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  #1  
Old 03-26-2015
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Default Path Practice

1. A 10 year old boy presented with complaint of easy fatigability and breathlessness. His GPE was palor +, icterus +. Hemoglobin electrophoresis is done and he was found to have HbSS . he denies taking any medications at home. Which of the following is true about his condition
A.Most common inheritance is autosomal recessive
B.Intravascular hemolysis
C.Increased incidence of brain tumors
D. Association with chronic liver disease
E. Splenectomy will be helpful

2. A 50 year old male smoker with 20 pack years presented with sudden onset of cough, chest pain, weight loss and an excruciating right knee joint pain. On examination he had areas if dark pigmented skin changes around the buttock and right hypochondria tenderness. Xray of the right knee showed fracture of the distal end of femur. Which of the following is most likely diagnosis?
A. Lung Abscess
B. Bronchiectasis
C. Metastatic deposits in lung
D. Hamartoma
E. ARDS

3. 7. A 25 year old clerk of the ministry of health had a routine annual medical checkup at the general hospital. The chest x-ray done showed a 2.7 cm diameter, spherical mass, and discrete mass in the outer middle of the right lung, there is no lung collapse or adenopathy. There are no other complaints. Which of the following history is most likely present
a. history of smoking cigarette 4 packs/day in the last 5 years
b. history of cough and hemoptysis
c. history of breast and colon cancer in the family
d. history of chest X ray few years ago with the same lesion with no appreciable change in size
e. history of significant alcohol consumption


4. A 72 year old Caucasian male is found to have diffuse gallbladder calcification as an incidental finding on abdominal xray. He denies any significant past medical history except an appendix operation done when he was 22 year of age. His vital signs are stable and physical examination is unremarkable. Which of the following is true about his condition

a. There is no increased risk of malignancy
b. There is increased risk of HCC
c. He has increased risk of colon cancer
d. It is associated with NSAIDís use


5. A 3 week old male born to a 23 year old Caucasian primigravada develops projectile non bilous vomiting after every meal. Abdominal inspection reveals prominent peristalsis in the epigastrium and an olive sized mass is felt on deep palpation of the right upper abdomen. What is the pathological feature in his condition?
A.Infection focus
B.Congenital duodenal atresia
C.Neoplastic cell proliferation
D.Inflammatory structure of pylorus
E.Neonatal hepatitis
F.Smooth muscle hypertrophy
G.Pancreatic juice accumulation
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  #2  
Old 03-29-2015
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1-a
2-c
3-d
4-a
5-f
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Last edited by spasemaster; 03-30-2015 at 01:33 AM. Reason: chose A instead of C in question 4 as in an elderly a calcified GB might be a normal finding maybe
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  #3  
Old 03-29-2015
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Default

I think:

A
C
E
A
F
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  #4  
Old 03-30-2015
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1. A, 2. C, 3. D, 4. A, 5. B
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  #5  
Old 03-30-2015
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can somebody explain answer to # 3
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Old 03-30-2015
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Correct Answer

Well, Q3: I don't have the answer key to those questions so I can't be sure about the answer but I'll tell ya how I made up my mind about it.
The patient doesn't have cancer b/c:
1-YOUNG 25yo
2-Asymptomatic
3-Haven't been smoking for too long (only 4 years, although smoking alot but still)
4-There's no adenopathy

Now, excluding the other choices:
A- we said why NOT above.
B-It already says in the stem of the question that patient has no other complains (symptoms)
C-Also not b/c the patient is too young and asymptomatic (eg, diarrhea, bowel obstruction, cachecxia) and also if it were metastasis you would usually find multiple lesions in the lung >2.
D-I think is the correct answer as this patient could have a hamartoma. USMLE is soo keen on you knowing that the first step in evaluating a patient with a lung mass, the FIRST step in evaluating the patient is to obtain old CXR and check if the same lesion was there or not (grew in size or not). If it's of the same size as before then it's benign.
E-I get the idea that by that option they want me to think of aspiration (lung abscess due to aspiration is very common in alcoholics) but that would present with a high fever foul smelling mouth odor and so on.



By the way, Answer to question 5 Can NOT be "duodenal atresia" first of all because that would present after birth (not after 3 weeks) second the vomiting would be BILIOUS. It's very classical of Pyloric hypertrophy to present at 3 weeks of age with non-bilious vomiting.
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