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  #1  
Old 07-20-2012
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Arrow NBME 13 Discussion

we all know that gemfibrozil and simvastatin combo will lead to severe myopathy.

is it due to gemfibrozil inhibiting cytochrome p450 leading to increased levels of statin and subsequent myopathy????? am i right or any other reason behind this?????
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  #2  
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I checked Kaplan Pharma- nothing clear about p450 so I google it.
I found this article - Myopathy is believed to occur as a result of the enhanced potential for gemfibrozil, like its well-known counterpart clofibrate, to injure muscle directly.
This link to full article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC101156/
I hope it will help you!
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Old 08-08-2012
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does anyone know the answer with explanation please

A 48 year old man comes to the physician coz he is concerned about his weight.He is 178 cm tall and weighs 91 Kg BMI is 29Kg/m2 His waist circumference is 100CM. His BP IS 140/90.His Lab shows fasting serum glucose and insulin conc. that are increased and remain increased2 hours after the patient received 75 gm of oral glucose.Which of the following set of additional lab findings in serum is most likely in this PATIENT

TG HDL FFA

A. Inc inc inc

B. Inc inc dec

C. Inc dec inc

D. Dec inc dec

E. Dec dec inc

F. DEC DEC DEC

e IS WRONG
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47-year-old woman comes to the physician because she wants to "do something about my wrinkles" PE shows fine wrinkles in photodamaged skin on face. Tx with tretinoin is started.Collagen synthesis will most likely be increased by which mechanism:

a. Activation of nuclear gene transcription
b.Decreased cAMP production
c.Displaced Vit.A from cellular stores
d.Inc. sebum production
e.Protection of keratinocytes from UVB irradiation
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Quote:
Originally Posted by pathophysio1 View Post
does anyone know the answer with explanation please

A 48 year old man comes to the physician coz he is concerned about his weight.He is 178 cm tall and weighs 91 Kg BMI is 29Kg/m2 His waist circumference is 100CM. His BP IS 140/90.His Lab shows fasting serum glucose and insulin conc. that are increased and remain increased2 hours after the patient received 75 gm of oral glucose.Which of the following set of additional lab findings in serum is most likely in this PATIENT

TG HDL FFA

A. Inc inc inc

B. Inc inc dec

C. Inc dec inc

D. Dec inc dec

E. Dec dec inc

F. DEC DEC DEC

e IS WRONG
the patient is diabetic so increased risk of hyperlipidemia
tryglycerides of course should be increased, hdl should be decreased (good lipoprotein) and ffa which is a bulding block for triglycerides should be decresed i.e tg's being synthesized but since its not in the option. i wil go for c.
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Old 08-09-2012
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Quote:
Originally Posted by pathophysio1 View Post
does anyone know the answer with explanation please

A 48 year old man comes to the physician coz he is concerned about his weight.He is 178 cm tall and weighs 91 Kg BMI is 29Kg/m2 His waist circumference is 100CM. His BP IS 140/90.His Lab shows fasting serum glucose and insulin conc. that are increased and remain increased2 hours after the patient received 75 gm of oral glucose.Which of the following set of additional lab findings in serum is most likely in this PATIENT

TG HDL FFA

A. Inc inc inc

B. Inc inc dec

C. Inc dec inc

D. Dec inc dec

E. Dec dec inc

F. DEC DEC DEC

e IS WRONG
answer is C..i got his one right.....
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Quote:
Originally Posted by pathophysio1 View Post
47-year-old woman comes to the physician because she wants to "do something about my wrinkles" PE shows fine wrinkles in photodamaged skin on face. Tx with tretinoin is started.Collagen synthesis will most likely be increased by which mechanism:

a. Activation of nuclear gene transcription
b.Decreased cAMP production
c.Displaced Vit.A from cellular stores
d.Inc. sebum production
e.Protection of keratinocytes from UVB irradiation
Answer is A......tretinoin is vit A analog, so it binds to nuclear receptors and it effects the gene expression of collagen
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Old 08-11-2012
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thank you!

what about this one...


the one about pattern of inheritance the girl on the low calorie diet pulse 120 bp 160/110 restlessness tremors excess sweating

AR is it porphyria ??
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and this one



Patient has genital herpes. which explains its longevity:
A) continuous replication in dendritic cells
B) continuous replication in epithelial cells of skin
C) continuous replication in sacral root ganglia (wrong)
D) continuous replication in T cells
E) establish latent infection in B cells (EBV?)
F) establish latent infection in circulating immune cells (CMV?)
G) establish latent infection in epithelial cells of skin
H) establish latent infection of sensory nerve cells
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n anyone further explain why the answer to this was "homing": The question about mice melanoma that spreads everywhere, until you inject an antibody in the liver that protects the liver from the mets. I went with invasion. wrong
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also then one on the screening test of prostate cancer.

what is the likely effect of PPV of this test

a decrease as prevalence increases WRONG
b increase as prevalence decreases
c increase as prevalence increases
d no change as prevalence changes
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  #12  
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Default please help!

A previously healthy 42-year-old Asian woman is brought to the emergency department because of a 24 hour history of nausea, vomiting, and progressive lethargy. She has smoked 1 pack of cigarettes daily for 25 years and drinks four glasses of wine daily. She uses high-dose acetaminophen daily for headaches. She not use illicit drugs. She is 155cm (5ft 1 in) tall and weighs 50 kg (110 lb); BMI is 21 kg/m2. She is responsive to painful stimuli. Initial lab studies show increased hepatic aminotransferase. Which of the following effects of alcohol most likely contributed to this patientís condition?
A) Decreased generation of N-acetyl-p-benzoquinoneimine
B)I ncreased glucuronidation
C) Increased heptic glutathione stores
D) Increased sulfation
E) induction of cytochrome p450
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Quote:
Originally Posted by pathophysio1 View Post
thank you!

what about this one...


the one about pattern of inheritance the girl on the low calorie diet pulse 120 bp 160/110 restlessness tremors excess sweating

AR is it porphyria ??
post the whole question...i dont remem exactly.....and the from 13 which i have has jumbled questions
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Quote:
Originally Posted by pathophysio1 View Post
and this one



Patient has genital herpes. which explains its longevity:
A) continuous replication in dendritic cells
B) continuous replication in epithelial cells of skin
C) continuous replication in sacral root ganglia (wrong)
D) continuous replication in T cells
E) establish latent infection in B cells (EBV?)
F) establish latent infection in circulating immune cells (CMV?)
G) establish latent infection in epithelial cells of skin
H) establish latent infection of sensory nerve cells
H----latent infection in sensory nerve cells
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Quote:
Originally Posted by pathophysio1 View Post
also then one on the screening test of prostate cancer.

what is the likely effect of PPV of this test

a decrease as prevalence increases WRONG
b increase as prevalence decreases
c increase as prevalence increases
d no change as prevalence changes
PPV increases as prevalence increases...option C

prevalence is directly related to PPV and inversely related to NPV
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  #16  
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Quote:
Originally Posted by pathophysio1 View Post
A previously healthy 42-year-old Asian woman is brought to the emergency department because of a 24 hour history of nausea, vomiting, and progressive lethargy. She has smoked 1 pack of cigarettes daily for 25 years and drinks four glasses of wine daily. She uses high-dose acetaminophen daily for headaches. She not use illicit drugs. She is 155cm (5ft 1 in) tall and weighs 50 kg (110 lb); BMI is 21 kg/m2. She is responsive to painful stimuli. Initial lab studies show increased hepatic aminotransferase. Which of the following effects of alcohol most likely contributed to this patientís condition?
A) Decreased generation of N-acetyl-p-benzoquinoneimine
B)I ncreased glucuronidation
C) Increased heptic glutathione stores
D) Increased sulfation
E) induction of cytochrome p450
the patient is suffering from acetaminophen toxicity

acetaminophen undergoes mainly glucuronidation and sulfation in the liver and also via P450 is converted to N-acetyl-p-benzoquinoneimine(toxic metabolite).So in chronic alcoholic states, there is induction of cytochrome P450 and more conversion of acetaminophen to the above toxic compound with the resultant liver injury....hope this helps
answer is E
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Quote:
Originally Posted by pathophysio1 View Post
n anyone further explain why the answer to this was "homing": The question about mice melanoma that spreads everywhere, until you inject an antibody in the liver that protects the liver from the mets. I went with invasion. wrong
answer here is HOMING.....
i would give the example of parvovirus B19---it has a surface glycoprotein which can bind to P antigen on the surface of erythroid progenitor cells in the bone marrow, so it primarily infects the RBC( this is called tissue tropism)

similarly melanoma cells have surface molecules that bind to their corresponding cell surface molecules in lung, liver and ovaries and forms mets( this is HOMING----just like the ways lymphocytes 'home' to lymph nodes after their maturation process in bone marrow/thymus).

But when u inject antibodies that bind to and mask the liver cell surface antigen, ur preventing the attachment of melanoma cells to liver cells and hence no development of mets---preventing 'homing' to liver

hope i was clear
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  #18  
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thanks alot.

what about this one??

18 year old man has temp of 38.3Cel. a sore throat and cervical lymph node enlargment for eight days. latex agg. test for EBV is positive. Abundant cells with lacey cytoplasm in peripheral blood smear most likely derivd from which of the following

B lymphocytes WRONG
basophils
neutrophils
plasma cells
t lymphocytes this is the right asnwer

but could you please explain thank you
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and this one

30 Year old woman brought to emergency 6 hours after onset of severe abdominal pain and confusion. her brother father paternal grandmother had similar symptoms.2 weeks ago she began a low calorie diet. pulse 120 bp 160/110. physical examinations shows reslessness sweating tremors. there is no abdominal tenderness. urine study shows increases porphobilinogen conc. which is the most likely cause of this condition.

Autosomal dominant
autosomal recessive
mito DNA mutation
mutifactoral
x linked dominant
x linked reccessive
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Old 08-19-2012
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Quote:
Originally Posted by pathophysio1 View Post
thanks alot.

what about this one??

18 year old man......
t lymphocytes this is the right asnwer

but could you please explain thank you

The lymphocytosis in infectious mononucleosis is predominantly ( ~75%) t lymphocytes. These reactive/atypical/Downey cells are tlymphocytes responding to virus infected b cell proliferation.




Quote:
Originally Posted by pathophysio1 View Post
and this one

30 Year old woman brought to emergency 6 hours after onset of severe abdominal pain......
Abdominal pain and confusion/neuropathy on fasting=acute intermittent porphyria(autosomal dominant). The inheritance pattern seen in the patients family history is consistent with an autosomal dominant disease.
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  #21  
Old 08-20-2012
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Default Request for NBME 13

Quote:
Originally Posted by anomali View Post
we all know that gemfibrozil and simvastatin combo will lead to severe myopathy.

is it due to gemfibrozil inhibiting cytochrome p450 leading to increased levels of statin and subsequent myopathy????? am i right or any other reason behind this?????
Please dear, can you email NBME 13 to me. My email is pjondez@yahoo.com

Thank you in advance
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  #22  
Old 08-21-2012
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Help explanations anyone? please.

I got these wrong so if anyone can explain, I'll be very grateful:

1. The question which shows a vertebral column of 77 year woman who died of long illness. The process shown is caused by increase in:
a. Ca
b. Estrogen
c. IL 1
d Monoclonal Ig
e. Vit D

2. The question about 3 year old boy with self mutilating behavior and Missense mutation in TrK A gene. Which of the following is disrupted?
a. Binding of nerve growth factor to its receptor
b. Formation of TrK A homodimer in response to its growth factor
c. phosphorylation of downstream molecules in response to nerve growth factor.
d. retrograde transport of nerve growth factor from nerve terminals.
e. Synthesis of nerve growth factor.

3. the image which shows brain section of 40 year old woman with 25 year h/o stable seizure disorder who dies in Motor Vehicle Accident. Which of the following is most likely cause of patients seizure disorder?
a. Glioblastoma multiforme
b. HSV encephalitis
c. mesial temporal sclerosis.
d. neonatal ishemic stroke
e. vascular malformation

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

5. The question about the 42 yr old woman with h/o numbness of fingers of left hand for 3 wks and loss of touch Graphesthesia and two point discrimination o/e. Which region of the brain is affected? Again I would have liked to post the pic but...

PLEASE, I need to know the right answers and the explanations. All my Beh science questions and lot of other questions were wrong so I will post separately because I don't want to crowd one post.
Any response will be appreciated. Thanks in advance.
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Old 08-21-2012
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Quote:
Originally Posted by drssbaz View Post
I got these wrong so if anyone can explain, I'll be very grateful
1. I think the picture shows osteoporosis. The answer would be Interleukin-1. It activates osteoclasts.
2.TRK is a tyrosine kinase-associated recptor. Naturally, one would assume that a mutation in this receptor would lead to decreased phosphorylation of cell proteins on binding of the growth factor to its receptor(since that's tyrosine kinase's job).
3. That's a vascular malformation.
4. The graphs show frequency of stimulation. At the lowest frequency, the muscle will have time to pump calcium ions back into the cell. At the highest frequency, there's no time to pump calcium back into the SR, leading to its accumulation in the cytoplasm. This is what we call tetanus.

Its been a while since I took form 13 so I don't remember the last question, sorry.
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  #24  
Old 08-21-2012
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Quote:
Originally Posted by smanthrav View Post
1. I think the picture shows osteoporosis. The answer would be Interleukin-1. It activates osteoclasts.
2.TRK is a tyrosine kinase-associated recptor. Naturally, one would assume that a mutation in this receptor would lead to decreased phosphorylation of cell proteins on binding of the growth factor to its receptor(since that's tyrosine kinase's job).
3. That's a vascular malformation.
4. The graphs show frequency of stimulation. At the lowest frequency, the muscle will have time to pump calcium ions back into the cell. At the highest frequency, there's no time to pump calcium back into the SR, leading to its accumulation in the cytoplasm. This is what we call tetanus.

Its been a while since I took form 13 so I don't remember the last question, sorry.
Thank you so much.
For all of us I have posted a list of my correct answers here NBME 13 Answer Key
It will be great if you may benefit from it or contribute to it.
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Old 08-21-2012
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Quote:
Originally Posted by pathophysio1 View Post
and this one



Patient has genital herpes. which explains its longevity:
A) continuous replication in dendritic cells
B) continuous replication in epithelial cells of skin
C) continuous replication in sacral root ganglia (wrong)
D) continuous replication in T cells
E) establish latent infection in B cells (EBV?)
F) establish latent infection in circulating immune cells (CMV?)
G) establish latent infection in epithelial cells of skin
H) establish latent infection of sensory nerve cells
H. latent infection in sensory nerve cells
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Quote:
Originally Posted by pathophysio1 View Post
thanks alot.

what about this one??

18 year old man has temp of 38.3Cel. a sore throat and cervical lymph node enlargment for eight days. latex agg. test for EBV is positive. Abundant cells with lacey cytoplasm in peripheral blood smear most likely derivd from which of the following

B lymphocytes WRONG
basophils
neutrophils
plasma cells
t lymphocytes this is the right asnwer

but could you please explain thank you
Cells with abundant lacey cytoplasm-> Reactive T-lymphos (aka Atypical Lympho, Downey Cell) that are fighting with EBV infected B cells
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Old 04-08-2014
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Default q nbme 13 plz help thank u

Hey guys, Does anyone know how to answer this q? It seems to me its NDI so do we answer based on if ADH were present ?? Thanks for your time


5. A 22-year-old woman is admitted to the hospital because of a 10-day history of polydipsia and polyuria. She says that the urge to urinate often awakens her at night. She has been taking lithium carbonate for 2 years for bipolar disorder; her dosage was increased 6 months ago because of recurrent severe manic episodes. Her vital signs are within normal limits. Physical examination shows no abnormalities. Over the next 24 hours, urine excretion totals 6.5 L. Laboratory studies at this time show a serum sodium concentration of 148 mEq/L, serum osmolality of 315 mOsmol/kg, and urine osmolality of 75 mOsmol/kg. After administration of desmopressin, urine output and osmolality do not change. Which of the following findings in the nephron best describes the tubular osmolality, compared with serum, in this patient?

Proximal Tubule Juxtaglomerular Apparatus Medullary Collecting Duct

A) Hypertonic hypertonic hypertonic

B) Hypertonic hypertonic hypotonic

C) Hypertonic hypotonic hypotonic

D) Isotonic isotonic isotonic

E) Isotonic hypotonic hypertonic

F) Isotonic hypotonic hypotonic

G) Hypotonic hypertonic hypertonic

H) Hypotonic hypotonic hypertonic

I) Hypotonic hypotonic hypotonic
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Old 04-28-2014
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a 70 year old man comes to the emergency department 30 minutes after the onset of weakness, nausea, and lower abdominal and back pain that radiates to the lower extremities. he appears pale and has a cold sweat. pulse is 110/min and blood pressure is 90/60mm Hg. pulses in the lower extremities are weak. a Faint bruit is heard in the lower abdomen. muscle stretch reflexes are normal in both lower extremities. Which of the following is the most likely diagnosis?

A) Acute compression fracture of the L3 vertebral body
B) Herniated L3 to L4 intervertbral disc
C) Leaking aortic aneurysm
D) Leaking left renal artery aneurysm
E) Perforated rectum
F) perforated sigmoid colon

Can Sumone Please Explain this Questions and why the Answer is Leaking Aortic Aneurysm...
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Old 06-02-2014
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i got this wrong and i cannot understand why:

an executor of an estate consults with a physician concerning the terms of a will. The deseased woman was a philanthropist who was active in addressing disparities in health care. She designated that a large sum of her money be used to educate the public about the leading cause of death in women. The most appropriate use of this money would be a program addressing which of the following diseases?
a) breast cancer (correct)
b) cardiovascular disease
c) cerebral infaction
d) cervical cancer
e) ovarian cancer

i answered B, because i thought that breast cancer is 1st in incidence rate while in mortality rate heart disease is 1st. Please someone explain this to me!
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Old 06-02-2014
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Quote:
Originally Posted by obsess&compulse View Post
i got this wrong and i cannot understand why:

an executor of an estate consults with a physician concerning the terms of a will. The deseased woman was a philanthropist who was active in addressing disparities in health care. She designated that a large sum of her money be used to educate the public about the leading cause of death in women. The most appropriate use of this money would be a program addressing which of the following diseases?
a) breast cancer (correct)
b) cardiovascular disease
c) cerebral infaction
d) cervical cancer
e) ovarian cancer

i answered B, because i thought that breast cancer is 1st in incidence rate while in mortality rate heart disease is 1st. Please someone explain this to me!
B is correct, maybe you clicked it wrong. Leading cause of death is CV disease... highest incidence of cancer in women is breast... highest mortality of cancer is lung
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  #31  
Old 06-03-2014
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Quote:
Originally Posted by obsess&compulse View Post
i got this wrong and i cannot understand why:

an executor of an estate consults with a physician concerning the terms of a will. The deseased woman was a philanthropist who was active in addressing disparities in health care. She designated that a large sum of her money be used to educate the public about the leading cause of death in women. The most appropriate use of this money would be a program addressing which of the following diseases?
a) breast cancer (correct)
b) cardiovascular disease
c) cerebral infaction
d) cervical cancer
e) ovarian cancer

i answered B, because i thought that breast cancer is 1st in incidence rate while in mortality rate heart disease is 1st. Please someone explain this to me!
hello obsse/compul

we have studied in FA that in women leading cause of cancer mortality is

LUNG>BREAST>COLO-RECTAL. choose an option among these. in the above given question there is only BREAST cancer,then u will get the correct answer is breast cancer. but leading cause of death in general in elder people 5oyrs its is cardiovascular (M.I)
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  #32  
Old 06-07-2014
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Question

A previously healthy 54-year-old man comes to the clinic because of light-headedness for 6 hours. His symptom began after skiing at a resort at an altitude of 2743 m (9000 ft). He has
been taking a carbonic anhydrase inhibitor since 2 days before arrival at the resort. His blood pressure is 110/60 mm Hg while sitting and 95/50 mm Hg while standing. Physical examination shows no other abnormalities. Which of the following is the most likely cause of his orthostatic hypotension?
A) High-altitude sickness
B) Hypovolemia
C) Hypoxia
D) Impaired sympathetic nerve activity
E) Respiratory alkalosis

i went with HYPOVOLEMIA, an answer key i found says is C hypoxia, which doesnt make sense to me, just want to confirm is it hypovolemia? thanks.
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  #33  
Old 06-07-2014
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Quote:
Originally Posted by drpisho View Post
A previously healthy 54-year-old man comes to the clinic because of light-headedness for 6 hours. His symptom began after skiing at a resort at an altitude of 2743 m (9000 ft). He has
been taking a carbonic anhydrase inhibitor since 2 days before arrival at the resort. His blood pressure is 110/60 mm Hg while sitting and 95/50 mm Hg while standing. Physical examination shows no other abnormalities. Which of the following is the most likely cause of his orthostatic hypotension?
A) High-altitude sickness
B) Hypovolemia
C) Hypoxia
D) Impaired sympathetic nerve activity
E) Respiratory alkalosis

i went with HYPOVOLEMIA, an answer key i found says is C hypoxia, which doesnt make sense to me, just want to confirm is it hypovolemia? thanks.
yup that is hypovolemia..did it online..got it correct
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  #34  
Old 06-07-2014
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Originally Posted by faith255 View Post
yup that is hypovolemia..did it online..got it correct
thanks, those answer keys on the web can be wrong sometimes.
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  #35  
Old 10-12-2014
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Quote:
Originally Posted by pathophysio1 View Post
and this one



Patient has genital herpes. which explains its longevity:
A) continuous replication in dendritic cells
B) continuous replication in epithelial cells of skin
C) continuous replication in sacral root ganglia (wrong)
D) continuous replication in T cells
E) establish latent infection in B cells (EBV?)
F) establish latent infection in circulating immune cells (CMV?)
G) establish latent infection in epithelial cells of skin
H) establish latent infection of sensory nerve cells
Established latent infection in the sensory nerve cells. and activates when immune system goes down...
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  #36  
Old 10-13-2014
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Yeah it's hypovolemia.
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  #37  
Old 04-10-2015
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Quote:
Originally Posted by smanthrav View Post
The lymphocytosis in infectious mononucleosis is predominantly ( ~75%) t lymphocytes. These reactive/atypical/Downey cells are tlymphocytes responding to virus infected b cell proliferation.





Abdominal pain and confusion/neuropathy on fasting=acute intermittent porphyria(autosomal dominant). The inheritance pattern seen in the patients family history is consistent with an autosomal dominant disease.
yep it is AD.
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  #38  
Old 04-11-2015
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HI. am looking for NBME form if any one can help me, this my email. aymansati2011@hotmail.com.
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