 208 Posts Reputation: 370
Hey

Quote:
 Originally Posted by WillyGarcia I answered D, and was incorrect. I think the Q. is directed to ask about Gout in a patient of this age and conditions, even when generally speaking the absence of HPRT as cause of uremia, could provoke Gout, I still think the "MOST COMMON IN PATIENTS WITH THIS CONDITION" should conduce us to Answer E
I said it previously and have to remind for all again, if you want to receive a nice help with quetions, you are obligated with a constructed type of quetion.
Just type quetion in same mode as you see in form , it;s most easily to read and view in ansamble quetions...
Best luck for all...
#78
02-13-2016
 USMLE Forums Scout Steps History: 1+CK+CS Posts: 41 Threads: 23 Thanked 2 Times in 2 Posts Reputation: 12

Quote:
 Originally Posted by ginseng plus Methotrexate anticancer effects? Inhibition of Thymidilate Synthase  Optimal diagnostic cut point for results of test need to include all of the "infected"  Best likelihood of survival of colorectal carcinoma? Poorly differentiated carcinoma confined to mucosa  -PPD skin test, predominance of what cell types? Macrophages  -High thyroid during pregnancy due to what? Estrogen  -Histology of Type I DM pancreas? cell necrosis with inflammatory infiltrate  -Decreased amniotic fluid and normal size fetal kidney, bladder and ureter distended, what is the problem? posterior urethral valves  CSF gram stain shows spore forming, gram+ bacilli, widening of mediastinum, what is the virulence factor that enable to avoid phagocytosis? polyglutamic acid (Anthrax)  Why do mitochondrial have their own tRNA? Because they use non-standard genetic code  Bicylclist with back program and erectile dysfunction, has back tenderness and hemorrhoids. What cause erectile dysfunction? Damaged blood and nerve supply to erectile tissues  CHF patient has pleural effusions, pleural fluid: 80 glucose, 2 protein, 25 LDH, 500 nucleated cell ct. What is cause? Increased hydrostatic pressure  -What causes the contraction of skin after several weeks of healing? Myofibroblast activity  Parkinson's disease with history of major depressive disorder, treated with fluoxetine. What antiparkinsonian drug is contraindicated? Selegiline (MAO Inhibitor)  -Withdrawal symptoms and yawn a lot, dilated pupil? Heroin withdrawal  -Secretin increase what? Pancreatic bicarb  Diabetic patient with poor glycemic control, what is activated early when he goes exercising? Phosphorylase kinase  -left eyelid drooping, weakness on right side. what is diagnosis? Lower midbrain lesion (Weber syndrome)  Drug Y at 1 um decrease potency but doesn't decrease Vmax, Drug Y at 10um decrease potency AND Vmax, Drug Y by itself has no effect, what is Drug Y to X Noncompetitive antagonist  2 day history of progressive confusion, fever, when he speaks, he enunciate clearly. Words uttered made no sense. Does not follow commands, what is diagnosis? Meningococcal meningitis  -Surgical neck fracture, what is cutaneous problem? Lateral aspect of arm lose sensation (axillary nerve)  Drug X is to design blocking HIV entry into cell. What is the appropriate target for Drug X? Chemokine receptor (CCR4, CXCR5)  Jaundice, with blood regurgitation, elevated ALP (AST and ALT normal). What GI pathology? Esophageal varices  Fluid in abdominal cavity has specific gravity greater than 1.020, numerous leukocytes, cellular debris. what describe the fluid? Transudate  -Levofloxacin resistance, how? mutation of gene encoding topoisomerase II  Painless jaundice, dark urine and pale stool, CT has large poorly defined soft tissue density at head of pancreas. what causes jaundice? Common bile duct obstruction  10 year old boy, 46 XY in 15 cells and 69XXY in 5 cells, what is explanation of the finding? Mosaicism  -HTN and Raynauds disease, what antihypertensive drug will help both? Nifedipine  -diaper rash and swelling of hands and feet, face and lips are red, conjunctivae injected, bilateral cervical lymphadenopathy, S3 gallop no murmur, edema and erythema of hands and feet, what pathological process will be found? Acute arteritis with aneurysm in coronary arteries (Kawasaki disease)  Central california, mild eosinophilia, patchy bronchopneumonia. Culture grow mold show in picture, what is problem? Coccioides immitis  -Treatment of precocious puberty Leuperlide  Gradual onset of fatigue, fever, pain in muscle during past 3 weeks, lost 8 lbs, takes no medication, fever, BP 140/95, trunks and extremities has areas of raised, reticular, cyanotic discoloration consistent with lived reticularis. left foot drop. Has p-ANCA. what is diagnosis? Vasculitis  -What best to classify N. meningitides into serogroup? Antibodies to capsular polysaccharide  -Long face, prominent ears, large testes, has 800 CGG repeat. What is the effect of the repeats on transcription of FMR1 mRNA? Decrease transcription  -Cuase of PSGN? Strep Pyogenes (Group A strep)  3 week old newborn brought to physician because recurrent vomiting after feeding. Eager to feed even after vomiting. Abdomen with 1-2 cm mobile mass in epigastrium to right of midline. If condition have lower threshold of liability in males than females, which relative have greatest risk to also develop this disorder? Brother, if newborn is Female (??)  2 month old boy with failure to thrive and poor feeding. Jaundice, cataracts, hepatomegaly. Decreased glucose concentration. Urine has positive reaction to copper reduction test, negative reaction to glucose oxidase. Deficiency of what enzyme? Galactose-1-phosphate uridultransferase (Classic galactossemia)  -What stimulate VEGF in tumor mass? Decreased PO2  Cleft lip cause? Failure of maxillary and nasal prominences to fuse  Decarease NE effect, decrease Phenylephrine effect, what drug is it? Prazosin  Swollen, itchy eyes, runny nose, sneezing for past week. What history is important to establish diagnosis? New pet in threshold (allergy)  -Bosentan, blockade of what? Endothelin recepotrs  Mom thinks kids are lazy and fight with each other, she is poor and uses portable heater. kids have headache and dizzy. What is initial action? Need to assess possibility of CO poisoning  Husband call to find out diagnosis for wife, what should you say? I am sorry, but i cannot tell you anything about your wife's diagnosis without her permission  -Polio vaccine, what does it do? Increase neutralizing antibodies in circulation  Rapidly progressive degenerative neurologic disease at Pacific Ocena island. Infected cells have RNA dependent DNA polymerase activity. What is the virus? HIV  Infection with Staph Aureus, Serum electrophoresis show what pattern? normal albumin. Elevated alpha, beta1, beta2. Low gamma.  76 year old women with severe back pain for past 2 weeks. Taking prednisone for RA for 6 months and has HRT with estrogen for 15 years. X ray show vertebral fracture. Cuase? Decreased bone formation due to inhibition of osteoblast differentiation  -Hypersalivation, fever, confusion, right arm weakness, tingling, numbness. what animal? Bat (rabies)  Lyme disease picture. The likely cause of this patient's infection is taxonomicaly and morphologically most similar to infection agent of which condition? Letpospirosis (because this is also a spirochete)  50 year old with menopause symptoms. Has atrophic vaginal mucosa. Pap smear with increased paranasal epithelia cells with no dysplasia. Due to decrease production of what? Steroid hormones by ovarian follicles  -Kidney venous PO2 is higher than others, why? Ratio of oxygen consumption to blood flow is lower in kidney than in other organs  -Mycoplasma. DOC? Azithromycin (Macrolide)  500 worker with bladder cancer, 200 without bladder cancer. Bladder cancer: 250 has exposure. No bladder cancer: 50 have exposure. What is odds ratio? 3.0 (OR= De Hne / Dne He) -De=disease exposed -Hne=healthy not exposed -Dne=disease not exposed -He=healthy exposed  -Gastric band surgery, needs to pass through what? Lesser omentum  X-ray of chest. Where is the valve replacement Tricuspid (show on the middle right behind sternum)  -Panic disorder, drug activates benzodiazepine binding sites on GABA. what is the drug? Alprazolam  Men with purulent urethral discharge and dysuria. Found Gonorrhea, treated with ceftriaxone. Symptoms go away for 2 days, but discharge come back. Why? Has infection with both N. gonorrhea and chlamydia  -Cuase of bacteria vaginosis Gardnerella vaginosis  E coli has resistance. Carried by plasmid. What observation best support the hypothesis? Transfer require cell to cell contact  -What is most useless tendon that can be used to fix others? palmaris longus  -Anticough drug other than codeine? Dextromethorphan  Drug that act as D2 receptor agonist. what is drug? Ropinirole  -Neutrophil chemotaxis and oxidative metabolism are defective due to increase activity of which enzymes? Adenylyl cyclase  -Sign of irreversible cell injury? Disruption of plasma membrane  Female infant dies at 12 days. Autopsy shown, what is the infant most likely infected by? Hyperbilirubinemia  After open carpal tunnel release operation, new numbness of right thenar eminence. Has shock like sensation radiating to affected area. Which nerve injury during operation? Palmer cutaneous branch of median nerve  -AST and ALT high, no other risk factors except for fat and HTN with thiazide. Why high AST and ALT? Nonalcoholic steatohepatitis  -HIV patient has dysarthria for 3 months, homonymous heminopia. Has enhancing lesion in cortex. Diagnosis? Lymphoma  Gene product of CMV cause translocation of nascent MHC I from endoplasmic reticulum into cytosol. What will occur regarding to MHC I? Degradation by proteosome  Women with Crohns disease has radio labeled laculose. She execrate more lactulose than normal subject. What inflammation associated changes in integrity of what epithelial structure? Tight junctions (zona occludens)  -Adipocyte play important role in maintaining homeostasis when fasting. how? Glucagon activate hormone sensitive lipase  -Invasive melanoma with regression. Why regression? T lymphocyte mediated cytotoxicity  -NNRTI mechanism? block replication of HIV genome in host cells  Need to reach involved vessels that feed leiomyoma, what is most direct course of catheter after entering femoral artery? External iliac artery->internal iliac artery->uterine artery  Treat oral candidiasis? Nystatin  -Cause of renal cell carincoma. Risk factor? 2- napthylamine exposure  Tingling and numbness of his hands. Has NHL. What medication cause this finding? Vincristine  -Albuterol MOA? beta 2 agonist->increase cAMP in smooth muscle  Biopsy of lung shows anapestic, biphasic neoplasm that express calretinin, cytokeratin but not carcinoembryonic antigen. What additional structure in lung tissue? -Work as insulation installer Ferruginuous bodies (Asebetos!)

Just a quick correction: the specific gravity of the fluid is more than 1.020, many leukocytes and cell debris makes it a choice for EXUDATE not transudate.

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