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Discussion Starter · #1 ·

My name is Alejandro and I'm currently preparing the usmle step 1. My concern is not about the gross content of each subject, as the mather of fact that is "easy" to understand, my concern is about what I call "low yield".

With any course, you will repeat until get tired about diseases and basic sciences in a general panorama but, what about the real hard quiestions?

For example:

A question of some qbank around asks for the hormone that rises enzyme translocation to the pancreatic acinus, it might be the CCK, but what about the receptor that CCK produces?

Did you know (I mean, maybe you knew, but did you learn it from a course?) that CCK and Gastrin has a aminoacid initial pentamer in common? Are basically the same family and both uses CCK receptor...

What if the question is: (Any question that, while you read, your mind says "it´s obviously CCK). Which of this receptors is used exclusively by CCK?

C.- washawasha receptor
D.- washawasha2- receptor
E.- batman's grandmother receptor

I mean, are we ready to answer a kind o hard question like this one?

This is what I call "low yield" because is not gonna make you pass the exam, is not the gross part, is the fine part that will make you BEAT THAT EXAM (if you have the gross part ready)

I propose you to post a very hard question here, so we all are able to read and know a little bit more of the hardests parts.

I will start:

A 23 yo man is admitted to the hospital after a car accident were he sustained a cervical fracture. It's approach and treatment is stablished and complies a urinary catheter also receiving empiric IV antibiotics. After 14 days a urine sample is cultured and grows a G-, oxidase positive, blue-green colonies on blood agar. Antibiotic sensitivity demonstrate a beta-lactamase producing bacteria, aminoglycoside and chloramphenicol acetyltranferases.
Molecular research approach shows that genetic code of these enzymes is in a plasmid that posses a tra operon.
What can be the mechanism by which plasmid appeared?

A.- Accumulation of mobile genetic elements
B.- Homologous recombination
C.- Transformation
D.- Generalized transduction
E.- Specialized transduction

Correct answer:

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