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Discussion Starter · #21 ·
A 5 year old boy with mental retardation is grossly obese and has features of prader willi syndrome. Karyotipind and fluorescent in situ hybridization studies do not show deletion in the usual site on chromosome 15. Which of the following findings is most likely to confirm PWS in this child?

DEletion in the short arm of chromosome 15
Duplication within chromosome 15 no
Large trinucleotide repeat expansion in the PWS area of chromosome 15 no
Maternal origin of both chromosome 15, ?????? one paternal and one maternam must be????
Translocation in the short arm of chromosome 15 wrooooooooong
Prade willi syndrome
Mental retardation, hyperphagia, obesity, hypogonadism, hypotonia, and behavior like tantrum
Individual has normally inactivated maternal allele. Paternal allele should be active but is deleted.

We know diseases with trinucleotide expansion like Huntington, muscular dystrophy,Freidrich ataxia, x fragile syndrome.

DEletion in the short arm of chromosome 15??? Answer must be with deletion of Paternal chromosome 15, but may match response with just a partial deletion of chromosome too?
 

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Discussion Starter · #22 ·
Endocrinology

A 38 yo woman comes to the physician because of a 10 week history of epigasric pain and frequent stools. She has had two episodes of renal calculi during the past 2 years. Physical examination shows multiple superficial lipomata and mild epigastric tenderness. Upper endoscopy shows two large nonbleeding duodenal ulcers. Her gastric pH is 2.3 and serum gastrin concentration obtained immediately after the procedure is 2000pg'mL Norma less than 100. Proton pump inhibitor therapy is begun. Measurement of which of the following is the most appropiate next step in management?

Serum calcium concentration
Serum cortisol concentration
Serum tissue tranglutaminas activity
Stool alpha antitrypsin concentriation
Urine 5 hydroxyindolacetic acid concentration wronggggggg

Epigastric pain plus increased serum gastrin, and duodenal ulcers mimic Gastrinoma
Renal calculi give a sign of parathyroid gland hyperfuncion, which most common is a parathyroid adenoma, and in combination form a MEN 1 endocrine neplasia

Answer will be increased calcium
 

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Discussion Starter · #23 ·
Behavioral treatment :)

A 19 year old woman is brought to the physician be her mother because she has been increasingly withdrawn and isolated since graduating from high school 1 year ago. The mother reports that the patien stays in her bedroom much of the time and rarely sees friends. The patient says that she is not interested in her old friends or activities.
She has been anxious and depressed about what she has learned by listening to radio broadcasts that only she can hear. She has been spending most of her time thinking about a government scheme to control th physic pain feel. She does not dring alcohol or use ilicit drugs. She appears disheveld and is malodorous. Vital signs are within normal limits. Physical examinatino shows no abnormalities. On mental status examination, she is distracted. She has a sad mood and an anxious , sad, and blunted affect. She is oriented to person place and time. Which of the following is the most appropiate pharmacotherapy?

Buspirone wrong
Donepezil
LIthium carbonate
Risperidone
Trazodone

Please hepl to establish diagnosis for first, and wich drug can be use for this state treatment???
 

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Discussion Starter · #24 ·
Hi

A 9 year old boy is brought to the physician by his mother because of a 1 year history of cough productive of mucoid sputum, wheezing and shortness of breath with exertion. He has history of recurrent upper respiratory tract and sinus infections since birth. He is at the 25 percentile for height and weight. The mother says that his younger sibling is beginning to develop similar problems. Physical examination shows mild clubbing of the fingers. Laboratory studies show markedly increased sweat chloride and sodium concentration. A defect of which of the following is this patietns bronchial epithelium is most likely causing these symptoms?

Adrenoreceptors nooo
Membrane receptor
Nuclear receptor
Protein regulator wrongggg
Protein stucture

????
 

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Discussion Starter · #25 ·
Hi

A 9 year old boy is brought to the physician by his mother because of a 1 year history of cough productive of mucoid sputum, wheezing and shortness of breath with exertion. He has history of recurrent upper respiratory tract and sinus infections since birth. He is at the 25 percentile for height and weight. The mother says that his younger sibling is beginning to develop similar problems. Physical examination shows mild clubbing of the fingers. Laboratory studies show markedly increased sweat chloride and sodium concentration. A defect of which of the following is this patietns bronchial epithelium is most likely causing these symptoms?

Adrenoreceptors nooo
Membrane receptor
Nuclear receptor noooo
Protein regulator wrongggg
Protein stucture

????
It's clear that diagnosis is a cystic fibrosis
BUt a pathogenesis of CF consist by an abnormal traficking of a transmembrane protein.
Mutation causes abnormal protein folding, resulting in degradation of channel before reaching cell surface.
Protein stucture May somebody verify if i deduce a corect answer???
 

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Discussion Starter · #26 ·
Neurology

A 65 year old woman comes to the physician because of a 3 month history of headache, weakness of her arms, and left flank pain, She also has had a 14 kg weght loss during this period. Physical examination shows weakness of the proximal upper and lower extremety muscles. there is augmentation of strengh with repetitive testing of the deltoid muscles. An MRI of the brain shows a single well demarcated mass surrounded by edema in the right frontal lobe. A stereotactic biopsy specimen of the lesion shows a malingnant small blue cell neoplasm thatt expresses cytokeratin chromogranin, and synaptophysin, Which of the following is the biopsy specimen is the most likely?

Anaplastic ependimoma wroooooooongggg

Extranodal primary central nervous system lymphoma

Glioblastoma multiforma

Primary cerebral neuroblastoma

Pulmonary small cell carcinoma metastatic to the brain
 

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Discussion Starter · #27 ·
NBME

A 65 year old woman comes to the physician because of a 3 month history of headache, weakness of her arms, and left flank pain, She also has had a 14 kg weght loss during this period. Physical examination shows weakness of the proximal upper and lower extremety muscles. there is augmentation of strengh with repetitive testing of the deltoid muscles. An MRI of the brain shows a single well demarcated mass surrounded by edema in the right frontal lobe. A stereotactic biopsy specimen of the lesion shows a malingnant small blue cell neoplasm thatt expresses cytokeratin chromogranin, and synaptophysin, Which of the following is the biopsy specimen is the most likely?

Anaplastic ependimoma wroooooooongggg

Extranodal primary central nervous system lymphoma

Glioblastoma multiforma

Primary cerebral neuroblastoma

Pulmonary small cell carcinoma metastatic to the brain
Because tumor show no clasic presantation of brain tumors, but we see a blue small cell cancer metastasis
One of the often sides of metastasis from lung is BRAIN, adrenal gland,...

expresses cytokeratin chromogranin, and synaptophysin all these indicate neurosecretory type of tissue, small cell carcinoma may secrete as ACTH as ADH
 

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Discussion Starter · #28 ·
nbme

A 76 year old man with a one month history of a pulsatile abdominal mass is diagnosed with an abdominal aortic aneurysm. CT scans of the abdomen with contrast also showed an incidental finding of a horseshoe kidney, In this setting the surgical approach to repair of the aneurysm in this patient is most likely to be further complicated by the presence of which of the following?

Abnormal origin of the superior mesenteric artery
Abnormal origins of multiple renal arteries to each kidney
Friability of vascular tissue as a result of collagen synthesis abnormalities wrongggggg

Multiple wreters with abnormal courses
Tumors with malignant degeneration
 

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Discussion Starter · #29 ·
NBME

A 76 year old man with a one month history of a pulsatile abdominal mass is diagnosed with an abdominal aortic aneurysm. CT scans of the abdomen with contrast also showed an incidental finding of a horseshoe kidney, In this setting the surgical approach to repair of the aneurysm in this patient is most likely to be further complicated by the presence of which of the following?

Abnormal origin of the superior mesenteric artery
Abnormal origins of multiple renal arteries to each kidney
Friability of vascular tissue as a result of collagen synthesis abnormalities wrongggggg

Multiple wreters with abnormal courses
Tumors with malignant degeneration
Short stature
Lymphedema (swelling) of the hands and feet
Broad chest (shield chest) and widely spaced nipples
Low hairline
Low-set ears
Reproductive sterility
Rudimentary ovaries gonadal streak (underdeveloped gonadal structures that later become fibrosed)
Amenorrhoea, or the absence of a menstrual period
Increased weight, obesity
Shield shaped thorax of heart
Shortened metacarpal IV
Small fingernails
Characteristic facial features
Webbed neck from cystic hygroma in infancy
Aortic valve stenosis
Coarctation of the aorta
Bicuspid aortic valve
Horseshoe kidney
Visual impairments sclera, cornea, glaucoma, etc.
Ear infections and hearing loss
High waist-to-hip ratio (the hips are not much bigger than the waist)
Attention Deficit/Hyperactivity Disorder or ADHD (problems with concentration, memory, attention with hyperactivity seen mostly in childhood and adolescence)
Nonverbal Learning Disability (problems with math, social skills and spatial relations)

Abnormal origins of multiple renal arteries to each kidney

Variant arterial supply - Bilateral renal arteries, Inferior mesenteric Artery, Arteries arising from aorta or common iliac, internal iliac, external iliac or inferior mesenteric arteries.
 

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Discussion Starter · #30 ·
NBME

A 4 month old boy is diagnosed with a rare autosomal recessive skeletal dysplasia involving abnormal endochondral bone formation. Genetic analysis shows null mutations on a gene for a protein that controls the traffic of vesicles into the Golgi complex. Electron microscopy of this patient;s cells will most likely show which of the following findings?

Decreased rough endoplasmic reticulum wrrrrrrrrrrrrrong
Decreased smooth endoplasmic reticulum
Dilated rough endoplasmic reticulum
Increased smooth endoplasmic reticulum
Large lysosomes
Small lysosomes
 

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Discussion Starter · #31 ·
nbme

A 4 month old boy is diagnosed with a rare autosomal recessive skeletal dysplasia involving abnormal endochondral bone formation. Genetic analysis shows null mutations on a gene for a protein that controls the traffic of vesicles into the Golgi complex. Electron microscopy of this patient;s cells will most likely show which of the following findings?

Decreased rough endoplasmic reticulum wrrrrrrrrrrrrrong
Decreased smooth endoplasmic reticulum
Dilated rough endoplasmic reticulum
Increased smooth endoplasmic reticulum
Large lysosomes
Small lysosomes
I cell disease Inherited lysosomal storage disease, failure of addition of mannose 6 phosphate to lysosome proteins , enzymes are secreted outside te cell instead of being targeted to the lysosome

And i think that these substances are filled with proteins, and lysosomes will become more in size? Large lysosomes
 

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Discussion Starter · #32 ·
nbme

Behavioral

A study is designed to evaluate the relationship between ambient noise and hearing loss in an automobile manufacturing plant. Different locations in the manufacturing plant have strikingly different levels of ambient noise. Each employee is given a test for hearing acuity, and then the ambient noise level is measured at his or her workstation. Which of the following best describes this study design?

Case series
Cohort
Crossover
Cross-sectional
Randomized clinical trial wrrrrrrrrrrrrong
 

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Discussion Starter · #33 ·
Hi

Behavioral

A study is designed to evaluate the relationship between ambient noise and hearing loss in an automobile manufacturing plant. Different locations in the manufacturing plant have strikingly different levels of ambient noise. Each employee is given a test for hearing acuity, and then the ambient noise level is measured at his or her workstation. Which of the following best describes this study design?

Case series
Cohort
Crossover noooo
Cross-sectional noooo
Randomized clinical trial wrrrrrrrrrrrrong
Cohort study Compares a group with a given exposure or risk factor to a group without, Can be prospective or retrospective.
Looks to see if exposure increase the likelihood of disease...
Done
 

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Discussion Starter · #34 ·
Hi

Immunology

A 54 yo woman who works as a nurse comes to the physician for routine tuberculosis screening. A sample of her whole blood is incubated within a mixture of the synthetic peptides representing two proteins of the suspected pathogen. Three days later. supernatant is collected for evaluation. Measurement of which of the following cytokine concentration is most likely to indicate a positive result?

Granulocyte macrophage colony stimulating factor
Interferon alpha
Interferon gamma
Interleuking 4
interleukin 10
Transforming growth factorr betta
 

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Discussion Starter · #35 ·
Hi

Immunology

A 54 yo woman who works as a nurse comes to the physician for routine tuberculosis screening. A sample of her whole blood is incubated within a mixture of the synthetic peptides representing two proteins of the suspected pathogen. Three days later. supernatant is collected for evaluation. Measurement of which of the following cytokine concentration is most likely to indicate a positive result?

Granulocyte macrophage colony stimulating factor
Interferon alpha
Interferon gamma
Interleuking 4
interleukin 10
Transforming growth factorr betta
What i found interesting about this blood test of TB, because is different from that injected subcutaneously...

http://www.cdc.gov/tb/publications/factsheets/testing/igra.htm
 

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Discussion Starter · #36 ·
Hi

A 45 year old man has fever chills dysuria and tender, enlarged prostate. Which of the following is the most likely causal organism?

Adenovirus
Chlamydia tracomatis wrooooooooooong
Escherichia coli
Pseudomonas aeruginosa
Ureaplasma urealyticum
 

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Discussion Starter · #37 ·
Hi

A 45 year old man has fever chills dysuria and tender, enlarged prostate. Which of the following is the most likely causal organism?

Adenovirus most common in children???
Chlamydia tracomatis wrooooooooooong
Escherichia coli
Pseudomonas aeruginosa
Ureaplasma urealyticum
What are the complications of benign prostatic hyperplasia?
The complications of benign prostatic hyperplasia may include
acute urinary retention
chronic, or long lasting, urinary retention
blood in the urine
urinary tract infections (UTIs)
bladder damage
kidney damage
bladder stones
Urinary tract infection

E.coli most common
Staph aureus
Klebsiella pneumoniae
Serratia marcescens
Enterobacter
Proteus
Pseudomonas
 

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Discussion Starter · #38 ·
Hi

Behavioral

A 62 year old man comes to the physician for a follow up examination. Two weeeeeeeeeks ago , he was discharged from the hospital after sustaining an acute myocardial infarction. He smokes 2 packs of cigarettes and drinks four 12 beers daily. His diet mostly consists of cured meats and fast food. He does not exercise. the patient 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 dont have the willpower to quit smoking and drinking and all that stuff ritght now.
Which of the following best describes this patients stage of behavioral change????

Precontemplation wrrrrrrrrrrrrrrong
Contemplation
preparation
Action
maintanance
 

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Discussion Starter · #39 ·
Hi

Behavioral

A 62 year old man comes to the physician for a follow up examination. Two weeeeeeeeeks ago , he was discharged from the hospital after sustaining an acute myocardial infarction. He smokes 2 packs of cigarettes and drinks four 12 beers daily. His diet mostly consists of cured meats and fast food. He does not exercise. the patient 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 dont have the willpower to quit smoking and drinking and all that stuff ritght now.
Which of the following best describes this patients stage of behavioral change????

Precontemplation wrrrrrrrrrrrrrrong
Contemplation
preparation
Action
maintanance
Hey guys i can tell for everyone that Doctors in training is a gold for USMLE step 1, because thay accentuate more useful an Yield information, and help you memorise all during this long process of hours watching actively they video...

Stages of behavioral changes

Precontemplation ( dont think you have a problem)
Contemplation ( do think you have a problem) here you realize that problem exist
Preparation
Action
Maintanance
RElapse

Contemplation
 

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Discussion Starter · #40 ·
Hi

A 24 year old african american man coooooooooooomes to the physician because of a 3 month history of red bumps on his face and chin. he says that the bumps are iithcy and painful. Physical examination shows hyperpigmentated papules over the cheeks, jawline, and neck. Which of the following is the most likely diagnosis?

Acne vulgaris wroooooooooooooooooooong
Cutaneous lupus erythematosus no
Keloids nooooooo
Pseudofoliculitis barbae
Rosacea
 
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