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  #1  
Old 03-12-2014
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Default NBME 16 discussion

Hello everyone. I've made recently nbme 16. If anyone can help with answers and to participate in discussion, please, you're welcome.

1-2
An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal
male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes
is most likely to be observed?

Mucus Production and Secretion up/down

Alveolar Macrophage Function up/down

Activity of Airway Cilia up/down

1-4
Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular ribosomes. Which of the following additional structural features of poliovirus mRNA is the most likely cause of its ability to be translated in the absence of a cap?
A) Absence of a 3' untranslated region (UTR)
B)Absence of a 5' UTR
C) Absence of a poly(A) tail
D) Presence of an internal ribosome entry site
E) Very short open reading frame

1-11
An 85-year-old woman is diagnosed with a fracture of the right femur and begins treatment with morphine by patient-controlled analgesic pump. Three days later, her respirations are 6/min. Physical examination shows pinpoint pupils. Her serum creatinine concentration is 1.8 mg/dL. Which of the following best explains this patient's clinical deterioration after the initiation of morphine therapy?
A) Chronic dosing of morphine decreases its bioavailability
B) Morphine bioavailability increases with chronic dosing
C) Morphine downregulates mu-opioid receptors with chronic dosing
D) Morphine inhibits its own metabolism
E) Morphine is metabolized to active metabolites that accumulate
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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

Last edited by Kras; 03-12-2014 at 11:19 AM.
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Hi,
I think 1-11 is E. I marked B & got it wrong. The only answer left that makes sense is E due to overdose or patient's renal failure.
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Quote:
Originally Posted by Kras View Post
Hello everyone. I've made recently nbme 16. If anyone can help with answers and to participate in discussion, please, you're welcome.

1-2
An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal
male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes
is most likely to be observed?

Mucus Production and Secretion up/down

Alveolar Macrophage Function up/down

Activity of Airway Cilia up/down

1-4
Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular ribosomes. Which of the following additional structural features of poliovirus mRNA is the most likely cause of its ability to be translated in the absence of a cap?
A) Absence of a 3' untranslated region (UTR)
B)Absence of a 5' UTR
C) Absence of a poly(A) tail
D) Presence of an internal ribosome entry site
E) Very short open reading frame

1-11
An 85-year-old woman is diagnosed with a fracture of the right femur and begins treatment with morphine by patient-controlled analgesic pump. Three days later, her respirations are 6/min. Physical examination shows pinpoint pupils. Her serum creatinine concentration is 1.8 mg/dL. Which of the following best explains this patient's clinical deterioration after the initiation of morphine therapy?
A) Chronic dosing of morphine decreases its bioavailability
B) Morphine bioavailability increases with chronic dosing
C) Morphine downregulates mu-opioid receptors with chronic dosing
D) Morphine inhibits its own metabolism
E) Morphine is metabolized to active metabolites that accumulate
1-11 answer is E i just saw my wrong questions questions i have selected D which is wrong !! explanation for this one is http://en.wikipedia.org/wiki/Morphine-6-glucuronide
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yes answer is E i saw my wrong questions and i have selected D which is wrong
explanation for this one is http://en.wikipedia.org/wiki/Morphine-6-glucuronide
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yes 11 1 answer is E i choose d which was wrong the only one that make sense is E plus in vikipedia there is explanation for this Morphine-6-glucuronide (M6G) is a major active metabolite of morphine, and as such is the molecule responsible for much of the pain-relieving effects of morphine (and thus heroin)[citation needed]. M6G is formed from morphine by the enzyme UDP-Glucuronosyltransferase-2B7 (UGT2B7). M6G can accumulate to toxic levels in kidney failure.[1][2]
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Quick question ... I will be taking NBME 16 next week. How does it compare to other ones you have taken (Difficulty, pics... etc) ... Thanks!
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Quote:
Originally Posted by usmle1 View Post
yes 11 1 answer is E i choose d which was wrong the only one that make sense is E plus in vikipedia there is explanation for this Morphine-6-glucuronide (M6G) is a major active metabolite of morphine, and as such is the molecule responsible for much of the pain-relieving effects of morphine (and thus heroin)[citation needed]. M6G is formed from morphine by the enzyme UDP-Glucuronosyltransferase-2B7 (UGT2B7). M6G can accumulate to toxic levels in kidney failure.[1][2]
Yes, I like it. There's also written about renal failure: Contraindications "due to accumulation of the metabolites morphine-3-glucuronide and morphine-6-glucuronide".
But what about 1-25? Are you sure A is correct?
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Quote:
Originally Posted by thomasfx10 View Post
Quick question ... I will be taking NBME 16 next week. How does it compare to other ones you have taken (Difficulty, pics... etc) ... Thanks!
A little more hard than nbme 13, less pictures, questions are not long.
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Quote:
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Yes, I like it. There's also written about renal failure: Contraindications "due to accumulation of the metabolites morphine-3-glucuronide and morphine-6-glucuronide".
But what about 1-25? Are you sure A is correct?
yes im sure about that i havent heard about ghrelin before but i thought it would be something like leptin and i guessed thsi one and it was correct
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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.

Quote:
Originally Posted by Kras View Post
Yes, I like it. There's also written about renal failure: Contraindications "due to accumulation of the metabolites morphine-3-glucuronide and morphine-6-glucuronide".
But what about 1-25? Are you sure A is correct?
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Hey thnx there is some nbme 16 discussion going now,as my exam is just after 4 days n i wasnted some answers for my wrong qs.Can yu plz tell me r yu typing all by urself or i sthere any way of copy pasting cuz it takes time.as m so close to my exam i ve 5 to 8 qs which m confused about.thnx
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There was a qs in which they said about IGF1 n destruction of GTPase.n options were tyrosine kinase,adenyl cyclate,janus kinase,phospholopiase c.
i marked tyrosine kinase but that was wrong.
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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
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Default nbme 16 sec 3 qs 15

sec 3 qs 15..in which there was FUR protein,n its low or high concentartion varied,.
so was it splicing,methylation,or post trans modification,or transcript,or translation???
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there are thousands of questions on question banks.why is it only the nbme that interest some people to discuss in a public forum.it defeats the whole purpose.
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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
First order elimination means that a constant fraction per time is eliminated.

In the first 2 hours, 2.5/12.5 or 20% was eliminated.

In the next 2 hours, another 20% will be eliminated: .20 * 10 = 2. So, 10-2 = 8, E.
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Quote:
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there are thousands of questions on question banks.why is it only the nbme that interest some people to discuss in a public forum.it defeats the whole purpose.
I think it is because the NBME exams do not offer explanations for their questions. Every other qbank (that I'm aware of) does.
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It's translation bc inc conc is detected by Western blot, if this is same question you're concerned

Quote:
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sec 3 qs 15..in which there was FUR protein,n its low or high concentartion varied,.
so was it splicing,methylation,or post trans modification,or transcript,or translation???
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Quote:
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There was a qs in which they said about IGF1 n destruction of GTPase.n options were tyrosine kinase,adenyl cyclate,janus kinase,phospholopiase c.
i marked tyrosine kinase but that was wrong.
Adenyl cyclase

Last edited by Kras; 03-13-2014 at 11:48 PM.
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Can yu plz tell me r yu typing all by urself or i sthere any way of copy pasting cuz it takes time.as m so close to my exam i ve 5 to 8 qs which m confused about.thnx
http://youtu.be/EwacBTIoedg
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http://youtu.be/EwacBTIoedg
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a screening program in institute for detection of vaginal clamydia tracomis among first year women college students.at the initial screening evidence of clamydia tracomatis infection is founf in 500 of 2500 student .one year later evidence of C tramotis is found in an additional 200 students which of the following is anual incidence of c tracomatis infection in this population of students
A 8%
B10 %
c 16 %
d20%
e28 %
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a screening program in institute for detection of vaginal clamydia tracomis among first year women college students.at the initial screening evidence of clamydia tracomatis infection is founf in 500 of 2500 student .one year later evidence of C tramotis is found in an additional 200 students which of the following is anual incidence of c tracomatis infection in this population of students
A 8%
B10 %
c 16 %
d20%
e28 %
Incidence is the number of new cases per population in a specified time (usually a year, and here specifically asked as annually).

There are 200 new cases in following year out of the population of 2500 students. 200/2500 = .08; A

The population of students should remain 2500 because this is an acute condition that when found in a screening program like this would be treated. Those that had C trachomatis treated, would be free to contract it again.
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answer is B. 200/2000 = 10%. 500 are not included in group of risk.
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Quote:
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answer is B. 200/2000 = 10%. 500 are not included in group of risk.
Sure they are. If it were a chronic condition like HIV, then you would remove them from the at risk group.

From the CDC website:

When calculating the number of prevalent and incident infections, only those infections that were sexually transmitted were counted. In general, CDC estimated the total number of infections in the calendar year, rather than the number of individuals with infection, since one person can have more than one STI at a given time (e.g., HPV and chlamydia) or more than one episode of a single STI (e.g., repeat chlamydia infection).
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just did a similar Uworld question:

Incidence= new cases / people at risk

those 500 who already have it aren't at risk anymore to get it.

therefore 200/2000 is the correct answer...
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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?
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Quote:
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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?
There are many assumptions that we have to make when answering these questions. If I read about a university screening program for a STI, I am going to assume they get treated.

However, you guys are right according to NBME, the answer is 10%...but IMO only because of the word 'additional' before students. I guess this would imply that the 500 are being removed from the population. If it just said 200 students showed evidence of infection, you would have to include the original 500.
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Quote:
Originally Posted by Frank Lee View Post
Incidence is the number of new cases per population in a specified time (usually a year, and here specifically asked as annually).

There are 200 new cases in following year out of the population of 2500 students. 200/2500 = .08; A

The population of students should remain 2500 because this is an acute condition that when found in a screening program like this would be treated. Those that had C trachomatis treated, would be free to contract it again.
i choose A but it was wrong !! so i guess answer is 10 % new cases 200/2500-500= 10
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You can't add earlier positive-tested individuals in group of risk - they will harm incidence "statistical significance". Earlier positive-tested shouldn't be tested again. How can you distinguish between bad treatment or new infection in this group? They will injure the study and so cannot be included.

Quote:
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There are many assumptions that we have to make when answering these questions. If I read about a university screening program for a STI, I am going to assume they get treated.

However, you guys are right according to NBME, the answer is 10%...but IMO only because of the word 'additional' before students. I guess this would imply that the 500 are being removed from the population. If it just said 200 students showed evidence of infection, you would have to include the original 500.
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Quote:
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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?
yes it was and answer is 10% new cases are 200 we have subtract old ones from the population 2500-500 =2000
200/2000=10 % incidence
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Quote:
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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?
what about absolute risk reduction one .i got that one wrong too if u can solve it please?
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what about absolute risk reduction one .i got that one wrong too if u can solve it please?
Sorry, what do you mean?
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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%

Last edited by usmle1; 03-14-2014 at 10:05 AM.
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Please, can you post the question completely?
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Quote:
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Please, can you post the question completely?
i post it but cant write it the way it was written though
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was 12, became 4. ARR = 8.
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wiki: the absolute risk reduction (risk difference or excess risk) is the change in risk of a given activity or treatment in relation to a control activity or treatment.
FA-2014: The difference in risk (not the proportion) attributable to the intervention as compared to a control (e.g., if 8% of people who receive a placebo vaccine develop flu vs. 2% of people who receive a flu vaccine, then
ARR = 8% − 2% = 6% = .06).
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wiki: the absolute risk reduction (risk difference or excess risk) is the change in risk of a given activity or treatment in relation to a control activity or treatment.
FA-2014: The difference in risk (not the proportion) attributable to the intervention as compared to a control (e.g., if 8% of people who receive a placebo vaccine develop flu vs. 2% of people who receive a flu vaccine, then
ARR = 8% − 2% = 6% = .06).
thanks and how do you differentiate between RRR relative reduction and absolute risk reduction i cant understand the explanation of these two given in FA 2014 and uworld ??
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thanks and how do you differentiate between RRR relative reduction and absolute risk reduction i cant understand the explanation of these two given in FA 2014 and uworld ??
ARR shows us the difference between two absolute units (8% - 2% = 6%) or absolute difference between two relative units . Reduction - is decreasing by another words. Without vaccine - 8% are ill, with vaccine - 2%. So, we want to know, what is the purpose (the use) of vaccination. ARR answer us for this question. Vaccine decrease the incidence by 6% (ARR).

Relative risk (RR) - it is a relation (ratio) - 8%/2% or 2%/8% depends on purpose. So, incidence in unvaccinated group is 4 times more than in vaccinated or incidence in vaccinated group is 0,25 of incidence in unvaccinated. Now we get: FA-2014 - RRR= 1 - RR (1 - 0,25 = 0,75), and in wiki - RRR=ARR/incidence in control (without vaccine in this case).
RRR= 0,06/0,08 = 0,75.

May be this will be helpful.
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  #42  
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This question is not clear for me. I've answered C and got incorrect.
An 8-year-old girl is brought to the physician for a 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 60th percentile for weight. Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughter's 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) "I think that your daughter is likely to begin menstruating in the next few months."
C) "I would like to order laboratory studies to ensure that your daughter's development is normal."
D) “Your daughter's breast development is somewhat less than might be expected for her age."
E) “Your daughter's development is normal."

Here we see Tanner-2 (10-11,5 y.o.), hypothyroidism(?)
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  #43  
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For 1-2
Would everything decrease since smoke impairs mucociliary clearance?

http://www.ncbi.nlm.nih.gov/books/NBK53021/
" In addition, high-level exposures, particularly when sustained, may overwhelm the lung’s defenses, and some agents have the potential to reduce the efficacy of these defenses. Cigarette smoke, for example, contains components that impair mucociliary clearance (Table 7.3)."

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Originally Posted by Kras View Post
Hello everyone. I've made recently nbme 16. If anyone can help with answers and to participate in discussion, please, you're welcome.

1-2
An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal
male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes
is most likely to be observed?

Mucus Production and Secretion up/down

Alveolar Macrophage Function up/down

Activity of Airway Cilia up/down

1-4
Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular ribosomes. Which of the following additional structural features of poliovirus mRNA is the most likely cause of its ability to be translated in the absence of a cap?
A) Absence of a 3' untranslated region (UTR)
B)Absence of a 5' UTR
C) Absence of a poly(A) tail
D) Presence of an internal ribosome entry site
E) Very short open reading frame

1-11
An 85-year-old woman is diagnosed with a fracture of the right femur and begins treatment with morphine by patient-controlled analgesic pump. Three days later, her respirations are 6/min. Physical examination shows pinpoint pupils. Her serum creatinine concentration is 1.8 mg/dL. Which of the following best explains this patient's clinical deterioration after the initiation of morphine therapy?
A) Chronic dosing of morphine decreases its bioavailability
B) Morphine bioavailability increases with chronic dosing
C) Morphine downregulates mu-opioid receptors with chronic dosing
D) Morphine inhibits its own metabolism
E) Morphine is metabolized to active metabolites that accumulate
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I chose the same answer. Some sources show tanner stage 2 for girls range from 8-15 yo, boys: 10-15 yo

I don't get this micro question.
26 month old boy with SOB & cough who had cutaneous abscesses caused by S. aureus. febrile, x-ray shows cavitary infiltrate of left lingula. Culture grows filamentous gram + rods. Answer choices are
A. Bacillus anthracis
B. Candida
C. Nocardia
D. Pneumocystis
E. Strep bovis

I think it's A but it's wrong. Any thoughts? Thanks.

Quote:
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This question is not clear for me. I've answered C and got incorrect.
An 8-year-old girl is brought to the physician for a 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 60th percentile for weight. Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughter's 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) "I think that your daughter is likely to begin menstruating in the next few months."
C) "I would like to order laboratory studies to ensure that your daughter's development is normal."
D) “Your daughter's breast development is somewhat less than might be expected for her age."
E) “Your daughter's development is normal."

Here we see Tanner-2 (10-11,5 y.o.), hypothyroidism(?)
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  #45  
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Originally Posted by Kras View Post
This question is not clear for me. I've answered C and got incorrect.
An 8-year-old girl is brought to the physician for a 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 60th percentile for weight. Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughter's 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) "I think that your daughter is likely to begin menstruating in the next few months."
C) "I would like to order laboratory studies to ensure that your daughter's development is normal."
D) “Your daughter's breast development is somewhat less than might be expected for her age."
E) “Your daughter's development is normal."

Here we see Tanner-2 (10-11,5 y.o.), hypothyroidism(?)
I would say A
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I chose the same answer. Some sources show tanner stage 2 for girls range from 8-15 yo, boys: 10-15 yo

I don't get this micro question.
26 month old boy with SOB & cough who had cutaneous abscesses caused by S. aureus. febrile, x-ray shows cavitary infiltrate of left lingula. Culture grows filamentous gram + rods. Answer choices are
A. Bacillus anthracis
B. Candida
C. Nocardia
D. Pneumocystis
E. Strep bovis

I think it's A but it's wrong. Any thoughts? Thanks.
answer is C nocardia filamentous gram positive rods
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  #47  
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a 3 year old boy has 1 week history of nonproductive cough wheezing nausea coarse bilateral crackles are heard on auscultation of the chest .stool culture shows 1.6cm roundworm larwa,chest xray shows bilateral infiltratethis disease was most likely cause by ingestion of which of the following? A) feces contaminated soil b )improperly caned beans c )pork products (i select this one but its wrong) d) raw shrimp e) under cooked meat
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a 3 year old boy has 1 week history of nonproductive cough wheezing nausea coarse bilateral crackles are heard on auscultation of the chest .stool culture shows 1.6cm roundworm larwa,chest xray shows bilateral infiltratethis disease was most likely cause by ingestion of which of the following? A) feces contaminated soil b )improperly caned beans c )pork products (i select this one but its wrong) d) raw shrimp e) under cooked meat
A. Strongyloides stercoralis.
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This question is not clear for me. I've answered C and got incorrect.
An 8-year-old girl is brought to the physician for a 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 60th percentile for weight. Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughter's 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) "I think that your daughter is likely to begin menstruating in the next few months."
C) "I would like to order laboratory studies to ensure that your daughter's development is normal."
D) “Your daughter's breast development is somewhat less than might be expected for her age."
E) “Your daughter's development is normal."
Have anybody answered this question correctly in their test?
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a 3 year old boy has 1 week history of nonproductive cough wheezing nausea coarse bilateral crackles are heard on auscultation of the chest .stool culture shows 1.6cm roundworm larwa,chest xray shows bilateral infiltratethis disease was most likely cause by ingestion of which of the following? A) feces contaminated soil b )improperly caned beans c )pork products (i select this one but its wrong) d) raw shrimp e) under cooked meat


How is this Strongyloides ???
and it cant be cause strongyloides enters by larvae in soil penetrating sking which is not an option. Can anyone please answer this question ?
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a 3 year old boy has 1 week history of nonproductive cough wheezing nausea coarse bilateral crackles are heard on auscultation of the chest .stool culture shows 1.6cm roundworm larwa,chest xray shows bilateral infiltratethis disease was most likely cause by ingestion of which of the following? A) feces contaminated soil b )improperly caned beans c )pork products (i select this one but its wrong) d) raw shrimp e) under cooked meat


How is this Strongyloides ???
and it cant be cause strongyloides enters by larvae in soil penetrating sking which is not an option. Can anyone please answer this question ?
I don't have another ideas.

-roundworm larvae
-pneumonitis
Strongyloides fits most of other roundworms.
Trichinella spiralis may be ingested, but there would be muscle symptoms.

3 year-old child theoretically may ingest soil with larvae.
But, the size of larvae (1,6 cm) doesn't fit.
Necator americanus???
What are your suggestions?
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"In rare cases, human infection can result from ingesting contaminated foods", http://www.mlo-online.com/articles/2...case-study.php

Confirmation of my theory. ))
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wow you guys know worms really well i thought only treatment is important for parasitology
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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.
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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.
E unbalanced chrosomal rearrangement (trisomies)
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x linked recessive disease is seen in aproximately 1/100,000 males which of the following is expected prevalance of heterozygous females
a 1 /1000 b 1/10,000 c 1/50,000 d 1/200,000 e 1/10,000,000
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Quote:
Originally Posted by usmle1 View Post
x linked recessive disease is seen in aproximately 1/100,000 males which of the following is expected prevalance of heterozygous females
a 1 /1000 b 1/10,000 c 1/50,000 d 1/200,000 e 1/10,000,000
p2 + 2pq + q2.
In X-recessive among males q2 = q, because all males with trait are diseased males as well.
Heterezygous females (females with trait) are 2pq. p tends to one, so we have: 2*1*1/100000 = 1/50000.
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  #58  
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p2 + 2pq + q2.
In X-recessive among males q2 = q, because all males with trait are diseased males as well.
Heterezygous females (females with trait) are 2pq. p tends to one, so we have: 2*1*1/100000 = 1/50000.
in FA 2014 they say the frequency of an X linked recessive disease in males=q and in females =q2 ???????
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in FA 2014 they say the frequency of an X linked recessive disease in males=q and in females =q2 ???????
That's right. Among females in XR-diseases calculations are the same as in AR-diseases. Because female may be a carrier or diseased (XHXh or XhXh) - like in AR: Aa or aa.

frequency of female-carrier (XHXh) = 2pq; of diseased female = q2.

But males-carriers in XR-diseases are diseased males at the same time (XhY, there's no another variant, he is ill and carrier in one). So the only unit that is used in calculations - q.
Try to repeat it in Kaplan lecture notes. This type of question I met in the Kaplan QBank.

May be the following discussion will be useful (I don't remember where it's from):
Let q be the frequency of the recessive affected allele and p be the frequency of the dominant unaffected allele. Thus, the female recessive homozygote genotype frequency is q2, so:

q2 = 9% = 0.09
q = 0.3

Since the allele is on the X chromosome, the frequency of affected males is equal to the allele frequency, so the frequency of affected males is 0.3 (or 30%). Note that this means that of the males, 30% of them will be affected.

Since I am assuming there are only two alleles, then the sum of the frequencies of the alleles is one:

p + q = 1
p = 1 - q
p = 1 - 0.3
p = 0.7

So, the frequency of unaffected males is 0.7 (or 70%).

The dominant homozygotes (and recessive homozygotes) and carriers will all be females (since they have two X chromosomes), and the frequency of the females that are carriers is given by 2pq:

2pq = 2 x 0.7 x 0.3 = 0.42

In order to determine the frequency of the population that are carriers, we would need to know the the frequencies of males and females in the population. Then, we could calculate the frequency of carriers in the whole population by multiplying the frequency of carriers by the percentage of the population that are females. Note that the above number (0.42) is simply the frequency of females that are carriers, not the frequency of carriers in the whole population.
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21. A 35-year-old man comes to the physician because of a 6-month history of burning abdominal pain that occurs 1 to 2 hours After he eats. he also has had black stools for 2 days. Use of over the counter antacids and Histamine 2 (h2)-receptor blocking agents has not been effective in relieving his symptoms He is sweatlng profusely and has light-headedness when stands.His blood pressure is 105/70 mm/hg while sitting Physical examination shows epigastrIc tendemess A CT scan of the abdomen shows 1 cm mass in the pancreas. Immunohistochemical labeling of neoplastic CellS in a biopsy specimen is most likely to involve the use on antibodies directed to which which of the following substances ?

A) Amylase
B) Gastrin
C)Glucagon
D) Human pancreatic polypeptide
E) Insulin
F) Lipase
G) Serotonin
H) Somatostatin
I) vasoactive Intestinal polypeptide

i can seem to understand what time of Tumor this is Im confused if its a Gastrinoma or something else?

Any answers?
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21. A 35-year-old man comes to the physician because of a 6-month history of burning abdominal pain that occurs 1 to 2 hours After he eats. he also has had black stools for 2 days. Use of over the counter antacids and Histamine 2 (h2)-receptor blocking agents has not been effective in relieving his symptoms He is sweatlng profusely and has light-headedness when stands.His blood pressure is 105/70 mm/hg while sitting Physical examination shows epigastrIc tendemess A CT scan of the abdomen shows 1 cm mass in the pancreas. Immunohistochemical labeling of neoplastic CellS in a biopsy specimen is most likely to involve the use on antibodies directed to which which of the following substances ?

A) Amylase
B) Gastrin
C)Glucagon
D) Human pancreatic polypeptide
E) Insulin
F) Lipase
G) Serotonin
H) Somatostatin
I) vasoactive Intestinal polypeptide

i can seem to understand what time of Tumor this is Im confused if its a Gastrinoma or something else?

Any answers?
it is gastrinoma for sure
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then what is the answer for this mcq. ? GASTRIN ?
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then what is the answer for this mcq. ? GASTRIN ?
yes gastrin
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32. A female newborn is delivered at term to a 35-year-old primigravid woman. Pregnancy was complicated by untreated maternal Graves disease. Her respirations are 66/min Physical examination shows stridor, nasal flaring, intercostal retractions, and an asymmetric neck mass. Which of the following is the most likely cause of the newborn's stridor?
A) Cystic hygroma
B) Enlarged thyroid gland
C)Thymglossal duct cyst
D) Tracheomalacia
E) Vascular ling

Is the answer B ?
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Quote:
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32. A female newborn is delivered at term to a 35-year-old primigravid woman. Pregnancy was complicated by untreated maternal Graves disease. Her respirations are 66/min Physical examination shows stridor, nasal flaring, intercostal retractions, and an asymmetric neck mass. Which of the following is the most likely cause of the newborn's stridor?
A) Cystic hygroma
B) Enlarged thyroid gland
C)Thymglossal duct cyst
D) Tracheomalacia
E) Vascular ling

Is the answer B ?
Unfortunately I answered this question incorrectly. TSH-receptor binding antibodies cross placenta and induce goiter development. Answer is "B".
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Unfortunately I answered this question incorrectly. TSH-receptor binding antibodies cross placenta and induce goiter development. Answer is "B".
Yea i also got this wrong. worst when the right answer was your ur second option. lol
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Just wanted to confirm some answers.

40. A 54-year-old woman who works as a nurse comes to the physician for routine tuberculosis screening. A sample of her whole blood is incubated with a mixture of synthetic peptides representing two proteins of the suspected pathogen. Three days later, supernatant is collected for evaluation. Measurement of which of the following cytokine concentrations is most likely to indicate a positive result?
A) Granulocyte-macrophage colony-stimulating factor
B) Interferon alpha
C) Interferon gamma
D) Interlukein-4
E) IL - 10
F) Transsforming growth factor-beta

Not sure about this one. Answered A which was wrong.


34 A 24-year-old woman was slung on her right thumb by a bee 30 minutes ago. She develops an urticarial lesion at the site of the sting. Six hours later, the area has become indurated and firm. Which of the following explains the induration at the site of the sting?
A) Decrease in the expression of adhesion molecules on vascular endothelial cells
B) Decrease in serum C-reactive protein concentration
C) Influx of macrophages producing interleukin-1, IL-6, and tumor necrosis factor-a
D) Lysis of endothelial cells by the alternative complement pathway
E) Vasoconstriction

Is C right ?
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[QUOTE=drws;262610]Just wanted to confirm some answers.

40. A 54-year-old woman who works as a nurse comes to the physician for routine tuberculosis screening. A sample of her whole blood is incubated with a mixture of synthetic peptides representing two proteins of the suspected pathogen. Three days later, supernatant is collected for evaluation. Measurement of which of the following cytokine concentrations is most likely to indicate a positive result?
A) Granulocyte-macrophage colony-stimulating factor
B) Interferon alpha
C) Interferon gamma
D) Interlukein-4
E) IL - 10
F) Transsforming growth factor-beta

Not sure about this one. Answered A which was wrong.


34 A 24-year-old woman was slung on her right thumb by a bee 30 minutes ago. She develops an urticarial lesion at the site of the sting. Six hours later, the area has become indurated and firm. Which of the following explains the induration at the site of the sting?
A) Decrease in the expression of adhesion molecules on vascular endothelial cells
B) Decrease in serum C-reactive protein concentration
C) Influx of macrophages producing interleukin-1, IL-6, and tumor necrosis factor-a
D) Lysis of endothelial cells by the alternative complement pathway
E) Vasoconstriction

40 C) Interferon gamma 34 C influx of macrophages producing interleukin-1, IL-6, and tumor necrosis factor-a
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  #69  
Old 03-16-2014
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a study is designed to evaluate the relationship b/w ambient noise and hearing loss in an automoblile plant .different location in the manufacturing plant have different levels of ambient noise .each employe is given a test for hearing acuity and the the noise level is measured at his or her workstation which of the following describe this study design a) case series b )cohort c )crossover d )cross sectional e )randomized c trial
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Old 03-16-2014
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a study is designed to evaluate the relationship b/w ambient noise and hearing loss in an automoblile plant .different location in the manufacturing plant have different levels of ambient noise .each employe is given a test for hearing acuity and the the noise level is measured at his or her workstation which of the following describe this study design a) case series b )cohort c )crossover d )cross sectional e )randomized c trial

D) cross sectional.

measures simultaneously the exposure and the outcome.

It like cutting the population and taking a cross section and checking both the exposure and the outcome i.e checking the Prevalence at that particular point in time.

Last edited by drws; 03-16-2014 at 10:13 PM.
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45. An otherwise healthy 60-year-old man comes to the physician for a follow-up examination 2 weeks after he was found to have a serum prostate-specific antigen concentration of 5.3 ng/mL (N,..4) A biopsy specimen of the prostate shows evidence of adenocarcinoma. A CT scan of the spine shows osteoblastic lesions at LI. The patient undergoes bilateral orchiectomy. Five months later, he dies suddenly of a massive myocardial infarction. At autopsy, which of the following microscopic changes in the prostate resulting from the orchiectomy is most likely present,
A) Corpora amylacea
B) Edema
C) Hypertrophied cells
D) Necrosis of the blood vessel walls
E) Scattered shrunken cells
F) Widespread necrosis

Is it E ?
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Originally Posted by drws View Post
45. An otherwise healthy 60-year-old man comes to the physician for a follow-up examination 2 weeks after he was found to have a serum prostate-specific antigen concentration of 5.3 ng/mL (N,..4) A biopsy specimen of the prostate shows evidence of adenocarcinoma. A CT scan of the spine shows osteoblastic lesions at LI. The patient undergoes bilateral orchiectomy. Five months later, he dies suddenly of a massive myocardial infarction. At autopsy, which of the following microscopic changes in the prostate resulting from the orchiectomy is most likely present,
A) Corpora amylacea
B) Edema
C) Hypertrophied cells
D) Necrosis of the blood vessel walls
E) Scattered shrunken cells
F) Widespread necrosis

Is it E ?
Yes, E (Scattered shrunken cells)
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30. A 25-year-old man comes to the physician 8 hours after the onset of severe pain of his low back that radiates down his left leg. He started a weight-lifting regimen earlier in the day during which he tried to lift a bar loaded with 91 kg (200 lb) from the ground to over his head. The pain began almost immediately after this attempt Which of the following is the most likely cause of this patients pain?

A) A fracture of a lumbar vertebra
B)Rupture of the deltoid tendon
C) Rupture of an intervertebral disc
D) A tear in the sciatic nerve
E)A torn muscle in the lower back

Is it A ?
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Old 03-17-2014
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Quote:
Originally Posted by drws View Post
30. A 25-year-old man comes to the physician 8 hours after the onset of severe pain of his low back that radiates down his left leg. He started a weight-lifting regimen earlier in the day during which he tried to lift a bar loaded with 91 kg (200 lb) from the ground to over his head. The pain began almost immediately after this attempt Which of the following is the most likely cause of this patients pain?

A) A fracture of a lumbar vertebra
B)Rupture of the deltoid tendon
C) Rupture of an intervertebral disc
D) A tear in the sciatic nerve
E)A torn muscle in the lower back

Is it A ?
Here is "C".
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Old 03-18-2014
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78 years old man with hoarse shoe kidney ,palpable mass in the abdomen surgery repair f aneyrysm will be difficult due to

anomalous multiple renal arteries????
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78 years old man with hoarse shoe kidney ,palpable mass in the abdomen surgery repair f aneyrysm will be difficult due to

anomalous multiple renal arteries????


Haven't done nbme16 yet, so I don't know the question. A horseshoe kidney is stuck underneath the inferior mesenteric artery... maybe that helps with the answer, or you just post the answer choices.
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Originally Posted by Curacao View Post
Haven't done nbme16 yet, so I don't know the question. A horseshoe kidney is stuck underneath the inferior mesenteric artery... maybe that helps with the answer, or you just post the answer choices.
surgical approach to repair the aneurysm is further complicated by
abnormal origion of superior mesenteric artery
anomalous origin of multiple renal arteries
multiple ureters with abnormal course
tumors with malignant degenration
friability of vascular tissue collagin synthesis abnormalities (this one is wrong)
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Originally Posted by usmle1 View Post
surgical approach to repair the aneurysm is further complicated by
abnormal origion of superior mesenteric artery
anomalous origin of multiple renal arteries
multiple ureters with abnormal course
tumors with malignant degenration
friability of vascular tissue collagin synthesis abnormalities (this one is wrong)
multiple renal arteries.
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  #79  
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Originally Posted by usmle1 View Post
surgical approach to repair the aneurysm is further complicated by
abnormal origion of superior mesenteric artery
anomalous origin of multiple renal arteries
multiple ureters with abnormal course
tumors with malignant degenration
friability of vascular tissue collagin synthesis abnormalities (this one is wrong)

yes I would go with b then....they have a few more renal arteries...
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Old 03-19-2014
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can any one tell me easy way of doing MRI of cruciate ligaments.i am always confusing anterior vs posterior cruciate ligaments
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Originally Posted by usmle1 View Post
can any one tell me easy way of doing MRI of cruciate ligaments.i am always confusing anterior vs posterior cruciate ligaments
Watch this video.
http://youtu.be/q96M0jRqn7k?t=1m24s
Try to remember direction of the guide-needle on 1:24 min - from medial side to lateral. I saw this procedure a lot of time in operating room, and remembered in such manner I think.
It's not MRI, but for understanding may be useful.
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how did you guys find name 16 compared to the others in terms of difficulty?
just finished it now and it scored lower than the previous 3 I did....
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Quote:
Originally Posted by Kras View Post
Watch this video.
http://youtu.be/q96M0jRqn7k?t=1m24s
Try to remember direction of the guide-needle on 1:24 min - from medial side to lateral. I saw this procedure a lot of time in operating room, and remembered in such manner I think.
It's not MRI, but for understanding may be useful.
thanks ,it was really interesting anterior cruciate attaches anteromedial to tibia at least i wont forget this now
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[QUOTE=granuloma;267538]how did you guys find name 16 compared to the others in terms of difficulty?
just finished it now and it scored lower than the previous 3 I did....[/QUOTE
it is harder then the previous ones
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[QUOTE=usmle1;267594]
Quote:
Originally Posted by granuloma View Post
how did you guys find name 16 compared to the others in terms of difficulty?
just finished it now and it scored lower than the previous 3 I did....[/QUOTE
it is harder then the previous ones
thanks....feeling a little bit discouraged after finishing it...my scores were slowly improving...
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Old 03-20-2014
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Quote:
Originally Posted by Kras View Post
1-4
Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular ribosomes. Which of the following additional structural features of poliovirus mRNA is the most likely cause of its ability to be translated in the absence of a cap?
A) Absence of a 3' untranslated region (UTR)
B)Absence of a 5' UTR
C) Absence of a poly(A) tail
D) Presence of an internal ribosome entry site
E) Very short open reading frame
Answer is D.
Unlike the host cell's mRNAs the 5' end of poliovirus RNA is extremely long—over 700 nucleotides—and is highly structured. This region of the viral genome is called internal ribosome entry site (IRES) and it directs translation of the viral RNA. (http://en.wikipedia.org/wiki/Poliovirus).
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Quote:
Originally Posted by drws View Post
30. A 25-year-old man comes to the physician 8 hours after the onset of severe pain of his low back that radiates down his left leg. He started a weight-lifting regimen earlier in the day during which he tried to lift a bar loaded with 91 kg (200 lb) from the ground to over his head. The pain began almost immediately after this attempt Which of the following is the most likely cause of this patients pain?

A) A fracture of a lumbar vertebra
B)Rupture of the deltoid tendon
C) Rupture of an intervertebral disc
D) A tear in the sciatic nerve
E)A torn muscle in the lower back

Is it A ?
no its C,.
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Quote:
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I would say A
its not A i marked A got it wrong..may be E?
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a 3 year old boy has 1 week history of nonproductive cough wheezing nausea coarse bilateral crackles are heard on auscultation of the chest .stool culture shows 1.6cm roundworm larwa,chest xray shows bilateral infiltratethis disease was most likely cause by ingestion of which of the following? A) feces contaminated soil b )improperly caned beans c )pork products (i select this one but its wrong) d) raw shrimp e) under cooked meat


How is this Strongyloides ???
and it cant be cause strongyloides enters by larvae in soil penetrating sking which is not an option. Can anyone please answer this question ?
here its due to ascaris..round worm..A
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Originally Posted by Kras:
This question is not clear for me. I've answered C and got incorrect.
An 8-year-old girl is brought to the physician for a 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 60th percentile for weight. Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughter's 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) "I think that your daughter is likely to begin menstruating in the next few months."
C) "I would like to order laboratory studies to ensure that your daughter's development is normal."
D) “Your daughter's breast development is somewhat less than might be expected for her age."
E) “Your daughter's development is normal."

Here we see Tanner-2 (10-11,5 y.o.), hypothyroidism(?)
i marked A its wrong..is it E?
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Quote:
Originally Posted by genini View Post
Originally Posted by Kras:
This question is not clear for me. I've answered C and got incorrect.
An 8-year-old girl is brought to the physician for a 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 60th percentile for weight. Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughter's 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) "I think that your daughter is likely to begin menstruating in the next few months."
C) "I would like to order laboratory studies to ensure that your daughter's development is normal."
D) “Your daughter's breast development is somewhat less than might be expected for her age."
E) “Your daughter's development is normal."

Here we see Tanner-2 (10-11,5 y.o.), hypothyroidism(?)
i marked A its wrong..is it E?
Puberty starts on average in girls between ages 8-13 and in boys between ages 9-14.so the right answer to this question is E
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Puberty starts on average in girls between ages 8-13 and in boys between ages 9-14.so the right answer to this question is E
E is not right, cause thats what i marked and got wrong. I think its A.
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So, what we have? ))
I answered C
Usmle1 answered A
Drws answered E
All of us were wrong unfortunately.
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The most appropriate remains B.
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Quote:
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So, what we have? ))
I answered C
Usmle1 answered A
Drws answered E
All of us were wrong unfortunately.
Sorry guys. I just checked i answered B. which is wrong. I was confused between B and E and wasn't sure what i answered. But just checked again and it was B which is wrong.

So i guess E is the right answer if we rule out everything else by considering everyones answers.
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Sorry guys. I just checked i answered B. which is wrong. I was confused between B and E and wasn't sure what i answered. But just checked again and it was B which is wrong.

So i guess E is the right answer if we rule out everything else by considering everyones answers.
your daughters development is normal is the answer E first dr has to tell her that daughter's development is normal then he would tell her that she would start menstruation i answered E and it was correct
and this is normal puberty cause precocous puberty starts before 7 years of age
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cystic fibrosis is a defect in
protein regulation or
protein structure??
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cystic fibrosis is a defect in
protein regulation or
protein structure??
Protein structure i think.
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70 yr old african american women come to physician after 1 day onset of back pain. She's a part time cashier, low income, and smoked 1/2 a pack for 50 years and drinks 3 caffeinated beverages a day. X-ray shows vertebral compression fracture of L3 and she has decreased bone mineral density.
Answer Choices
A.Ethnicity
B.Gender
C. Occupation
D.Smoking
E. Socioeconomic status

I got this one wrong but thinks it's D or E
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Originally Posted by usml12314 View Post
70 yr old african american women come to physician after 1 day onset of back pain. She's a part time cashier, low income, and smoked 1/2 a pack for 50 years and drinks 3 caffeinated beverages a day. X-ray shows vertebral compression fracture of L3 and she has decreased bone mineral density.
Answer Choices
A.Ethnicity
B.Gender
C. Occupation
D.Smoking
E. Socioeconomic status

I got this one wrong but thinks it's D or E
It's B. Gender. increased risk of osteoporosis for women.
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