just finishes nbme 13, i searched for some answers, but still not quite certain about several questions, can anyone help give some simple explanation to it? thanks alot
#1 previously healthy 54 yo man comes to the clinic because of lightheadedness for 6
hours. His symptoms began after skiing at a resort at an altitude of 9000 ft. he
has been taking a carbonic anhydrase inhibitor since 2 days before arriving at the
resort. His BP is 110/60 which sitting and 95/50 while standing. PE shows no other
abnormalities. Which of the following is the most likely cause of his orthostatic
hypotension?
a). High-alt. sickness
b). Hypovolemia
c). Hypoxia
d). Impaired sympathetic nerve activity (wrong)
e). Respiratory alkalosis
i think carbonic anhydrase inhibitor does not have strong diuretic effect,not enough to cause hypovolemia?
#2 A 43-year-old woman with metastatic colon cancer has maintained remission by
taking bevacizumab as a single agent. The ability to administer this agent despite
it being a foreign protein is most likely a result of which of the following?
a.The agent being a humanized antibody
b.The agent containing the variable region of a murine antibody molecule directed
against vascular endothelial growth factor
c.B-cell dysfunction
d.The immunosuppressive effect of previously administered chemotherapy
e.T-cell dysfunction (wrong)
3# A 22 yo woment comes to the physician 3 months after she noticed a painless slowly
enlarging mass on the left side of her neck. PE shows a freely mobile soft cystic
mass with a cutaneous surface opening. the physicial explain that it is from
incomplete fusion during embryo development. which of the following is the most
likely location of the opening of the duct leading to the mass of the pt?
a. ant. to the sternocleidomastoid muscle
b. midline of the neck
c. postauricular
d. pos. to the parotid gland
e. submental
4# 5 year old boy is brought to physician by his mother bc of progressive clumsiness
and fatigue for the past 6 months.He said his legs are tired.Delivered at term
after uncomplicated pregnancy. He has met all developmental milestones although
there was some delay compare to other children his age. He is alert and has
difficulty rising from chair;he uses his arms to push himself into a standing
position.He can't jump with both feet together.PE shows hypertrophy of the calf
muscles.This pt most likely has weak hip adduction as a result of disfunction of a
muscle inserting onto the femur from which of the following locations:
a anterior sacrum
b iliac crest
c iliac spine
d ischium
e lateral ilium
5#A 25 yr.old woman undergoes a radical mastectomy with axiallary LYMPH NODES
removal of left side. after the operation she develops painful edema of left upper
extremity.
which of the following is most likely to decrease swelling
a.application of heat
b.compression sleeve
c.diuretic therapy
d.exercise therapy
e.passive movement
6# A 54-year-old man has a squamous cell carcinoma of the right lung. Analysis of his
germline DNA shows two alleles. m and n, at the microsatellite locus Z tightly
linked to the p53 gene. Similar analysis of the
neoplastic cells shows the presence of the m allele only. These findings are most
likely due to which of the following processes?
A) Germline mosaicism
B) Loss of heterozygosity. right?
C) p53 Gene amplification
D) Pericentric inversion involving p53 and locus Z
E) Point mutation of allele n WRONG
7# A study is conducted to evaluate the onset and course of cardiovascular disese in
african american men and women in the USA. census data from the year 2000 are used
to select the study sample. Aseries of factors including family income and years
of education is defined. census tratcs most representive of the national census
data for the factors selected are used for sampling whch of the following best
describes this sampling tecnique
a blocked randomization
b population based
c sample of convenience
D self selection
E sequential
8# A 63-year-old man comes to the emergency department 30 minutes after the sudden
onset of right-sided chest pain and shortness of breath that began after a 10-hour
drive in his truck. The pain is more severe with inspiration. He does not smoke
cigarettes. His pulse is 110/min, and respirations are 32/min. The lungs are clear
to auscultation. Which of the following findings is most likely on ventilation-
perfusion lung scans?
A) Absence of perfusion in some areas that are ventilated
B) Absence of ventilation in some areas that are perfused
C) Absence of ventilation-perfusion mismatching
D) Decreased perfusion gradient from the apices to the bases of the lungs
E) Increased ventilation-perfusion ratios at lung bases compared with those at the
apices
#9 A 52-year-old man comes to the physician because of a 3-month history of
epigastric abdominal pain; he also has had an unintentional 6.8-kg (15-lb) weight
loss during this period. He has osteoarthritis treated with naproxen as needed. He
has immigrated to the UsA from Japan 6 months ago. He eats mostly traditional
Japanese food prepared by his wife. He has smoked 2 packs of cigarettes daily for
30 years and drinks three to four glasses of wine daily. He is 170 cm (5 ft 7 in)
tall and now weighs 82 kg (180 lb); BMI is 28 kg/m^2. Physical examination shows
epigastric tenderness. Upper gastrointestinal endoscopy shows a 4-cm ulcer in the
stomach. Examination of a biopsy specimen of the lesion confirms adenocarcinoma.
Which of the following is the strongest predisposing risk factor for the patient's
condition?
A. Alcohol use
B. Diet
C. Ethnicity
D. Naproxen
E. Tobacco use
#10 A 16year old boy has a 6 month history of type 1 diabetes mellitus and requires
daily insulin injections. his blood glucose control has been poor recently, which
the physician suspects may be related to the pt's rluctance to self administer
insulin. which of the following questions is most appropriate to broach this issue
with the pt?
A> givin yourself insulin injections can be difficult. what's it like for you?
B> i get the feeling you have not been taking your insulin regularly. would you
like me to arrange some training for you by our nurses?
C> its been my experience that most poorly controlled diabetics have trouble
giving themselves insulin. do you have this problem?
D> you are clearly having difficulty with insulin injections. would you like to
arrange for a family member to give you your shots?
E> you seem to have missed your shots. how often has this happend?
#11 A 72 year old man is brought to the emergency department because of a 1-week
history of increasingly severe abdominal pain, diarrhea, and loss of appetite. He
has had a fever for 2 days. His temperature is 101 F, and pulse is 106/min.
Abdominal exam shows distention and rebound tenderness localized to the left lower
quadrant. His leukocyte count is 18,000/mm3 (segmented neutrophils 80%, bands 10%,
lymphocytes 10%). An abdominal CT scan with contrast shows a 7mm thickened colonic
wall, and pericolic fat inflammation; there is a collection of contrast in this
region. Which of the following is the most likely diagnosis?
A) Amebiasis
B) Collagenous Colitis
C) Colon Cancer
D) Diverticulitis
E) Ulcerative Colitis
#1 previously healthy 54 yo man comes to the clinic because of lightheadedness for 6
hours. His symptoms began after skiing at a resort at an altitude of 9000 ft. he
has been taking a carbonic anhydrase inhibitor since 2 days before arriving at the
resort. His BP is 110/60 which sitting and 95/50 while standing. PE shows no other
abnormalities. Which of the following is the most likely cause of his orthostatic
hypotension?
a). High-alt. sickness
b). Hypovolemia
c). Hypoxia
d). Impaired sympathetic nerve activity (wrong)
e). Respiratory alkalosis
i think carbonic anhydrase inhibitor does not have strong diuretic effect,not enough to cause hypovolemia?
#2 A 43-year-old woman with metastatic colon cancer has maintained remission by
taking bevacizumab as a single agent. The ability to administer this agent despite
it being a foreign protein is most likely a result of which of the following?
a.The agent being a humanized antibody
b.The agent containing the variable region of a murine antibody molecule directed
against vascular endothelial growth factor
c.B-cell dysfunction
d.The immunosuppressive effect of previously administered chemotherapy
e.T-cell dysfunction (wrong)
3# A 22 yo woment comes to the physician 3 months after she noticed a painless slowly
enlarging mass on the left side of her neck. PE shows a freely mobile soft cystic
mass with a cutaneous surface opening. the physicial explain that it is from
incomplete fusion during embryo development. which of the following is the most
likely location of the opening of the duct leading to the mass of the pt?
a. ant. to the sternocleidomastoid muscle
b. midline of the neck
c. postauricular
d. pos. to the parotid gland
e. submental
4# 5 year old boy is brought to physician by his mother bc of progressive clumsiness
and fatigue for the past 6 months.He said his legs are tired.Delivered at term
after uncomplicated pregnancy. He has met all developmental milestones although
there was some delay compare to other children his age. He is alert and has
difficulty rising from chair;he uses his arms to push himself into a standing
position.He can't jump with both feet together.PE shows hypertrophy of the calf
muscles.This pt most likely has weak hip adduction as a result of disfunction of a
muscle inserting onto the femur from which of the following locations:
a anterior sacrum
b iliac crest
c iliac spine
d ischium
e lateral ilium
5#A 25 yr.old woman undergoes a radical mastectomy with axiallary LYMPH NODES
removal of left side. after the operation she develops painful edema of left upper
extremity.
which of the following is most likely to decrease swelling
a.application of heat
b.compression sleeve
c.diuretic therapy
d.exercise therapy
e.passive movement
6# A 54-year-old man has a squamous cell carcinoma of the right lung. Analysis of his
germline DNA shows two alleles. m and n, at the microsatellite locus Z tightly
linked to the p53 gene. Similar analysis of the
neoplastic cells shows the presence of the m allele only. These findings are most
likely due to which of the following processes?
A) Germline mosaicism
B) Loss of heterozygosity. right?
C) p53 Gene amplification
D) Pericentric inversion involving p53 and locus Z
E) Point mutation of allele n WRONG
7# A study is conducted to evaluate the onset and course of cardiovascular disese in
african american men and women in the USA. census data from the year 2000 are used
to select the study sample. Aseries of factors including family income and years
of education is defined. census tratcs most representive of the national census
data for the factors selected are used for sampling whch of the following best
describes this sampling tecnique
a blocked randomization
b population based
c sample of convenience
D self selection
E sequential
8# A 63-year-old man comes to the emergency department 30 minutes after the sudden
onset of right-sided chest pain and shortness of breath that began after a 10-hour
drive in his truck. The pain is more severe with inspiration. He does not smoke
cigarettes. His pulse is 110/min, and respirations are 32/min. The lungs are clear
to auscultation. Which of the following findings is most likely on ventilation-
perfusion lung scans?
A) Absence of perfusion in some areas that are ventilated
B) Absence of ventilation in some areas that are perfused
C) Absence of ventilation-perfusion mismatching
D) Decreased perfusion gradient from the apices to the bases of the lungs
E) Increased ventilation-perfusion ratios at lung bases compared with those at the
apices
#9 A 52-year-old man comes to the physician because of a 3-month history of
epigastric abdominal pain; he also has had an unintentional 6.8-kg (15-lb) weight
loss during this period. He has osteoarthritis treated with naproxen as needed. He
has immigrated to the UsA from Japan 6 months ago. He eats mostly traditional
Japanese food prepared by his wife. He has smoked 2 packs of cigarettes daily for
30 years and drinks three to four glasses of wine daily. He is 170 cm (5 ft 7 in)
tall and now weighs 82 kg (180 lb); BMI is 28 kg/m^2. Physical examination shows
epigastric tenderness. Upper gastrointestinal endoscopy shows a 4-cm ulcer in the
stomach. Examination of a biopsy specimen of the lesion confirms adenocarcinoma.
Which of the following is the strongest predisposing risk factor for the patient's
condition?
A. Alcohol use
B. Diet
C. Ethnicity
D. Naproxen
E. Tobacco use
#10 A 16year old boy has a 6 month history of type 1 diabetes mellitus and requires
daily insulin injections. his blood glucose control has been poor recently, which
the physician suspects may be related to the pt's rluctance to self administer
insulin. which of the following questions is most appropriate to broach this issue
with the pt?
A> givin yourself insulin injections can be difficult. what's it like for you?
B> i get the feeling you have not been taking your insulin regularly. would you
like me to arrange some training for you by our nurses?
C> its been my experience that most poorly controlled diabetics have trouble
giving themselves insulin. do you have this problem?
D> you are clearly having difficulty with insulin injections. would you like to
arrange for a family member to give you your shots?
E> you seem to have missed your shots. how often has this happend?
#11 A 72 year old man is brought to the emergency department because of a 1-week
history of increasingly severe abdominal pain, diarrhea, and loss of appetite. He
has had a fever for 2 days. His temperature is 101 F, and pulse is 106/min.
Abdominal exam shows distention and rebound tenderness localized to the left lower
quadrant. His leukocyte count is 18,000/mm3 (segmented neutrophils 80%, bands 10%,
lymphocytes 10%). An abdominal CT scan with contrast shows a 7mm thickened colonic
wall, and pericolic fat inflammation; there is a collection of contrast in this
region. Which of the following is the most likely diagnosis?
A) Amebiasis
B) Collagenous Colitis
C) Colon Cancer
D) Diverticulitis
E) Ulcerative Colitis
