41 Questions from NBME Form 2-- HELP!!!

[02115]

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I took the NBME Form 2 and boy was that a killer. The third block I almost broke down and cried. I ended up getting a 490 (216) which was a big improvement from the 410 I got on Form I.

Anyhow, I copied down a lot of the questions I didn't know and would appreciate any help in figuring out the right answers. I am going to study these and will post what I am thinking:

ANY INSIGHT YOU COULD OFFER ON THESE IS GREATLY APPRECIATED. THANK YOU!!!
_________________
A child is born without limbs is found to have mutation in receptor for fibroblast growth factor. Absence of limbs is most likely resulting from disruption of process controlling

a) apoptosis
b) differentiation
c) Epithelial-mesenchymal conversion
d) Proliferation

(C??)
___________________
A woman breaks her humerus. Serum studies 3 weeks after show an increased concentration of:

a) Alkaline phosphatase
b) calcium
c) creatine kinase
d) gamma-glutamyltransferase
e) phosphorus

(A???)
_________________________
Alveolitis with interstitial edema, inflammatory cell accumulation, and type II epithelial cell hypertrophy and hyperplasia is believed to be an early and central event in the pathogenesis of

a) Anthracosis
b) Asthma
c) Centriacinar emphysema
d) Chronic bronchitis
e) Pulmonary fibrosis

(D???)
____________________________
A 5 month old male develops lethargy, somnolence, hypothermia, feeding problems, and persistent jaundice. After several days he develops a hoarse cry and hypotonic muscles. The tongue is large and protruding and an umbilical hernia is noted. Hematologic evaluations show no abnormalities. DX is:

a) Agenesis of parathyroids
b) Congenital adrenal hyperplasia
c) Maternal diffuse toxic goiter
d) Thyroid hypoplasia
e) Trisomy 21

(D???)
_____________________________
A 20 y/o man has a painless 2 cm nodule in his right scrotum. The nodule is difficult to distinguish from the right testis and does not transilluminate. The is no additional swelling or inguinal adenopathy. The most likely DX is

a) crytporchidism
b) Hydrocele
c) Scrotal cyst
d) testicular CA
e) Testicular torsion
f) Varicocele

(c???)
______________________________
THIS WAS ON FORM I AS WELL!!!

What cells regenerate lung tissue
a) Clara cell
b) Fibroblast
c) Macrophage
d) Type I pneumocyte
e) Type II pneumocyte

E???
______________________________
The absorption of calcium from the intestinal tract results principally from the direct action of which of the following:

a) Calcitonin
b) cAMP
c) 1,25 dihydroxycholecalciferol
d) 25-hydroxycholecalciferol
e) PTH

(C???)
______________________________
A 63 y/o woman has chest pain while climbing stairs. She takes some medication which improves pain. The mechanism of the drug is

a) Decreased afterload
b) Decreased preload
c) Increased afterload and preload
d) increased preload
e) increased contractility

______________________________
A 16 y/o girl is evaluated because she has not yet had a menstrual period. She is 4'10" and weighs 93 lbs. Breast development is Tanner 1/5 and pubic hair is 2/5. She has a low hairline, short 4th metacarprals bilaterally and multiple pigmented nevi. A cervix is seen on pelvic exam. Lab studies show an increased serum follicle stimulating hormone conentration. Serum TSH and prolactin are normal. DX is

a) Androgen insensitivity
b) Turners
c) Gonadotropin-secreting pituitary tumor
d) Isolated gonadotropin deficiency
e) paramesonephric (mullerian) aplasia.

_____________________________________
A 16 y/o girl has generalized weakness and nocturnal leg cramps. She is not taking any meds. Labs: Na 135, Cl 108, K 2.8 HCO3 21 Urine pH 7. DX:

a) Adrenal insufficiency,
b) hyporeninemic hypoaldosteronism
c) nephrogenic diabetes insipidus
d) renal tubular acidosis
e) SIADH
____________________________________
A hyperactive 6 y.o develops microcytic anemia, cerebral edema, and ataxia. Which of the following serum enzyme activities would most likely to confirm the DX:

A) 5-aminolevulinic acid dehydrogenase
b) Glucose 6-phosphate dehydrogenase
c) Glutathione transferase
d) Lactate dehydrogenase
e) Pyruvate kinase
(B????)
______________________________________
A 4cm bronchogenic cyst is an incidental finding at autopsy of a 55 year old man. The cyst mostlikely arose from which of the following embryonic structures
a) Allantois
b) Foregut
c) Mesonephric (wolfian duct)
D) Metanephric duct
e) Omphalomesenteric duct

(b???)
______________________________________
Which group of regulators involving Type I hypersensitivity reactions causes increased vascular permeability and attraction of leukocytes

a) Essential Fatty Acids
b) Leukotrienes
c) Prostaglandis
d) Thromboxane
______________________________________
A 78 y/o man has had urinary retention for 1 week. 2 week HX of TX for chronic neuropathic pain. Drug is

a) Amitriptyline
b) Bupropion
c) Carbamazepine
d) Fluoxetine
e) Trazodone
f) Venlafaxine

C???
______________________________________
A 27 y/o with DM1 is brought to the ED with DKA. Diabetes usually well controlled. Wife says he has had a fever and productive cough for several days and has been taking an OTC cough syrup. Cause of DKA is

A) Cough syrup,
b) Dehydration
c) Failure to take insulin
d) Infection
e) Lack of excercise

E????
______________________________________
A 14 y/o F has not begun to menstruate. PE: Normal breast development, no pubic hair, normal external female genitalia, bilateral inguinal hernias, vagina that ends in a blind pouch. No palpable uterus or ovaries. US: Absence of normal female genitalia.

A) Defective androgen receptors
b) Excess fetal estrogen
c) Excess fetal progesterone
d) Insuff fetal testosterone
e) Insuff production of paramesonephric mullerian inhibiting substance. (E???)
_____________________________________
A 19 month old F dies after ingesting mothers iron supp. Autopsy microscopic exam of hepatic tissue shows lysosomal degradation. Mechanism is:

a) Activation of glutathione peroxidase
b) Inhibition of Gstransferase
c) DNA peroxidation
d) Peroxidation of membrane lipids C???
____________________________________
A 67 y/o man is admitted to the hospital because of worsening dyspnea over the past 6 h. He was DX with HTN 10 years ago. T 36C, P 100/min RR 22, BP 136/87. PE: S3 Gallop and bilateral coarse rales halfway up lungs bilaterally. Diet should be:

A) Clear liquid
b) Enteric feeding via NG tube
C) Full liquid diet
D) High fiber diet
E) Low residue diet
F) Parenteral nutritioin via central venous access
G) Protein restricted diet
H) Regular hospital diet
I) Sodium restricted diet

(CHF??? I???)
________________________________
A healthy 25 y/o F at 24 weeks gestation develops heartburn 1 h after eating. Most likely cause?

A) Decreased competency of lower esophageal sphincter
b) Decreased esophageal motility
c) Increased gastric acid production
d) Increased gastric emptying
e) Increased gastric mobility

(A???)
________________________________
A 62 y/o man develops numerous superficial blisters over scalp, face, groin, trunk. New lesions develop over areas subjected to minimal trauma. BX shows intraepidermal blister with suprabasal acantholysis. Serologic studies are likely to show Ab directed against

A) Anchoring filaments
B) Basement membrane proteins
C) Desmosomal proteins
D) Hemidesmosomal proteins
E) Integrns

(D???)

_______________________________
A patient who is taking probenecid is expected to have increased excretion of
a) Cephalosporin
b) Creatinine
C) Penicillin
D) Tetracycline
E) Urate

_______________________________
Which drug produces vasoconstriction that is not blocked by prazosin and bradycardia that is blocked by scopolamine

A) Amphetamine
b) Angiotensin
c) NE
d) Phenylephrine
(C???)
_______________________________
Which of the following best differentiates central diabetes insipidus vs nephrogenic diabetes insipidus

a) Injection of ADH
b) Injection of hypertonic saline
C) Injection of insulin
D) Water deprivation
E) Water loading.

A???
_______________________________
When are chromasomes most condensed and easily analyzed

a) Anaphase
b) Interphase
C) Metaphase
D) Prophase
E) Telophase

(C????)
_______________________________
What is the major consequence of a hereditary defect in the production of active pyruvate kinase in the liver and erythrocytes

A) Decreased capacity to fix CO2
b) Decreased gluconeogenesis from Alanine
C) Decreased oxidation of pyruvate
D) Decreased production of ATP from glucose
E) Increased affinity of Hb for oxygen

(E????)

 

[02115]

______________________________
42 y/o F with 3 month HX intermittent red-brown d/c from nipple of breast. No masses, pain, tenderness. DX:

A) Fibroadenoma
B) Fibrocystic dz
C) Intraductal papilloma
D) Lobular papiloma
E) Mastitis
F) Traumatic fat necrosis

(C???)
________________________________
73 y/o F w/ Bronchopneumonia. Numerous neutrophils attracted by 5-hydroperoxyeicosatetranoic acid (5-HPETE) and leukotrienes present in bronchioles and alveoli. Which enzyme produces these molecules

A) C3 convertase
B) Cyclooxygenase
C) 5-lipoxygenase
D) Phosphatase
E) SOD

C???
________________________________

The prevalence of a disease is half as great in town A than B, but the incidence of the disease is no different. Which explains these findings

A) Case fatality rate is twice as high in A
B) Duration is twice as long in B
C) Number of new cases in A is twice B
D) People in town A use medical care facilities half as often as those in B
E) Proportion of asymptomatic cases is twice as much in B than A

(A???)
_______________________________
45 y/o F says feet feel hot. Skin of feet is pink, dry and hot. Which of the following fibers are most likely disrupted

A) Autonomic afferent
B) Postganglionic sympathetic
C) Preganglionic parasympathetic
D) Somatic cutaneous afferent

(B???)
________________________________
45 y/o man has MI. Coronary stent restores blood flow but reperfusion causes paradoxical increase in damage. Mechanism of NEW myocardial damage is

A) Direct poisoning of mitochondrial enzymes
B) Increase in lipid peroxidation
C) Inhibition of ATP-ase dependent transport
D) Loss of intracellular aminoacids
E) Prevention of cross linking labile amino acids

(B???)
_________________________________
20 y/o F takes ibuprofen and misoprostol for rheumatoid arthritis. She is planning to become pregnant. She should stop taking misoprostol to avoid:

A) Fetal malformations
B) Intrauterine growth ******ation
C) Premature closure of ductus
D) Spontaneous abortion

(A???)
____________________________________
15 y/p has appendicitis. Which of the following histologic findings establish diagnosis of appendicitis

A) Follicular lymphoid hyperplasia
B) Histocytic infiltrate of lamina propria
C) Lymphoid infiltrate of mucosa
D) Mucosal ulceration
E) Neutrophilic inflitrate of muscularis

(E???)
___________________________________
How does C. Perfingens evade destruction by neutrophils in patients with clostridial myonecrosis

A) Damaging neutrophil membranes by means of a membrane-damaging toxin B) Preventing contact with neutrophils by means of a polysaccharide capsule C) Preventing phagocytosis by disruption of neutrophil actin polymerization D) Survival in the cytoplasm of a neutrophil
E) Survival in the phagosome of a macrophage

(B???)
__________________________________
A stressed myocardial cell that has no calcium gradient across its plasma membrane most likely has undergone:

A) Abortive mitosis
B) Adaptation
C) Cell death
D) Repolarization
E) Reversible cell injury

(E???)
_____________________________________
Young couple unable to conceive. Normal sperm quality and quantity. Woman has regular menstrual cycles and takes no contraceptives. Sinus shows epithelial cells with majority of cilia bent at half their length. The most likely functional cause of infertility is:

A) Capacitation of spermatozoa
b) Completion of meiosis by ovulated oocytes
c) Implantation into uterus
D) Migration of conceptus
E) Mobility of spermatazoa

(D???)
_____________________________________
Normal cycles of ciliogenesis in oviduct epithelial cells depend directly on:

A) Biogenesis of additional mitochondria
b) Chromosomal DNA replication
C) Glycosylations within the golgi body
D) Multiplications of centrioles
e) Synthesis of cytokeratin
________________________________________

Which of the following modifications of an endogenous pharmacologically active peptide would slow the metabolism of the peptide, thus decreasing its clearance and increasing its half life

A) Administering peptide with an enteric coating
B) Decreasing the number of AA in peptide
C) Ensuring a free amino group at the N-terminal
D) Ensuring a free carboxyl group at the C terminal
E) Substituting D for L amino acid.

(E??)

_______________________________
45 y/o man has frequent H/A, diffuse athralgias, generalized weakness, pain in both hands, TMJ pain w/ chewing, increasing shoe size, difficulty picking up small objects. DX:

A) Acromegaly
B) Cushing
C) Hypothyroidisim
D) Prolactinoma
E) Kleinfelter's

A??

________________________________
A 10 y/o asthmatic is receiving oral hydrocortisone in increasing doses for the past 2 y. He is obese and has growth ******ation and edema of lower limbs. What is the most likely explanation for edema?

A) Drug binds to glucocorticoid and mineralocorticoid receptors
b) Drug converted to mineralocorticoid in liver
c) Pulmonary production of angiotensin is increased
d) Renin activity is increased because of stress
e) Secretion of ADH is increased because of stress

(B????)
_______________________________
A 12 y.o girl is admitted b/c of SOB, erythematous rash, arthritis. Antistreptolysin O titer high. X-ray: Cardiomegaly. Develops intractable CHF and dies on day 2. Which cardiac abn seen on autopsy:

A) Granulomatous pericarditis with caseous necrosis
b) Multiple microabscesses in myocardium
c) Myocardial edema with Aschoff bodies
D) Stenosis of aortic valve
e) stenosis of mitral valve.

C???
________________________________
PKU is autosomal recessive. What is the probability that the asymptomatic brother or sister of a child w/ disease is a heterozygous carrier

A) 0
B) 1/4
C) 1/2
D) 2/3
E) 3/4

C????

 

[02115]

A 5 month old male develops lethargy, somnolence, hypothermia, feeding problems, and persistent jaundice. After several days he develops a hoarse cry and hypotonic muscles. The tongue is large and protruding and an umbilical hernia is noted. Hematologic evaluations show no abnormalities. DX is:

a) Agenesis of parathyroids
b) Congenital adrenal hyperplasia
c) Maternal diffuse toxic goiter
d) Thyroid hypoplasia
e) Trisomy 21

(D???)

In reading first aid, this sounds like the SX of cretinism: Pot-bellied, pale, puffy faced child with protruding umbilicus and protuberant tongue.

 

[pekq]

If you labelled these with numbers, it'd be easier to help you since you posted so many questions.

For the first question, it's lack of proliferation. I don't think the other choices would lead to absence of limb.

For the 63yo woman with stable angina, nitroglycerine increases vasodilation and thus decreases preload.

For the questions about the short 16yo, I think that's turner's.

 

[02115]

Thanks for that reply pekq. I looked up nitroglycerine in Katzung and it says:

"Smooth muscle relaxation leads to peripheral venodilation which ressults in reduced CO through reduced preload. Reduced afterload, from arteriolar dilation, may contribute to an increase in ejection and a further decrease in cardiac size." So I am thinking I should have said both??? But FA says dilate veins >> arteries decrease preload. This is so confusing!!!

 

[Idiopathic]

A child is born without limbs is found to have mutation in receptor for fibroblast growth factor. Absence of limbs is most likely resulting from disruption of process controlling

a) apoptosis
b) differentiation
c) Epithelial-mesenchymal conversion
d) Proliferation

(C??) (I would say A, poor control over apoptosis)
___________________
A woman breaks her humerus. Serum studies 3 weeks after show an increased concentration of:

a) Alkaline phosphatase
b) calcium
c) creatine kinase
d) gamma-glutamyltransferase
e) phosphorus

(A???) (Yes)
_________________________
Alveolitis with interstitial edema, inflammatory cell accumulation, and type II epithelial cell hypertrophy and hyperplasia is believed to be an early and central event in the pathogenesis of

a) Anthracosis
b) Asthma
c) Centriacinar emphysema
d) Chronic bronchitis
e) Pulmonary fibrosis

(D???) (I would say E)
____________________________
A 5 month old male develops lethargy, somnolence, hypothermia, feeding problems, and persistent jaundice. After several days he develops a hoarse cry and hypotonic muscles. The tongue is large and protruding and an umbilical hernia is noted. Hematologic evaluations show no abnormalities. DX is:

a) Agenesis of parathyroids
b) Congenital adrenal hyperplasia
c) Maternal diffuse toxic goiter
d) Thyroid hypoplasia
e) Trisomy 21

(D???) (Sounds right. Looks like cretinism)
_____________________________
A 20 y/o man has a painless 2 cm nodule in his right scrotum. The nodule is difficult to distinguish from the right testis and does not transilluminate. The is no additional swelling or inguinal adenopathy. The most likely DX is

a) crytporchidism
b) Hydrocele
c) Scrotal cyst
d) testicular CA
e) Testicular torsion
f) Varicocele

(c???) (Solid mass inside the testicle is CA until proven otherwise. I say D)
______________________________
THIS WAS ON FORM I AS WELL!!!

What cells regenerate lung tissue
a) Clara cell
b) Fibroblast
c) Macrophage
d) Type I pneumocyte
e) Type II pneumocyte

E??? (Yes)
______________________________
The absorption of calcium from the intestinal tract results principally from the direct action of which of the following:

a) Calcitonin
b) cAMP
c) 1,25 dihydroxycholecalciferol
d) 25-hydroxycholecalciferol
e) PTH

(C???) (I think so, but it might be cAMP)
______________________________
A 63 y/o woman has chest pain while climbing stairs. She takes some medication which improves pain. The mechanism of the drug is

a) Decreased afterload
b) Decreased preload
c) Increased afterload and preload
d) increased preload
e) increased contractility

(B. Nitroglycerin is primarily a venodilator)
______________________________
A 16 y/o girl is evaluated because she has not yet had a menstrual period. She is 4'10" and weighs 93 lbs. Breast development is Tanner 1/5 and pubic hair is 2/5. She has a low hairline, short 4th metacarprals bilaterally and multiple pigmented nevi. A cervix is seen on pelvic exam. Lab studies show an increased serum follicle stimulating hormone conentration. Serum TSH and prolactin are normal. DX is

a) Androgen insensitivity
b) Turners
c) Gonadotropin-secreting pituitary tumor
d) Isolated gonadotropin deficiency
e) paramesonephric (mullerian) aplasia.

(B, I think)

A 78 y/o man has had urinary retention for 1 week. 2 week HX of TX for chronic neuropathic pain. Drug is

a) Amitriptyline
b) Bupropion
c) Carbamazepine
d) Fluoxetine
e) Trazodone
f) Venlafaxine

C??? (A. Dont the TCA's have anticholinergic effects?)
______________________________________
Thats all for now 😉

 

[pekq]

No, if it was defect in apoptosis, there would be webbed fingers not missing limb.

Also, the 6yo kid with microcytic anemia has lead poisoning so answer is A.

One thing i've learned from NBME is if someone on pain/antidepressant/etc has some sort of problem, when in doubt, pick TCA. Your Miles May Vary

 

[02115]

Also, the 6yo kid with microcytic anemia has lead poisoning so answer is A.

THANK YOU, YOU ARE SO SMART!!

P.S. Where did you learn the term "Your miles may vary" What does it mean?

 

[pekq]

Your Miles May Vary = YMMV
It just means the result may vary from person to person.
Term is frequently used on consumer website discussions on calling store reps for price matching semi-sketchy ads.

On another note, having FA and BRS in front of you will make anyone look smart

 

[pekq]

____________________________________
A 16 y/o girl has generalized weakness and nocturnal leg cramps. She is not taking any meds. Labs: Na 135, Cl 108, K 2.8 HCO3 21 Urine pH 7. DX:

a) Adrenal insufficiency,
b) hyporeninemic hypoaldosteronism
c) nephrogenic diabetes insipidus
d) renal tubular acidosis
e) SIADH

I'd guess D

Which group of regulators involving Type I hypersensitivity reactions causes increased vascular permeability and attraction of leukocytes

a) Essential Fatty Acids
b) Leukotrienes
c) Prostaglandis
d) Thromboxane

I'd choose leukotrienes though I think prostaglandins also attracts leukocytes.
______________________________________

______________________________________
A 27 y/o with DM1 is brought to the ED with DKA. Diabetes usually well controlled. Wife says he has had a fever and productive cough for several days and has been taking an OTC cough syrup. Cause of DKA is

A) Cough syrup,
b) Dehydration
c) Failure to take insulin
d) Infection
e) Lack of excercise

Infection increases stress which increases insulin requirement FA257
______________________________________
A 14 y/o F has not begun to menstruate. PE: Normal breast development, no pubic hair, normal external female genitalia, bilateral inguinal hernias, vagina that ends in a blind pouch. No palpable uterus or ovaries. US: Absence of normal female genitalia.

A) Defective androgen receptors
b) Excess fetal estrogen
c) Excess fetal progesterone
d) Insuff fetal testosterone
e) Insuff production of paramesonephric mullerian inhibiting substance.

It's not E because paramesonephric mullerian factor prevents development of internal female reproductive system. Answer is most likely A

_______________________________
A patient who is taking probenecid is expected to have increased excretion of
a) Cephalosporin
b) Creatinine
C) Penicillin
D) Tetracycline
E) Urate

Probenicid is for gout so urate
_______________________________
Which drug produces vasoconstriction that is not blocked by prazosin and bradycardia that is blocked by scopolamine

A) Amphetamine
b) Angiotensin
c) NE
d) Phenylephrine
(C???) This is a tough one. I'd probably guess B cause it's different from the others (not via catecholamine at least I don't think so).
_______________________________
When are chromasomes most condensed and easily analyzed

a) Anaphase
b) Interphase
C) Metaphase
D) Prophase
E) Telophase

(C????) yes
_______________________________
What is the major consequence of a hereditary defect in the production of active pyruvate kinase in the liver and erythrocytes

A) Decreased capacity to fix CO2
b) Decreased gluconeogenesis from Alanine
C) Decreased oxidation of pyruvate
D) Decreased production of ATP from glucose
E) Increased affinity of Hb for oxygen

It's D, they are not trying to trick you (at least I don't see it) [/QUOTE]

 

[Idiopathic]

______________________________
42 y/o F with 3 month HX intermittent red-brown d/c from nipple of breast. No masses, pain, tenderness. DX:

A) Fibroadenoma
B) Fibrocystic dz
C) Intraductal papilloma
D) Lobular papiloma
E) Mastitis
F) Traumatic fat necrosis

(C???) (Yes...MCC of bloody nipple discharge.)
________________________________
73 y/o F w/ Bronchopneumonia. Numerous neutrophils attracted by 5-hydroperoxyeicosatetranoic acid (5-HPETE) and leukotrienes present in bronchioles and alveoli. Which enzyme produces these molecules

A) C3 convertase
B) Cyclooxygenase
C) 5-lipoxygenase
D) Phosphatase
E) SOD

C??? (I think so)
________________________________

The prevalence of a disease is half as great in town A than B, but the incidence of the disease is no different. Which explains these findings

A) Case fatality rate is twice as high in A
B) Duration is twice as long in B
C) Number of new cases in A is twice B
D) People in town A use medical care facilities half as often as those in B
E) Proportion of asymptomatic cases is twice as much in B than A

(A???) (Yes)
_______________________________
45 y/o F says feet feel hot. Skin of feet is pink, dry and hot. Which of the following fibers are most likely disrupted

A) Autonomic afferent
B) Postganglionic sympathetic
C) Preganglionic parasympathetic
D) Somatic cutaneous afferent

(B???) (Yes)
________________________________
45 y/o man has MI. Coronary stent restores blood flow but reperfusion causes paradoxical increase in damage. Mechanism of NEW myocardial damage is

A) Direct poisoning of mitochondrial enzymes
B) Increase in lipid peroxidation
C) Inhibition of ATP-ase dependent transport
D) Loss of intracellular aminoacids
E) Prevention of cross linking labile amino acids

(B???) (Yes. They are looking for reperfusion effect, thats the only one that I can see making sense)
_________________________________
20 y/o F takes ibuprofen and misoprostol for rheumatoid arthritis. She is planning to become pregnant. She should stop taking misoprostol to avoid:

A) Fetal malformations
B) Intrauterine growth ******ation
C) Premature closure of ductus
D) Spontaneous abortion

(A???) (D. Misoprostol is a PGE analogue that stimulates myometric contraction. It is one half of the abortion pill, with mifepristone)
____________________________________
How does C. Perfingens evade destruction by neutrophils in patients with clostridial myonecrosis

A) Damaging neutrophil membranes by means of a membrane-damaging toxin B) Preventing contact with neutrophils by means of a polysaccharide capsule C) Preventing phagocytosis by disruption of neutrophil actin polymerization D) Survival in the cytoplasm of a neutrophil
E) Survival in the phagosome of a macrophage

(B???) (A)
__________________________________
A stressed myocardial cell that has no calcium gradient across its plasma membrane most likely has undergone:

A) Abortive mitosis
B) Adaptation
C) Cell death
D) Repolarization
E) Reversible cell injury

(E???) (C. This is apoptosis)
_____________________________________
Young couple unable to conceive. Normal sperm quality and quantity. Woman has regular menstrual cycles and takes no contraceptives. Sinus shows epithelial cells with majority of cilia bent at half their length. The most likely functional cause of infertility is:

A) Capacitation of spermatozoa
b) Completion of meiosis by ovulated oocytes
c) Implantation into uterus
D) Migration of conceptus
E) Mobility of spermatazoa

(D???) (Ill agree)
_____________________________________
45 y/o man has frequent H/A, diffuse athralgias, generalized weakness, pain in both hands, TMJ pain w/ chewing, increasing shoe size, difficulty picking up small objects. DX:

A) Acromegaly
B) Cushing
C) Hypothyroidisim
D) Prolactinoma
E) Kleinfelter's

A?? (Yes)

________________________________
A 10 y/o asthmatic is receiving oral hydrocortisone in increasing doses for the past 2 y. He is obese and has growth ******ation and edema of lower limbs. What is the most likely explanation for edema?

A) Drug binds to glucocorticoid and mineralocorticoid receptors
b) Drug converted to mineralocorticoid in liver
c) Pulmonary production of angiotensin is increased
d) Renin activity is increased because of stress
e) Secretion of ADH is increased because of stress

(B????) (A. These glucocorticoids typically have weaker mineralocorticoid effects, and this is responsible for the edema)
_______________________________
A 12 y.o girl is admitted b/c of SOB, erythematous rash, arthritis. Antistreptolysin O titer high. X-ray: Cardiomegaly. Develops intractable CHF and dies on day 2. Which cardiac abn seen on autopsy:

A) Granulomatous pericarditis with caseous necrosis
b) Multiple microabscesses in myocardium
c) Myocardial edema with Aschoff bodies
D) Stenosis of aortic valve
e) stenosis of mitral valve.

C??? (Yes)
________________________________
PKU is autosomal recessive. What is the probability that the asymptomatic brother or sister of a child w/ disease is a heterozygous carrier

A) 0
B) 1/4
C) 1/2
D) 2/3
E) 3/4

C???? (Yes. XX = 25%, Xx = 50%, xx = 25%)

 

[Kashue]

PKU is autosomal recessive. What is the probability that the asymptomatic brother or sister of a child w/ disease is a heterozygous carrier

A) 0
B) 1/4
C) 1/2
D) 2/3
E) 3/4


Last one is a trick question. The probability is going to be 2/3. They said the brother or sister is Asymptomatic hence they cannot be the xx genotype(recessive). So they can either be XX Xx ==> Answer is 2/3. I agree with the rest of Idiopathic's answers.

 

[lealf-ye]

The prevalence of a disease is half as great in town A than B, but the incidence of the disease is no different. Which explains these findings

A) Case fatality rate is twice as high in A
B) Duration is twice as long in B
C) Number of new cases in A is twice B
D) People in town A use medical care facilities half as often as those in B
E) Proportion of asymptomatic cases is twice as much in B than A

(A???) (Yes)


why not B?

 

[xjacob]

I agree with most of the answers you gave or the corrections people have posted.
A few of my own comments:

Young couple unable to conceive. Normal sperm quality and quantity. Woman has regular menstrual cycles and takes no contraceptives. Sinus shows epithelial cells with majority of cilia bent at half their length. The most likely functional cause of infertility is:

A) Capacitation of spermatozoa
b) Completion of meiosis by ovulated oocytes
c) Implantation into uterus
D) Migration of conceptus
E) Mobility of spermatazoa

(D???) This I think it is actually E. I don't think it is D, b/c to my knowledge the movement in the fallopian tubes is mostly peristaltic rather than cilliary beats. Likewise, I don't think it is A, b/c capacitation refers to a bunch of enzymatic reactions allowing spermatozoa to move. I think it is E, b/c with reduced cilliary function, the cervical mucus is likely to accumulate, rendering it inpenetrable to the sperm...but this is just a guess (I'm actually not sure if there are ciliated cells in that area)
_____________________________________
Normal cycles of ciliogenesis in oviduct epithelial cells depend directly on:

A) Biogenesis of additional mitochondria
b) Chromosomal DNA replication
C) Glycosylations within the golgi body
D) Multiplications of centrioles
e) Synthesis of cytokeratin

This has been answered on a different board. Anyway, it is D (think cilia = microtubular structures that need to be attached to the microtubule organizing particle, also known as centriole. This is analogous to the mitotic spindle aparatus, which also utilizes microtubules and centrioles)
________________________________________

Which of the following modifications of an endogenous pharmacologically active peptide would slow the metabolism of the peptide, thus decreasing its clearance and increasing its half life

A) Administering peptide with an enteric coating
B) Decreasing the number of AA in peptide
C) Ensuring a free amino group at the N-terminal
D) Ensuring a free carboxyl group at the C terminal
E) Substituting D for L amino acid.

(E??) Yes, E sounds right. I think this is how they actually make some of these long lasting hormone substitutes (maybe DDAVP?)

Regarding the girl with the funny electrolytes, I agree that she prob. has renal tubular acidosis, just but eliminating the other questions...anyone know something about RTA's?

 

[NYC-girl]

A 27 y/o with DM1 is brought to the ED with DKA. Diabetes usually well controlled. Wife says he has had a fever and productive cough for several days and has been taking an OTC cough syrup. Cause of DKA is

A) Cough syrup,
b) Dehydration
c) Failure to take insulin
d) Infection
e) Lack of excercise

Infection increases stress which increases insulin requirement FA257

I actually put dehydration (B). This is because on the wards, you will always see that pts who are in diabetic ketoacidosis will be treated with Hydration 1st.

 

[lealf-ye]

A 27 y/o with DM1 is brought to the ED with DKA. Diabetes usually well controlled. Wife says he has had a fever and productive cough for several days and has been taking an OTC cough syrup. Cause of DKA is

A) Cough syrup,
b) Dehydration
c) Failure to take insulin
d) Infection
e) Lack of excercise

Infection increases stress which increases insulin requirement FA257

I actually put dehydration (B). This is because on the wards, you will always see that pts who are in diabetic ketoacidosis will be treated with Hydration 1st.

I think the consequence of DKA is dehydration but the cause is usually some kind of stress. I will pick D infection

 

[lealf-ye]

A 16 y/o girl has generalized weakness and nocturnal leg cramps. She is not taking any meds. Labs: Na 135, Cl 108, K 2.8 HCO3 21 Urine pH 7. DX:

a) Adrenal insufficiency,
b) hyporeninemic hypoaldosteronism
c) nephrogenic diabetes insipidus
d) renal tubular acidosis
e) SIADH

I'd guess D


Why not B

 

[xjacob]

A 16 y/o girl has generalized weakness and nocturnal leg cramps. She is not taking any meds. Labs: Na 135, Cl 108, K 2.8 HCO3 21 Urine pH 7. DX:

a) Adrenal insufficiency,
b) hyporeninemic hypoaldosteronism
c) nephrogenic diabetes insipidus
d) renal tubular acidosis
e) SIADH

I'd guess D


Why not B

As a rule of thumb, any state with low aldo has low Na and high K. In this pt's case, the sodium is a little bit on the low side, but K is really low. Hence, not B.

 

[Idiopathic]

PKU is autosomal recessive. What is the probability that the asymptomatic brother or sister of a child w/ disease is a heterozygous carrier

A) 0
B) 1/4
C) 1/2
D) 2/3
E) 3/4


Last one is a trick question. The probability is going to be 2/3. They said the brother or sister is Asymptomatic hence they cannot be the xx genotype(recessive). So they can either be XX Xx ==> Answer is 2/3. I agree with the rest of Idiopathic's answers.

Correct, good catch.

 

[Idiopathic]

The prevalence of a disease is half as great in town A than B, but the incidence of the disease is no different. Which explains these findings

A) Case fatality rate is twice as high in A
B) Duration is twice as long in B
C) Number of new cases in A is twice B
D) People in town A use medical care facilities half as often as those in B
E) Proportion of asymptomatic cases is twice as much in B than A

(A???) (Yes)


why not B?

I think you are right actually. For it to be A, we would have to assume that death is the only endpoint, which is likely not true. B makes much more sense, even thouth A or B could be true.

 

[Idiopathic]

A 16 y/o girl has generalized weakness and nocturnal leg cramps. She is not taking any meds. Labs: Na 135, Cl 108, K 2.8 HCO3 21 Urine pH 7. DX:

a) Adrenal insufficiency,
b) hyporeninemic hypoaldosteronism
c) nephrogenic diabetes insipidus
d) renal tubular acidosis
e) SIADH

I'd guess D


Why not B

Probably not RTA. Normal biarbonate and no gap.

a) Not likely d/t low K.
b) Not likely d/t low K.
c) Would likely see solute concentration
d) Explained above
e) My vote, due to the fact that I ruled out everything else😉

Would like to know the answer though.

 

[02115]

A patient who is taking probenecid is expected to have increased excretion of
a) Cephalosporin
b) Creatinine
C) Penicillin
D) Tetracycline
E) Urate

Well, probenecid is uricosuric! DOH! I can't believe I missed that. Probenecid will inhibit the secretion of penicillin.

The prevalence of a disease is half as great in town A than B, but the incidence of the disease is no different. Which explains these findings

A) Case fatality rate is twice as high in A
B) Duration is twice as long in B
C) Number of new cases in A is twice B
D) People in town A use medical care facilities half as often as those in B
E) Proportion of asymptomatic cases is twice as much in B than A

I was really stressed about A vs. B but the reason why I discarded B was that imagine if this is like a really short disease that lasts maybe minutes (Anaphylaxis???). Then I couldn't see how the prevalence would be different.

 

[02115]

PKU is autosomal recessive. What is the probability that the asymptomatic brother or sister of a child w/ disease is a heterozygous carrier

A) 0
B) 1/4
C) 1/2
D) 2/3
E) 3/4


Last one is a trick question. The probability is going to be 2/3. They said the brother or sister is Asymptomatic hence they cannot be the xx genotype(recessive). So they can either be XX Xx ==> Answer is 2/3. I agree with the rest of Idiopathic's answers.

I am confused about this. I thought about that answer too during the exam, but isn't the probability of having a disease intrinsic and not influenced by whether or not a sibling has it? For example, like flipping a coin. You always have a 1/2 chance of heads even if you got ten heads in a row before?????

 

[Idiopathic]

I am confused about this. I thought about that answer too during the exam, but isn't the probability of having a disease intrinsic and not influenced by whether or not a sibling has it? For example, like flipping a coin. You always have a 1/2 chance of heads even if you got ten heads in a row before?????

Your statement is correct, but it says the person of interest is 'asymptomatic' and therefore, CANNOT be x/x. For this individual the only options are X/X (1/3) or X/x (2/3). If it left out 'asymptomatic' then it would be 50%.

 

[xjacob]

I am confused about this. I thought about that answer too during the exam, but isn't the probability of having a disease intrinsic and not influenced by whether or not a sibling has it? For example, like flipping a coin. You always have a 1/2 chance of heads even if you got ten heads in a row before?????

True, it has no bearing on the probability, per se, but it does give us some info about the family's genes.
Consider the following scenarios (where A is a helathy allele and a is unhealthy and we are looking at parental genotypes:
1) AA AA
2) AA Aa
3) AA aa
4) Aa Aa
5) Aa aa
6) aa aa


We can discard 1), 2), 3) (no way to get an aa kid), 6) all kids would be aa.
So we are left with Aa Aa and Aa aa.
For Aa Aa, there is a chance of 2/3 of being a heterozyg (knowing that he's asymptomatic), while for Aa aa there is also a chance of 100%.
Now, I am not sure about the allelic frequency in PKU, but I am guessing it is not that high, so the parents are much more likely to be Aa Aa (rather than Aa aa), so 2/3 seems to be the right answer (although I'd say "a little higher than 2/3").

 

[02115]

Your statement is correct, but it says the person of interest is 'asymptomatic' and therefore, CANNOT be x/x. For this individual the only options are X/X (1/3) or X/x (2/3). If it left out 'asymptomatic' then it would be 50%.

You are sooo right! Thanks for explaining that!

 

[lealf-ye]

Young couple unable to conceive. Normal sperm quality and quantity. Woman has regular menstrual cycles and takes no contraceptives. Sinus shows epithelial cells with majority of cilia bent at half their length. The most likely functional cause of infertility is:

A) Capacitation of spermatozoa
b) Completion of meiosis by ovulated oocytes
c) Implantation into uterus
D) Migration of conceptus
E) Mobility of spermatazoa

(D???) This I think it is actually E. I don't think it is D, b/c to my knowledge the movement in the fallopian tubes is mostly peristaltic rather than cilliary beats. Likewise, I don't think it is A, b/c capacitation refers to a bunch of enzymatic reactions allowing spermatozoa to move. I think it is E, b/c with reduced cilliary function, the cervical mucus is likely to accumulate, rendering it inpenetrable to the sperm...but this is just a guess (I'm actually not sure if there are ciliated cells in that area)


I think the person who has the problem with cilia is the female. So I will pick D.

 

[Idiopathic]

Young couple unable to conceive. Normal sperm quality and quantity. Woman has regular menstrual cycles and takes no contraceptives. Sinus shows epithelial cells with majority of cilia bent at half their length. The most likely functional cause of infertility is:

A) Capacitation of spermatozoa
b) Completion of meiosis by ovulated oocytes
c) Implantation into uterus
D) Migration of conceptus
E) Mobility of spermatazoa

(D???) This I think it is actually E. I don't think it is D, b/c to my knowledge the movement in the fallopian tubes is mostly peristaltic rather than cilliary beats. Likewise, I don't think it is A, b/c capacitation refers to a bunch of enzymatic reactions allowing spermatozoa to move. I think it is E, b/c with reduced cilliary function, the cervical mucus is likely to accumulate, rendering it inpenetrable to the sperm...but this is just a guess (I'm actually not sure if there are ciliated cells in that area)


I think the person who has the problem with cilia is the female. So I will pick D.

Thats the key. I assumed it was with the female as well. Otherwise its Kartageners syndrome and its E.

 

[xjacob]

Thats the key. I assumed it was with the female as well. Otherwise its Kartageners syndrome and its E.

Well that's not what I was arguing. I think the q. is clearly indicating that the spermatozoa are ok and that the problem is on the side of the female.
Anyway, contrary to my general policy not to look up things during the boards time, I googled this, since it was driving me crazy. It turns out that women with the immotile cilia Sx are less fertile (but usu. not totally infertile, as men would be). They say the reason for this remains "controversial" but the best theory is impairment of oocyte/conceptus migration thru the tubes and uterus. Since most of this movement is done by muscular contractions, rather than cilia, female fertility is not as imared.
Anyway, I think it is really weird to put q's on the test that contain "controversial" issues, whose mechanism is far from clear...so I think this q. is really unfair.

 

[daktar]

I think you are right actually. For it to be A, we would have to assume that death is the only endpoint, which is likely not true. B makes much more sense, even thouth A or B could be true.

My only reason for choosing B...

Prevalence= Incidence X duration.

Both have the same incidence, so the only thing that would make the prevalence in A half of that in B would be an increase in duration in town B

 

[Idiopathic]

My only reason for choosing B...

Prevalence= Incidence X duration.

Both have the same incidence, so the only thing that would make the prevalence in A half of that in B would be an increase in duration in town B

Yes, but assuming everyone died from the disease, then a doubling of the death rate would have the same effect. However, if the death rate were only 1%, then doubling the death rate would definitely not cut the prevalance in half.

 

[exmike]

Probably not RTA. Normal biarbonate and no gap.

a) Not likely d/t low K.
b) Not likely d/t low K.
c) Would likely see solute concentration
d) Explained above
e) My vote, due to the fact that I ruled out everything else😉

Would like to know the answer though.

it is RTA. She is pissing off K+ and retaining H+. Elevated urine pH proves she is retaining acid. Anion gap doesnt matter.

 

[exmike]

I think the consequence of DKA is dehydration but the cause is usually some kind of stress. I will pick D infection

Any stressor (esp infection) can precipitate DKA in DMI

 

[xjacob]

it is RTA. She is pissing off K+ and retaining H+. Elevated urine pH proves she is retaining acid. Anion gap doesnt matter.

I agree, but I am still not really sure what RTA is. I mean, I remember learning back in renal about like the 3 types of RTA's etc. etc. that all had different presentations. I also got the impression that they were congenital/early onset...which is prob. not entirely true given this question.
Also, "pissing off K+ and retainind H+", isn't that similar to what acetazolamide does?
The last thing I remember about RTA's is that they present with acidosis WITHOUT anion gap. So, once you infer from her urine pH that she's acidotic, it is nice to know that anion gap (although, I agree that it is sorta redundant here).
Anyway, if anyone knows anything "useful" about RTA's, I'd really appreciate some info (I just don't ant to read another one of those 10 page articles on RTA that spend more time explaining how RTA IIb-alpha1 differs from RTA IIb-alpha3.4, than what it RTA actually is).

 

[keeping-it-real]

PKU is autosomal recessive. What is the probability that the asymptomatic brother or sister of a child w/ disease is a heterozygous carrier

A) 0
B) 1/4
C) 1/2
D) 2/3
E) 3/4


Last one is a trick question. The probability is going to be 2/3. They said the brother or sister is Asymptomatic hence they cannot be the xx genotype(recessive). So they can either be XX Xx ==> Answer is 2/3. I agree with the rest of Idiopathic's answers.

isn't the key here "heterozygous carrier"?

wouldn't it then eliminate XX and you'd just be left with the probability of being Xx... i.e. 1/2 ?

 

[exmike]

isn't the key here "heterozygous carrier"?

wouldn't it then eliminate XX and you'd just be left with the probability of being Xx... i.e. 1/2 ?

The "trick" here is that since the person in question does not have the disease, she cannot be xx, therefore, there are only three squares on the punnet square she can be. Xx, xX, and XX. so it is 2/3

 

[02115]

I think this is RTA. From Wikipedia:http://en.wikipedia.org/wiki/Renal_tubular_acidosis

Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and in increase in plasma chloride concentration.

One of the most important causes of hyperchloremic acidosis is renal tubular acidosis (RTA).

Is this even in FA??? I have never even heard of this before

It wouldn't entirely surprise me if this is one of the "thrown out" questions as the definition of type IV RTA seems to overlap with hyporeninemic hypoaldosteronism.http://www.emedicine.com/med/topic1139.htm

 

[exmike]

I think this is RTA. From Wikipedia:http://en.wikipedia.org/wiki/Renal_tubular_acidosis

Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and in increase in plasma chloride concentration.

One of the most important causes of hyperchloremic acidosis is renal tubular acidosis (RTA).

Is this even in FA??? I have never even heard of this before

It wouldn't entirely surprise me if this is one of the "thrown out" questions as the definition of type IV RTA seems to overlap with hyporeninemic hypoaldosteronism.http://www.emedicine.com/med/topic1139.htm

Its not in FA, but we were taught it in our renal course.

 

[keeping-it-real]

The "trick" here is that since the person in question does not have the disease, she cannot be xx, therefore, there are only three squares on the punnet square she can be. Xx, xX, and XX. so it is 2/3

i guess i'm not following you.

i agree they can't be xx since they do not have the disease.

but you are saying they can be XX which which i don't agree with because that's not a heterozygous condition. XX is neither heterozygous nor a carrier. Perhaps i'm missing something, though. Anyone else care to comment?

 

[exmike]

i guess i'm not following you.

i agree they can't be xx since they do not have the disease.

but you are saying they can be XX which which i don't agree with because that's not a heterozygous condition. XX is neither heterozygous nor a carrier. Perhaps i'm missing something, though. Anyone else care to comment?

Ok rephrase. If she is not diseased (xx), then she can be either Xx, xX, or XX. Since she MUST be a carrier, she can be Xx, and xX but not XX, and thus 2/3 possible combinations.

 

[keeping-it-real]

Ok rephrase. If she is not diseased (xx), then she can be either Xx, xX, or XX. Since she MUST be a carrier, she can be Xx, and xX but not XX, and thus 2/3 possible combinations.

ah... it just clicked.

that is sneaky...

 

[Idiopathic]

Im an idiot. That is a slightly decreased HCO3 level, but still decreased, and RTAs have no gap, I should have remembered that. Looks like RTA to me.

 

[Idiopathic]

I think this is RTA. From Wikipedia:http://en.wikipedia.org/wiki/Renal_tubular_acidosis

Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and in increase in plasma chloride concentration.

One of the most important causes of hyperchloremic acidosis is renal tubular acidosis (RTA).

Is this even in FA??? I have never even heard of this before

It wouldn't entirely surprise me if this is one of the "thrown out" questions as the definition of type IV RTA seems to overlap with hyporeninemic hypoaldosteronism.http://www.emedicine.com/med/topic1139.htm

This is pretty straightforward, but I had to review a little bit of renal, since its been about 2 years since Ive had a renal lecture. Non gap acidosis are caused by either loss of pure bicarb or gain of pure H+, so the main etiologies are: intrinsic renal disease, diarrhea (hypersecretory things) and weird stuff like carbonic anhydrase inhibitors and pancreatic fistulae. But the key when you see a nongap acidosis (which isnt superevident here with only a minimally decreased bicarb) is to think loss/retention of end product = end organ damage.

This is not type IV RTA (or hyporenin/hypoaldosterone) but it could be type 1 RTA.

 

[BRUINMD]

PKU is autosomal recessive. What is the probability that the asymptomatic brother or sister of a child w/ disease is a heterozygous carrier

The definition for AR inheritance is Both parents are HETEROZYGOTES who Do NOT Phenotypically manifest the disorder. 1/4 of their children will be HOMOzygous for the trait and will phenotypically manifest the disorder. 1/4 of the children will NOT inherit the trait (i.e. AA). 1/2 of the children will be HETEROZYGOTES (i.e. Aa or aA .. same thing).

This Q is about Asympotmatic (i.e do not Phenotypically manifest the disorder) bro or sis of the child w/disease is a HETEROZYGOUS carrier.
so if you read the def. again, both of the parents are Heterzygotes and also are Asymptomatic (they are Both Aa). So that will give you the answer that 50% chance that the child's bro or sister will be a Asymptomatic and a heterzygous carrier. 😛

 

[(nicedream)]

PKU is autosomal recessive. What is the probability that the asymptomatic brother or sister of a child w/ disease is a heterozygous carrier

The definition for AR inheritance is Both parents are HETEROZYGOTES who Do NOT Phenotypically manifest the disorder. 1/4 of their children will be HOMOzygous for the trait and will phenotypically manifest the disorder. 1/4 of the children will NOT inherit the trait (i.e. AA). 1/2 of the children will be HETEROZYGOTES (i.e. Aa or aA .. same thing).

This Q is about Asympotmatic (i.e do not Phenotypically manifest the disorder) bro or sis of the child w/disease is a HETEROZYGOUS carrier.
so if you read the def. again, both of the parents are Heterzygotes and also are Asymptomatic (they are Both Aa). So that will give you the answer that 50% chance that the child's bro or sister will be a Asymptomatic and a heterzygous carrier. 😛

As was explained by some of the other posters previously, while prior to birth (before symptoms would be apparent) the chances would be 2/4, we know that the sibling is asymptomatic in this case - ruling out aa. Thus the possibilities are only AA, Aa, and Aa - 2/3 chance of being a carrier.