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nbme 17

here are few nbme 17 ques, if any one can help to answer these que
1) 45 yr old women comes to the physician for a follow up examination 8 weeks after beginning tamoxifen therapy for estrogen and progesterone positive invasive ductal carcinoma of breast. Her 50 yr old sister also has hormone sensitive breast cancer treated with temoxifen therapy. Physical examination shows no abnormality. Serum study shows decreased concentration of endoxifen, the active metabolite of prodrug temoxifen. Genetic analysis shows the homozygous presence of cytochrom p450 2D6*4 alleles. Which of following best represents the likelyhood that the patient's sister has same allele?
a) 0%
b) 25%
d) 75%
e) 100%
2) a 15 yr old girl is brought to the physician by her mother because of a1 day history of redness and painful skin following sunbathing. She reports that she used sunblock every few hours. She takes no medications. Physical examination shows severe erythema of the back and extremities. There are no blisters which of following best describes her condition?
A) allergic reaction to the sun
B) first degree burn
C) rhus dermatitis
D) second degree burn
E) third degree burn

3) oxidized metabolites-----------6 MP-------------→ 6 methyl mercaptopurine

6 thioguininr nucleotide
6MP is used to treat ALL. In human, 6MP is acted on by a series of cellular enzymes to produce 6 thioguinine nucleotides(TGN). These modified nucleotides can be incorporated into DNA. Both the efficacy and toxicity of the 6MP therapy are correlated with final serum 6TGN concentration. High serum concentration of 6TGN are toxic and can lead to life threatning complications. Exogenously administered 6MP can be acted on by XO, TPMP or both. Both of these pathway leads to the production of inactive and nontoxic metabolites. Which of the following are clinical consequence for pt with ALL who are homozygous for low activity allele of TPMP?
A. they must be given normal dose of 6MP
B. they must be given decreased dose of 6MP
C. they must be given increased dose of 6MP
D. they must be given injection of XO if treated with 6MP
4) a 14 yr old boy is brought to the physician by his mother b/z of daily headache for 2 months. The headache describes as a b/l aching in temples. His mother also states that he also ''has not been himself'' for past few months. He seems more confused, often forgetting names, dates, places and he is clumsy with frequent fall. His school performance also has declined over past quarter. Physical examinations show a broad based ataxia gait. He is alert and oriented to person place and time, but he is slow to answer a questions. Chronic abuse of which of the following substances is most likely cause of this patient's condition?
a. cocaine
b. ethanol
c. inhaled glue
d. methamphetamine
e. PCP

5) a 75 year old man comes to physician b/L of 2 year history of leed force of his urinary stream and need to urinate several time through the night. His stream BUN is 55 mg/dl and S creat conection is 5.0 mg/dl.USG OF urinary tract shows b/L hydronephroso a dialated ureters. Which of the following is most likely match of the patient's renal failure ?
a. bed hydrostatic pr in glomenulor capillary.
b. bed renal plasma flow
c. bed hydrostatic pr in bowmen space
d. precipitation of uric acid in renal tubule
6) a previously healthy 17 year old girl is brought to the emergency dept. b/L of 1 day history of shortness of breath weakness a muscle tenderness. She completed a triathlon. The previous day she appears restless. She is 163 cm (5 fit 4 inch) tall and weighs 50 kg(110 lb) BMI-19 kg/m2 temp 38oC (100.4o F) respiration are 20/min & BP crackles are heard in lower lung. Lobes an accumulation of chest physical examination shows muscle tenderness. Her S create 4 mg/dl. Urine analysis shows 3+protein, 4+Hb. Most likely cause of this patient's condition is an Ted release of which of following substance?

a. aldolase
b. creatine kinase
c. Hb
d. myoglobin
e. tropoin -l
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