NBME 12 discussion

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titan25

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1 v max 1 enzyme is 300 and 2 nd 30 compare the Km values

km1 is 10 times km 2
km1 is 1/10 km2
we cant compare


2 upregulation of which protects from ARDS is IL 10

3 which anti hypertensive restores back potassium other k sparing

4 a 14 years old brougt to physian because mostly sleeping withdrawn and complaining of abdomen pain 3 weeks , what history will u take first...should we recretion drug history....options school history , devlopmental, family history

5 a drug given in two patients obese and normal given same doses graph ploted with conc on y axis and time on x , slope of normal person is greater
compared to normal person drug x in obese has

greater VD/ lower bioavailability / higher clearance/ shorter absorption

6 pedigree given four genrations AD 1st genration gene seq 4 5 6 changes to 156 cause...is it recombination

7 cytoplasmic enzyme mutated at 127 alanine replaced by serine why reduction of enzyme activity

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very helpful notbob, but is ALL always PreT and PreB only? On wiki it's not really clear since there's a little chart which has pre B, pre T, and B. and omg i don't know or understand this surface ig and k and L stuff. test is in a week. ddidn't really feel like i had or have any time to review immuno :(

yea, but T-ALL is super rare even for Step 1. Here, you have signs of a B cell ALL instead of a T-cell ALL. So you could piece it together without having to know everything about BCR recombination/production.

And wiki can be misleading for this stuff because wiki has shades of grey while succeeding in Step 1 is all about making the material as black and white as possible.
 
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a new compound has potent inhibitory effects on the replication of HIV. the drug's mechanism of action shows no effect on viral binding to cellular receptors, viral entry into cells, reverse transcription, or integration of proviral DNA into cellular host chromosomes. however the drug prevents post-translational processing of polyprotein products into core proteins. based on these properties, this new drug's mechanism of action is likely to be most similar to that of which of the following?

A)Efavirenz
B)Indinavir
C)Nevirapine
D)Staduvudine (d4T)
E)Zidovudine (AZT)

Is B correct?
 
A 25-year-old man is lost in the desert for 1 week with an ample supply of water but no food. Enzymes and molecules below (inc or dec)

F2,6P
G6Pase
PEPCK
PK

I put all dec and got it wrong (I reasoned that ketogenesis was predominant since he was starving for a week). Anyone actually got this question right and know the answer? Read the previous pages and it was mostly speculation.

I thought form 12 was pretty brutal too, lots of distractors that ended up successfully distracting me. My score dropped 10 pts from forms 6, 7, 11.
 
I have ome confusion abt 3rd q.
It says dilated 4 th ventricle.
so it means it i swell developed from mesencephalaon right
?
1. Klinefelter's, look for the Barr body in easily obtainable cells.

2. Pulm vasculature. I believe the idea is an outdated one (at least so we were told by lecturers), but ACE is present in high amounts at capillary beds. FA "covers" this in the renal chapter with a picture of the lungs in the AngII discussion. This was quite tricky, actually, and should serve as a reminder to read all choices.

3. That's Dandy-Walker and is from absent formation of the 4th vent. If I remember correctly, Met is the right answer. (e.g., no cerebellar vermis which arises from Met). Between Met and Myencephalon, I don't know how you would pick. Luckily Mye was not a choice.

4. No muscle atonia in REM. FA covers this fairly well in Behavioral chapter.

5. Took me a while to figure this one out, but you've copied it wrong. I had to go to my test to find this out. The boy has increased ketones and hepatosplenomegaly. Increased ketones rules out MCAD/LCAD and Carnitine transfer deficiencies. The time course is also much better for a disorder of gluconeogenesis than one of impaired FA oxidation.

6. Parasympathetic outflow is responsible for the vasovagal response (aka neurocardiogenic syncope), which is a fancy way of saying "fainting." People faint when anxious (giving blood, needles, etc.) and can experience warmth, nausea, and light-headedness prior to going out. Think about the important diagnostic points separating cardiac syncope (all the other causes listed) from fainting and seizures. This is more of a third year thing, admittedly. As a test taking skill, you should also note that all the others imply structural damage to the heart and would be unlikely in a young military recruit who is undergoing BT. Another place this skill is useful is in lung pathology questions: separate obstructive from restrictive answer choices, increased A-a gradient choices from normal A-a choices, increased AG met acidosis from normal AG choices, and so on.

Edit: Just wanted to add that these are tough questions and if you can minimize your careless errors on test day you'll likely do super. For my own education, what were you looking for with FISH of subtelomeres in the infertile man?
 
a new compound has potent inhibitory effects on the replication of HIV. the drug's mechanism of action shows no effect on viral binding to cellular receptors, viral entry into cells, reverse transcription, or integration of proviral DNA into cellular host chromosomes. however the drug prevents post-translational processing of polyprotein products into core proteins. based on these properties, this new drug's mechanism of action is likely to be most similar to that of which of the following?

A)Efavirenz
B)Indinavir
C)Nevirapine
D)Staduvudine (d4T)
E)Zidovudine (AZT)

Is B correct?

Yes I think so-- protease inhibitors end in -navir and "post-translational processing of polyprotein products into core proteins" sounds most like a protease inhibitor. You can also eliminate D and E right off the bat since they are both NRTIs and A and C are both NNRTIs, so just by process of elimination.

can someone explain 30 yr old woman with Myasthenia ,decreased number of receptors on ?
clathrin coated vesicles
lysosomes
nuclear lamina
plasma membrane
smooth er?

Probably plasma membrane-- antibody binds to post-synaptic AChR and prevents it from working, so this could either be a functional decrease in # of receptors or actual decrease by activation of complement or endocytosis of the receptor-antibody complex.

I know these are from last year but maybe this will help other people reading the thread!
 
So I didn't bother to look any previous post so pls forgive me if any has asked this q.
Can anyone help me with this q?

A 58 yr old man comes to the physician for a routine exam. During the interview, he tells the physician that he has a long standing hx of a cough and shortness of breath with exertion. He adds that his voice has become hoarse, which he attributes to smoking. He has smoked 1 and 1/1 packs of cigarettes daily for 35 yrs. He has had an 8 kg of weight loss since his last visit 1 yr ago. Vital signs are within normal limits. Rhonchi are heard in both lung bases. A chest x-ray shows hyperinflation consistent with chronic obstructive pulmonary dz, elevation of the Lt. hemidiaphragm, and a Lt apical lung mass. Involvement of which of the following structures best explains the Lt. hemidiaphragm x-ray findings in this pt?

A. intercostobrachial nerve
B. paravertebral sympathetic ganglion
C. phrenic nerve
D. pulmonary plexus
E. recurrent laryngeal nerve
F. vagus nerve


A 39 yr old woman at 30 weeks gestation has a systolic murmur at the lower Lt. sternal border and splitting of S2 that are both more pronounced during inspiration. The remainder of the physical exam is unremarkable. Which of the following is the best explanation for these findings?

A. aortic stenosis
B. constrictive pericardial dz
C. hypertrophic cardiomyopathy
D. mitral insufficiency
E. mitral stenosis
F. normal physiologic response

So when they say "lower Lt. sternal border" that's the tricuspid area right?
 
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Haven't taken 12 but it looks like c(phrenic paresis-->diaphragm paresis) and F ( hugely increased blood volume leads to overload of heart and a little regurgitation)
 
I need some help with these q:

1. In a pt with chronic peripheral neuropathy, enzyme histochemical staining of a muscle biopsy shows fiber grouping. Which of the following is the most likely cause of this finding?

A. altered expression of muscle enzyme due to damaged nerve fibers
B. altered trophic substance from the innervating neurons
C. regeneration of muscle fibers
D. reinnervation of muscle fibers by regenerating axons
E. selective loss of nerve fibers to type II muscle fibers

2. An otherwise healthy 22 yr old man comes to the physician after noticing a painless mass in his Rt. testicle. He was kicked in the scrotum during soccer practice 1 week ago. Vital signs are normal. Physical exam shows a 2 cm hard mass that does not transilluminate. His serum alpha fetoprotein conc. is increased. Which of the following is the most likely diagnosis?

A. hematoma
B. leydig cell tumor
C. nonseminoma neoplasm
D. sertoli cell tumor
E. spermatocele

3. A 45 yr old man is admitted to the hospital for treatment of septic shock from a pneumococcal infection. He is hypotensive for 12 hours and subsequently develops an increased serum creatinine conc and decreased urine output. Despite appropriate care, he dies 1 day later. At autopsy, exam of the kidney shows necrosis of many of the renal tubular cells, without damage to the underlying stromal framework or glomeruli. If this pt had survived and healing of the kidneys had occurred, which of the following renal outcomes would have been most likely?

A. diffuse renal scarring
B. renal atrophy
C. renal hyperplasia
D. renal hypertrophy
E. normal renal architecture
 
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1. D (type grouping is a result of re-innervation of muscle fibers). You know that whole type 1 vs type 2 fiber thing? Well, the type of muscle fiber is determined by the axon that innervates each cell. Prior to denervation, the axons are all mixed, so you get a haphazard random checkerboard pattern of type 1 vs type 2 fibers. After denervation and subsequent re-innervation, the axons reestablish connections with broad clusters of muscle cells rather than in a haphazard pattern, thus you get type grouping.
2. C. AFP is one of the serum markers for a non-seminomatous germ cell tumor, specifically yolk sac tumor.
3. E. The patient, because of the septic shock, has ischemically damaged the renal tubular cells (ischemic ATN). They mention the underlying stromal framework is ok. Since the framework is ok, if the kidneys were allowed to heal, the tubular cells would grow back, and since the stromal framework is preserved, the kidneys would have normal renal architecture.
 
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I am debating between C and D. Any advise how I should approach this q?

A 51 yr old woman comes to the physician b/c of a firm lump in her neck for 5 months. She also has tired easily during this period. Physical exam shows modest symmetric enlargement of the thyroid gland. Her serum thyroxine (T4) conc is 1.8 ug/dl (low). Which of the following additional serum findings is most likely in this pt?

A. decreased thyroid-stimulating hormone conc
B. decreased thyrotropin-releasing hormone conc
C. increased thyroxine-binding globulin conc
D. presence of antithyroid peroxidase antibodies
E. presence of thyroid-stimulating antibodies
 
For this question, looking at the entire picture (middle aged women, more prone to autoimmune diseases), physical exam finding, low T4, fatigue, clearly hypothyroidism, most probably Hashimotos. of the given answer choices, D is best option. in the case of E, for TBG to be elevated there should be some kind of physiologic elevation in estrogen correct that would upregulate synthesis of SHBGs, which there is no evidence of, so yeah I would def go with D.
 
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For this question, looking at the entire picture (middle aged women, more prone to autoimmune diseases), physical exam finding, low T4, fatigue, clearly hypothyroidism, most probably Hashimotos. of the given answer choices, D is best option. in the case of E, for TBG to be elevated there should be some kind of physiologic elevation in estrogen correct that would upregulate synthesis of SHBGs, which there is no evidence of, so yeah I would def go with D.
good point, so if she is pregnant or taking OCP, C would be the answer. Thanks man!
 
Need some more help on these qs. Any help is greatly appreciated. If you could point out clues and the reasoning that would be great. Many thnx in advance.

1. A 25 yr old man comes to the physician 10 days after injuring while trying to lift an 80 lb dumbbell at the gym. When he attempted to lift the weight from the rack, he felt a popping sensation and pain in his right elbow. He uses anabolic steroids. His pulse is 78/min and bp is 150/95 mmHg. Exam of the Rt. upper extremity shows swelling of the antecubital fossa and ecchymoses from the antecubital fossa to the mid forearm on the anterior side. There is tenderness to palpation over the proximal aspect of the anterior forearm. He is able to flex the elbow actively, but he is unable to flex the elbow or supinate the forearm against resistance. The pt has most likely injured a muscle-tendon unit that is supplied by which of the following nerves?

A. anterior interosseous
B. median
C. musculocutaneous
D. radial
E. ulnar

2. A 30 yr old woman is brought to the physician b/c of double vision, muscle weakness, and fatigue for 2 weeks. She also has a 1 month hx of difficulty chewing and weakness of her neck muscles that causes her neck to fall forward. Physical exam shows ptosis. There is no loss of sensation, and deep tendon reflexes are present. Following the administration of neostigmine, there is improvement in the muscle weakness. The most likely cause of these findings is a decreased number of receptors on which of the following myocyte components?

A. clathrin-coated vesicles
B. lysosomes
C. nuclear lamina
D. plasma membrane
E. smooth endoplasmic reticulum

3. A 62 yr old man has had petechiae and easy bruising for the past month. He has a 2 yr hx of alcoholic cirrhosis with portal HTN. Lab studies show:
upload_2016-1-1_18-51-39.png


Which of the following is the most likely cause of the pancytopenia?

A. DIC
B. hypersplenism
C. iron def
D. vit B1 (thiamine) def
E. vit C def


4. A 65 yr old woman with severe sensorineural hearing loss undergoes surgical placement of a cochlear implant. This neural prosthesis converts sound energy to electrical signals, which results in stimulation of which of the following structures?

A. auditory nerve endings in the cochlea
B. cochlear nerve as it enters the pons
C. inner hair cells of the cochlea
D. olivocochlear efferent axons that innervate outer hair cells
E. oval window of the cochlea


5. A 45 yr old woman with multiple sclerosis is brought to the emergency dept by a friend b/c of a 1 hour hx of increasing confusion; she is now stuporous. She has been in remission for 2 yrs. Her temp is 37.2C, pulse is 72/min, respirations are 8/min, and bp is 116/66 mmHg. Percussion of the chest shows decreased lung volumes. The lungs are clear to auscultation. Breath sounds are distant. There is a minimal gag response. When aroused, she is mildly combative, moves all four extremities, and then drifts back into stupor. Arterial blood gas analysis on room air shows:

pH: 7.12
pCO2: 76 mmHg
pO2: 50 mmHg

Which of the following is the most likely cause of this pt's condition?

A. acute respiratory distress syndrome
B. aspiration pneumonia
C. opioid overdose
D. pulmonary embolism
E. upper airway obstruction


6. A 60 yr old man comes to the physician b/c of a 1 month hx of a persistent hoarse voice. He has smoked 1 1/2 packs of cigarettes daily for 40 yrs. Physical exam shows no abnormalities. Laryngoscopy shows a lesion on the true vocal cords. Photomicrographs of a biopsy specimen of the lesion are shown. Which of the following best describes this pt's lesion?
upload_2016-1-1_19-13-32.png

A. adenocarcinoma
B. adenoma
C. squamous cell carcinoma
D. squamous cell papilloma
E. vocal cord polyp


7. A 56 yr old man with alcoholism comes to the physician b/c of a 2 month hx of increasingly severe stomach pain and increased volumes of foul-smelling stool; he also has had a 9 kg weight loss during this period. He has a hx of multiple visits to the emergency dept b/c of severe abdominal pain. He has consumed one bottle of red wine daily for 5 yrs. His temp is 37C. Physical exam shows epigastric tenderness. His fasting serum glucose conc is 150 mg/dl. A CT scan of the abdomen shows pancreatic calcification. The most likely cause of this pt's current symptoms is a decrease in which of the following?

A. bile acid synthesis
B. colonic bacteria
C. duodenal pH
D. fecal elastase
E. 7 alpha hydroxylase activity


8. A study is conducted of nerve regeneration after injury in an experimental animal. A nerve guidance conduit is placed within a 4 mm gap of a severed nerve. The conduit, filled with a keratin gel extracted from human hair, is found to enhance visible nerve regeneration across the gap. Microscopic exam of the regeneration site after initial exposure to the keratin gel would most likely show mitotic activity in which of the following cells?

A. fibroblasts
B. macrophages
C. neurons
D. plasma cells
E. schwann cells
F. undifferentitated stem cells


9. During an experiment, an investigator compares the immune response of lymphocytes from 2 month old mice with that of 2 yr old mice. There is a decrease in responses to Chlamydophila pneumoniae in the older mice. An age related change in which of the following cell types is the most likely cause of this decreased immune response?

A. B lymphocytes
B. macrophages
C. neutrophils
D. plasma cells
E. T lymphocytes


10. A 54 yr old woman comes to the physician for a follow-up exam. Two months ago, she was diagnosed with hypertension, treatment with hydrochlorothiazide was begun at that time. Her bp today is 150/100 mmHg, compared with 165/108 mmHg 2 months ago. Her serum potassium conc is 3.2 mEq/L compared with 4.5 mEq/L 2 months ago. Addition of which of the following antihypertensive drugs to this pt's medication regimen is most likely further decrease bp and restore potassium conc toward the reference range?

A. atenolol
B. furosemide
C. losartan
D. nifedipine
E. prazosin


11. A researcher wants to evaluate the association btw asbestos exposure and mesothelioma. Which of the following is the most appropriate study design?
A. case-control
B. case series
C. ecologic
D. randomized clinical trial
 
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1. curling an 80 pound dumbbell would undoubtedly tear your biceps muscle (unless your The Rock or Phil Heath or some demi-god).. Biggest clue here is "when he attempted to lift the weight, he felt a popping sensation and pain in his right elbow. This straight up is a biceps tear. this is further supported by a) the swelling of the antecubital fossa and ecchymoses, this distribution is biceps tendon and b) inability to flex the elbow or supinate the forearm against resistance (these are functions of muscles supplied by musculocutaneous nerve). Hence C is the answer.

2. Weakness of bulbar muscles, eye symptoms, NO loss of sensation suggests pure motor involvement. likely myasthenia gravis since ptosis and dysphagia are earlier signs. this is supported by her age and sex (epidemiology is seriously important in ruling in or ruling out conditions). Neostigmine improves symptoms which is saying she was deficient in ACh, which screams MG. Now the receptors that are deficient are the post synaptic nicotinic ACh receptors, these are found on the plasma membrane of skeletal muscle (this may also be referred to as sarcolemma). D is the answer.

3. this gentleman has alcoholic cirrhosis. he has petechiae and easy bruising. so when I hear "petechiae", my knee jerk is thrombocytopenia. looking at his labs he indeed has low platelets. he also has anemia. for this particular q, i just rule out things that arent feasible. DIC should be ruled out because his aPTT is normal, fibrinogen is normal and should be low, split products are normal and should be high. iron def can be ruled out because his MCV is 100ish. also we havent been given any info about causes of bleeding like varices. b1 deficiency does not cause pancytopenia. Hypersplenism makes sense, because he has portal HTN which increases pressure in splenic veins (remember portal vein is formed by union of splenic and superior mesenteric veins). splenomegaly causes sequestration of rbcs, platelets) etc and fits the picture here. B is the answer.

5. Respiratory rate of 8 means respiratory depression. now normally pCO2 is main stimulator of ventilation, since her CO2 is elevated without an increase in ventilation, she has resp depression. minimal gag reflex tells us she has CNS depression, and opiod overdose fits the picture here, its a classic presentation.

6. smoking is a risk factor for squamous cell CA of larynx. larynx is important for sound production, so cancer here would present with hoarseness. pay attention to histology here, you can see the large blue irregular cells on the left, you can also see the intercellular bridges amongst them. I think the pink is keratin. on the right, i dont see any papillary morphology. this is SCC.


7. A 56 yr old man with alcoholism comes to the physician b/c of a 2 month hx of increasingly severe stomach pain and increased volumes of foul-smelling stool; he also has had a 9 kg weight loss during this period. He has a hx of multiple visits to the emergency dept b/c of severe abdominal pain. He has consumed one bottle of red wine daily for 5 yrs. His temp is 37C. Physical exam shows epigastric tenderness. His fasting serum glucose conc is 150 mg/dl. A CT scan of the abdomen shows pancreatic calcification. The most likely cause of this pt's current symptoms is a decrease in which of the following?

A. bile acid synthesis
B. colonic bacteria
C. duodenal pH
D. fecal elastase
E. 7 alpha hydroxylase activity

7. History of alcoholism, 9kg weight loss in 2 months is a red flag. foul smelling stool = steatorrhea. pancreatic calcifications are common in chronic pancreatitis. elevated fasting glucose and steatorrhea essentially says this is pancreatic insufficency. now lets rule out things which dont make sense. A and E mean the same thing since 7a hydroxylase is rate limiting enzyme for bile acid synthesis. B is stupid. between C and D, when ACID hits the duodenum and secretin is released by S cells of duodenum, bicarbonate is not being released by pancreas. consequently the duodenal pH drops which is a problem cause enzymes are denatured. now important digestive enzymes not working and we get malabsorption. Interestingly, fecal elastase has been implicated as a marker of pancreatic exocrine insufficiency, read up about this if your curious. answer is C.

10. Losartan is an Angiotensin Receptor Blocker. By inhibiting the Angiotensin pathway, we decrease aldosterone production, which conserves potassium. we also reduce BP since RAAS is inhibited. B is a diuretic which would waste potassium. oversimplification but cannot write anymore lol.

hope this helps.
 
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1. A 19 yr old man comes to the emergency dept b/c of increasingly severe shoulder and abdominal pain for 3 days. His temp is 39C. Physical exam shows signs of peritonitis. An abdominal x-ray is shown. Which of the following is the most likely cause of this pt's current condition?
upload_2016-1-2_4-30-21.png

A. ileus
B. intraperitoneal abscess
C. nephrolithiasis
D. perforated viscus
E. retained foreign body


2. An otherwise healthy 3 yr old boy is brought to the physician b/c of multiple abscesses in hair follicles on his arms. Culture of material from these lesions yields clumps of gram + cocci. Which of the following is the most likely anatomic site of long-term carriage for the causative organism?

A. lips
B. mouth
C. nares
D. scalp
E. urethra
 
1. there is air under the diaphragm on the right. this is classic perforated viscus, likely a perforated DU. perforation causes peritonitis. irritation of diaphragm causes referred pain to shoulder via phrenic nerve, this is called Kehrs sign.

2. multiple abscesses in hair follices, gram + cocci in clumps (clumps = clusters), is staph aureus. nasal carriage of S. aureus is very common, so C nares.
 
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1. there is air under the diaphragm on the right. this is classic perforated viscus, likely a perforated DU. perforation causes peritonitis. irritation of diaphragm causes referred pain to shoulder via phrenic nerve, this is called Kehrs sign.

2. multiple abscesses in hair follices, gram + cocci in clumps (clumps = clusters), is staph aureus. nasal carriage of S. aureus is very common, so C nares.
thank you so much for the explanation. I really do appreciate this. Here are my last questions. Any help is greatly appreciated. I also put the questions, I think I got the questions right, but weren't 100% sure about it.

1. A 30 yr old woman comes to the physician b/c of a 7 week hx of palpitations and shortness of breath with exertion. Her pulse is 116/min, and respiration are 25/min. Physical exam shows a non-palpable thyroid gland; there is no exopthalmos. Serum studies show:

TSH: 0.01 uU/ml
FT4: 2.6 (N=0.8-2.4)
123 I uptake: 1% at 24 hr (N=8%-30%)
Thyroglobulin: <0.5 (N=2-55)
Thyroglobulin antibodies: <0.5 IU/ml

A. exogenous use of levothyroxine
B. lymphocytic infiltration of the thyroid gland
C. mutation activation in the TSH receptor
D. stimulation by cytokines of B lymphocytes against thyroid antigens
E. tumor production of B-human chorionic gonadotropin


2. A 16 month old girl is brought to the physician b/c she has refused to move her Rt. arm since her older brother grabbed her Rt hand 1 hour ago to stop her from running into the street. On exam, she is holding the Rt. arm in pronation. Any motion of the Rt. elbow produces pain. There is no visible edema. Which of the following is the most likely explanation for these findings?

A. dislocation of the shoulder
B. fracture of the distal radius and ulna
C. salter-Harris type 1 fracture of the humerus
D. septic arthritis
E. subluxation of the radial head


3. A 17 yr old boy is brought to the emergency dept b/c of a 2 day hx of fever and shortness of breath. He underwent bone marrow transplantation for acute myelogenous leukemia 2 months ago. His temp is 39C, and respirations are 32/min. Diffuse crackles are heard over the lung fields on auscultation. A chest x-ray shows interstitial pneumonia. A photomicrograph of a biopsy specimen of the lung tissue is shown. Decreased function of which of the following most likely predisposed this patient to infection?
upload_2016-1-3_14-59-16.png


A. dendritic cells
B. eosinophils
C. mast cells
D. neutrophils
E. T lymphocytes


4. In a historical study, 4753 nulliparous women with confirmed pregnancies were randomized to either folic acid supplementation or trace element supplementation. In both the folic acid and trace element groups, 88% of the women had pregnancies ending in live birth, late fetal death, stillbirth, or termination of pregnancy after prenantal diagnosis of a defect. The following pregnancy outcomes were found:
upload_2016-1-3_15-11-37.png


Based on these data, using the trace element group as a control group, which of the following best represents how many nulliparous women with confirmed pregnancies would have to be treated with folic acid to prevent one congenital abnormality?

A. 0
B. 0.29
C. 1.3
D. 2.3
E. 80
F. 100
G. 120
H. 344
I. 4756


5. A 55 yr old man is admitted to the hospital b/c of a 2 day hx of vomiting and severe abdominal pain in the Rt. upper quadrant. He drinks six 12 ounce beers daily. Abdominal exam shows spider angiomata. The liver is hard and nodular on palpation. A CT scan of the abdomen is shown; the arrow indicates a mass.
Hypertension of which of the following is most likely in this pt?
upload_2016-1-3_15-29-29.png

A. hepatic
B. inferior phrenic
C. renal
D. short gastric
E. suprarenal


6. During an experiment, the insulin-stimulated transport of glucose into cultured myocytes is analyzed. The dependence of the rate of glucose uptake on the media glucose conc in the presence (dashed line) and absence (solid line) of insulin is measured. Which of the following graphs most closely resembles the expected results of this exp?
upload_2016-1-3_15-38-22.png



7. A 6 month old boy is diagnosed with a respiratory syncytial virus infection. Which of the following cell surface protein complexes is most likely involved in recognition and clearance of virus-infected cells in this pt?

A. Fas ligand
B. IL-2 receptor
C. MHC 1
D. TNF receptor


8. A 56 yr old man is brought to the emergency dept 45 min after being found in a semicomatose condition in a public restroom. His pulse is 96/min, respirations are 28/min and labored, and bp is 80/40 mm Hg. Physical exam shows cool, dry skin and partial obtundation. Lab studies show:
upload_2016-1-3_15-43-23.png

Which of the following best represents the renal compensatory response to the acid-base findings in this pt?
A. decreased H+ secretion into the tubule
B. decreased proximal tubule HCO3- reabsorption
C. decreased titratable acid excretion
D. increased HCO3- excretion
E. increased NH4Cl excretion


9. A study is conducted to assess the effectiveness of a registry for identifying pts 50 yrs old and older eligible for colon cancer screening. Medical practices are selected based on equal and proportional representation of both genders and socioeconomic and ethnic groups, including those who have medical insurance and those who do not. Half of the practices will use the registry for a 15 yr period and the other half will provide usual care w/o the registry during the same period. Results show that the colon cancer mortality rate decreased in the practices using the registry, and the researchers recommend use of a pt registry to decrease the number of deaths due to colon cancer. Which of the following study characteristics most directly supports the researchers' recommendation?

A. accuracy
B. external validity
C. face validity
D. precision
E. reliability
 
2. classic description of radial head subluxation which occurs commonly in this age group from pulling on arm. arm usually held in pronation. pretty weak in anatomy so cant say much more, other options can be ruled out based on basic knowledge of how those occur.

3. owels eye appearance of inclusion bodies can be seen in the image. transplant patients are immunosuppressed to prevent acute rejection usually with cyclosporine/tacrolimus etc, these inhibit IL-2 transcription which essentially inhibits T Cell activation/proliferation/activity. and we know T lymphocytes are big in battling intracellular organisms like viruses, so this guy has suppressed T lymphocyte activity predisposing him to CMV (hence the prevalence of CMV in transplant recipients)

4. basically asking for NNT. NNT = 1/ARR. so first gotta find ARR. ARR = Event Rate control - Event rate treatment. so they told us to use "trace elements" as control group. so 2.3-1.3 = 1%. ARR = 1%. NNT = 1/ARR = 1/0.01 = 100.

5. not 100% of my thinking is correct but i assumed he had cirrhosis and portal hypertension. so everything upstream from portal vein would be affected. since portal vein is formed by union of SMV and splenic vein then answer must be short gastric since it drains into splenic and pressure would backup into it.

6insulin responsivetissues are adipose tissue and skeletal muscleB correctly displays this relationship since dashed curve (in presence of insulin) displays increasing rate of uptake and solid curve (absence of insulin) displays zero uptake.

7. viral immunity is mediated via MHC 1/CD8+ T cells.

9. this kinda stuff, eliminate everything you can, safely that is. D and E mean same thing so eliminate. cant comment on accuracy since not given any supportive information in stem. Face validity is not something which can be used to make a recommendation. external validity however can be used by researchers to make recommendations. so this study conducted DID have a sample population which represented the people the study was meant to represent therefore the results CAN be generalized to the public. sorry if this isnt medically accurate wording.
 
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So my nbme12's score was 202. I got 25% of the questions wrong. A lot of the questions were like the ones I thought I got them right and was a surprise to me. I would really appreciate any help. I also put down my answers and my reasoning of choosing them.

1. 4. A 65 yr old woman with severe sensorineural hearing loss undergoes surgical placement of a cochlear implant. This neural prosthesis converts sound energy to electrical signals, which results in stimulation of which of the following structures?

A. auditory nerve endings in the cochlea
B. cochlear nerve as it enters the pons
C. inner hair cells of the cochlea
D. olivocochlear efferent axons that innervate outer hair cells
E. oval window of the cochlea

--> I chose C and got it wrong. Any idea?

2. A 20 yr old woman is brought to the emergency dept by her roommate 30 min after she ingested a large quantity of acetaminophen tablets during a suicide attempt. The physician asks her why she tried to kill herself. She replies tearfully, "My boyfriend told me that he doesn't want to see me again, and he won't return any of my phone calls. I loved him more than I've loved anyone else in my entire life. I was going to marry him! Now I hate his guts for what he's done to me. I just wanted to die." On further questioning, the physician learns that she had only two dates with this man. She tells the physician, "I just can't bear being alone. But I can tell that you understand. You're the only doctor who's ever understood how I fell." This pt most likely has which of the following types of personality disorders?

A. borderline
B. dependent
C. histrionic
D. narcissistic
E. obsessive compulsive
--> I chose B, and got it wrong. Any idea?


3. A 14 yr old boy is brought to the physician's office b/c of decreased appetite and abdominal pain over the past 3 weeks. His mother says that during the same time he has withdrawn from everyone and sleeps constantly. He describes his symptoms vaguely. Physical exam is normal. During further hx-taking, it is most critical for the physician to obtain which of the following?

A. developmental hx
B. family hx of affective disorders
C. orientation to time, place, and person
D. school hx
E. suicidal ideation or attempts

--> I chose A and got it wrong, so perhaps B? what are the important clues from the question stem?


4. A 67 yr old woman has transient ischemic attacks. She cannot tolerate aspirin. Which of the following drugs is an appropriate alternative cerebral infarction prophylaxis in this pt?

A. acetaminophen
B. clopidogrel
C. dipyridamole
D. ibuprofen
E. tissue plasminogen activator
--> I chose C dipyridamole thinking that this was the closest to aspirin since it blocks platelet aggregation just like aspirin, but I got it wrong. So I guess I had to choose another NSAID right? So D is the answer then?


5. A 48 yr old woman comes to the physician b/c of a 1 yr hx of progressive ringing in her Rt. ear. She also felt dizzy while exercising. Neurologic exam shows dysmetria of the Rt. upper and lower extremities. Muscle strength and somatosensory function testing of all extremities shows no abnormalities. Audiometry shows moderate hearing loss in the Rt. ear. An MRI of the brain is most likely to show a mass compressing which of the following labeled structures in the photograph of a cross section of the brain stem?

upload_2016-1-4_11-56-4.png


So the unilateral hearing loss and dysmetria indicate CN8 and cerebellum lesion so A is the answer right?


6. A 29 yr old man comes to the physician b/c of a 4 month hx of premature ejaculation. He states that about half of the time, he ejaculates prior to sexual intercourse, and the other half of the time, he ejaculates immediately on vaginal penetration. Physical exam shows no abnormalities. If pharmacotherapy is indicated, which of the following is the most appropriate?

A. atropine
B. cyproheptadine
C. paroxetine
D. sildenafil
E. trazodone
--> I chose D since I thought it is used for also premature ejaculation, but I got it wrong.
So perhaps the answer is cyproheptadine for SSRI this pt may be taking? I would damned if that's the answer! lol!


7. A 30 yr old woman comes to the physician b/c of a 7 week hx of palpitations and shortness of breath with exertion. Her pulse is 116/min, and respiration are 25/min. Physical exam shows a non-palpable thyroid gland; there is no exopthalmos. Serum studies show:

TSH: 0.01 uU/ml
FT4: 2.6 (N=0.8-2.4)
123 I uptake: 1% at 24 hr (N=8%-30%)
Thyroglobulin: <0.5 (N=2-55)
Thyroglobulin antibodies: <0.5 IU/ml

A. exogenous use of levothyroxine
B. lymphocytic infiltration of the thyroid gland
C. mutation activation in the TSH receptor
D. stimulation by cytokines of B lymphocytes against thyroid antigens
E. tumor production of B-human chorionic gonadotropin

--> I chose C and got it wrong. Since her FT4 is high, I was thinking hyperthyroidism, toxic multinodular goiter.


8. A 21 yr old man comes to the emergency dept in the winter b/c of headache, nausea, and dizziness for 4 hours. He has not had fever, chills, or shortness of breath. He has no hx of major medical illness. He lives in a basement apartment of a three story house; no one else in the house has similar symptoms. He smokes 2 packs of cigarettes daily. Physical exam shows no abnormalities. Which of the following pathophysiologic processes best explains this pt's symptoms?

A. acidosis causing shifting of the oxyhemoglobin dissociation curve to the Rt.
B. activation of nicotinic receptors in locus caeruleus
C. cerebral arteriolar constriction caused by increased carbon dioxide conc in the blood
D. competitive inhibition of oxyhemoglobin formation
E. inactivation of cytochrome oxygenase by cyanide
--> I chose C and got it wrong. Now I'm thinking perhaps CO poisoning so perhaps D is the answer?
 
So my nbme12's score was 202. I got 25% of the questions wrong. A lot of the questions were like the ones I thought I got them right and was a surprise to me. I would really appreciate any help. I also put down my answers and my reasoning of choosing them.

1. 4. A 65 yr old woman with severe sensorineural hearing loss undergoes surgical placement of a cochlear implant. This neural prosthesis converts sound energy to electrical signals, which results in stimulation of which of the following structures?

A. auditory nerve endings in the cochlea
B. cochlear nerve as it enters the pons
C. inner hair cells of the cochlea
D. olivocochlear efferent axons that innervate outer hair cells
E. oval window of the cochlea

--> I chose C and got it wrong. Any idea? Read up about this, I also missed this one. its how a cochlear implant works.

2. A 20 yr old woman is brought to the emergency dept by her roommate 30 min after she ingested a large quantity of acetaminophen tablets during a suicide attempt. The physician asks her why she tried to kill herself. She replies tearfully, "My boyfriend told me that he doesn't want to see me again, and he won't return any of my phone calls. I loved him more than I've loved anyone else in my entire life. I was going to marry him! Now I hate his guts for what he's done to me. I just wanted to die." On further questioning, the physician learns that she had only two dates with this man. She tells the physician, "I just can't bear being alone. But I can tell that you understand. You're the only doctor who's ever understood how I fell." This pt most likely has which of the following types of personality disorders?

A. borderline
B. dependent
C. histrionic
D. narcissistic
E. obsessive compulsive
--> I chose B, and got it wrong. Any idea? Suicidal female after having only gone out on TWO dates. this is a red flag for severe emotional instability/lability, and in terms of the group B aka "Bad to the Bone" personality disorders listed in FA 2015, this is classic BPD. in dependentPD, these people end up in abusive relationships but thats very different from actually inflicting self-abuse. also another clue in this vignette is the sentence I bolded (see above), you'll recognize splitting.


3. A 14 yr old boy is brought to the physician's office b/c of decreased appetite and abdominal pain over the past 3 weeks. His mother says that during the same time he has withdrawn from everyone and sleeps constantly. He describes his symptoms vaguely. Physical exam is normal. During further hx-taking, it is most critical for the physician to obtain which of the following?

A. developmental hx
B. family hx of affective disorders
C. orientation to time, place, and person
D. school hx
E. suicidal ideation or attempts

--> I chose A and got it wrong, so perhaps B? what are the important clues from the question stem? See the words I've bolded above. this boy has features of depression, and in every single patient in which depression is suspected, you must screen for suicidal ideations/attempts, it is the most critical action to take.


4. A 67 yr old woman has transient ischemic attacks. She cannot tolerate aspirin. Which of the following drugs is an appropriate alternative cerebral infarction prophylaxis in this pt?

A. acetaminophen
B. clopidogrel
C. dipyridamole
D. ibuprofen
E. tissue plasminogen activator
--> I chose C dipyridamole thinking that this was the closest to aspirin since it blocks platelet aggregation just like aspirin, but I got it wrong. So I guess I had to choose another NSAID right? So D is the answer then? If this lady is unable to tolerate aspirin, then she wouldn't tolerate any other NSAID, since MOA is all the same. Now we need to give something which blocks platelets since that is a basic management following any vascular event (TIA, CVA, etc). Acetaminophen works centrally and wouldnt have any effect on platelets. Ibuprofen is same thing as aspirin so she wont be able to tolerate it. TPA is not a drug used prophylactically. It is also CI with a history of a hemorrhagic stroke (this is just one CI, there are numerous others). Clopidogrel is an ADP receptor antagonist which prevents platelet activation and degranulation. Specifically, it inhibits P2Y12 subtype of ADP (somebody on this forum mentioned you need to know that, so know that).


5. A 48 yr old woman comes to the physician b/c of a 1 yr hx of progressive ringing in her Rt. ear. She also felt dizzy while exercising. Neurologic exam shows dysmetria of the Rt. upper and lower extremities. Muscle strength and somatosensory function testing of all extremities shows no abnormalities. Audiometry shows moderate hearing loss in the Rt. ear. An MRI of the brain is most likely to show a mass compressing which of the following labeled structures in the photograph of a cross section of the brain stem?

View attachment 199258

So the unilateral hearing loss and dysmetria indicate CN8 and cerebellum lesion so A is the answer right? Yes A is correct.


6. A 29 yr old man comes to the physician b/c of a 4 month hx of premature ejaculation. He states that about half of the time, he ejaculates prior to sexual intercourse, and the other half of the time, he ejaculates immediately on vaginal penetration. Physical exam shows no abnormalities. If pharmacotherapy is indicated, which of the following is the most appropriate?

A. atropine
B. cyproheptadine
C. paroxetine
D. sildenafil
E. trazodone
--> I chose D since I thought it is used for also premature ejaculation, but I got it wrong.
So perhaps the answer is cyproheptadine for SSRI this pt may be taking? I would damned if that's the answer! lol! Sildenafil is not given for premature ejaculation, it is used for erectile dysfunction. Cyproheptadine is an antagonist/ partial agonist depending on the receptor at many receptors, one of which is serotonin. it can be used if someone has OD on SSRIs. this is a classic question where you must know drug MOA and side effects, and exploit a certain side effect to possibly treat the patient. SSRIs are known to delay ejaculation, sometimes even cause anorgasmia but it is a reasonable approach for patients with premature ejaculation.


7. A 30 yr old woman comes to the physician b/c of a 7 week hx of palpitations and shortness of breath with exertion. Her pulse is 116/min, and respiration are 25/min. Physical exam shows a non-palpable thyroid gland; there is no exopthalmos. Serum studies show:

TSH: 0.01 uU/ml
FT4: 2.6 (N=0.8-2.4)
123 I uptake: 1% at 24 hr (N=8%-30%)
Thyroglobulin: <0.5 (N=2-55)
Thyroglobulin antibodies: <0.5 IU/ml

A. exogenous use of levothyroxine
B. lymphocytic infiltration of the thyroid gland
C. mutation activation in the TSH receptor
D. stimulation by cytokines of B lymphocytes against thyroid antigens
E. tumor production of B-human chorionic gonadotropin

--> I chose C and got it wrong. Since her FT4 is high, I was thinking hyperthyroidism, toxic multinodular goiter. She has a non-palpable thyroid gland, that would (at least for USMLE purposes) rule out any cause for a goiter, since by definition, a goiter is a swelling of the neck due to an enlarged thyroid gland. this question is tricky since she clearly has hyperthyroidism evidenced by symptoms and labs. Big clue here is the 123 I uptake which is low. this is seen in exogenous use of levothyroxine.


8. A 21 yr old man comes to the emergency dept in the winter b/c of headache, nausea, and dizziness for 4 hours. He has not had fever, chills, or shortness of breath. He has no hx of major medical illness. He lives in a basement apartment of a three story house; no one else in the house has similar symptoms. He smokes 2 packs of cigarettes daily. Physical exam shows no abnormalities. Which of the following pathophysiologic processes best explains this pt's symptoms?

A. acidosis causing shifting of the oxyhemoglobin dissociation curve to the Rt.
B. activation of nicotinic receptors in locus caeruleus
C. cerebral arteriolar constriction caused by increased carbon dioxide conc in the blood
D. competitive inhibition of oxyhemoglobin formation
E. inactivation of cytochrome oxygenase by cyanide
--> I chose C and got it wrong. Now I'm thinking perhaps CO poisoning so perhaps D is the answer?
first sign of carbon monoxide poisoning is a headache. living in a basement apartment suggests combustion of some sort going on there.
 
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Here are some biochem q I got wrong. Any help would be greatly appreciated.

1. In a study of mutations that reduce the activity of a cytoplasmic enzyme, a mutation is found that results in substitution of an alanine residue for the serine residue normally present at position 127 in the enzyme. This mutation is most likely to reduce the activity of the enzyme by preventing which of the following?

A. attachment of farnesyl groups
B. attachment of N-linked oligosaccharides
C. formation of disulfide bonds
D. phosphorylation of the enzyme
E. targeting of the enzyme to the correction cellular location


2. The sequence of the human beta globin gene, with the three exons in bold capital letters, is shown in the figure. The translation start codon ATG at position 154 to 156 and the translation stop codon TAA at position 1575-1577 are underlined. Which of the following mutations (circled) will most likely lead to beta-thalassemia?

upload_2016-1-4_20-54-29.png


A. C --> T at position 1
B. G --> A at position 246
C. G --> A at position 672
D. G --> A at position 2049


3. A healthy 20 yr old man comes to the physician with his wife for genetic counseling prior to conception. His sister died of cystinosis, an autosomal recessive disorder affecting cystine transport across lysosomal membranes. The incidence of this disorder in the general population is approximately 1/40,000. The wife's hx is noncontributory. The wife's risk for being a carrier of this disorder is closest to which of the following?

A. 1/2
B. 2/3
C. 1/50
D. 1/100
E. 1/200
--> Knowing that her sister was homozygous and she is healthy, I chose B (2/3) but got it wrong. So is it A (1/2)?
 
Last edited:
Here are some more questions I got wrong. Any help is greatly appreciated.

2. A 6 hr old female newborn has a harsh systolic murmur at the Lt. upper sternal border. Findings on physical exam are otherwise unremarkable. Three hours later, the murmur has a diastolic component. Twelve hours later, there is no murmur, and ultrasonography disloses no cardiac abnormalities. Which of the following is the most likely cause of the murmur?

A. mitral regurge
B. patent ductus arteriosus
C. persistent truncus arteriosus
D. transient tricuspid insufficiency
E. ventricular septal defect with Rt. to Lt. shunt
--> harsh systolic murmur at the Lt. upper sternal border made me think pulmonic stenosis and tetralogy of fallot. I really have no idea about then getting a diastolic component and then having no abnormalities after 12 hrs. Any idea?


3. A study is conducted of nerve regeneration after injury in an experimental animal. A nerve guidance conduit is placed within a 4 mm gap of a severed nerve. The conduit, filled with a keratin gel extracted from human hair, is found to enhance visible nerve regeneration across the gap. Microscopic exam of the regeneration site after initial exposure to the keratin gel would most likely show mitotic activity in which of the following cells?

A. fibroblasts
B. macrophages
C. neurons
D. plasma cells
E. schwann cells
F. undifferentiated stem cells


4. A 30 yr old woman whose child has Duchenne muscular dystrophy comes to the physician b/c of progressive muscle weakness during the past 3 yrs. A muscle biopsy specimen obtained from the woman shows findings typical of hemizygous muscular dystrophy. Which of the following is the most likely explanation for the findings in this pt?

A. chromosomal translocation
B. maternal chromosome constitution 45, X
C. nondisjunction
D. unfavorable lyonization


5. During an experiment, Staph aureus organisms are introduced into subcutaneous tissue and begin to proliferate. It is observed that segmented neutrophils marginate and roll onto the endothelium of venules in the region of the infection. Analysis of the endothelial cell surface shows upregulation of a molecule that promotes loose and transient attachment by the neutrophils. Which of the following is the most likely cause of these findings?

A. integrin
B. intercellular adhesion molecule-1
C. prostacyclin
D. selectin
E. thrombomodulin
--> I chose B and got it wrong. Any idea?
 
1. An investigator is studying a large family with many members who are affected by a disorder caused by a fully penetrant autosomal dominant inherited gene mutation. A pedigree is shown. Most affected members also have a rare allele at a locus thought to be closely linked to the dz locus. A father (individual III-3) and his daughter (individual IV-3) have the disorder, but they have the wild-type allele at the linked locus. Which of the following is the most likely cause of these findings?

A. insertion of a LINE sequence
B. random segregation
C. recombination
D. single nucleotide polymorphism
E. transduction
 

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1. An investigator is studying a large family with many members who are affected by a disorder caused by a fully penetrant autosomal dominant inherited gene mutation. A pedigree is shown. Most affected members also have a rare allele at a locus thought to be closely linked to the dz locus. A father (individual III-3) and his daughter (individual IV-3) have the disorder, but they have the wild-type allele at the linked locus. Which of the following is the most likely cause of these findings?

A. insertion of a LINE sequence
B. random segregation
C. recombination
D. single nucleotide polymorphism
E. transduction
Can anyone help me pls?
 
Can anyone help me pls?
It's recombination. The disease is normally linked to the rare allele, but through recombination, these two ended up with the wild type allele instead. It's like that formula for determining how close two genes are, the closer they are, they'll occur more frequently with a particular allele. If they're far apart, they won't be seen together with as high frequency because recombination mixes them up.
 
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Here are some biochem q I got wrong. Any help would be greatly appreciated.

1. In a study of mutations that reduce the activity of a cytoplasmic enzyme, a mutation is found that results in substitution of an alanine residue for the serine residue normally present at position 127 in the enzyme. This mutation is most likely to reduce the activity of the enzyme by preventing which of the following?

A. attachment of farnesyl groups
B. attachment of N-linked oligosaccharides
C. formation of disulfide bonds
D. phosphorylation of the enzyme
E. targeting of the enzyme to the correction cellular location


2. The sequence of the human beta globin gene, with the three exons in bold capital letters, is shown in the figure. The translation start codon ATG at position 154 to 156 and the translation stop codon TAA at position 1575-1577 are underlined. Which of the following mutations (circled) will most likely lead to beta-thalassemia?

View attachment 199272

A. C --> T at position 1
B. G --> A at position 246
C. G --> A at position 672
D. G --> A at position 2049


3. A healthy 20 yr old man comes to the physician with his wife for genetic counseling prior to conception. His sister died of cystinosis, an autosomal recessive disorder affecting cystine transport across lysosomal membranes. The incidence of this disorder in the general population is approximately 1/40,000. The wife's hx is noncontributory. The wife's risk for being a carrier of this disorder is closest to which of the following?

A. 1/2
B. 2/3
C. 1/50
D. 1/100
E. 1/200
--> Knowing that her sister was homozygous and she is healthy, I chose B (2/3) but got it wrong. So is it A (1/2)?
Can anyone help me with these q?
 
Can anyone help me with these q?
1) D. Without serine groups, serine-threonine kinases cannot phosphorylate the protein.
2) B. Donor (GT) splice site mutations can cause B thalassemia.
3) D. q^2 = 1/40,000. Square root of both sides yields an allele frequency of q = 1/200. The frequency of the heterozygote genotype is 2pq. 2 times q = 1/100

Hope this helps.
 
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1. A 41 yr old woman comes to the physician for a follow-up exam 6 weeks after the diagnosis of hypertension was made. Her bp today is 162/104. A Rt. bruit is heard. Physical exam shows no other abnormalities. Serum studies show:

Na+: 135
K+: 3.2
Cl-: 105
HCO3-: 28
Urea nitrogen: 9
Creatinine: 0.9

On renal arteriography, sampling shows a Lt. renal vein renin activity of 5 uU/mL (N=5-97) and Rt. vein renin activity of 176 (N=5-97). The systemic hypertension in this pt is directly mediated by a vasoconstrictor that emerges from which of the following?

A. adrenal medullary chromaffin cells
B. glomerular afferent arteriole
C. glomerular efferent arteriole
D. pulmonary vasculature
E. renal juxtaglomerular cells
--> I chose E and got it wrong, so is it B then?


2. A 2495 g female newborn is delivered at term to a 30 yr old woman who had no prenatal care. Physical exam of the newborn shows jaundice, nasal flaring, and grunting. Lab studies show marked anemia and hyperbilirubinemia. Further testing shows that the newborn is blood group O, Rh-positive, and the mother is blood group O, Rh-negative. Which of the following most likely mediated the transplacental transfer of the maternal factor causing this newborn's symptoms?

A. C3b receptor
B. Fc receptor
C. interleukin-2 receptor
D. alpha/beta T lymphocyte receptor
E. transferrin receptor

I chose C thinking that that may worsen the inflammatory rxn to the baby, but now I am thinking the answer might have been A, any thought?

So why not C?
 
1) D. Without serine groups, serine-threonine kinases cannot phosphorylate the protein.
2) B. Donor (GT) splice site mutations can cause B thalassemia.
3) D. q^2 = 1/40,000. Square root of both sides yields an allele frequency of q = 1/200. The frequency of the heterozygote genotype is 2pq. 2 times q = 1/100

Hope this helps.
So for the 2nd q,
1. how did you know that B is the splice site?
2. also it could be due to a mutation in promoter region right? so why not like A, which is the one I chose.
 
So for the 2nd q,
1. how did you know that B is the splice site?
2. also it could be due to a mutation in promoter region right? so why not like A, which is the one I chose.
Donor splice sites have GT/GU sequences, acceptor splice sites have AG sequences.
 
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1. A 38 yr old man comes to the physician b/c his wife has been unable to conceive for 3 yrs. Previous evaluation of his wife showed no abnormalities. He is 188 cm tall and weighs 86 kg. BMI is 24. Physical exam shows small testes. Semen analysis shows no sperm. Which of the following genetic studies is most likely to establish the diagnosis?

A. chromosomal analysis of lymphocytes
B. cystic fibrosis mutation analysis
C. DNA for trinucleotide expansion in FRAX gene
D. fluorescent in situ hybridization subtelomeres
E. sequence SRY gene
--> This is definitely Klienfelter and I chose D and got it wrong. So what is the answer?


2. A previously healthy 7 yr old girl is brought to the physician by her parents b/c of a 1 month hx of excessive urination. She also had a 2.3 kg weight loss during this period. Her pulse is 110, and bp is 92/58. Physical exam shows poor skin turgor and a fruity odor to her breath. Her blood glucose conc is 612 mg/dl. Which of the following is most likely to be decreased in this pt?

A. arterial PCO2
B. arterial PO2
C. serum acetone conc
D. serum potassium conc
E. serum triglyceride conc
G. serum urea nitrogen conc
--> I thought this was DKA and chose E since there will be significant break down of TG into free FA, but I got it wrong. So why isn't E the answer? So is it A due to the Kussmal resp???
 
1. A 38 yr old man comes to the physician b/c his wife has been unable to conceive for 3 yrs. Previous evaluation of his wife showed no abnormalities. He is 188 cm tall and weighs 86 kg. BMI is 24. Physical exam shows small testes. Semen analysis shows no sperm. Which of the following genetic studies is most likely to establish the diagnosis?

A. chromosomal analysis of lymphocytes
B. cystic fibrosis mutation analysis
C. DNA for trinucleotide expansion in FRAX gene
D. fluorescent in situ hybridization subtelomeres
E. sequence SRY gene
--> This is definitely Klienfelter and I chose D and got it wrong. So what is the answer?


2. A previously healthy 7 yr old girl is brought to the physician by her parents b/c of a 1 month hx of excessive urination. She also had a 2.3 kg weight loss during this period. Her pulse is 110, and bp is 92/58. Physical exam shows poor skin turgor and a fruity odor to her breath. Her blood glucose conc is 612 mg/dl. Which of the following is most likely to be decreased in this pt?

A. arterial PCO2
B. arterial PO2
C. serum acetone conc
D. serum potassium conc
E. serum triglyceride conc
G. serum urea nitrogen conc
--> I thought this was DKA and chose E since there will be significant break down of TG into free FA, but I got it wrong. So why isn't E the answer? So is it A due to the Kussmal resp???
1) A. Klinefelter. Looking for Barr body (XXY)
2) A. Compensated increased AG metabolic acidosis (Kussmaul breathing).
 
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Here are some more questions I got wrong. Any help is greatly appreciated.

2. A 6 hr old female newborn has a harsh systolic murmur at the Lt. upper sternal border. Findings on physical exam are otherwise unremarkable. Three hours later, the murmur has a diastolic component. Twelve hours later, there is no murmur, and ultrasonography disloses no cardiac abnormalities. Which of the following is the most likely cause of the murmur?

A. mitral regurge
B. patent ductus arteriosus
C. persistent truncus arteriosus
D. transient tricuspid insufficiency
E. ventricular septal defect with Rt. to Lt. shunt
--> harsh systolic murmur at the Lt. upper sternal border made me think pulmonic stenosis and tetralogy of fallot. I really have no idea about then getting a diastolic component and then having no abnormalities after 12 hrs. Any idea?


3. A study is conducted of nerve regeneration after injury in an experimental animal. A nerve guidance conduit is placed within a 4 mm gap of a severed nerve. The conduit, filled with a keratin gel extracted from human hair, is found to enhance visible nerve regeneration across the gap. Microscopic exam of the regeneration site after initial exposure to the keratin gel would most likely show mitotic activity in which of the following cells?

A. fibroblasts
B. macrophages
C. neurons
D. plasma cells
E. schwann cells
F. undifferentiated stem cells


4. A 30 yr old woman whose child has Duchenne muscular dystrophy comes to the physician b/c of progressive muscle weakness during the past 3 yrs. A muscle biopsy specimen obtained from the woman shows findings typical of hemizygous muscular dystrophy. Which of the following is the most likely explanation for the findings in this pt?

A. chromosomal translocation
B. maternal chromosome constitution 45, X
C. nondisjunction
D. unfavorable lyonization


5. During an experiment, Staph aureus organisms are introduced into subcutaneous tissue and begin to proliferate. It is observed that segmented neutrophils marginate and roll onto the endothelium of venules in the region of the infection. Analysis of the endothelial cell surface shows upregulation of a molecule that promotes loose and transient attachment by the neutrophils. Which of the following is the most likely cause of these findings?

A. integrin
B. intercellular adhesion molecule-1
C. prostacyclin
D. selectin
E. thrombomodulin
--> I chose B and got it wrong. Any idea?
Can anyone help me with these 5 q? Many thanks in advance.
 
5. Respiratory rate of 8 means respiratory depression. now normally pCO2 is main stimulator of ventilation, since her CO2 is elevated without an increase in ventilation, she has resp depression. minimal gag reflex tells us she has CNS depression, and opiod overdose fits the picture here, its a classic presentation.

So why is there a fever? Is it common with opioid overdose? The fever led me to choose the infection and I got that wrong.
 
So why is there a fever? Is it common with opioid overdose? The fever led me to choose the infection and I got that wrong.

fever is incredibly nonspecific. alot of things can cause fever. remember never fixate on one thing, always look at the entire picture and use your best judgement. i would think in this vignette due to the respiratory depression, the fever is a mechanism to help right shift the dissociation curve and enhance delivery of oxygen to tissues (however limited it may be).
 
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Hi all,

I redid nbme 12 questions and did lot better this time, but still ended up with some questions wrong and I am having difficult time figuring out the answers. I would really appreciate any feedback. Many thanks in advance.

1. 16 yr old girl with type 1 diabetes mellitus is brought to the physician b/c of a 10 kg weight loss during the past 6 months. The pt reports that she is feeling fine, and she does not think that anything is wrong. She says that she is happy to have lost the weight, and she would like to lose more weight. She says that her diabetes has been in good control, and she is not aware of any insulin reactions. She is 165 cm tall and now weighs 46 kg. BMI is 17. Physical exam shows no other abnormalities. Lab studies show a hemoglobin A1c of 8.4%. 6 months ago, it was 5.8%. Which of the following pt behaviors most likely led to her weight loss?

A. decreasing the amount of self-administered insulin dose
B. overuse of laxatives
C. restricting calorie consumption
D. self-induced vomiting after meals
E. starting an intense aerobic exercise program
--> I chose C. I did not see any clues for anorexia nor bulemia. So is it A then? But her A1c got better right?

2. A healthy 20 yr old man comes to the physician with his wife for genetic counseling prior to conception. His sister died of cystinosis, and autosomal recessive disorder affecting cystine transport across lysosomal membranes. The incidence of this disorder in the general population is approximately 1/40,000. The wife's hx is noncontributory. The wife's risk for being a carrier of this disorder is closest to which of the following?

A. 1/2
B. 2/3
C. 1/50
D. 1/100
E. 1/200
--> I chose B and got it wrong. I really thought this was the answer... dang...

3. Respiratory surveillance programs worldwide show doubling of the number of influenza-like illness compared with the yearly average for the preceding 5 yrs, with an accompanying increase in mortality. Characterization of roughly 60 influenza isolates from various geographic locations indicates that they are all similar to one another, and that they differ from isolates recovered in previous years. Compared with isolates from previous years, genetic alteration of the current isolates was most likely caused by which of the following?

A. point mutations involving genes encoding hemagglutinin
B. point mutations involving genes encoding the matrix protein
C. point mutations involving genes encoding the ribonucleoprotein
D. reassortment involving genes encoding hemagglutinin
E. reassortment involving genes encoding the matrix protein
F. reassortment involving genes encoding the ribonucleoprotein
--> Isn't this an example of genetic/antigenic drift? So I chose A... and got it wrong. Any idea?

4. A 55 yr old man is admitted to the hospital b/c of a 2 day hx of vomiting and severe abdominal pain in the Rt. upper quadrant. He drinks six 12-ounce beers daily. Abdominal exam shows spider angiomata. The liver is hard and nodular on palpation. A CT scan of the abdomen is shown; the arrow indicates a mass. Hypertension of which of the following veins is most likely in this pt?
upload_2016-2-9_5-10-52.png


A. hepatic
B. inferior phrenic
C. renal
D. short gastric
E. suprarenal
--> so this is portal HTN, so is D the answer? I was looking for a Lt. gastric vein... are they the same?


5. A 24 yr old man comes to the physician b/c of a 1 month hx of recurrent episodes of headaches, palpitations, sweating, and restlessness. He says that these episodes last for 15 min and then subside. He appears anxious. His bp is 140/100. Physical exam shows a soft abdomen with no masses. A CT scan of the abdomen shows a large suprarenal mass on the Rt. side. The tissue involved in this pt's condition most likely arose from which of the following embryologic process?

A. ectodermal outpouching
B. ecotermal retention
C. endodermal invagination
D. mesodermal clustering
E. neural crest migration
--> So this is pheochromocytoma and I went for B and got it wrong. So is the answer A? Can anyone confirm pls?


6. A 2,495 g female newborn is delivered at term to a 30 yr old woman who had no prenatal care. Physical exam of the newborn shows jaundice, nasal flaring, and grunting. Lab studies show marked anemia and hyperbilirubinemia. Further testing shows that the newborn is blood group O, Rh-positive, and the mother is blood group O, Rh-negative. Which of the following most likely mediated the transplacental transfer of the maternal factor causing this newborn's symptoms?

A. C3b receptor
B. Fc receptor
C. IL-2 receptor
D. alpha/beta T-lymphocyte receptor
E. transferrin receptor
--> So is B the answer? then how can Fc receptor be transplacental??? Isn't the IgG from Mom attacking the baby's RBC???


7. A previously healthy 73 yr old man with benign prostatic hyperplasia comes to the physician b/c of a 2 day hx of pain with urination and a 12 hr hx of fever and chills. His temp is 38.3 C. Physical exam shows moderate tenderness of the Lt. flank. Urinalysis shows 50 to 100 WBC/hpf. Culture of urine grows 100,000 colonies/ml of a gram positive organism. Which of the following is the most likely causal organism?

A. Enterococcus faecalis
B. Escherichia coli
C. Shigella dysenteriae
D. Staph aureus
E. Strep pyogenes
--> So I think I fell into the trap of choosing D since I thought it was gram positive. So the answer is A, right?? Most common cause of UTI is E. coli and gram positive was a distractor of being a contaminant right?


8. A previously healthy 75 yr old man is brought to the emergency dept by his wife b/c of a 12 hr hx of confusion. Medical hx is otherwise unremarkable. He is stuporous. Physical exam shows a markedly distended bladder up to the umbilicus. The prostate gland is moderately and symmetrically enlarged w/o nodules. Lab evaluation shows a serum creatinine conc. of 10.5 mg/dL and a serum urea nitrogen (BUN) conc of 130 mg/dL. Urinalysis shows no abnormalities. Which of the following is the most likely diagnosis?

A. benign prostatic hyperplasia
B. bladder malignanacy
C. neurogenic bladder
D. renal cell carcinoma
E. urolithiasis
--> So I thought this was postrenal azotemia with inc. BUN and chose E and got it wrong. So is it simply just BPH, A???


9. A 19 yr old man comes to the emergency dept b/c of increasingly severe shoulder and abdominal pain for 3 days. His temp is 39C. Physical exam shows signs of acute peritonitis. An abdominal x-ray is shown. Which of the following is the most likely cause of this pt's current condition?
upload_2016-2-9_6-9-58.png


A. ileus
B. intraperitoneal abscess
C. nephrolithiasis
D. perforated viscus
E. retained foreign body
 
hey dude if you scroll above you'll see that i previously answered some of the questions that you have reposted.
 
Hey guys I'm terrible at pharm and I think this question shows it since it didn't seem like it's been asked yet lol
It's the graph that shows the mean steady steak plasma concentrations of drug x as a function of time in someone who is normal weight and someone who is obese. Both subjects take 10mg daily. So the. It says describe the disposition of drug x in the obese patient compared with the patient who has normal weight. I don't have a pic but the obese curve reaches the same y axis point but does so more gradually (slope isn't as steep). Answers: greater volume of distribution, higher clearance, lower bioavailability, slower absorption (that's what I put), shorter half life. Looking back there isn't really any mechanism for slower absorption or anything and now I would probably out greater volume of distribution because I remember that has something to do with the drug being deposited in fat...thoughts?


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Hey guys I'm terrible at pharm and I think this question shows it since it didn't seem like it's been asked yet lol
It's the graph that shows the mean steady steak plasma concentrations of drug x as a function of time in someone who is normal weight and someone who is obese. Both subjects take 10mg daily. So the. It says describe the disposition of drug x in the obese patient compared with the patient who has normal weight. I don't have a pic but the obese curve reaches the same y axis point but does so more gradually (slope isn't as steep). Answers: greater volume of distribution, higher clearance, lower bioavailability, slower absorption (that's what I put), shorter half life. Looking back there isn't really any mechanism for slower absorption or anything and now I would probably out greater volume of distribution because I remember that has something to do with the drug being deposited in fat...thoughts?
I got this question wrong, but figured it out. This is a concept of fat soluble vs. water soluble drugs. Let's define the two different axis first. Your x axis is time, your y axis is plasma. Plasma is mostly composed of water, so your in a water soluble environment.

Great. Now we have two graphs, a normal patient who's curve goes upwards and at hits the y axis in a faster time period. Then we have an obese patient who's graph is linear. It takes longer to hit the same spot on the y axis. This makes sense, because the obese patient carries more fat. Fat does not mix with water, so it's going to take longer to reach same point in the plasma.

So the answer is volume of distribution, let's talk about normal first. The normal VOD is 41 L and is composed of plasma volume (3-5L) + interstitial volume (14-16L) + cellular volume (remainder). Volume of distribution is how much of the drug is present in all three of these components. So if a patient is obese, most of the drug will be in the cellular volume (fat area), then in the interstitial volume, and a portion will be in the plasma volume. He will have a higher VOD than a normal patient, but less in the plasma component.

The matching Uworld question is Q1710, and they just flipped it, asking about a patient having a drug with a VOD of 4.5L (which is low) and asking what properties does it have? The first 3-5L is in the plasma. Plasma is water soluble or highly charged (which is the answer). The explanation has the all the VOD info I provided above.
 
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anybody know this one?
35yo woman with shortness of breath after undergoing oophorectomy. Has a large embolus in the pulmonary artery. Which of the following hemodynamic changes would you expect after lysis of the clot?

Decreased LV pressure
Decreased PV pressure
Decreased RV pressure
Increased LA pressure
Increased PA pressure
Increased RA pressure
 
one more..:
A 20 year old man comes to physician with his wife for genetic counseling. His sister died of cystinosis, an autosomal recessive disease affecitng cystine transport. The incidence of the disorder is 1/40,000. The wife's history is noncontributory. What is the wife's risk for being a carrier of this disorder?
A) 1/2
B) 2/3
C) 1/50
D) 1/100
E) 1/200
 
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