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4 a 14 years old brougt to physian because mostly sleeping withdrawn and complaining of abdomen pain 3 weeks , what history will u take first...should we recretion drug history....options school history , devlopmental, family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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3 (12.3.2). sounds like chronic pancreatitis, which would both lower duodenal ph and fecal elastase... does someone know the actual answer?

1. Pt has duchenne's muscular dystrophy. Think pain, weakness, esp central weakness (gluteal), you want to check CK.

2. Opiod, no respiratory effort will cause distant breath sounds.

3. decreased pH, no bicarb production by pancreas

4. decreased RV pressure. Reduction in pulmonary resistance will decrease RV pressure. (overload of RV is why people die suddenly in PE so this is an important point)

5. This is definitely chlamydia. When did you go to med school? its been known since the 80s that silver nitrate doesn't work very well for preventing chlamydia opthalmia.
 
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Test is tomorrow (PLEASEEEE help me!)...this is the only one I really can't answer. Does anyone know what the answer is?

51 yo woman with symmetric enlargement of thyroid gland for past 5 mths and hypothyroidism symptoms. Low T4 (1.8). Which of the following serum findings are most likely?
a. Dec TSH b. Dec TRH c. Inc TBG d. Presence of antithyroid peroxidase antibodies e. Presence of thyroid stimulating antibodies

I can narrow it down to C (high estrogen stimulating TBG, but that's usually euthyroid) or D (hasimoto's).
 
Test is tomorrow (PLEASEEEE help me!)...this is the only one I really can't answer. Does anyone know what the answer is?

51 yo woman with symmetric enlargement of thyroid gland for past 5 mths and hypothyroidism symptoms. Low T4 (1.8). Which of the following serum findings are most likely?
a. Dec TSH b. Dec TRH c. Inc TBG d. Presence of antithyroid peroxidase antibodies e. Presence of thyroid stimulating antibodies

I can narrow it down to C (high estrogen stimulating TBG, but that's usually euthyroid) or D (hasimoto's).

She's euthyroid with a high total T4 - that means the estrogen she's taking for her osteoporosis is causing increased TBG synthesis (higher total T4, normal unbound T4)


Does anyone remember the question about the girl having lateral neck surgery, who ends up with horner syndrome? They asked what had been damaged to cause it, and I can't figure out how one of the answers is incorrect:

The correct answer was "postsynaptic neurons from the superior cervical ganglion." Sure, that'll cause it (though I wonder what sort of neck surgery she's having done all the way up at the level of C1...)
Another answer that was supposedly incorrect was "presynaptic neurons from the stellate ganglion"

The stellate ganglion is the fusion of the inferior cervical ganglion and the first thoracic ganglion. The sympathetic fibers exiting the spinal cord must travel through the stellate ganglion before synapsing in the superior cervical ganglion, so as I understand it, damaging "presynaptic neurons from the stellate ganglion" would absolutely cause horner syndrome. Why then is that an incorrect answer?
 
did anybody do poorly on this exam compared to other NBMEs?

6: 240, 7: 242, 11: 254

12: 235?? why did my score drop so much from the last?

also, can anybody explain the hardy weinburg equation question? i thought i knew how to do this one but i guess not.. somebody mentioned a hardy weinburg allele table??

Thanks!

I got nearly the exact same pattern as you. got a 240 on 7 and a 235 on 12 a week later after studying my ***** off. I wouldn't worry about it too much. I took UWSA 2 a few days after 12 and got a 259...so I think NBME 12 is definitely the anomaly.
 
I got nearly the exact same pattern as you. got a 240 on 7 and a 235 on 12 a week later after studying my ***** off. I wouldn't worry about it too much. I took UWSA 2 a few days after 12 and got a 259...so I think NBME 12 is definitely the anomaly.

Took nbme 12 today after studying for about 4-5 days since NBME 11 , went from a 650/254 --> 590/242. To be honest i don't feel like i know any more or any less, just felt the physio was a bit trickier on this one, curve seems pretty rough on these tests. There weren't any 'super hard' questions, just a lot of 'moderately' difficult ones, in my opinion...in any case, taking nbme 7 in a few days so we'll see how i stack up on that.
 
-the thyroid one is anti peroxidase. i took extended feedback and did not get it marked wrong. she does seem hypothyroid with low T4.(if i remember right, the question mentions low T4. unless they specifically say free T4, I take that as total T4 and thus C is ruled out).

- low duodenal ph is the right answer. No secretion from pancreas which is fried from the alcohol.

- one question i have:

the graph where they ask u to calculate prevalence for some disease on December 31st.

Is that answer not 3? i got it marked wrong. There is a ditto graph pattern in Kaplan Beh Science which I saw and followed the same pattern. The reasoning being the lines that dont reach upto the point of calculation are dead.

4 lines reach upto Dec 31st and one of those lines does not have a start point for disease, meaning he/she is not affected.?????
 
-the thyroid one is anti peroxidase. i took extended feedback and did not get it marked wrong. she does seem hypothyroid with low T4.(if i remember right, the question mentions low T4. unless they specifically say free T4, I take that as total T4 and thus C is ruled out).

- low duodenal ph is the right answer. No secretion from pancreas which is fried from the alcohol.

- one question i have:

the graph where they ask u to calculate prevalence for some disease on December 31st.

Is that answer not 3? i got it marked wrong. There is a ditto graph pattern in Kaplan Beh Science which I saw and followed the same pattern. The reasoning being the lines that dont reach upto the point of calculation are dead.

4 lines reach upto Dec 31st and one of those lines does not have a start point for disease, meaning he/she is not affected.?????

I think the 4th line that "didn't" have a start point actually did have a start point but it just wasn't in the time interval of the graph. I still included it and put 4 and got it right.
 
unfortunately... i was confused and thought that the $60 for extended review was $60 EXTRA to get the answers and i did not purchase the extended review!

can you guys give me any idea of what percent correct a score in the 230s is? thanks!
 
unfortunately... i was confused and thought that the $60 for extended review was $60 EXTRA to get the answers and i did not purchase the extended review!

can you guys give me any idea of what percent correct a score in the 230s is? thanks!

i got 233 and missed 30?s so 85%
 
Might be F. There is something called acne mechanica, involves repetitive skin abrasion and sweat and sebum trapping under a helmet on a hot day. As we all know, it is the sebum and anaerobic conditions that allows Propionibacterium acnes to flourish.

Above chocolate: I did read the most recent research about how chocolate can make acne worse. However, the First Aid Internal medicine book that I use made it very clear that "DIET HAS NO CORRELATION TO ACNE"


Moreover, the NBME may take a while before it incorporates new research into their questions

Edit: I am not trying to be a jerk saying this: Although I was initially floored by this question because it wasn't explicitly in any review book, upon careful thinking of the pathophysiology of acne, this question became readily apparent.

Yeah, I read some stuff about how glycemic index may be tied to acne. And this is TOTALLY true, at least for me. It annoys me when the dogma (that we're tested on, no less) is not reflective of the research. Ah well.

Takes docs years to change from the dogma they've learned too.
 
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20 y/o female who ingested a ton of acetaminophen after her boyfriend broke up with her (she had only been on 2 dates with him). She said “I loved him more than anything in my life. I was going to marry him. Now I hate his guts.” She tells the physician “You’re the only one who has understood how I feel.” What’s the personality disorder?

Answer choices: borderline, dependent, histrionic, narcissistic, obsessive-compulsive

This Q was posted in the prev page and someone said the ans is borderline. Why is it not histrionic?

Histrionic think sexually provocative, attention-seeking & dramatic. Also, think vain/pre-occupied with appearance.

This case is classic borderline-- unstable relationship, esp the bit about I'm so in love with him, followed by finding out she was only on 2 dates with him. Also the suicide attempt itself suggests borderline rather than histrionic.

Another clue is that she tells the physician "you're the only one who understands"; she is engaging in splitting- classic defense mech borderline pts do (i.e. the good cop, bad cop routine, sees things black/white)
 
-- Q where glycosylation of proteins designed to be exported from a hepatocyte occurs. Diagram shows "rER & mitochondria".

Can someone explain what the diagram is pointing at? I know that N-glycosylation occurs in rER, but for some reason I'm not understanding this picture.

-- Alcoholic 56 yo guy w/ 2-mo hx abdominal pain; foul-smelling stool + epigastric tenderness + glucose 150 + pancreatic calcifications

Cause of current sxs is a decrease in ? Is this gallstone induced pancreatitis?

-- guy w/ 4-hr headache, dizziness nausea; lives in basement; smoker; is it competitive inhibition of O2 binding Hb?

-- 30 yo woman w/ non-palpable thyroid + palpitations/dyspnea on exertion + tachycardic & (+) respir rate;

(-) TSH, slightly (+) free T4 (2.6, nl is 0.8-2.4), (-) 123-I uptake, (-) thyroglobulin

Is she taking exogenous T4, so that's why 123-I uptake is low-- not actually making hormone?

What does the thyroglobulin tell us?

-- Dexamthasone given to promote synth of surfactant in fetal lung; binds what to promote differentiation of surfactant making cell ?

I was looking for cytosolic R, but the only thing there was nuclear R. I thought only thyroid hormones had nuclear Rs?
 
75 year old man, stuporous, with a markedly distended bladder up to the umbilicus. prostate gland is moderately enlarged without nodules. creatinine and BUN is high, urinalysis is normal.
BPH
bladder malignancy
neurogenic bladder
renal cell CA
urolithiasis

is it neurogenic bladder? related to his stupor?
 
75 year old man, stuporous, with a markedly distended bladder up to the umbilicus. prostate gland is moderately enlarged without nodules. creatinine and BUN is high, urinalysis is normal.
BPH
bladder malignancy
neurogenic bladder
renal cell CA
urolithiasis

is it neurogenic bladder? related to his stupor?

I believe it's BPH, causing obstruction & post-renal azotemia.
 
-- Q where glycosylation of proteins designed to be exported from a hepatocyte occurs. Diagram shows "rER & mitochondria".

Can someone explain what the diagram is pointing at? I know that N-glycosylation occurs in rER, but for some reason I'm not understanding this picture.
the rough ER is only partially shown, i believe it's the arrow pointing to the inside of the rER

-- Alcoholic 56 yo guy w/ 2-mo hx abdominal pain; foul-smelling stool + epigastric tenderness + glucose 150 + pancreatic calcifications

Cause of current sxs is a decrease in ? Is this gallstone induced pancreatitis?
someone earlier said a decrease in the pH of the duodenum

-- guy w/ 4-hr headache, dizziness nausea; lives in basement; smoker; is it competitive inhibition of O2 binding Hb?
yes, living in basement in winter, using space heater = CO

-- 30 yo woman w/ non-palpable thyroid + palpitations/dyspnea on exertion + tachycardic & (+) respir rate;

(-) TSH, slightly (+) free T4 (2.6, nl is 0.8-2.4), (-) 123-I uptake, (-) thyroglobulin

Is she taking exogenous T4, so that's why 123-I uptake is low-- not actually making hormone?

yup, exogenous T4

What does the thyroglobulin tell us?

-- Dexamthasone given to promote synth of surfactant in fetal lung; binds what to promote differentiation of surfactant making cell ?

I was looking for cytosolic R, but the only thing there was nuclear R. I thought only thyroid hormones had nuclear Rs?

don't remember choices for the last one
 
- Shouldn't it be dependent personality disorder? since she states that she cant live alone. Her splitting is not to the extent of comparison that "You are better than the other doctor", She seems like shes again displaying dependence on the doctor? And the cause of her suicide is dependence too..?

- Cadherin, that question is wierd.Cadherin is cell to cell- and they are asking for basement membrane.Either I read the question wrong or ?
 
Hi guys- I have read the posts in regards to the B-Thalassemia question, however, I still don't understand how to figure out the answer? Any inputs would be helpful!

Also, there is a question about a 16 year old with diabetes who lost weight and her Hemoglobin A1C is higher than it was 6 months prior. So which would be a reason for her weight loss?
Choices were decreasing the amount of self administered insulin doses, overuse of laxatives, restricting calories, self-induced vomiting after meals, or intense exercise.

Any advice on how to improve your score with 3.5 weeks to go? I got a 205 on this NBME :( I've done all of Uworld and am going through them again now, I'm currently doing a block of Kaplan questions a day as well as USMLERx in addition to going through each organ system with Rapid Review and other quick review books. I'd appreciate any advice :)
 
The dexamethasone question in pt with hyaline memb dz really pisses me off... How can the correct answer be nuclear "receptor" ?? And on top of that there was no option with cytosolic receptor. So, I chose multilamellar body which, retrospectively seems to be a dumb choice.
 
sadly enough i took this a wk ago and this wasnt in my wrongs. i think my brain is fried from cramming FA. anyway she is anemic so we should have decreased O2 carrying capacity...i think.

Guys, for the vomiting girl, answer is decreased P50. ODC shifts to the left which means at 50% Hb saturation corresponding arterial P02 would be low (which is definition of P50). FA 2011 pg 506
 
1).14 yr old bot with decreased appetit and abdo pain for past 3 weeks. he is also withdrawn and from everyone and sleeps constantly. P.E. is normal. what further hist shud b asked??
ANS- devolpmntal hist, family hist of affective disorder, orinetation to TPP( i choose this, but its wrong), school hist, suicidal ideation or attempts

2). physician enters the room of a 79 yr old and smells urine, how shud he approach bst towards urinary incontinence??
ANS- Are u having prob that u may b too ashamed to talk abt?(this is wrong),
i culdnt help bt i noticed an odor when i came into the room.r u havindifficulty holdin urine ,
i undrstnd dis can b difficlt to talk abt bt do u hav fecal /urinary incontince
i kno dis cn b embarassin bt people somtimes hav difficlty holdin urine as they gt older so is dis ever a prob 4 u?
its nt surprisin dat som1 of ur age is havin probs wid urinary incontince hw many accidnts do u hav a day?

3).can som1 pls explain d mutation in beta thal. the que with all diff codons and we wer supposed to identify the mutation...all those alphabets made me crazy:eek:
 
1).Pt has a PE post vaginal hysterectomy, wat r the hemodynamic findings
ANS- dec LV pressure, dec pulm venous pressure, dec RV pressure, inc LA pressure, inc pulm art pressure, inc RA pressure...

pls help me wid this..thnx in advance
 
1).14 yr old bot with decreased appetit and abdo pain for past 3 weeks. he is also withdrawn and from everyone and sleeps constantly. P.E. is normal. what further hist shud b asked??
ANS- devolpmntal hist, family hist of affective disorder, orinetation to TPP( i choose this, but its wrong), school hist, suicidal ideation or attempts

2). physician enters the room of a 79 yr old and smells urine, how shud he approach bst towards urinary incontinence??
ANS- Are u having prob that u may b too ashamed to talk abt?(this is wrong),
i culdnt help bt i noticed an odor when i came into the room.r u havindifficulty holdin urine ,
i undrstnd dis can b difficlt to talk abt bt do u hav fecal /urinary incontince
i kno dis cn b embarassin bt people somtimes hav difficlty holdin urine as they gt older so is dis ever a prob 4 u?
its nt surprisin dat som1 of ur age is havin probs wid urinary incontince hw many accidnts do u hav a day?

3).can som1 pls explain d mutation in beta thal. the que with all diff codons and we wer supposed to identify the mutation...all those alphabets made me crazy:eek:

1. ask about suicide ideation. if you suspect someone is depressed (change in appetite, sleep, withdrawn) you must assess suicide risk.

2. I know this can be embarrassing but people sometimes have problems... my reason for picking this option is because you are allowing the patient to TELL you that he/she has a problem, instead of presuming he/she has a problem. I think this option is the most neutral of them all. Also, it fits with the ask tell ask model.

3. Can't remember the question in enough detail to know the answer or help you. Sorry.
 
The dexamethasone question in pt with hyaline memb dz really pisses me off... How can the correct answer be nuclear "receptor" ?? And on top of that there was no option with cytosolic receptor. So, I chose multilamellar body which, retrospectively seems to be a dumb choice.

The Glucocorticoid receptor is part of the "nuclear receptor family" this one in particular being a cytosolic receptor.
 
Hi guys, the graphs in section 3, (q 42) on the experiment with insulin-stimulated transport of glucose into cultured myocytes in the presence and absence of insulin. Which graph was the ans? Please explain? My physiology is weak. THANKS
 
Can someone please explain the question where the 12 y o boy had a upper resp tract infx past week. At birth had jaundice that resolved with phototherapy. Normal since then. Now he has icterus, jaundice, and splenomegay. There's a blood smear with cells that look like acanthocytes and the RBCs are really dense. The choices were:
abnl alpha globin gene, abnormal beta globin gene, dec bone marrow iron stores, dec RBC membrane stability, folic acid def, G6PD.
Thank you.
 
Can someone please explain the question where the 12 y o boy had a upper resp tract infx past week. At birth had jaundice that resolved with phototherapy. Normal since then. Now he has icterus, jaundice, and splenomegay. There's a blood smear with cells that look like acanthocytes and the RBCs are really dense. The choices were:
abnl alpha globin gene, abnormal beta globin gene, dec bone marrow iron stores, dec RBC membrane stability, folic acid def, G6PD.
Thank you.


edit: now I remembered that g6pd is an intravascular hemolysis and they mention that rbcs are really dense and the boy has icterus/splenomegaly so it is decreased membrane stability - spherocytosis
 
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Can anyone please answer these:
1- what does substitution of alanine for serine cause?
-formation of disulfide bonds
-phosphorylation of protein
-targetting enzyme to the correct cellular location.

2-the guy with BPH and 100000 colonies of G+ve? staph of enterococcus faecalis
 
Hey guys, a couple of questions still bothering me:

1.) Pic of an MRI in a woman with decreased hearing on right side. A mass compressing which structure??

Was the answer A?? (I hate this ones).

2.) Analysis of endothelial cells shows upregulation of a molecule that promotes loose and transient attachment by the neutrophils. Which one causes this??

Is the answer "Selectin" or is it "ICAM-1"?? Doesn't sound like PGI2, integrin or thrombomodulin.

3.) 59-year-old woman w/ vaginal bleeding for 3 days. Had previous episode. Curettage shows endometrial hyperplasia. Menopause 6 years ago. HRT for 2 years discontinued 4 years ago. Cause??

Is it the ovarian estrogen-producing tumor??

4.) Man starving for a week. Liver enzyme changes?? There were Fructose 2,6 BP, Glucose 6P-ase, PEP carboxykinase and Pyruvate Kinase (There seems to be different opinions on this one).

I chose all decreased.

5.) Maybe this is a dumb one, but the NSAID with PROLONGED effect on platelet agreggation is Aspirin right?? (don't know why that "prolonged" made me doubt with celecoxib and it's pro-agreggation interaction with TXA2).

Hated this NBME. Improved so little compared with NBME 11 and dropped like 15pts from UWSA1 and 2!! I'll see what NBME 7 that has to say in about a week... Biochem, genetics and Behavioral seriously kicked my butt (and my biochem performance on NBME 11 was excelent so don't really know what to think).

Should've get the feedback. MAN I made some STUPID mistakes on this one!! (there were some pretty BS question too). Great help from this thread. Hope I don't repeat those mistakes on the real deal...

Thanks in advance!
 
Question: 13 YO boy with pruritic rash on right foot. No fever, chills, cold. Patient's family spent weekend at a lake. (Rash is on top of foot and moving sort of linearly). Treat with a. clindamyin, b. fluconazole, c. mebendazole, d. metronidazole, or e. prednisone?

Did anyone know what this was? I thought it was a fungus but fluconazole was wrong. Parasitic maybe?

Hi I think it might be strongyloides . ans is mebendazole
 
The guy has scabies (prompt describes patient in lake water, pruritis after only 4 days), so the answer is still mebendazole but the real first line treatment for that is permethrin. The superficial linear tract on the foot is pretty characteristic.

I don't get why scabies isn't mentioned at all in First Aid if they know for a fact it appears on NBMEs and the random ass African worms they have on there never do.
 
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2.) Analysis of endothelial cells shows upregulation of a molecule that promotes loose and transient attachment by the neutrophils. Which one causes this??

Is the answer "Selectin" or is it "ICAM-1"?? Doesn't sound like PGI2, integrin or thrombomodulin.

I think that the answer is selectin - I put ICAM 1 and that's wrong. I think what they are implying is that promoting LOOSE and transient attachment means ROLLING, which is regulated by the selectins. See FIRST AID 2011 PAGE 222
 
2.) Analysis of endothelial cells shows upregulation of a molecule that promotes loose and transient attachment by the neutrophils. Which one causes this??

Is the answer "Selectin" or is it "ICAM-1"?? Doesn't sound like PGI2, integrin or thrombomodulin.

I think that the answer is selectin - I put ICAM 1 and that's wrong. I think what they are implying is that promoting LOOSE and transient attachment means ROLLING, which is regulated by the selectins. See FIRST AID 2011 PAGE 222
The correct answer was selectin.
 
Hello guys,
There were a few questions I wasn't able to find.

1) Recombinant Hepatitis B vaccine given. What is the response after second dose.
- Increased IgG to IgM, early IgG peak
- Increased IgG to IgM, late IgG peak
- Inc. IgM to IgG, early IgG peak
- Inc. IgM to IgG, late IgG peak

2) A patient has chronic peripheral neuropathy. Enzyme staining shows fibre grouping. Finding is due to:
- Regeneration of muscle fibre
- Re-innervation of muscle fibre by regenerating axons.

3) What embryological process failed in anencephaly?
- Development of Cerebellum
- " " " "" """" Midbrain
- Neurons in cerebellar cortex.

4) Macrophages secrete a protein for invasion and metastasis. The protein is:
- Cadherin
- Integrin
- Metalloproteinaise
- Tyrosine Kinase

I'd be highly thankful to the person giving correct answers. :)
 
Hello guys,
There were a few questions I wasn't able to find.

1) Recombinant Hepatitis B vaccine given. What is the response after second dose.
- Increased IgG to IgM, early IgG peak
- Increased IgG to IgM, late IgG peak
- Inc. IgM to IgG, early IgG peak
- Inc. IgM to IgG, late IgG peak

2) A patient has chronic peripheral neuropathy. Enzyme staining shows fibre grouping. Finding is due to:
- Regeneration of muscle fibre
- Re-innervation of muscle fibre by regenerating axons.

3) What embryological process failed in anencephaly?
-
closure of Rostral pore ........

4) Macrophages secrete a protein for invasion and metastasis. The protein is:
- Cadherin
- Integrin
- Metalloproteinaise
- Tyrosine Kinase

I'd be highly thankful to the person giving correct answers. :)
 
Hey needed help with a Few Qs .........

Qs 1) kidney transplant pt asking for a relatives kidney rather than cadaveric ???

Qs 2 ) a child that avoids eye contact , and social relations but watches weather forcast channel ???

Qs 3 ) 70 ys depressed female whoes husband died ??? i thought living with a relative would be a right ans ?????

Qs 4) Vmax of enzyme 1 = 300 and second Vmax = 30 ....... km ??? is Km of 1 greater than 2 ?????

Qs 5) AD inherited disorder with wild allele ???? due to ???? insertion of line sequence , recombination , single nucleotide polymorphism , tranduction ???

Qs 6 ) RA joint aspirate ....... is the Ans dec in complement , inc neutrophil , inc IL1 , inc TNF ??? ....... should there be a dec in TNF and IL1 or inc ???????

Qs 7) After cholecystectomy , pt has swelling and redness of great toe ?? also past H/o of great toe swelling ???

Qs 8) Diagram of RER and mitochondria for glycosylation of protein to be exported ......read in earlier page that ans is A ........ but A is mitochondria ??? how can glycosylation occur in it ??

Qs 9 ) Diagram of spinal cord .... F or G ??? why please do explain ??

Qs 10) Fracture of fibula ..... pain distal or proximal ??? marked B and got it wrong ??

Qs 11) Another CNS brainstem diagram .... a woman with ringing in her ear and dymetria of UL and LL ..mass compressing what ?? CP angle tumor ??

Qs 12) Cochlear implant stimulates ??

Qs 13) 12 yr boy with PAS stained glomerulus ???

Qs 14) amenorrhea after 2yr of child birth , with inc FSH and LH ????

Qs 15 ) 54 yr male with 30 mins of Respiratory distress and chest pain ..... with a Xray ......with options of dec or inc osmotic and hydrostatic pressure ....???

thanks ....:)
 
Hey needed help with a Few Qs .........

Qs 1) kidney transplant pt asking for a relatives kidney rather than cadaveric ???

Qs 2 ) a child that avoids eye contact , and social relations but watches weather forcast channel ???

Qs 3 ) 70 ys depressed female whoes husband died ??? i thought living with a relative would be a right ans ?????

Qs 4) Vmax of enzyme 1 = 300 and second Vmax = 30 ....... km ??? is Km of 1 greater than 2 ?????

Qs 5) AD inherited disorder with wild allele ???? due to ???? insertion of line sequence , recombination , single nucleotide polymorphism , tranduction ???

Qs 6 ) RA joint aspirate ....... is the Ans dec in complement , inc neutrophil , inc IL1 , inc TNF ??? ....... should there be a dec in TNF and IL1 or inc ???????

Qs 7) After cholecystectomy , pt has swelling and redness of great toe ?? also past H/o of great toe swelling ???

Qs 8) Diagram of RER and mitochondria for glycosylation of protein to be exported ......read in earlier page that ans is A ........ but A is mitochondria ??? how can glycosylation occur in it ??

Qs 9 ) Diagram of spinal cord .... F or G ??? why please do explain ??

Qs 10) Fracture of fibula ..... pain distal or proximal ??? marked B and got it wrong ??

Qs 11) Another CNS brainstem diagram .... a woman with ringing in her ear and dymetria of UL and LL ..mass compressing what ?? CP angle tumor ??

Qs 12) Cochlear implant stimulates ??

Qs 13) 12 yr boy with PAS stained glomerulus ???

Qs 14) amenorrhea after 2yr of child birth , with inc FSH and LH ????

Qs 15 ) 54 yr male with 30 mins of Respiratory distress and chest pain ..... with a Xray ......with options of dec or inc osmotic and hydrostatic pressure ....???

thanks ....:)

1) Ask him to explain his concerns about the kidney transplant. Open ended question, you want to know why he wants a relative txp.

2) Asperger's

3) Her husband has only been dead 3 weeks -- you should reassure her that her depression is normal. "Living with a relative" isn't the right answer because that's very situational advice -- maybe it would help in some cases, maybe not in others -- but it's not medical advice. The "trick" answer to that one is giving her an antidepressant, but she hasn't been depressed long enough.

4) Can't determine. Km is the substrate concentration for 1/2 Vmax, but it has to do with the affinity of the enzyme for the substrate -- you can't determine that solely from the Vmax.

5) Recombination. If two alleles are close together (and thus don't sort in a Mendelian fashion aka randomly), the only way that someone could end up with a mix is via recombination during meiosis for the germ cell.

6) Decreased C3, increased everything else. RA is a type III HSR, where you have immune complexes activating complement and then products of the complement pathway (C5a, etc) attract neutrophils/lymphocytes that produce the other components.

7) I don't remember this Q, so I'm not sure. Do you remember any more of the stem?

8) The answer is the arrow that points to the inside of the RER. Whoever told you it was the mitochondria was incorrect.

9) The answer was the more lateral of the two points in the anterior horn since she was having weakness of the intrinsic muscles of the hand -- the hand is more lateral in the anterior horn (you know it's a LMN disorder (and thus not corticospinal tract) since she's having weakness/atrophy and not spasticity/hyperreflexia).

10) She has pain proximal, no pain distally -- fracture of the fibular neck injures the common peroneal nerve, so she'd have foot drop and anesthesia over the dorsum of her foot/leg.

11) The labels were L/R MLF, L/R corticospinal tract, or L/R nuclei section of the brainstem -- I'm not great on neuroanatomy, but you know it's not MLF or corticospinal tract, so then you just have to figure if it's left or right. Since it's hearing loss, it should be ipsilateral, so it's whichever side she had symptoms.

12) Auditory nerve. It replaces the hair cells.

13) Minimal change disease. The PAS stain showed a totally normal glomerulus to light microscopy -- since he has nephrotic syndrome, the only explanation would be something you can't see on LM i.e. MCD. It's also the most common cause of nephrotic syndrome in kids.

14) I'm not sure exactly which question you're talking about, but I think it was primary ovarian failure. If her FSH and LH are elevated and she's not menstruating, it has to be an ovarian problem. The only ovarian path on there was primary failure.

15) Increased hydrostatic pressure in the pulmonary venous circulation. He was having a classic MI with sudden-onset pulmonary edema. Most likely cause would be left ventricular dysfunction from ischemia which leads to increased pressures in the pulmonary venous circulation from backup = pulmonary edema.



I didn't do feedback for mine so I don't know for sure that these are all right -- but I think most of them are correct.
 
Hello guys,
There were a few questions I wasn't able to find.

4) Macrophages secrete a protein for invasion and metastasis. The protein is:
- Cadherin
- Integrin
- Metalloproteinaise
- Tyrosine Kinase

I'd be highly thankful to the person giving correct answers. :)

AFAIK, this is not correct -- the answer is metalloproteinases. There was a cadherin question on the exam, which was asking about what protein is deficient in tumor cells that allows them to invade (aka not have contact inhibition), but the question about what macrophages secrete to help them invade should be MMPs.
 
Hello guys,
There were a few questions I wasn't able to find.

1) Recombinant Hepatitis B vaccine given. What is the response after second dose.
- Increased IgG to IgM, early IgG peak
- Increased IgG to IgM, late IgG peak
- Inc. IgM to IgG, early IgG peak
- Inc. IgM to IgG, late IgG peak

2) A patient has chronic peripheral neuropathy. Enzyme staining shows fibre grouping. Finding is due to:
- Regeneration of muscle fibre
- Re-innervation of muscle fibre by regenerating axons.

3) What embryological process failed in anencephaly?
- Development of Cerebellum
- " " " "" """" Midbrain
- Neurons in cerebellar cortex.
it's failed closure of the rostral neuropore

4) Macrophages secrete a protein for invasion and metastasis. The protein is:
- Cadherin
- Integrin
- Metalloproteinaise
- Tyrosine Kinase

I'd be highly thankful to the person giving correct answers. :)

Can someone explain the folic acid vs trace metal and number needed to treat?

This has already been answered 3 times in this thread. I don't remember the exact numbers but NNT= 1/ARR

So, ARR = 2.3%-1.3% = 1% = .01 ........ so 1/.01 = 100




I have a question, I know it's been asked but I would like an explanation please :D

8. Another carbonic anhydrase question. . CA deficiency in erythrocytes only; whats elevated in venous blood?

K+
Ca
Cl - so it seems that this is the correct answer
HCO3 - WRONG
Mg
Na


For some reason I can't wrap my brain around the Chloride shift. I THOUGHT: in the periphery (venous blood?) that chloride shifts INTO the RBC's, and HCO3 shift OUT of the RBC's. In the lungs the reverse of this happens. So with a lack of carbonic anhydrase, you would get an accumulation of HCO3 in the RBC's, and........... oh wait a second, I think I might have just misunderstood the question. I was thinking about the actual red blood CELLS versus the venous blood. Is this where my mistake is? :smuggrin:
 
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