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  #301  
Old 05-12-2014
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Quote:
Originally Posted by usmle778 View Post
-. A 35-year-old man is referred for psychiatric evaluation by a work-sponsored depression screening program. He has no
history of serious illness, and his last routine examination was 12 years ago. He says that for the past 2 years he has felt down
and has not fully enjoyed life. He is generally unmotivated and pessimistic about the future and has little energy for
relationships or work. He wonders if he is just getting old. He has not had any changes in his appetite or sleep pattern, and his
symptoms have not afiected his ability to work. Although he has had occasional thoughts that life is not worth living, he has not
had suicidal thinking or planning. Which of the following is the most likely diagnosis‘?
A) Adjustment disorder with depressed mood
B) Avoidant personality disorder
C) Bipolar disorder
D) Dysthymic disorder
E) Major depressive disorder
F) Schizoafiective disorder

Is D the correct answer? Tx~
Yep, D is correct
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  #302  
Old 05-12-2014
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Help

kallifreakin, help me out on the question with the mucociliary clearance after smoke exposure?? did you get it right?? PEOPLE SAY:

SMOKE: INCR mucus production, DECR mucociliary clearance, and DECR macrophage alveolar function.

i just want to confirm.
thanks in advance
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  #303  
Old 05-13-2014
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Default please urgent.

Please someone help out on q with the elderly that had fever + a murmur and had the urinary catheterization done previously,
no one has asked about it so it seems that everyone got it right! please guys what did you put on that one then??
help me out im close to my test and im analyzing all these errors, i cant seem to figure this one out yet!!

would it be bacterial endocarditis??
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  #304  
Old 05-13-2014
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Quote:
Originally Posted by drpisho View Post
Please someone help out on q with the elderly that had fever + a murmur and had the urinary catheterization done previously,
no one has asked about it so it seems that everyone got it right! please guys what did you put on that one then??
help me out im close to my test and im analyzing all these errors, i cant seem to figure this one out yet!!

would it be bacterial endocarditis??
Yes endocarditis
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  #305  
Old 05-14-2014
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34. A 43-year-old woman comes to the physician because of progressive difficulty walking during the past 3 months. Neurologic examination shows weakness and decreased muscle bulk of the lower extremities. Patellar and Achilles tendon reflexes are diminished. Sensations of joint position, pain, and temperature in the lower extremities are normal. Which of the following is the most likely cause of the findings in this patient?
A) Acute peripheral neuropathy
B) Degeneration of motoneurons of the lumbar cord
C) Demyelination of the corticospinal pathways
D) Loss of afferent la axons innervating muscle spindles
E) Myotonic muscular dystrophy

Seems to be LMN lesion. Is C the correct answer? What is her dx? Cannot be poliomyelitis virus infection.
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  #306  
Old 05-14-2014
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Quote:
Originally Posted by kld15 View Post
1-25 answer should be B. Ghrelin does the opposite with leptin. Ghrelin stimulates hunger. It starts to drop with food intake. Quick google search image will give a nice graph of its function just like the image on the exam.
I believe that the answer is A, for this reason. Ghrelin is Growth Hormone Release Inducing hormone. It is released when there is excess energy, i.e. a good time to grow. Immediately after you eat Ghrelin starts to be secreted, but it shouldn't peak until after the point of maximal nutrient absorption, an hour or so after you finish eating.

That's my logic, I probably would have gone with B on the exam, then cursed myself later.
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  #307  
Old 05-14-2014
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Quote:
Originally Posted by martha18 View Post
Can somebody give me a hand with this question?

It was about the niacin cholesterol mechanism

a. antagonizes VLDL cholesterol secretion
b. increase catabolism of LDL
c. inhibits cholesterol uptake (i think this is the answer)
d inhibit HMG COA
e. stimulates PPARa

But it could be also A. bc niacine also interfere directly w the enzymatic process that mediates the conversion of VLDL to LDL
Already answered by others, but this question illustrates some good points about treatment of high cholesterol and lipids.

a. antagonizes VLDL cholesterol secretion - Niacin
b. Increases catabolism of LDL - Statins and cholestyramine both increases LDL uptake, unuless this was a typo and it meant to say LPL, in which case it is the main mechanism of fibrates.
c. Inhibits cholesterol uptake - ezetimibe, think of it like acarbose for cholesterol. The newest class of cholesterol medication.
d. Inhibits HMG-CoA reductase - statins, but you know that already, didn't you?
e. Stimulates PPARa - the main target of fibrates (not PPARgamma, which is targeted by TZDs).
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  #308  
Old 05-14-2014
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Quote:
Originally Posted by jhas View Post
35. chloroquine spares which two plasmodium species?

really confused by this question
Depends on the setup (I haven't done this one, but I'm taking my exam soon enough that I'm not going to).

Vivax and ovale have hypnozytes, which are not effected by chloroquine (and this is why you use primaquine to treat them in addition to chloroquine). Alternatively, but less likley, it could be refering to the widespread resistance that P. falciprum displays to chloroquine throughout most of western Africa.

I'd go with the first answer on an exam. Was that one of the choices?
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  #309  
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Quote:
Originally Posted by jhas View Post
68 y/o woman has 1 year history of severe ab pain after meals. also has an unintentional 20lb weight los. pain is relieved when she decreases the amount of food she eats. p/e shows soft, nontender abdomen and abdominal bruit. pedal pulses diminished. which artery is stenosed?

greater pancreatic
hepatic
right gastric
superior mesenteric
supraduodenal
This sounds like colonic ischemia (superior mesenteric artery), but it doesn't mention bloody stools. The pedal pulses being diminished are likely just saying she has peripheral vascular disease with lots of atherosclerosis.
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  #310  
Old 05-14-2014
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Originally Posted by yakob32 View Post
A 33-year-old man comes to the physician because of a 3-month history of muscle weakness and cramping. He says that the symptoms appear shortly after he begins exercising. Physical examination shows no abnormalities. Serum creatine kinase concentration is increased. After the forearm muscles are exercised, venous blood obtained from the antecubital vein shows that lactate concentrations do not increase compared with preexercise values. This patient most likely has a deficiency in the activity of which of the following enzymes in muscle?
A) Carnitine palmitoyltransferase-1
B) Fumarase
C) Glucose-6-Phosphatase
D) Glycogen phosphorylase
E) Succinate Dehydrogenase

I think I panicked on my answer, maybe this should be an easy one. Does he just have difficulty making pyruvate since not making lactate, so it'd be an enzyme prior to that? Maybe D??

D. McArdles. Deficiency in Muscle glycogen phosphorylase causes muscle pain, weakness, and myoglobinuria on strenuous exercise.
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  #311  
Old 05-14-2014
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Quote:
Originally Posted by nakeya52 View Post
24. An increase in the amount of iron inside cultured hepatocytes leads to an increase in the amount of ferritin gene products detected by Westem blotting.
It does not change the amount of ferritin gene products detected by Northem blotting or by the polymerase chain reaction.
These results suggest that iron increases the frequency of which of the following events?

A) Maturation of the ferritin gene transcript
B) Transcription of the ferritin gene
C) Translation of ferritin mRNA
D) Transport of ferritin mRNA out of the nucleus

Is it C?
Yes. I actually studied this for the MCAT. Ferritin and transferrin are two classic examples of regulation of translation. They both have regions bound by iron binding proteins. When iron is high, the iron binding proteins bind mRNA. In ferritin's case, they bind in the 3' region, which hides a sequence that would otherwise target it for degradation. In transferrin's case, it binds a region in the 5' UTR, blocking translation. End results, as iron increases, you get more ferritin and less transferrin produced.
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  #312  
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Originally Posted by johnny5 View Post
I put low specificity since many other things can give you low GI bleed right? Though this was marked wrong :-(

Low sensitivity because its a screening test ???
Screening tests have high sensitivity, diagnostic tests have high specificity.
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  #313  
Old 05-14-2014
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Quote:
Originally Posted by TangoNet View Post
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...
A. Wouldn't present like this, he wouldn't have the cold sweat or abdominal pain, shouldn't effect pulses.
B. Reflexes (nerve roots) in lower extremities are normal.
C. Correct answer - look at the weakened pulses (meaning blood isn't getting to the lower extremities at full pressure), acute onset (it just tore), and location of pain.
D. Wouldn't effect pulses in lower extremities.
E. Rare (since the rectum isn't very prone to diverticula and is generally pretty tough). Wouldn't give you weakened pulses, he would be bleeding from his rectum.
F. Common in this population, but presents are diverticulitis/peritonitis
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  #314  
Old 05-14-2014
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Originally Posted by ama91 View Post
Male with a h/o abd pain and diarrhea, pain relieved by eating and antacids. Labs show gastrin of 500 and gastric acid secretion of 80. what is the most definitive treatment? low protein diet/abx therapy/antihistamine therapy/sectioning of the vagus nerve/surgical removal of the suspected tumor
Normal serum gastrin is <100, he's got Zollinger-Ellisons. Take out the tumor and he will be fine. If you don't take out the tumor, proton pumps inhibitors are the most effective.
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  #315  
Old 05-14-2014
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Quote:
Originally Posted by drpisho View Post
Blood Pressure Before Drug Blood Pressure After Drug
Drug Administered Injection (mm Hg) Injection (mm Hg)
Angiotensin II 110/70 150/105
Drug X 108/68 122/84
Angiotensin II + drug X 112/66 126/86

On three separate occasions, a 25-year-old man is given an injection of angiotensin II, an injection of drug X, or an injection of both angiotensin II and drug X. The table shows his blood pressure (in mm Hg) after each injection. Which of the following best describes drug X?

A ) Aldosterone receptor antagonist
B ) Angiotensin II-converting enzyme inhibitor
C ) Angiotensinogen inhibitor
D ) Partial agonist at angiotensin II receptors
E ) Renin inhibitor

what about this one???
curacao on a previous post i think suggested that it was a partial agonist...
but how can a partial agonist in PRESENCE of a FULL agonist behave as an agonist?? because it does INCREASE BP with addition of agII, when the addition of full agonist + partial agonist should have given ANTAGONISM
What you are missing here is that a partial agonist in the presence of a full agonist acts as an antagonist... to the full agonist, which is still present. Basically, it decreases the effect that angiotensin II would have, but since it is a partial agonist (not an antagonist) it cannot fully eliminate the effect.

Now here is how I solve things like this. Would any of the other answers cause the blood pressure to increase when given alone? No, therefore it is D.
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  #316  
Old 05-14-2014
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Quote:
Originally Posted by Kallifreakin View Post
Just thought I'd update with a shorter question list because Dr. Phisho answered so many...

3. Flow rate in L/min through aneurysm with cross-sectional area 2 cm^2 and mean velocity of blood flow at 20 cm/sec?
1, 2.4, 3.2, 3.6, or 4.0

5. Why is the asthma one Leukotrien C4 and not IL-10?? I understand LKC4 but why not IL-10 also? I thought IL-10 was one of the 3 main interleukins involved

6. Old man with fever chills fatigue SOB and weight loss. Underwent urinary catheterization for prostatic obstruction. High temp/pulse/BP. Soft s1 and normal S2. 2/6 early diastolic murmur and accentuated when pt leans forward with held expiration. Clear lungs. Which is most likely dx?

Bacterial endocarditis, peritonitis, prostatitis, PE, Viral pneumonia

7. Vocal cords position while swallowing, immediately after laryngeal irritation, and while coughing???

I saw an earlier post say closed, open, closed is correct but I put that and it is incorrect.

Also, one more...
8. With regards to the erection, asking for an intact spinal reflex arc between the sacral parasympathetic nerves and which of the following?

Genitofemoral, ilioinguinal, lumbosacral trunks, obdurator nerve, pudendal nerve
3. Its asking the flow rate in L/min = (1000cm^3)/(60*sec). Just multiply it out. I'll save you running to the calculator, it is 2.4L/min. 2cm^2 * 20cm/sec *60sec/min.
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  #317  
Old 05-14-2014
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Originally Posted by usmle778 View Post
-. A 35-year-old man is referred for psychiatric evaluation by a work-sponsored depression screening program. He has no
history of serious illness, and his last routine examination was 12 years ago. He says that for the past 2 years he has felt down
and has not fully enjoyed life. He is generally unmotivated and pessimistic about the future and has little energy for
relationships or work. He wonders if he is just getting old. He has not had any changes in his appetite or sleep pattern, and his
symptoms have not afiected his ability to work. Although he has had occasional thoughts that life is not worth living, he has not
had suicidal thinking or planning. Which of the following is the most likely diagnosis‘?
A) Adjustment disorder with depressed mood
B) Avoidant personality disorder
C) Bipolar disorder
D) Dysthymic disorder
E) Major depressive disorder
F) Schizoafiective disorder

Is D the correct answer? Tx~
Yes. Dysthemic is when they don't meet the criteria for depression, but it goes on for 2+ years.
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  #318  
Old 05-14-2014
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So I want to apologize to everyone for posting so many in a row, I with this was set up in a way so I could directly respond to each post.

usmle778, consider your own answer. You think it is a LMN defect. I agree, since there appear to be diminished reflexes and muscle wasting. However, you then say demyelination of corticospinal pathway. Do LMN synapse in the cortex? Instead, consider which of the answer talks about a neuron that directly connects to the muscle.

I would have gone for B, degeneration of motor neurons in the lumbar cord. The leg is innervated by many things, but the femoral, obturator, and sciatic all come (at least partially) from the lumbar spine. If you lost the LMN cell bodies (in the ventral and lateral horns of the lumbar spine), that would cause the symptoms seen here.

Quote:
Originally Posted by usmle778 View Post
34. A 43-year-old woman comes to the physician because of progressive difficulty walking during the past 3 months. Neurologic examination shows weakness and decreased muscle bulk of the lower extremities. Patellar and Achilles tendon reflexes are diminished. Sensations of joint position, pain, and temperature in the lower extremities are normal. Which of the following is the most likely cause of the findings in this patient?
A) Acute peripheral neuropathy
B) Degeneration of motoneurons of the lumbar cord
C) Demyelination of the corticospinal pathways
D) Loss of afferent la axons innervating muscle spindles
E) Myotonic muscular dystrophy

Seems to be LMN lesion. Is C the correct answer? What is her dx? Cannot be poliomyelitis virus infection.
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  #319  
Old 05-16-2014
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Originally Posted by Kras View Post
There is no info about how much students have got the treatment.

In this case right answer is B. It was correct in my NBME 16.

I want to ask USMLE1, does this question duplicated word to word?
Hey I just gave nbme 16. How do I check which questions are right/wrong on nbme?
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  #320  
Old 05-19-2014
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Originally Posted by doctor2k14 View Post
4 month y/o boy with skeletal dysplasia involving abnormal endochondral bone formation. Electron microscopy of patient will most likely show which?

a) decreased RER
b) decreased SER
c) dilated RER
d) increased SER
e) large lysosomes
f) small lysosomes

I know FGFR3 is activated and it is achondroplasia. Just had problem with the answer choices. would appreciate your input.
thank you.

I found this form really tough overall. Maybe it's just me.
Me too, it is really picky.

Question stem says 4 mo old boy was dx with rare AR skeletal dysplasia and achondroplasia is AD. Would that affect answer choices?
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  #321  
Old 05-22-2014
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Originally Posted by step1hell View Post

5- just to confirm the elliptical, purple budding organism that grows on sheep agar was sporothrix schenckii?
It's not sporothrix. That's what I put and it was incorrect. Does anyone have any insight into what the correct answer might be?

Edit: The consensus elsewhere seems to be that it's candida. Candida doesn't respond to broad spectrum antibiotics, grows in white colonies, and is purple with budding on gram stain.

Last edited by RoguePenguin109; 05-22-2014 at 02:31 PM.
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  #322  
Old 05-22-2014
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hey plz help me out with this
how u guys r saying,that u got particular question wrong or correct
just done with one NBME n i don't to where to check which question i marked correct or wrong
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  #323  
Old 05-22-2014
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Hey I just gave nbme 16. How do I check which questions are right/wrong on nbme?
plz guys help me out with this
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  #324  
Old 05-22-2014
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Quote:
Originally Posted by sobha View Post
Hey I just gave nbme 16. How do I check which questions are right/wrong on nbme?
plz guys help me out with this
You had to pay for the expanded feedback deal. If you did, view your results, click next on the bottom left until you get to the page showing the number of questions you got incorrect. The number of questions you got incorrect should be underlined in blue. Click it to view the questions you answered incorrectly.
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  #325  
Old 05-23-2014
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a 43 yr old woman, who has immune thrombocytopenic purport resistant to corticosteroid treatment, will undergo an operation to improve her condition. removing which organ in the ct scan will help? Is it choice B or C?

a, b, c, d, e
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  #326  
Old 05-23-2014
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Originally Posted by mikemike View Post
a 43 yr old woman, who has immune thrombocytopenic purport resistant to corticosteroid treatment, will undergo an operation to improve her condition. removing which organ in the ct scan will help? Is it choice B or C?

a, b, c, d, e
I got this one correct. It's the spleen. Splenectomy is a treatment for ITP. The splenic macrophages destroy the platelets.
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  #327  
Old 05-23-2014
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They had a picture of the chest/ribs
Systolic murmur is loudest at the point marked by X. Which cardiac abnormality is causing the murmur?
aortic valve regurgitation, aortic valve stenosis, mitral valve regurgitation, mitral valve stenosis, pulmonic regurgitation, pulmonic stenosis, tricus regurgitation, tricuspid stenosis
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  #328  
Old 05-23-2014
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Quote:
Originally Posted by RoguePenguin109 View Post
I got this one correct. It's the spleen. Splenectomy is a treatment for ITP. The splenic macrophages destroy the platelets.
man im horrible at cts. Choice B was the spleen right?
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Old 05-23-2014
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Quote:
Originally Posted by mikemike View Post
They had a picture of the chest/ribs
Systolic murmur is loudest at the point marked by X. Which cardiac abnormality is causing the murmur?
aortic valve regurgitation, aortic valve stenosis, mitral valve regurgitation, mitral valve stenosis, pulmonic regurgitation, pulmonic stenosis, tricus regurgitation, tricuspid stenosis
also what was the answer to this one
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  #330  
Old 05-23-2014
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Quote:
Originally Posted by mikemike View Post
also what was the answer to this one
Unfortunately, I don't remember the image. If you consider what's occurring during systole, you can eliminate some of the answer choices. The ventricles are ejecting blood into the aorta and pulmonary arteries, so the aortic and pulmonic valves will be open. That means it won't be pulmonic or aortic regurgitation. The mitral and tricuspid valves are supposed to be closed, so it won't be mitral stenosis or tricuspid stenosis. That leaves aorta stenosis, pulmonic stenosis, mitral regurgitation, or tricuspid regurgitation as possible answers. Mitral prolapse and VSD also cause systolic murmurs, but you didn't list those as options. So the answer depends on where the x is.

2nd right intercostal space: aortic stenosis
2nd left intercostal space: pulmonic stenosis
5th intercostal space at the left border of the sternum: Tricuspid regurgiation
5th space at the midclavicular line/apex: Mitral regurgitation

I also don't recall which letter corresponded to the spleen on that other question. Sorry, I can't help with that.
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1) A 62 yr old man comes to the physician for a follow up examination. Two weeks ago, he was discharged from the hosp after sustaining MI. He smokes 2 packs of cigarettes and drinks 4 12 oz beer daily. His diet mostly consists of cured meats and fast food. He does not exercise. The pt. tells the physician, "I know that I need to make some changes in how I live so that my heart can be healthier. I just don't have the willpower to quit smoking and drinking and all that stuff right now." Which of the following best describes this patient's stage of behavioural change? Is this contemplation?



Precontemplation, Contemplation, Preparration, Action, Maintenance





2) 51 yr old woman w/ pheochromocytoma. preoperative treatment w propranolol prescribed to decrease tachycardia. which drug should be admins. before starting propranol? Is it phenoxybenzamine?



atenolol, clonidine, nifedipine, phenoxybenzaminem sildenafil?





3) 70 yr old lady brought to er by husband 45 min after he found her unresponsive. She has anxiety disorder trted w/ diazepam. She recently started taking over the counter med for heart burn. she only responds to painful stimuli. interaction with which drug causing this prob? i know its a cytp450 inhibitor so is it cimetidine or ranitidine?

calcium carbonate, cimitidine, famotidine, magnesium trisilicate, ranitidine





4) 67 yr old lady hip replacement operation has shortness of breath and pain of back with deep breathing. She’s anxious..calf shows erythma…has large embolism occluding blood flow. Answer is dead space right since its a perfusion defect? I skipped out on details in the question because i figured you’d remember which question this was.

dead space, diffusion abnormality, hypoventilation, low fi02, shunt,
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1) 66 yr old man brought to er sudden substernal chest pain..jogging when pain began..hypertension trted w indapamide..pulse 90 min bp 150/90 cardiac exam s4. treatment w sublingual med fixed pain in 2 min…mech of action of which drug let to relaxation of vascular smooth muscle in this patient? Obv nitroglycerin so is the answer increased cGMP?



decreasing intracellular calcium, increasing camp, increased cGmp, inhibiting the sodium pump, stabilizing depolarization of the vascular smooth muscle cell membranee





2) previously healthy 67 yr old lady w 3 day history of fever, shortness of breath, nonproductive cough, headache, and muscle pain. Temp is 102 F. lungs clear to auscultation. Exanm shows no abnormalities. which vaccine coulda prevented this stuff?



diphteheria tetanus acellular pertussis, h. influ type b, hepatitis b, inactivated polio, influenza virus, mmr, typhoid, 23 valent pneumococ, varicella





3) 35 yr old man w long history of atrophic gastritis has increased lethargy and fizziness during past 2 weeks. pale skin and mucous membranes. no palpabl adenopathy. liver edge palpable. decreased vibratory sensation. hct of 27%, mcv 112, and platelet count 200,000. absence of sufficient numbers of which cell types explains these findings?

chief, columnar absorptive, enteroendocrine, goblet, mucous, paneth, parietal, undifferentiated crypt



4) 80 yr old woman fever cloudy urine after knee replacement. Temp is 100.4 F. Bandaged left knee and indwelling foley cath. Micro shows numerous gram negative rods. urine culture brain heart infusion medium grows more than 100,000 bacterial colonies predominantly one thats oxidase positive and produces diffusible green pigment. whig organism? Is this p.aueroginosa?



ecoli, kleb.pneumoniae, proteus mirabilis, p.aureoginosa, group a step pyogenes



5)a new antiplatlet agent is developed for the prevention of recurrence of strokein a large randomized clinical trial with equal numbers of men and women the rates of a stroke are lower in patients recieving the new agentsthan in patient recieving the standard treatment

ecurrent stroke rates per 1000 person .years

standard treatment new antiplatlet

women .12 .04

men .24 .08

overall .18 .06

absolute risk reduction in women is 8%,12%,16% 33% 50% 62% 67% 75%



Is the answer 8%? Is my calculation correct (.12-.04)= 8%?



6) An increase in the amount of iron inside cultured hepatocytes leads to an increase in the amount of ferritin gene products detected by Westem blotting.

It does not change the amount of ferritin gene products detected by Northem blotting or by the polymerase chain reaction.

These results suggest that iron increases the frequency of which of the following events?


A) Maturation of the ferritin gene transcript

B) Transcription of the ferritin gene

C) Translation of ferritin mRNA

D) Transport of ferritin mRNA out of the nucleus


Is it C?
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Quote:
Originally Posted by afrothunderman1 View Post
1) A 62 yr old man comes to the physician for a follow up examination. Two weeks ago, he was discharged from the hosp after sustaining MI. He smokes 2 packs of cigarettes and drinks 4 12 oz beer daily. His diet mostly consists of cured meats and fast food. He does not exercise. The pt. tells the physician, "I know that I need to make some changes in how I live so that my heart can be healthier. I just don't have the willpower to quit smoking and drinking and all that stuff right now." Which of the following best describes this patient's stage of behavioural change? Is this contemplation?



Precontemplation, Contemplation, Preparration, Action, Maintenance





2) 51 yr old woman w/ pheochromocytoma. preoperative treatment w propranolol prescribed to decrease tachycardia. which drug should be admins. before starting propranol? Is it phenoxybenzamine?



atenolol, clonidine, nifedipine, phenoxybenzaminem sildenafil?





3) 70 yr old lady brought to er by husband 45 min after he found her unresponsive. She has anxiety disorder trted w/ diazepam. She recently started taking over the counter med for heart burn. she only responds to painful stimuli. interaction with which drug causing this prob? i know its a cytp450 inhibitor so is it cimetidine or ranitidine?

calcium carbonate, cimitidine, famotidine, magnesium trisilicate, ranitidine





4) 67 yr old lady hip replacement operation has shortness of breath and pain of back with deep breathing. She’s anxious..calf shows erythma…has large embolism occluding blood flow. Answer is dead space right since its a perfusion defect? I skipped out on details in the question because i figured you’d remember which question this was.

dead space, diffusion abnormality, hypoventilation, low fi02, shunt,
ANSWERS in BOLD
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  #334  
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Quote:
Originally Posted by afrothunderman1 View Post
1) 66 yr old man brought to er sudden substernal chest pain..jogging when pain began..hypertension trted w indapamide..pulse 90 min bp 150/90 cardiac exam s4. treatment w sublingual med fixed pain in 2 min…mech of action of which drug let to relaxation of vascular smooth muscle in this patient? Obv nitroglycerin so is the answer increased cGMP?



decreasing intracellular calcium, increasing camp, increased cGmp, inhibiting the sodium pump, stabilizing depolarization of the vascular smooth muscle cell membranee





2) previously healthy 67 yr old lady w 3 day history of fever, shortness of breath, nonproductive cough, headache, and muscle pain. Temp is 102 F. lungs clear to auscultation. Exanm shows no abnormalities. which vaccine coulda prevented this stuff?



diphteheria tetanus acellular pertussis, h. influ type b, hepatitis b, inactivated polio, influenza virus, mmr, typhoid, 23 valent pneumococ, varicella





3) 35 yr old man w long history of atrophic gastritis has increased lethargy and fizziness during past 2 weeks. pale skin and mucous membranes. no palpabl adenopathy. liver edge palpable. decreased vibratory sensation. hct of 27%, mcv 112, and platelet count 200,000. absence of sufficient numbers of which cell types explains these findings?

chief, columnar absorptive, enteroendocrine, goblet, mucous, paneth, parietal, undifferentiated crypt



4) 80 yr old woman fever cloudy urine after knee replacement. Temp is 100.4 F. Bandaged left knee and indwelling foley cath. Micro shows numerous gram negative rods. urine culture brain heart infusion medium grows more than 100,000 bacterial colonies predominantly one thats oxidase positive and produces diffusible green pigment. whig organism? Is this p.aueroginosa?



ecoli, kleb.pneumoniae, proteus mirabilis, p.aureoginosa, group a step pyogenes



5)a new antiplatlet agent is developed for the prevention of recurrence of strokein a large randomized clinical trial with equal numbers of men and women the rates of a stroke are lower in patients recieving the new agentsthan in patient recieving the standard treatment

ecurrent stroke rates per 1000 person .years

standard treatment new antiplatlet

women .12 .04

men .24 .08

overall .18 .06

absolute risk reduction in women is 8%,12%,16% 33% 50% 62% 67% 75%



Is the answer 8%? Is my calculation correct (.12-.04)= 8%?



6) An increase in the amount of iron inside cultured hepatocytes leads to an increase in the amount of ferritin gene products detected by Westem blotting.

It does not change the amount of ferritin gene products detected by Northem blotting or by the polymerase chain reaction.

These results suggest that iron increases the frequency of which of the following events?


A) Maturation of the ferritin gene transcript

B) Transcription of the ferritin gene

C) Translation of ferritin mRNA

D) Transport of ferritin mRNA out of the nucleus


Is it C?
youre getting most of them right lol. wonder why you got them wrong!
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sigh....... lol
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lol i should've started off w/ an easier nbme. Oh well.

1) 59 old man history of fevers he ache. pdf of csf shows herpes simplex virus. give drug that inhibits which enzyme? acyclovir so DNA polymerase correct?
dna polymerase, neuraminidase, protease, reverse transcriptase, RNAase A

2) woman w 6 mon history of burning abdominal pain that occurs 1-2 hrs after eating…sweats and lightheadedness when standing…bp in 105/70mmhg while standing….epigastric tenderness….ct scan of abs shows 2 cm mass on prix duodenum….gastrin released by tumor cells stimulates which labeled cells in the photomicrograph shown to release hydrogen ions? This one had a pic..no idea help plz
a,b,c,d,e

3) 4 month boy w recurrent sinopulmonary infections since birth. Phys exam shows hypo pigmentation of skin, eyes, hair, ecchymoses over trunk and extremities. Blood smear shows giant granules in neurtophils and eosinophils. I know this is chediak higashi lol but still wanna double check

acute myeloblastic leukemia, ataxia telangiectasia, chediak higashi syndrome, leukocyte adhesion deficency, sezary syndrome

4) 12 yr old girl immigrated to us from central africa has 5 wk history of severe abdominal pain and vomits blood. temperature is 100F pulse is 110/min, respirations are 27/min, and BP is 112/65 mmHg. Phys exam shows hepatosplenomegaly and abdominal ascites. Leukocyte count slightly above normal..photo of the stool specimen shown. Whats the appropriate pharmacotherpay for this poor girl?
fluconazole, levofloxacin, metronidazole, praziquantel, trimeth-sulfameth

5) 62 yr old man has pain in the left hip for 3 wks. X-ray of ship shows 4.5 cm destructive osteoblastic lesion w an associated fracture in proximal femur and 2 separate similar smaller lesions in the bony pelvis. Needle core biopsy of femur shows metastatic carcinoma. Whats the most likely primary site of the cancer? prostate right cuz of the clues? if its not this then lung(most common metastasis site)

colon, kidney, lung, pancreas, prostate

6) Lady in study..steroid hormone in saliva…regular 28 day cycle with ovulation at day 14..during test, lab study shows increased estradiol and decreased progesterone..what day was this hormones measure?
day 12 right cuz estrogen peaks right before ovulation…and i rmr there being low progesterone during that phase..

day 1, day 6, day 12, day 18, day 26

7) 78 yr old man fever, chills, fatigue, shortness of breath, 12 lb weight loss over past month. Underwent urinary catheterization 6 wk ago for prostatic obstruction. Temperature is 101.3F, pulse is 100/min, respirations are 14/min, and bp is 160/80mmhg. Soft sa and normal s2 . Grade 2/6 diastolic murmur is maximal in second left intercostal space accentuated when patient leans forward with held expiration. Diagnosis? This has to be prostatitis right?

bacterial endocarditis, peritonitis, prostatis, pulmonary embolus, viral pnemonia
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Quote:
Originally Posted by afrothunderman1 View Post
lol i should've started off w/ an easier nbme. Oh well.

1) 59 old man history of fevers he ache. pdf of csf shows herpes simplex virus. give drug that inhibits which enzyme? acyclovir so DNA polymerase correct?
dna polymerase, neuraminidase, protease, reverse transcriptase, RNAase A

2) woman w 6 mon history of burning abdominal pain that occurs 1-2 hrs after eating…sweats and lightheadedness when standing…bp in 105/70mmhg while standing….epigastric tenderness….ct scan of abs shows 2 cm mass on prix duodenum….gastrin released by tumor cells stimulates which labeled cells in the photomicrograph shown to release hydrogen ions? This one had a pic..no idea help plz
a,b,c,d,e

I don't remember but here's a histology hint: Parietal cells are pink puffy cells. Like a puffy big pink balloon, they are in the upper region of gastric pits. (Compared to chief cells that are in the lower region, have rough endoplasmic reticulum making them blue, and are smaller!)

3) 4 month boy w recurrent sinopulmonary infections since birth. Phys exam shows hypo pigmentation of skin, eyes, hair, ecchymoses over trunk and extremities. Blood smear shows giant granules in neurtophils and eosinophils. I know this is chediak higashi lol but still wanna double check

acute myeloblastic leukemia, ataxia telangiectasia, chediak higashi syndrome, leukocyte adhesion deficency, sezary syndrome

4) 12 yr old girl immigrated to us from central africa has 5 wk history of severe abdominal pain and vomits blood. temperature is 100F pulse is 110/min, respirations are 27/min, and BP is 112/65 mmHg. Phys exam shows hepatosplenomegaly and abdominal ascites. Leukocyte count slightly above normal..photo of the stool specimen shown. Whats the appropriate pharmacotherpay for this poor girl?
fluconazole, levofloxacin, metronidazole, praziquantel, trimeth-sulfameth

Don't remember the picture, sorry!

5) 62 yr old man has pain in the left hip for 3 wks. X-ray of ship shows 4.5 cm destructive osteoblastic lesion w an associated fracture in proximal femur and 2 separate similar smaller lesions in the bony pelvis. Needle core biopsy of femur shows metastatic carcinoma. Whats the most likely primary site of the cancer? prostate right cuz of the clues? if its not this then lung(most common metastasis site)

colon, kidney, lung, pancreas, prostate

Osteoblastice is always prostate!


6) Lady in study..steroid hormone in saliva…regular 28 day cycle with ovulation at day 14..during test, lab study shows increased estradiol and decreased progesterone..what day was this hormones measure?
day 12 right cuz estrogen peaks right before ovulation…and i rmr there being low progesterone during that phase..

day 1, day 6, day 12, day 18, day 26

After estrogen surge, Lh causes ovulation. Progesterone is no where before ovulation because there is no egg (Remember, pro-gestation, no egg, no gestation, no progesterone!)

7) 78 yr old man fever, chills, fatigue, shortness of breath, 12 lb weight loss over past month. Underwent urinary catheterization 6 wk ago for prostatic obstruction. Temperature is 101.3F, pulse is 100/min, respirations are 14/min, and bp is 160/80mmhg. Soft sa and normal s2 . Grade 2/6 diastolic murmur is maximal in second left intercostal space accentuated when patient leans forward with held expiration. Diagnosis? This has to be prostatitis right?

Umm what would explain the murmur then? It's bacterial endocarditis due to the urogenital manipulations.
Diastolic narrows it to: PR AR MS TS
2nd intercostal space: PR


bacterial endocarditis, peritonitis, prostatis, pulmonary embolus, viral pnemonia
Answers in bold.
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  #338  
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Quote:
Originally Posted by nakeya52 View Post
Answers in bold.
Thank you!
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1) 68 y/o woman has 1 year history of severe ab pain after meals. also has an unintentional 20lb weight los. pain is relieved when she decreases the amount of food she eats. history of atherosclerosis and underwent triple coronary artery bypass grafting 2 yrs ago. p/e shows soft, nontender abdomen and abdominal bruit. pedal pulses diminished. which artery is stenosed?

greater pancreatic

hepatic

right gastric

superior mesenteric

supraduodenal



is this superior mesenteric and how come?





2) previously healthy 52 yr old lady has 2 mo history of progressive difficulty swallowing, double vision, and slurred speech. pays exam shows ptosis of the eyelids and waddling gait. muscle strength shows fatigable weakness of the neck, arms, hands, and fingers. Repetitive nerve stimulation shows a 25% decrease in muscle action potentials in several muscles. Which of the following mechanisms is the most likely cause of this patients disease? Obv myasthenia gravis but can’t decide between the first two options altho i think its the second option



binding of acetylcholine by an antibody, binding of antibody to the acetylcholine receptor, deceased acetylcholine production, decreased release of acetylcholine from the receptor, decreased reuptake of acetylcholine



3) During an experiment endothelial cells are incubated wit 30Mn of glucose compared w 5Mm of glucose, the results are:

G6P 180%

FRUCTO1,6BP 220%

GLYCERALDEHYDE 3P 210%

1,3 BPGLYCERATE 75%

PYRUVATE 70%

Wich of the following enzymes is most likely inhibited indirectly by increase of glucose concentration

a. Aldolase

b. Glyceraldehyde 3PDH

c. Hexokinase

d. PFK

e. PGlyceraldehyde mutase

f. puruvate kinase


someone said “As far as I think, the percentage tells you how much substrate you have... so there is 210% of Glyceraldehyde3P... so it backs up cause an enzyme following is blocked…” but I’m still kinda lost on this one…if anyone can explain that’ll help..I’ll have my first aid page opened to the one with all the biochem pathways



4)5 yr old stares blankly into space for several seconds. doesn’t respond to questions during these episodes. pays exam shows no abnormalities. reg shows 1-3 second hurts of 3 sec spike and wave activity. no abnormal motor movements are observed during this reg activity. therapy is ethosuximide cuz its absent seizure correct?



carbamazepine, ethosuximide, gabapentin, phenobarbital, phenytoin



5) 5 year old boy brought to the ER. with vomiting and sleepiness, he had a flu like illness 5 days ago that she treated with aspirin. Serum studies show increased ammonia, lactate, and transaminase levels. what's the most likely cause of the patient's coma?

a) cerebral edema

b) metabolic alkalosis (wrong)

c) subarachnoid hemorrhage

d) venous sinus thrombosis

e) viral encephalitis


kid probably has Reye's syndrome but why isn’t the answer viral encephalitis?? is it cerebral edema? someone wrote this explanation The answer is A. It would be Reye syndrome which leads to hepatic encaphalopathy. The mitochondrial damage is in the liver. Here i'm a little bit hazy but hopefully google should find something that can confirm or elucidate but: Liver damage --> hyperammonemia --> hepatic encephalopathy --> astrocyte swelling. I tried looking for that uworld id but it doesn't exist for me. But FA2014 pg 361 has it leading to hepatoencephalpathy





6)a 24 year old african american man comes to the physician because of a 3 month history of red bumps on his face and chin. he says that the bumps are itchy and painful. physical examination shows hyper pigmented papules over the cheeks, jawline, and neck. which of the following is the most likely diagnosis?


A) acne vulgaris

B) cutaneous lupus Erythematosus

C) Keloids

D) pseudofolliculitis barbae

E) Rosacea

someone wrote

“The answer is D) the guy has razor burn and African americans get it frequently”
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Old 05-25-2014
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Quote:
Originally Posted by Bullfrog529 View Post
(1)

Last question on the Iron deficiency anemia question i just don't see how one can tell the difference btw minor and iron def. My guess is the Hematocrit is lower in iron def

Help me out please
Can anyone explain it to me? Both are microcytic anemias.
The patient had a reticulocyte count of 0,8%.
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Quote:
Originally Posted by Curacao View Post
Can anyone explain it to me? Both are microcytic anemias.
The patient had a reticulocyte count of 0,8%.
Hey Curacao!
Can you paste the entire question? I don't remember this one!
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1. Liver showing centrilobular pallor and swelling of hepatocytes and kidneys showing proximal convoluted epithelial cells. Which is the mechanism?



A) activation of aspartate-spcific caspase

B) Binding of Fas ligand to receptor

C) Decreased function of Na/K ATPase

D) Ribosomal degradation

E) Stimulation of PFKase





is it decreased function of NA/K Atpase, since its a reversible cellular injury first of all(cellular swelling is classic for reversible injury) so the NA/K being screwed up means sodium will accumulate and water will follow and so swelling?





2) 26 yr old dude has tenesmus and bloody diarrhea. Apppearance of intestine from rectum to mid ascending colon shown in pic. Terminal ileum is normal(so we know its not chrons!) biopsy shows micro abscesses within the crypts and depletion of mucus from goblet cells? diagnosis? Is this ulcerative colitis? Sounds like it.



amebic sysentery, collagenous colitis, crohn disease, ischemic bowel disease, ulcerative colitis





3)60 yr old woman has 2 history of hypertension comes to doc for follow up examination. Hypertension has been poorly controlled during the past six months despite availability of appropriate pharmacotherapy. which of the following statements by the physician is most appropriate to begin a discussion about this patients possible noncompliance w her medication regimen?

Is it “it is hard to take pills every day for a condition that has no symptoms” i think its this..other choices

“i will arrange for nurse to visit to make sure you’re taking meds properly”

“I’m sorry but i must say missing your meds can kill you”

“you clearly have not been taking your meds. you must be more responsible”

“you realize that your high blood pressure could have been avoided”



4) 38 yr old lady w/ 10 wk history of epigatric pain and frequent stool. She had two episodes of renal calculi during the past 2 yrs. Physical exam shows multiple superficial lipomata and mild epigastric tenderness. Upper endoscopy show two large non bleeding duodenal ulcers. her gastric pH is 2.3, and serum gastrin concentration obtained immediately after the procedure is 2000 pg/ml(N<100). Proton pump inhibitor therapy is begun. measurement of which of the following is the most appropriate next step in management?



serum calcium concentration, serum cortisol concentration, serum tissue transglutaminase activity, stool alpha 1 antitripson concentration, urine 5 hydroxyindoleacetic acid concentration



5) 12 year old with walking abnormality for 6 months. mild atrophy and hammer toes.nerve biopsy shows

abnormal myelin sheaths

absence of shwann cells

lymphycytic infiltrate

abnormal astrocytes

abnormal oligodendrocytes


is this abnormal myelin sheaths(charcot marie tooth disease)?


6) 54 yr old man w/ aneurysm in distal portion of his abdominal aorta. Estimated cross-sectional area of the aneurysm is 2 cm^2 and the mean velocity of blood flow thru the aneurysm is 20cm/sec. which of the following best represents the flow rate in L/min thru the aneurysm? Can someone please help me out with this?


1.0, 2.4, 3.2, 3.6, 4.0



7)55 yr old dude w contipationsine taking meds for chronic persistent cough n sinus congestion. which ingredient in this med most likely cause of this patients new symptom? dextromethorphan right?


acetaminophen, dextromethorphan, guafenesin, loratidine phenylephrine


8) It was about the niacin cholesterol mechanism. Which one is the better answer? antagonizes VLDL cholesterol secretion or inhibits cholesterol uptake



9) 54y F admitted with acute MI, at which point there were no murmurs or signs of heart failure; but 2 days later, she has acute SOB and sweating; HR 100, RR 24, BP 160/98. Crackles bilaterally, +murmur. Which murmur is most likely?


(then they basically gave a descriptor for each murmur type "grade x/6, diastolic decrescendo murmur heard best at Y") I searched this up and someone said that the best answer is 4/6 holosystolic murmur heard best over lower left sternal border and cardiac apex. What do you think about this one?



10) 28 yr old lady w/ 1 month history of pelvic pain that has become increasingly severe during the past week. Her mensrual flow has been unusually heavy during her last three menstrual periods. Menses have occurred at 24-28 day intervals since menarche at the age of 12 years. Phys exam shows a palpable mass in the left adnexa. Serum studies show an increased CA 125 concentration. Vaginal ultrasonography shows an 8 cm mass in the left ovary. During surgical removal of the ovary, which of the following structures passing inferior to the ovary must be protected? I think its ureter but wanna double check w you



external iliac artery, internal iliac artery, ovarian ligament, round ligament of the uterus, ureter



11) 18 yr old dude w acute lymphblastic leukemia has 3 day history of intermittent fever and left sided chest pain. He’s in 5th week of induction chemotherapy consisting of asparaginase, daunorubicin, prednisone, and vincristine. His absolute neutrophil count has been less than 500/mm for the past month. Temp is 102 F and he has dullness to percussion and decreased breath sounds on the left side. Chest X-ray shows a left lower lobe infiltrate and a moderate pleural effusion on the left. Photo of pas-stain of pleural fluid shown in the pic of the question. Whats the appropriate therapy? I need help w this one



amphotericin B, Ertapenem, Ganciclovir, Infliximab, Rituximab



12) 16 yr old boy dove into pool, unable to move right upper and lower extremities. Most likely cause of movement deficits in this patient is damage to which region of the spinal cord? Is it G, by the ventral cord of the spinal cord?



a,b,c,d,e,f,g,h



13) a previously healthy 27-year-old woman comes to physician because of a 3 week history of episodes of left sided chest pain and tenderness. the pain radiates to the back and is exacerbated when she reaches over her head or behind her back. she has not had shortness of breath, sweating, or light-headedness. her temperature is 37.1 pulse is 92/min, respirations are 14/min, and blood pressure is 130/86 mm Hg. Cardiopulmonary examination shows no abnormalities. examination shows tenderness to palpation 2 cm lateral to the midline and 10 cm below the clavicle on the left. an x-ray of the chest and ECG show no abnormalities. Which of the following is most likely diagnosis?


A) Achalasia

B) Acute pericarditis

C) Costochondritis

D) Dissecting aortic aneurysm

E) Gastroesophageal reflux disease

F) pleurisy

G) pneumothorax

H) Stable angina pectoris



14) 23 yr old diagnosed w sjoren syndrome has burning pain in her toes for past month. rates pain 3 on 10 point scale. she uses capsaicin cream for pain which produces partial relief. Neuro exam shows decreased perception of temperature over feet bilaterally. Sensation to vibration, proprioception, reflexes, muscle strength, muscle tone, and bulk are normal. Which neurotransmitter mediating pain? Is it substance P?



gamma minobutyric acid, dopamine, enkephalin, serotonin, substance P



15) 15 yr old boy, 6’3 and weights 165 lb, BMI 21 kg, pulse is 85/min and bounding/ bp is 110/40. dislocation of right lens. Pectus excavatum. grade 3/6 decrescendo diastolic murmur heard at aortic area. Wide mediastinum. Genetic defect in what? so this is marfans so fibrillin correct?

collagen type 2, elastin, fibrillin, hyaluronate, proteoglycan
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  #343  
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1. Liver showing centrilobular pallor and swelling of hepatocytes and kidneys showing proximal convoluted epithelial cells. Which is the mechanism?



A) activation of aspartate-spcific caspase

B) Binding of Fas ligand to receptor

C) Decreased function of Na/K ATPase (correct answer - basic concept... low energy -> low ATP -> no function of NA/K ATPase -> accumulation of Na inside cell and water shifting inside -> water always follows Na

D) Ribosomal degradation

E) Stimulation of PFKase



2) 26 yr old dude has tenesmus and bloody diarrhea. Apppearance of intestine from rectum to mid ascending colon shown in pic. Terminal ileum is normal(so we know its not chrons!) biopsy shows micro abscesses within the crypts and depletion of mucus from goblet cells? diagnosis? Is this ulcerative colitis? Sounds like it.


amebic sysentery, collagenous colitis, crohn disease, ischemic bowel disease, ulcerative colitis


Absolutely UC -> continuous spread and abscesses within crypts




3)60 yr old woman has 2 history of hypertension comes to doc for follow up examination. Hypertension has been poorly controlled during the past six months despite availability of appropriate pharmacotherapy. which of the following statements by the physician is most appropriate to begin a discussion about this patients possible noncompliance w her medication regimen?

Is it “it is hard to take pills every day for a condition that has no symptoms” i think its this..other choices

“i will arrange for nurse to visit to make sure you’re taking meds properly”

“I’m sorry but i must say missing your meds can kill you”

“you clearly have not been taking your meds. you must be more responsible”

“you realize that your high blood pressure could have been avoided”

It is hard to take so many pills for a condition that has no symptoms... is 100% correct



4) 38 yr old lady w/ 10 wk history of epigatric pain and frequent stool. She had two episodes of renal calculi during the past 2 yrs. Physical exam shows multiple superficial lipomata and mild epigastric tenderness. Upper endoscopy show two large non bleeding duodenal ulcers. her gastric pH is 2.3, and serum gastrin concentration obtained immediately after the procedure is 2000 pg/ml(N<100). Proton pump inhibitor therapy is begun. measurement of which of the following is the most appropriate next step in management?

MEN syndrom...so check Parathyroids---> they make PTH-> increased CA2+


5) 12 year old with walking abnormality for 6 months. mild atrophy and hammer toes.nerve biopsy shows

abnormal myelin sheaths

absence of shwann cells (would be MS- patient too young and more likely in females)

lymphycytic infiltrate

abnormal astrocytes (brain)

abnormal oligodendrocytes (oligodendrocytes are in the brain)




is this abnormal myelin sheaths(charcot marie tooth disease)?


6) 54 yr old man w/ aneurysm in distal portion of his abdominal aorta. Estimated cross-sectional area of the aneurysm is 2 cm^2 and the mean velocity of blood flow thru the aneurysm is 20cm/sec. which of the following best represents the flow rate in L/min thru the aneurysm? Can someone please help me out with this?


1.0, 2.4, 3.2, 3.6, 4.0

(2cm^2*20cm)*60 (cause you one hour)= 2400 cm^3/h

divided by 1000 cause you want liters.... 2.4


7)55 yr old dude w contipationsine taking meds for chronic persistent cough n sinus congestion. which ingredient in this med most likely cause of this patients new symptom? dextromethorphan right?

yes dextrometorphan...opiods make constipation

acetaminophen, dextromethorphan, guafenesin, loratidine phenylephrine


8) It was about the niacin cholesterol mechanism. Which one is the better answer? antagonizes VLDL cholesterol secretion or inhibits cholesterol uptake

VLDL cholesterol secretion...

Ezetimibe inhibits cholesterol uptake



9) 54y F admitted with acute MI, at which point there were no murmurs or signs of heart failure; but 2 days later, she has acute SOB and sweating; HR 100, RR 24, BP 160/98. Crackles bilaterally, +murmur. Which murmur is most likely?

Nice concept...
So SOB and Crackles must be fluid backing up into the lung... therefore left sided heart failure -> the concept is that ischemia of the papillary muscles lead to Mitral insuff. -> murmur is holosystolic high pitched loudest at apex



10) 28 yr old lady w/ 1 month history of pelvic pain that has become increasingly severe during the past week. Her mensrual flow has been unusually heavy during her last three menstrual periods. Menses have occurred at 24-28 day intervals since menarche at the age of 12 years. Phys exam shows a palpable mass in the left adnexa. Serum studies show an increased CA 125 concentration. Vaginal ultrasonography shows an 8 cm mass in the left ovary. During surgical removal of the ovary, which of the following structures passing inferior to the ovary must be protected? I think its ureter but wanna double check w you


Ureter


11) 18 yr old dude w acute lymphblastic leukemia has 3 day history of intermittent fever and left sided chest pain. He’s in 5th week of induction chemotherapy consisting of asparaginase, daunorubicin, prednisone, and vincristine. His absolute neutrophil count has been less than 500/mm for the past month. Temp is 102 F and he has dullness to percussion and decreased breath sounds on the left side. Chest X-ray shows a left lower lobe infiltrate and a moderate pleural effusion on the left. Photo of pas-stain of pleural fluid shown in the pic of the question. Whats the appropriate therapy? I need help w this one

Well... what did you see? Compare the picture to FA page where they have the Mycoses listed.
Answer is Amphotericin B


12) 16 yr old boy dove into pool, unable to move right upper and lower extremities. Most likely cause of movement deficits in this patient is damage to which region of the spinal cord? Is it G, by the ventral cord of the spinal cord?

Don't have the picture but it is upper motoneuron so right side middle cause anterior is spinathalamic tract



13) a previously healthy 27-year-old woman comes to physician because of a 3 week history of episodes of left sided chest pain and tenderness. the pain radiates to the back and is exacerbated when she reaches over her head or behind her back. she has not had shortness of breath, sweating, or light-headedness. her temperature is 37.1 pulse is 92/min, respirations are 14/min, and blood pressure is 130/86 mm Hg. Cardiopulmonary examination shows no abnormalities. examination shows tenderness to palpation 2 cm lateral to the midline and 10 cm below the clavicle on the left. an x-ray of the chest and ECG show no abnormalities. Which of the following is most likely diagnosis?



A) Achalasia

B) Acute pericarditis

C) Costochondritis

D) Dissecting aortic aneurysm

E) Gastroesophageal reflux disease

F) pleurisy

G) pneumothorax

H) Stable angina pectoris

Pain increases by moving... common things are common and uncommon things are uncommon... and EKG is normal.... Costochondritis is correct esp. cause she has tenderness to palpation that basically kills all other answer choices.


14) 23 yr old diagnosed w sjoren syndrome has burning pain in her toes for past month. rates pain 3 on 10 point scale. she uses capsaicin cream for pain which produces partial relief. Neuro exam shows decreased perception of temperature over feet bilaterally. Sensation to vibration, proprioception, reflexes, muscle strength, muscle tone, and bulk are normal. Which neurotransmitter mediating pain? Is it substance P?



gamma minobutyric acid, dopamine, enkephalin, serotonin, substance P

Substance P!



15) 15 yr old boy, 6’3 and weights 165 lb, BMI 21 kg, pulse is 85/min and bounding/ bp is 110/40. dislocation of right lens. Pectus excavatum. grade 3/6 decrescendo diastolic murmur heard at aortic area. Wide mediastinum. Genetic defect in what? so this is marfans so fibrillin correct?

collagen type 2, elastin, fibrillin, hyaluronate, proteoglycan


Collagen!
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  #344  
Old 05-25-2014
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The question about lady stung by bee 30 minutes ago She develops urticarial lesion. 6 hours later the area becomes underrated and firm. What explains the induration at the site of the sting? Someone said the answer was "influx of macrophages producing IL1, IL6, TNF alpha. But that doesn't make sense because that describes DELAYED HYPERSENSITIVITY and bee stings are type 1 hypersensitivity. Please help.

decrease in expression of adhesion molecules on vascular endothelial cells, decrease in serum C reactive protein concentration, influx of macrophages producing IL1, IL6, and TNF alpha, Lysis of endothelial cells by the alternative compliment pathway, vasoconstriction

Thanks!
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  #345  
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Originally Posted by afrothunderman1 View Post
The question about lady stung by bee 30 minutes ago She develops urticarial lesion. 6 hours later the area becomes underrated and firm. What explains the induration at the site of the sting? Someone said the answer was "influx of macrophages producing IL1, IL6, TNF alpha. But that doesn't make sense because that describes DELAYED HYPERSENSITIVITY and bee stings are type 1 hypersensitivity. Please help.

decrease in expression of adhesion molecules on vascular endothelial cells
decrease in serum C reactive protein concentration
influx of macrophages producing IL1, IL6, and TNF alpha
Lysis of endothelial cells by the alternative compliment pathway
vasoconstriction

Thanks!
I know!! Your doubt is valid.

But what else would it rather be?
Lysis of endothelial cells by the alternative compliment pathway will not cause an induration.

Decrease in expression of adhesion molecules on vascular endothelial cells,
decrease in serum C reactive protein concentration and vasoconstriction doesn't happen in inflammation.

So by elimination, you are left with the silly macrophage option :|

Btw, Robbins does say IL 1, IL6 and TNF alpha are secreted in the late phase of type 1 hypersensitivity, but it is secreted by monocytes and neutrophils
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  #346  
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Yes! THIS

"Btw, Robbins does say IL 1, IL6 and TNF alpha are secreted in the late phase of type 1 hypersensitivity, but it is secreted by monocytes and neutrophils"


is the right and only proper explanation! Thank you so much for sharing
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Default Exam is in Next week

My exam is next week, I appreciate any help in answering the questions below:

47 During an experiment, the concentration of glycolytic intermediates is measured in human endothelial cells incubated with 30 mM(540 mg/dL) glucose compared with 5 mM (90 mg/dL) glucose. Results show: 30 mM Glucose Intermediate (Compared With 5 mM Glucose) Glucose 6-phosphate 180% Fructose 1,6-bisphosphate 220% Glyceraldehyde 3-phosphate 210% 1,3-Bisphosphoglycerate 75% Pyruvate 70% Based on these data, the activity of which of the following enzymes is most likely inhibited indirectly by increased glucose concentrations?
A) Aldolase
B)Glyceraldehyde-3-phosphate dehydmgenase
C)Hexokinase
D)Phosphofructokinase
E)Phosphoglycerate mutase
F) Pyruvate kinase

25. A 54-year-old man has an aneurysm in the distal portion of his abdominal aorta. The estimated cmss-sectional area of the aneurysm is 2 crn2 and the mean velocity of blood flow through the aneurysm is 20 cm/sec. Which of the following best represents the flow rate (in L/min) through the aneurysm?
A) 1
B) 2.4
C) 3.2
D) 3.6
E) 4.0

17. A 23-year-old man comes to the physician because of difficulty maintaining an erection. He was involved in an automobile collision that damaged his thoracic spinal cord, affecting motor and sensory function of the lower tunk and extremities. He is only able to obtain an erection thmugh physical contact with his penis by his wife, and the erection does not last a long time. The best explanation for this type of erection is an intact spinal reflex arc between the sacral parasympathetic nerves and which of the fallowing?
A) Genitofemaral nerves
B) Iliainguinal nerves
C) Lurnbosacral trunks
D) Obturator nerves
E) Pudendal nerves

1. Two sets of patients (Groups X and V) of similar age, weight, gender, and health status are given general anesthesia by inhalation. In Group X, anesthesia is induced by administering isofiurane at a concentration 1.5 times the minimal alveolar concentration (MAC) for this drug. In Group V, anesthesia is induced by administering a combination of isofiurane and nitrous oxide, each at 0.75 times the MAC for that drug. The onset of anesthesia is found Abe significantly faster in GmupY than in Group X. The different response rates between the two groups is best explained by differences in which of the following properties of isoflurane and nitrous oxide?
A) Blood:gas partition coefficient
B) Brain blood partition coefficient
C) Brain'gas partition coefficient
D) Hepatic metabolism
E) Lipid solubility
F) Minimal alveolar concentration
G) Molecular weight

40. A 48-year old man is referred for evaluation of possible hypertension On the basis of ten measurements, the patients average diastolic blood pressure is 113 mm Hg, and the standard deviation is 8 mm Hg. If four rather than ten measurements of the mean blood pressure are made, which of the following is the expected impact on the size of the 95% confidence interval about the mean blood pressure?
A) Change, but the direction cannot be predicted
B) Decrease in width
C) Increase in width
D) Remain the same

3. An 8-year-old girl is brought to the physician fora well-child examination. Her mother says that she has been well except for an occasional cold. Her immunizations are up to date. She is at the 50th percentile for height and 80th percentile for weight Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughters development is normal. Which of the following is the most appropriate initial response by the physician?
A)I am concerned that your daughter may have precocious puberty.
B)1 think that your daughter is likely to begin menstruating in the next few months.
C)1 would like to order laboratory studies to ensure that your daughters development is normal.
D)your daughters breast development is somewhat less than might be expected for her age.
E)Your daughters development is normal.
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  #348  
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Quote:
Originally Posted by M.Tayeb View Post
My exam is next week, I appreciate any help in answering the questions below:

47 During an experiment, the concentration of glycolytic intermediates is measured in human endothelial cells incubated with 30 mM(540 mg/dL) glucose compared with 5 mM (90 mg/dL) glucose. Results show: 30 mM Glucose Intermediate (Compared With 5 mM Glucose) Glucose 6-phosphate 180% Fructose 1,6-bisphosphate 220% Glyceraldehyde 3-phosphate 210% 1,3-Bisphosphoglycerate 75% Pyruvate 70% Based on these data, the activity of which of the following enzymes is most likely inhibited indirectly by increased glucose concentrations?
A) Aldolase
B)Glyceraldehyde-3-phosphate dehydmgenase
C)Hexokinase
D)Phosphofructokinase
E)Phosphoglycerate mutase
F) Pyruvate kinase

highest substrate is Glyceraldehyde 3-phosphate... after that there is a drop from 210% to 75% meaning there must be a block of the enzyme... correct answer is B. If you block enzyme B there is a lot of Glyceraldehyde 3-phosphate and only little of products than are following...

25. A 54-year-old man has an aneurysm in the distal portion of his abdominal aorta. The estimated cmss-sectional area of the aneurysm is 2 crn2 and the mean velocity of blood flow through the aneurysm is 20 cm/sec. Which of the following best represents the flow rate (in L/min) through the aneurysm?
A) 1
B) 2.4
C) 3.2
D) 3.6
E) 4.0

has been already answered with explanation yesterday.

17. A 23-year-old man comes to the physician because of difficulty maintaining an erection. He was involved in an automobile collision that damaged his thoracic spinal cord, affecting motor and sensory function of the lower tunk and extremities. He is only able to obtain an erection thmugh physical contact with his penis by his wife, and the erection does not last a long time. The best explanation for this type of erection is an intact spinal reflex arc between the sacral parasympathetic nerves and which of the fallowing?
A) Genitofemaral nerves
B) Iliainguinal nerves
C) Lurnbosacral trunks
D) Obturator nerves
E) Pudendal nerves

I chose Pudendal nerve and it was correct. The glans of the penis is innervated by a branch of the pudendal nerve.

1. Two sets of patients (Groups X and V) of similar age, weight, gender, and health status are given general anesthesia by inhalation. In Group X, anesthesia is induced by administering isofiurane at a concentration 1.5 times the minimal alveolar concentration (MAC) for this drug. In Group V, anesthesia is induced by administering a combination of isofiurane and nitrous oxide, each at 0.75 times the MAC for that drug. The onset of anesthesia is found Abe significantly faster in GmupY than in Group X. The different response rates between the two groups is best explained by differences in which of the following properties of isoflurane and nitrous oxide?
A) Blood:gas partition coefficient
B) Brain blood partition coefficient
C) Brain'gas partition coefficient
D) Hepatic metabolism
E) Lipid solubility
F) Minimal alveolar concentration
G) Molecular weight

Blood gas partition coefficient. Uworld question.

40. A 48-year old man is referred for evaluation of possible hypertension On the basis of ten measurements, the patients average diastolic blood pressure is 113 mm Hg, and the standard deviation is 8 mm Hg. If four rather than ten measurements of the mean blood pressure are made, which of the following is the expected impact on the size of the 95% confidence interval about the mean blood pressure?
A) Change, but the direction cannot be predicted
B) Decrease in width
C) Increase in width
D) Remain the same

Increase in width. The range is already pretty high but the more measurements you make the narrower it gets. The fewer measurements you take the wider the range becomes.

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

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

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

Hope that makes sense...



3. An 8-year-old girl is brought to the physician fora well-child examination. Her mother says that she has been well except for an occasional cold. Her immunizations are up to date. She is at the 50th percentile for height and 80th percentile for weight Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughters development is normal. Which of the following is the most appropriate initial response by the physician?
A)I am concerned that your daughter may have precocious puberty.
B)1 think that your daughter is likely to begin menstruating in the next few months.
C)1 would like to order laboratory studies to ensure that your daughters development is normal.
D)your daughters breast development is somewhat less than might be expected for her age.
E)Your daughters development is normal.

Daughter is normal. So whenever they have a question and one answer choice says:"it is normal" most often it is the right answer. Precocious puberty is before the age of 7. So it is normal for an 8 year old girl to have breast buds and some pubic hair.
answers are in the quote
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  #349  
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Quote:
Originally Posted by Curacao View Post
answers are in the quote
That's great! thank you for detailed explanation.

I was going through previous posts and didn't come up with the final conclusion for Vocal cord question! I picked up E which is what happened with the man in which it was open on swallowing, closed with laryngeal irritation and open during cough reflex to remove the food particle, but the answer was wrong!
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Quote:
Originally Posted by Curacao View Post
answers are in the quote
thanks curacao. never quite understood the biochem q, now it makes sense.
i thought at first it was aldolase due to the high susbtrate 1,6 Fructose Biphosphate.
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Quote:
Originally Posted by mikemike View Post
a 43 yr old woman, who has immune thrombocytopenic purport resistant to corticosteroid treatment, will undergo an operation to improve her condition. removing which organ in the ct scan will help? Is it choice B or C?

a, b, c, d, e

B: spleen
D and C are kidneys
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Quote:
Originally Posted by jhas View Post
33. a newborn female is diagnosed with hypothyroidism 2 days after birth. ultrasonography of the neck shows no gland tissue. p/e and reflexes are normal. maternal to fetal transfer of which of the following explains the normal development in the newborn?

iodine
thyroglobulin
tsh
thyrotropin releasing hormone
t4
Answer is Thyroxin (T4). MEDSCAPE
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  #353  
Old 05-29-2014
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This question is a dumb mistake, but still confused about the answer.

Gram stain is performed on a sputum specimen. Pink rods and blue cocci are observed. Which of the following features is characteristic only of the pink rods?
A Endoplasmic reticulum
B Growth inhibition by ciprofloxacin
C Outer membrane
D Peptidoglycan cell wall
E Polysaccharide capsule
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  #354  
Old 05-31-2014
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Quote:
Originally Posted by M.Tayeb View Post
This question is a dumb mistake, but still confused about the answer.

Gram stain is performed on a sputum specimen. Pink rods and blue cocci are observed. Which of the following features is characteristic only of the pink rods?
A Endoplasmic reticulum
B Growth inhibition by ciprofloxacin
C Outer membrane
D Peptidoglycan cell wall
E Polysaccharide capsule
Gram-negative organisms are seen as pink/red. Only Gram-negative organisms have outer membrane (C). Both Gram-negative and Gram-positive have polysaccharide capsule and peptidoglycan cell wall.
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  #355  
Old 06-01-2014
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Quote:
Originally Posted by ub245 View Post
29. A 32-year-old man begins to laugh while eating dinner with his friends. A small particle of food irritates his larynx and provokes him to cough. Which of the following best describes the position of his vocal cords throughout this sequence?
Immediately After
While Swallowing Laryngeal Irritation While Coughing

A) Closed closed open

B) Closed open closed

C) Closed open open

D) Open closed closed

E) Open closed open

F) Open open closed

Im guessing its A or C but not sure.
please someone post the answer to this q.
im thinking A but i cant find the answer clear anywhere.
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  #356  
Old 06-02-2014
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no one got this right???
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  #357  
Old 06-02-2014
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Hi ppl. How useful is form 16 for the exam.. I mean does it help u get prepared for some unusual questions. Or is it not relevant yet n not that useful. Plz reply
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  #358  
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Quote:
Originally Posted by Fibroblast View Post
It's normal oral flora, the sample was probably contaminated. I remember that the original question mentioned something about oral hygiene or halitosis or something along those lines.

Normal oral flora is usually strep viridens which is G(+) cocci, which would explain the G(+) findings, but why wouldn't the G(-) be Haemophilus?
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Quote:
Originally Posted by Fibroblast View Post
It's normal oral flora, the sample was probably contaminated. I remember that the original question mentioned something about oral hygiene or halitosis or something along those lines.
he is an alcoholic.Probably has CVA and related aspiration pneumonia.Which makes oral flora most likely
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  #360  
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Quote:
Originally Posted by drpisho View Post
7. Vocal cords position while swallowing, immediately after laryngeal irritation, and while coughing???

I saw an earlier post say closed, open, closed is correct but I put that and it is incorrect.

--------------------------------------------------

its CLOSED during swallowing, OPEN AND OPEN.

i got it wrong because it implied that the patient was laughing while eating THEY ASKED what was the sequence IN THE patient, so i guess he would have had OPEN vocal cords while swallowing (normally is closed), so actually they were meaning what happens NORMALLY.
I used the same reasoning however Closed during swallowing, open and open is wrong. And someone mentioned in this thread that Closed during swallowing, open and closed is wrong as well.
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  #361  
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please help me wt this questn i had attached
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Quote:
Originally Posted by dannye View Post
Normal oral flora is usually strep viridens which is G(+) cocci, which would explain the G(+) findings, but why wouldn't the G(-) be Haemophilus?
Haemophilus is not part of normal oral flora as far as I know. There are other gram- bacteria that are in normal oral flora. The patient was an alcoholic --> aspiration pneumonia is most likely.
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  #363  
Old 06-10-2014
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Originally Posted by step1murder View Post
I used the same reasoning however Closed during swallowing, open and open is wrong. And someone mentioned in this thread that Closed during swallowing, open and closed is wrong as well.
I think I chose closed closed and open and got it right. Logic would be during swallowing, food goes down esophagus, thus vocal cords don't need to be open. Right at irritation would be because the area before the vocal cords are irritated, those would be closed during this time because you are swallowing. Coughing would be open because you need to expel air out of the lungs.
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Old 06-10-2014
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Originally Posted by Curacao View Post
15) 15 yr old boy, 6’3 and weights 165 lb, BMI 21 kg, pulse is 85/min and bounding/ bp is 110/40. dislocation of right lens. Pectus excavatum. grade 3/6 decrescendo diastolic murmur heard at aortic area. Wide mediastinum. Genetic defect in what? so this is marfans so fibrillin correct?

collagen type 2, elastin, fibrillin, hyaluronate, proteoglycan


Collagen!
I think its actually fibrillin. The vignette suggests Marfans syndrome, not Ehlers-Danlos (which would be collagen associated). The tip off is the dislocation of the lens
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  #365  
Old 06-12-2014
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Originally Posted by usmle1 View Post
a 35 year old woman is given 500 mg of drug X iv .several minutes later the serum concentration X is 12.5.two hours later the serum concentration is 10mg/L. asuming the drug X has first order elimination which of the following will be serum concentration of drug X in mg/L in another two hours
a 6
b6.5
c7
d7.5
e8
f8.5 plese explain it
zero order constant fraction is removed so
2.5/12.5=1/5
1/5*10=2
therfore answer is 10-2=8
=
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Old 06-12-2014
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Default fgfr3

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Originally Posted by doctor2k14 View Post
4 month y/o boy with skeletal dysplasia involving abnormal endochondral bone formation. Electron microscopy of patient will most likely show which?

a) decreased RER
b) decreased SER
c) dilated RER
d) increased SER
e) large lysosomes
f) small lysosomes

I know FGFR3 is activated and it is achondroplasia. Just had problem with the answer choices. would appreciate your input.
thank you.

I found this form really tough overall. Maybe it's just me.
i think mutated fgfr3 has long half life it help ossification of bone by converting chondrocyte to mature bone also pt has abnormal lysosomes as a result their is decrease degradation of fgfr3 thus fgfr3 has prolong action
so i think small lysosomes is the answer correct me if i am wrong
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Old 06-14-2014
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Default 1st order kinetics

Quote:
Originally Posted by usmle1 View Post
a 35 year old woman is given 500 mg of drug X iv .several minutes later the serum concentration X is 12.5.two hours later the serum concentration is 10mg/L. asuming the drug X has first order elimination which of the following will be serum concentration of drug X in mg/L in another two hours
a 6
b6.5
c7
d7.5
e8
f8.5 plese explain it
In first order kinetics, the concentration of the drug decreases at a constant PERCENTAGE (vs. a zero order kinetics drug's concentration decreases by a constant AMOUNT). Since 10 is 80% of 12.5, the drug decreased by 20% in the first two hours. So in two more hours, the drug should decrease by another 20% ---> 1 - 10(.20) = 8 .... the answer is E.
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  #368  
Old 06-22-2014
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Originally Posted by drpisho View Post
please someone post the answer to this q.
im thinking A but i cant find the answer clear anywhere.

its a..i gt it right
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  #369  
Old 06-28-2014
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Originally Posted by martha18 View Post
Is NOT translation bc I got it wrong
Ferric uptake regulation protein (Fur) is a global regulator, ubiquitous in Gram negative bacteria, that acts as a transcriptional repressor when it binds ferrous ion
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  #370  
Old 06-28-2014
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Originally Posted by pankaj00 View Post
i think mutated fgfr3 has long half life it help ossification of bone by converting chondrocyte to mature bone also pt has abnormal lysosomes as a result their is decrease degradation of fgfr3 thus fgfr3 has prolong action
so i think small lysosomes is the answer correct me if i am wrong
I got Small lysosomes incorrect

Enlarged endoplasmic reticulum in cartilage cell found with pseudoachondroplasia

Last edited by Z.Usmle; 06-28-2014 at 01:02 AM.
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10. A 9 YO M is brought to the physician by his mother because of a 1 yr hx of cough productive of mucoid sputum, wheezing, and sob with exertion hx of recurrent upper respiratory tract and sinus infections since birth. he is at the 25th percentile for height ans weight. the mother says that his younger sibling is being develop similar problems. physical examination shows mild clubbing of the fingers. laboratory studies show markedly increased sweat chloride and sodium concentration. which of the following in this pt's bronchial epithelium is most likely causing these symptoms? a. adrenoreceptors b. membrane receptors c. nuclear receptors d. protein regulation e. protein structure
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  #372  
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A 35 yr old man comes to the physician becoz of a 3yr h/o enlarging nose, coarseninf of his facial features, muscle weakness and increased hand and foot size. PE shows prognathism and large fleshy nose. Serum studies show increased IGF-1 conc. An MRI of the brain shows a pitutary adenoma. Morphologic analysis of the biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G-Alpha S subunit of G proteins in the tumor cells lack GTPase activity. The tumor cells in this pt. most likely have an increased activity of which of the following enzymes? A)Adenyly cyclase B)Guanylyl cyclase C)Janus kinase D)Phoapho lipase c E)Tyrosine kinase

Is it A or B?
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  #373  
Old 07-07-2014
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Originally Posted by drws View Post
43. A 32 year old woman, gravida 4, para 0, aborta 3, delivers a female newborn at term with dysmorphic features and numerous organ anomalies. The mother has had multiple spontaneous abortions , and this is her first live newborn child. Which of the following is the most likely explanation for the abnormalities seen in this newborn?
A) Autosomal dominant inheritance
B) Autosomal recessive inheritance
C) Gonadal mosaicism
D) Submicroscopic deletion
E) Unbalanced chromosome rearrangement

Anybody know the answer to this. Please urgent i have an exam in a week.
Answer is e- unbalanced chromosomal rearrangement. Specifically speaking its robertsonian translocation which causes recurrent abortions in a young female and a child born is usually abnormal
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  #374  
Old 07-07-2014
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Originally Posted by Z.Usmle View Post
A 35 yr old man comes to the physician becoz of a 3yr h/o enlarging nose, coarseninf of his facial features, muscle weakness and increased hand and foot size. PE shows prognathism and large fleshy nose. Serum studies show increased IGF-1 conc. An MRI of the brain shows a pitutary adenoma. Morphologic analysis of the biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G-Alpha S subunit of G proteins in the tumor cells lack GTPase activity. The tumor cells in this pt. most likely have an increased activity of which of the following enzymes? A)Adenyly cyclase B)Guanylyl cyclase C)Janus kinase D)Phoapho lipase c E)Tyrosine kinase

Is it A or B?
It's a growth hormone tumor. Typical symp + increased igf1. So shouldn't it be increased janus kinases. The gtpase is confusing
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Originally Posted by Z.Usmle View Post
10. A 9 YO M is brought to the physician by his mother because of a 1 yr hx of cough productive of mucoid sputum, wheezing, and sob with exertion hx of recurrent upper respiratory tract and sinus infections since birth. he is at the 25th percentile for height ans weight. the mother says that his younger sibling is being develop similar problems. physical examination shows mild clubbing of the fingers. laboratory studies show markedly increased sweat chloride and sodium concentration. which of the following in this pt's bronchial epithelium is most likely causing these symptoms? a. adrenoreceptors b. membrane receptors c. nuclear receptors d. protein regulation e. protein structure
CFTR is a Protein whose structure is altered
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  #376  
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Originally Posted by pankaj00 View Post
i think mutated fgfr3 has long half life it help ossification of bone by converting chondrocyte to mature bone also pt has abnormal lysosomes as a result their is decrease degradation of fgfr3 thus fgfr3 has prolong action
so i think small lysosomes is the answer correct me if i am wrong
For bone formation substances should be secreted extracellularly and since Thats not happening there must b a defect in targeting in rer so the substances accumulate in the red resulting in dilated rer
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  #377  
Old 07-07-2014
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A 35 yr old man comes to the physician becoz of a 3yr h/o enlarging nose, coarseninf of his facial features, muscle weakness and increased hand and foot size. PE shows prognathism and large fleshy nose. Serum studies show increased IGF-1 conc. An MRI of the brain shows a pitutary adenoma. Morphologic analysis of the biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G-Alpha S subunit of G proteins in the tumor cells lack GTPase activity. The tumor cells in this pt. most likely have an increased activity of which of the following enzymes? A)Adenyly cyclase B)Guanylyl cyclase C)Janus kinase D)Phoapho lipase c E)Tyrosine kinase


its A ) adenyl cyclase
bc increase in GS>Adenyl cyclase > cAMP > protein kinases
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  #378  
Old 07-07-2014
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10. A 9 YO M is brought to the physician by his mother because of a 1 yr hx of cough productive of mucoid sputum, wheezing, and sob with exertion hx of recurrent upper respiratory tract and sinus infections since birth. he is at the 25th percentile for height ans weight. the mother says that his younger sibling is being develop similar problems. physical examination shows mild clubbing of the fingers. laboratory studies show markedly increased sweat chloride and sodium concentration. which of the following in this pt's bronchial epithelium is most likely causing these symptoms? a. adrenoreceptors b. membrane receptors c. nuclear receptors d.protein regulatione. protein structure

its E) its mutation that leads to alter protein structure! CFTR
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  #379  
Old 07-13-2014
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hey arsalan...could u please elaborate on the adenylyl cyclase and why not janus kinase....im really confused
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  #380  
Old 07-13-2014
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Originally Posted by usmle4k View Post
hey arsalan...could u please elaborate on the adenylyl cyclase and why not janus kinase....im really confused
Thats bcoz janus kinase is used by GH, whereas adenylyl cyclase is used by GHRH. The symptoms in the patient can be caused by GH or GHRH , and the clue to the answer being GHRH is that the GTPase in increased. Hope this helps u!
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  #381  
Old 07-14-2014
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ok...that makes it a lot more clear...but the question says its a pituitary adenoma...with an increase in somatomamotrophs....so shouldnt it be an inc in GH???
could you also explain the Gprotein part....because while answering this question i read it like Gprotein isnt functioning properly if youre inhibiting the GTPase of the alpha subunit...thanks
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Old 07-14-2014
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Originally Posted by usmle4k View Post
ok...that makes it a lot more clear...but the question says its a pituitary adenoma...with an increase in somatomamotrophs....so shouldnt it be an inc in GH???
could you also explain the Gprotein part....because while answering this question i read it like Gprotein isnt functioning properly if youre inhibiting the GTPase of the alpha subunit...thanks
The increased ghrh is making the pituitary secrete more n more GH so it grows into an adenoma. It's like increased tsh causes hypertrophy of the thyroid gland.
Coming to the gtpase. G protein was 3 subunits alpha beta and gamma. The alpha subunit is bound to GDP which on activation becomes gtp. That gtp is cleaved by gtpase . so when the gtpase is lost or nonfunctional gtp is uninhibited and causes
continuedsignalling in the downstream pathway which in this case is GH synthesis. So yeah actually GHRH is not increased but a defect in its signaling pathway after it stimulates it's receptor which is located on the pituitary causes continuous stimulation to produce GH causing a pituitary adenoma and also the aforementioned sympyoms.
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  #383  
Old 07-15-2014
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thankyou so much!!its very clear now
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Old 07-21-2014
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can anyone explain which the preventative vaccine would have been for the previously heathy 67 year old q:

"previously healthy 67 yr old lady w 3 day history of fever, shortness of breath, nonproductive cough, headache, and muscle pain. Temp is 102 F. lungs clear to auscultation."

- i have read that it was Hib...but i put down Influenza, seeing that the lady has a non-productive cough, didn't think the cause would be bacterial.....also the muscle pains and headache geared my thoughts towards the flu...

any help is appreciated, my exam is in a week n 1/2!!
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Old 07-26-2014
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Quote:
Originally Posted by USMLEgen View Post
can anyone explain which the preventative vaccine would have been for the previously heathy 67 year old q:

"previously healthy 67 yr old lady w 3 day history of fever, shortness of breath, nonproductive cough, headache, and muscle pain. Temp is 102 F. lungs clear to auscultation."

- i have read that it was Hib...but i put down Influenza, seeing that the lady has a non-productive cough, didn't think the cause would be bacterial.....also the muscle pains and headache geared my thoughts towards the flu...

any help is appreciated, my exam is in a week n 1/2!!
It is Influnza ,since it have muscle pain stuff like that and non-productive (mean it couldn't be bacterial , also , we got seasonal or annual flu shot .
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  #386  
Old 07-26-2014
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Hey guys , just took NBME16, need some extra help ,PLZ/

1 , a non-compliant patient with poorly-controlled HTN , what will you do?

A arrange nurse
B don't take ,will kill you
c it is hard to take pill since no symptoms
d you are not taking it , not responsible
e you know you can avoid this HTN (my answer,but wrong)

2 , 45yr man with prostatitis , what is MCC ?

A adeno
B chlamydia (my answer , thought he is sexual active)
C E.coli (this one ?)
D pseudomona
E Ureaplasm


3 , a man with HTN , take 10 measurements have average BP 113 , and SD is 8 . now if only take 4 measurements ,what will you expected the impact on 95% Confidence interval ?

A change , but direction not be predicted
B decrease in size( my answer)
C increase in size
D remain same


4 , a boy have fine pale hair has not change color since birth ,eyes are blue , turns away his head when flashlight come and cry , what is the cause of his pale skin ?

A aberrant migration of neural crest (my answer )
B decrease melanocyte (this one ?)
C immnue destruction of melanocyte
D no produce melanin
E melanin dropout to the dermis


5 , a woman after anesthesia of cholecystectomy ,vomit ,what drug should you give ? may need some explanation

A diphenhydramine
B dronabinol (my answer)
C loperamide
D ondansetron
E scopolomine




THANKS , THAT'S ALL
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Old 07-26-2014
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1. c- have to relate to the patient, and see eye-to-eye with him in order for them to know that you can understand where they're coming from.
2. ecoli- MCC, especially with prostatits..chlamydia would cause urethritis.
3. i thought of the number of measurements as "n" in the CI equation..and when you look at the equation you can deduce that n is inversely proportional to CI..therefore if you decrease "n", you increase the CI, i.e. making it wider
4. my answer was no production in melanin ( i.e. tyrosinase deficiency or defect in the tyrosine transporter, which would ultimately lead to a decrease in melanin). decreased melanocytes are seen in Vitiligo( i believe)
5. my answer was Odansetron, 5-HT3 antagonist ( ion channel in the central trigger zone)...used for post-operative patents, like the patient in this question.
dronabinol is a THC derivative..i think this is more commonly used in patients undergoing chemo, or MS...etc.

hope this helps, if there are mistakes, please correct them!
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Old 07-27-2014
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Quote:
Originally Posted by USMLEgen View Post
1. c- have to relate to the patient, and see eye-to-eye with him in order for them to know that you can understand where they're coming from.
2. ecoli- MCC, especially with prostatits..chlamydia would cause urethritis.
3. i thought of the number of measurements as "n" in the CI equation..and when you look at the equation you can deduce that n is inversely proportional to CI..therefore if you decrease "n", you increase the CI, i.e. making it wider
4. my answer was no production in melanin ( i.e. tyrosinase deficiency or defect in the tyrosine transporter, which would ultimately lead to a decrease in melanin). decreased melanocytes are seen in Vitiligo( i believe)
5. my answer was Odansetron, 5-HT3 antagonist ( ion channel in the central trigger zone)...used for post-operative patents, like the patient in this question.
dronabinol is a THC derivative..i think this is more commonly used in patients undergoing chemo, or MS...etc.

hope this helps, if there are mistakes, please correct them!
THX man! but still have some problems to understand first question , if you say so , is it kind of encourage patient to avoid pills ? actually , It is the first choice I scrapped off......

but THX for all the other answers , really helpful!
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Old 07-27-2014
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Quote:
Originally Posted by USMLEgen View Post
1. c- have to relate to the patient, and see eye-to-eye with him in order for them to know that you can understand where they're coming from.
2. ecoli- MCC, especially with prostatits..chlamydia would cause urethritis.
3. i thought of the number of measurements as "n" in the CI equation..and when you look at the equation you can deduce that n is inversely proportional to CI..therefore if you decrease "n", you increase the CI, i.e. making it wider
4. my answer was no production in melanin ( i.e. tyrosinase deficiency or defect in the tyrosine transporter, which would ultimately lead to a decrease in melanin). decreased melanocytes are seen in Vitiligo( i believe)
5. my answer was Odansetron, 5-HT3 antagonist ( ion channel in the central trigger zone)...used for post-operative patents, like the patient in this question.
dronabinol is a THC derivative..i think this is more commonly used in patients undergoing chemo, or MS...etc.

hope this helps, if there are mistakes, please correct them!

also wonder why infant have albinism will feel pain when light came in >?
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  #390  
Old 07-28-2014
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Hi guys just gave nbme 16. Scored256. How close is this exam to real usmle?
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Old 07-29-2014
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i believe the colour of the cornea is protective for light infiltration..in albinism, there is decreased pigment, therefore the patient will experience discomfort ( to say the least).

its the same as melanin and skin protection in lighter v.s. darker complexioned people!

and about the first question with regards to the non-compliant patient, it may seem like you are supporting non compliance, but actually, you are opening up discussion and giving the opportunity to the patient to express their concerns

hope this helps! GL
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  #392  
Old 07-29-2014
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Quote:
Originally Posted by Kras View Post
1-25
A healthy 24-year-old woman participates in a study to determine the role of ghrelin in appetite. She is given free access to food during the study. The graph shows plasma concentrations of ghrelin in the woman during the study period. Which of the following labeled points on the curve most likely represents the consumption of a meal?

Sorry, I can't insert the image.

Link to image: https://drive.google.com/file/d/0B3Y...it?usp=sharing
Grelin increases appetite. It will only start to decrease when you start to eat.
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Old 07-31-2014
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Originally Posted by USMLEgen View Post
i believe the colour of the cornea is protective for light infiltration..in albinism, there is decreased pigment, therefore the patient will experience discomfort ( to say the least).

its the same as melanin and skin protection in lighter v.s. darker complexioned people!

and about the first question with regards to the non-compliant patient, it may seem like you are supporting non compliance, but actually, you are opening up discussion and giving the opportunity to the patient to express their concerns

hope this helps! GL
Make sense , THX! When I take the NBME 16 , I was wondering whether the albinism question is "ocular albinism" , which I found in biochemistry section .
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Old 07-31-2014
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Originally Posted by davidyangyan View Post
Make sense , THX! When I take the NBME 16 , I was wondering whether the albinism question is "ocular albinism" , which I found in biochemistry section .
i recall the question specifying the child having a very light complexion, which would probably full out ocular albinism only, but its the same concept..lack of melanin, etc.
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  #395  
Old 08-02-2014
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Originally Posted by usml12314 View Post
this q has a pic.
a 10 yr old girl had fatigue and appears pale. her father underwent spleenectomy as a youth and recently underwent cholystectomy. her blood ct shows
hb-decreased
MCV-90
leukocyte-6000
N-58%
E-2%
L-35%
M-5%
platelet 188,000
Retic-9%(Increased)

A.Abnormal Hb structure
B.Abnormal Iron absorption
C.Def. of erythrocyte Spectrin
D.Impaired Oxidatiive enzyme function
E. Inadequate erytrhopotein production.
how it can be C ,. i will go for A. it cant be spherocytosis as MCV is within normal , and patient should not have cholecystectomy after spleenectomy as chronic anemia is corrected after speenectomy in speerocytosis but in sickl cell tdisease it is not corrected
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Old 08-02-2014
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Quote:
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1. Pt with CHF with 2 relatives dying from dilated cardiomyopathy and cirrhosis. P/E of pt shows cardiac enlargement and hyper pigmentation and glucose is 320. endomyocardial tissue will show excess of

A.Amyloid
B.alpha 1 antitrypsin
C. Cerebroside
D,Copper
E. Eosinophils
F. Iron
G. Lysosomal Glcogen
H. Mucopolysaccharide



2. 65 yr old woman w/3 month history of headache, flank pain, and weakness of arm w/31 lb weight loss. P/e weakness of proximal and upper and lower extremity muscles. augmentation of strength with repetitive testing of deltoid muscles. MRi shows well demarcated mass with surrounding edema in frontal lobe. specimen of lesion shows malignant small blue cell neoplasm that has cytokeratin, chrmagrin, and synaptophysisn.

A.anaplastic ependymoma
B. Extranodular CNS lymphoma
C.Glioblasta Multriforma
D. Primary cerebral neuroblastoma
E. Pulmonary Small cell carcinoma with metastasis to Brain
(Is it E as the others don't make much sense)
1st question is about heamochromatosis but i think there is restrictive cardiomyopathy instead of dilated ... correct me if m wrong
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Old 08-02-2014
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1st question is about heamochromatosis but i think there is restrictive cardiomyopathy instead of dilated ... correct me if m wrong
Iron overload will cause both DILATED and RESTRICTIVE cardiomyopathy.
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how it can be C ,. i will go for A. it cant be spherocytosis as MCV is within normal , and patient should not have cholecystectomy after spleenectomy as chronic anemia is corrected after speenectomy in speerocytosis but in sickl cell tdisease it is not corrected
It can be, and it is! keep this in mind: Hereditary spherocytosis is an NORMOCITIC haemolytic anemia, which means MCV is NORMAL, what increases is the MCHC and RDW. Also, the splenectomy helps the anemia, but the cells would still be round so extravascular hemolisis still happens --> bilirrubin gallstones.

And lastly, they showed a picture with the rounded RBC + no central pallor.
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It can be, and it is! keep this in mind: Hereditary spherocytosis is an NORMOCITIC haemolytic anemia, which means MCV is NORMAL, what increases is the MCHC and RDW. Also, the splenectomy helps the anemia, but the cells would still be round so extravascular hemolisis still happens --> bilirrubin gallstones.

And lastly, they showed a picture with the rounded RBC + no central pallor.
ok . i did'nt find any pic here but checkit out what they said in medscape link 9 3rd paragraph)
m confused

http://emedicine.medscape.com/article/206107-workup
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ok . i did'nt find any pic here but checkit out what they said in medscape link 9 3rd paragraph)
m confused

http://emedicine.medscape.com/article/206107-workup

Don't be confused. HS has always been in the normocytic haemolytic anemias, wherever you look (Kaplan, FA, Pathoma, Goljan etc...) besides the Lab hallmark is increased MCHC and reticulocytosis.
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