NBME 11 discussion

[CD15]

Those who have done NBME 11 can you please suggest the correct answers for the following questions

Don't read the questions if you are planning to do NBME 11

1. A 62-year-old man is brought to the physician by his wife because of increasing confusion during the past 6 months. His wife says that he has become lost twice in the past month when going to work, even though he has been going to the same office for 12 years. She adds that he often has difficulty finding objects such as his glasses and keys, sometimes
cannot recall his grandchildren’s names, and has become very critical of her cooking, which he used to enjoy. When asked, he can name only the current president and none of the candidates for an upcoming presidential election, although he and his wife watch the television news together each night. Neurologic examination shows no motor or sensory abnormalities. His Mini-Mental State Examination score is 19/30. Treatment with a cholinesterase inhibitor is most likely to improve this patient’s memory because of its ability to target synaptic connections between which of the following structures?
A) The basal forebrain and neurons in the cerebral cortex
B) The dentate nucleus and the thalamus
C) The fornix and neurons in the mammillary bodies
D) The substantia nigra and the neurons of the globus pallidus
E) The thalamus and neurons in layer 4 of the cerebral cortex

( C is wrong)

2. A male newborn delivered at term has marked hypopigmentation with white hair, milky white skin, and blue irides. The most likely cause of this condition is a defective enzyme
contained in which of the following organelles?
A) Golgi complex
B) Lysosomes
C) Melanosome
D) Mitochondria
E) Nucleus

(I picked Golgi complex & was wrong. I though that given melanin is a amino acid derivative, may be it was synthesiZed in Golgi & then transferred to the melanosomes. So I guess it's C) Melanosome)

3. A 1-year-old boy is brought to the emergency department because of a 6-day history of temperatures to 39.4°C (103°F) and a 2-day history of a severe diaper rash and swelling of his hands and feet. His temperature is now 39.4°C (103°F). (Image showing baby with erythematous rash in both groin) The face and lips appear red and the conjunctivae appear injected. There is bilateral cervical lymphadenopathy. The lungs are clear to auscultation. Cardiac examination shows an S3 gallop with no murmur. There is edema and erythema of the hands and feet. Which of the following pathologic findings is most likely in this patient?
A)Acute arteritis with aneurysms in coronary arteries
B)Epidermal hyperplasia with epidermal microabscesses and parakeratosis
C)Granulomas with caseous necrosis in cervical lymph nodes
D)Granulomatous arteritis in cervical and temporal arteries
E)Paracortical lymphoid hyperplasia with eosinophilic intranuclear inclusions in perihilar lymph nodes
(I missed this question somehow. Is this Kawasaki's ds? A?)

4. A 24-year-old man comes to the physician because of a 3-month history of inability to obtain an erection and occasional penile pain. He also has had mild chronic back pain for 2 years and hemorrhoids that bleed on occasion. He is married and has a 2-year-old son. He enjoys his job, and he and his wife have a good relationship. He lifts weights regularly and trains on his bicycle. He usually rides for 2 hours daily during the week and 5 to 6 hours daily on the weekend. On questioning, he does not recall having spontaneous nocturnal erections. Physical examination shows no abnormalities except for back tenderness and external hemorrhoids. Which of the following is the most likely cause of this patient’s erectile
dysfunction?
A) Compromised blood flow from the pampiniform plexus
B) Damaged blood and nerve supply to the erectile tissue
C) Lumbosacral strain
D) Obturator nerve compression
E) Pressure of hemorrhoids on the erectile tissue

( C is wrong)

5. A study is conducted to assess the relationship between age and serum total cholesterol concentration in three groups. Group X consists of 50 children (ages 6 to 10 years), Group Y consists of 50 adolescents (ages 12 to 16 years), and Group Z consists of 50 young adults (ages 21 to 25 years). The fasting serum total cholesterol concentration is measured in all participants. Which of the following statistical tests is most appropriate to compare the serum total cholesterol concentration results among Groups X, Y, and Z in this study?
A) Analysis of variance
B) Chi-square test
C) Independent t-test
D) Multiple logistic regression
E) Paired t-test
F) Pearson's correlation

(I guess this would be A) ANOVA however, I picked F) because I thought the study wanted to "assess the relationship between age and serum total cholesterol concentration" )

6. During an experiment, the US1 1 gene product of cytomegalovirus is expressed constitutively after stable transfection in an experimental tumor cell line. It is found that this gene product causes translocation of nascent class I MHC molecules from the endoplasmic reticulum into the cytosol. Which of the following is most likely to occur regarding the class I
MHC products?
A) Association with invariant chain
B) Binding of peptides from the endocytic pathway
C) Degradation by the proteasome
D) Formation of class I MHC/class II MHC hybrid molecules
E) Interaction with the T-Iymphocyte receptor

( E is wrong)

7. A female newborn delivered at term is found to have a cleft palate with cleft lip bilaterally. Physical examination shows no other abnormalities. Cranial ultrasonography shows no abnormalities. Failure of fusion at which of the following sites is the primary cause of this patient’s cleft lip?
A) Frontonasal and eye prominences
B) Frontonasal and maxillary prominences
C) Mandibular process and external auditory meatus
D) Mandibular prominence and secondary pharyngeal arch
E) Maxillary and nasal prominences

(I always get confused, I picked B and it was wrong. So I guess it's E?)

8. A 25-year-old man with type 1 diabetes mellitus comes to the physician because of poor diabetic control for 3 months. He has had ketones in his urine, and his blood glucose concentrations have been in the 200—400 mg/dL range, particularly after exercise. He has been receiving two injections of insulin daily. Physical examination shows no abnormalities. His hemoglobin A1 is 12%. Following exercise on a treadmill for 45 minutes, the patient has an increase in his serum glucose concentration from 175 mg/dL to 225 mg/dL. Which of the following hepatic enzymes is most likely activated initially by exercise in this patient?
A) Debranching enzyme
B) Glycogen synthase
C) Phospholipase C
D) Phosphorylase kinase
E) Protein kinase B
F) Protein kinase G
G) Receptor protein-tyrosine kinase

(A is wrong)

9. A 32-year-old woman is found to have panic disorder with agoraphobia. A drug is prescribed that activates benzodiazepine binding sites on the y-aminobutyric acid A (GABA-A) receptor. This drug is most likely which of the following?
A) Alprazolam
B) Buspirone
C) Flumazenil
D) Hydroxyzine
E) Ramelteon

(A?)

10. A 28-year-old woman wants to lose weight. She is 160 cm (5 ft 3 in) tall and weighs 81.5 kg (180 Ib); BMI is 32 kg/m2. She consumes 1800 calories daily and has a sedentary lifes tyle. Assume that there are 3500 calories per pound and that brisk walking consumes 500 calories per hour. Which of the following regimens is most likely to help her lose 0.9 kg (2 Ib) weekly?

----Calories Per Day--------Brisk Walking Daily
A) Decrease by 100------------- 1/2 hour
B) Decrease by 100------------- 1 hour
C) Decrease by 500------------- 1/2 hour
D) Decrease by 500------------- 1 hours
E) No change ------------------- 1 hour
F) No change ------------------- 1/2 hours

(E?)

11. A 35-year-old man who is an undocumented immigrant is diagnosed with tuberculosis. Despite feeling ill, he did not previously seek medical care because he could not afford to lose time at work. He pleads with the physician not to report the diagnosis to anyone because he is afraid he will be deported. After empathizing with the patient, it is most appropriate for the physician to take which of the following actions?
A) Do not report the case and insist that the patient wear a mask at all times
B) Do not report the case as long as the patient agrees to isolate himself while being treated
C) Do not report the case because that would violate the patient’s right to privacy and confidentiality
D) Do not report the case, but begin contacting the patient’s family members and work site contacts directly to arrange for evaluation
E) Report the case to the health department but assure the patient that no other individuals will be notified
F) Report the case to the health department to ensure that family members and work site contacts are identified and evaluated
G) Report the case to the immigration and naturalization service


12. A 40-year-old woman comes to the physician because of a 2-month history of increasing redness around her nose and cheeks, and pimples around her mouth. She appears very upset and tells the physician, “I look like a teenaged Santa Claus.” Which of the following initial responses by the physician is most appropriate?
A) “Can you tell me how often you go out in the sun and what kind of protection you use?”
B) “Don’t worry. Let me assure you this is not a serious condition.”
C) “It’s upsetting when you have a skin problem on your face.”
D) “Maybe a little. At least you are keeping your sense of humor about the situation.”
E) “You really do look rather odd. I can understand why you are so upset.”
(A is wrong)


13. One day after a total abdominal hysterectomy with salpingo-oophorectomy for stage Ill cervical cancer, a 42-year-old woman has abdominal distention. She has passed only 200 mL of urine since the operation. Ultrasonography shows an accumulation of fluid in the abdominal cavity; the physician suspects that the fluid is urine. This patient most likely sustained injury to the ureter during intraoperative ligation of which of the following arteries?
A) Internal iliac artery
B) Ovarian artery
C) Pudendal artery
D) Superior vescicle arteries
E) Ureteric branches of the renal artery

(I guess this should be B) ovarian artery in the infundibulo-pelvic ligament)

14. A 60-year-old man comes to the physician for a routine health maintenance examination. Physical examination shows no abnormalities.
Urinalysis shows:
pH 6.0
Specific gravity 1.018
Blood 3+
Glucose negative
Protein 1+
Microscopic examination of the urine shows atypical cells. A CT scan of the abdomen discloses a lesion of the right kidney. (Gross image of kidney cut section showing whitish mass filling renal pelvis and calyces) Which of the following compounds is the most significant predisposing risk factor for this patient’s condition?
A) Arsenic
B) Beryllium
C) 2-Naphthylamine
D) Nickel
E) Vinyl chloride
(could this be B? A was wrong)


I scored borderline in Behavioral Sciences
I have done Behav. Sc from BRS & UWorld but these questions were like weird! Any suggestions on how to improve on Behav Sc?

If you have any other questions regarding NBME 11 I would be glad to discuss those

Thanks & good luck to all.

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[sanityonleave]

Just took NBME 11. I didn't get feedback, so I can't guarantee these are correct.

1. A) basal forebrain / neurons in the cerebral cortex -- he has classic Alzheimer's disease which is caused (at least in part) by a decrease in ACh release from the basal nucleus of Mynert.

2. C) melanosome -- not sure on this one, but he has albinism due to a deficiency of tyrosinase, which I think is a melanosome enzyme.

3. A) acute arteritis with aneurysms in the coronary arteries -- yup, Kawasaki's. Weird picture but the description was classic.

4. B) damaged blood and nerve supply to the erectile tissue -- bike riding

5. A) ANOVA -- comparing means between more than two groups = ANOVA

6. C) degradation by the proteasome -- wrong localization signal = MHC I ends up in cytoplasm = degraded because it shouldn't be there.

7. I put B as well and missed this one, so I'm guessing E is correct. I hate embryo.

8. D) phosphorylase kinase -- activates glycogen phosphorylase to break down glyocgen. I don't know why A is wrong (since both A and D seem like they should be right), but I chose D since A seemed like too much of a "gimme" answer.

9. A) alprazolam -- at least I assume that's right. They said "benzodiazepine receptor" and that's the only benzo on the list.

10. D) decrease by 500 -- 1 hour -- I'm not sure about this one, but since she needs to lose 2# of fat/week = 7000 calories/week = decrease of 1000 cal/day, so 500 calorie intake decrease and 1 hour of walking. I went on the assumption that her 1800 cal/day was maintaining her current weight, but if that assumption is wrong my calculations are bonk.

11. I chose E for this but, in retrospect, I think the answer is F. The reason being that you can't assure him that no one else will be notified because the health department will notify his contacts and check them for TB since it's a reportable disease -- at least I think so.

12. C) It's upsetting when you have a skin problem on your face. You need to empathize with the patient before jumping right into questioning as she's clearly upset.

13. B) ovarian artery

14. C) 2-naphthylamine -- I just guessed on this one. Arsenic and vinyl chloride are both associated with hepatic angiosarcoma (and not with bladder cancer as far as I remembered), Beryllium is associated with lung disease, and nickel is associated with cutaneous hypersensitivity reactions but no systemic disease AFAIK. According to wikipedia, 2-naphthylamine is an aniline dye, but I didn't know that -- just used process of elimination.


As I said, not sure that these answers are correct, but I think most of them are. NBME 11 was tough, imho -- I took NBME 12 yesterday and dropped 7 points on NBME 11 (245 vs 252). I also scored borderline in behavioral sciences -- I think that mostly has to do with the stupid ethics questions, which are easy to miss and hard to study.

 

[CD15]

Hi sanityonleave
Thanks for the explanations. That weight loss/calories question tripped me up & had to rush the remaining questions in the block
How are you planning to improve your Behav Sc?

 

[MudPhud20XX]

Can anyone help me out with these questions

A 31 yr old man comes to the physician b/c of chronic pain decreased range of motion in the left knee. He runs 5 miles daily. Evaluation 2 months ago showed no structural abnormalities. The physician recommended physical therapy, use of nonsteroidal anti-inflammatory drugs (NSAIDs), and decreasing running. The patient stopped physical therapy after 1 week, rarely took NSAIDs, continued to run, and missed several appointments. Today he speaks with some sadness about inadequacy of his pain control. Which of the following best describes the personality trait exhibited by this behavior?

A. Borderline
B. Dependent
C. Histrionic
D. Obsessive-compulsive
E. Paranoid
F. Passive aggressive

A 57 yr old woman is brought to the emergency department b/c she has been unable to open her Lt. eye since she awoke 2 hours ago. She has no hx of trauma to the eye. Her vital signs are within normal limits. When the Lt. eyelid is raised during exam, her eye is fixed in the out position. When the pt. is asked to move her eye out, the eye intorts. An MRI of the brain shows an aneurysm of the left posterior communicating artery. The most likely cause of this pt's condition is compression of which of the following nerves?

A. Abducens nerve
B. Long ciliary nerve
C. Oculomotor nerve
D. Ophthalmic branch of the trigeminal nerve
E. Trochlear nerve


A 6 yr old girl is brought to the physician by her mother b/c of swollen, itchy eyes, a runny nose, and sneezing for the past week. Knowledge of which of the following components of the pt's hx is likely to be most productive in establishing a diagnosis?

A. new medication
B. new pet in the household
C. occupations of parents
D. recent illness in a family member
E. recent school performance

 

[tasar1898]

1) passive-aggressive: didn't do what was expected because of underlying "hate" for physician , didn't express direct aggression , now whines for inadequacy of tx--> typical passive aggressive... But could be borderline due to production
of Drama.. Could someone confirm?? Didn't pay for ext feedback

2) oculomotor , down and out gaze , Pcom aneurysm , check FA

3) new pet , symptoms shout ALLERGY!!

 

[MudPhud20XX]

1) passive-aggressive: didn't do what was expected because of underlying "hate" for physician , didn't express direct aggression , now whines for inadequacy of tx--> typical passive aggressive... But could be borderline due to production
of Drama.. Could someone confirm?? Didn't pay for ext feedback

2) oculomotor , down and out gaze , Pcom aneurysm , check FA

3) new pet , symptoms shout ALLERGY!!

Thanks man.

For the 2nd q, it says the pt's eye intorts... how is that down and out?, Isn't that more like down and in??

 

[MudPhud20XX]

Here are some more questions I got wrong and have no clue what the answers are. Any help is appreciated.

1. A 66 yr old man with type 2 diabetes mellitus and hypertension is brought to the emergency department 30 minutes after the sudden onset of Lt. eyelid dropping, double vision, and mild weakness of the Rt. hand and leg. His pulse is 88/min and regular, and Bp is 159/99. Exam of the head shows a substantially droopy Lt. eyelid, and in primary gaze, the Lt. eye is exotropic and somewhat lower than the Rt. He has slowed finger movements on the rt, a pronator drift with the Rt. hand, and mild hyperreflexia on the Rt. Which of the following is the most likely site and diagnosis of the Pt's lesion?

A. angular gyrus (Gerstmann syndrome)
B. dorsolateral thalamus (Dejerine-Roussy syndrome)
C. lower medulla (Wallenberg syndrome)
D. lower midbrain (Weber syndrome)
E. upper spinal cord (Horner syndrome)

2.

A lesion of which of the following lettered structures results in loss of the pupillary light reflex in the Lt. eye when light is shone into either eye?

 

[tasar1898]

CN3 signs + CST signs = medial midbrain . Memorize image for brain stem strokes

Loss of pup reflex on left = left cn3 = G in the image

Dunno what "intorts" means ..
God I have to stop checking SDN and read FA..

 

[MudPhud20XX]

Here are more.

1. A female newborn dies at the age of 12 days. A photograph of a section of the brain as seen at autopsy is shown. The newborn was most likely affected by which of the following?

A. arteriovenous malformation
B. germinal matrix hemorrhage
C. hyperbilirubinemia
D. hypoxia-ischemia
E. transtentorial herniation


2. A 40 yr old man with alcoholism is admitted to the hospital b/c of a 2 day hx of confusion. Serum studies show a sodium conc of 99 mEq/L. He is treated with 0.9% saline. Four days later, he develops slurred speech. Physical exam shows mild-to-moderate muscle weakness of all extremities and dysarthria. Sensation is intact. Babinski sign is present bilaterally. These findings are most likely caused by a lesion in which of the following locations?

A. bilateral cerebral hemispheres
B. brain stem
C. medial diencephalon
D. muscle
E. neuromuscular junction
F. peripheral nerve


3. A 35-year-old man who is an undocumented immigrant is diagnosed with tuberculosis. Despite feeling ill, he did not previously seek medical care because he could not afford to lose time at work. He pleads with the physician not to report the diagnosis to anyone because he is afraid he will be deported. After empathizing with the patient, it is most appropriate for the physician to take which of the following actions?
A) Do not report the case and insist that the patient wear a mask at all times
B) Do not report the case as long as the patient agrees to isolate himself while being treated
C) Do not report the case because that would violate the patient’s right to privacy and confidentiality
D) Do not report the case, but begin contacting the patient’s family members and work site contacts directly to arrange for evaluation
E) Report the case to the health department but assure the patient that no other individuals will be notified
F) Report the case to the health department to ensure that family members and work site contacts are identified and evaluated
G) Report the case to the immigration and naturalization service

 

[tasar1898]

C -- typical kernicterus

B-- from low to high , your pons will die

F-- TB mandatory reportable to health department

 

[MudPhud20XX]

Here are some biochem qs I got wrong. Any help is greatly appreciated.

1. A study is conducted of the oxygen-binding properties of hemoglobin in an experimental animal. The hydrogen ion conc is increased in blood. Results show that the oxygen hemoglobin dissociation curve shifts to the Rt. This effect will most likely result in which of the following processes?

A. binding of carbon dioxide in tissue capillaries
B. binding of oxygen in the lungs
C. decrease in erythrocyte 2,3-BPG conc
D. increase in erythrocyte 2,3-BPG conc
E. release of carbon dioxide in the lungs
F. release of oxygen in tissue capillaries


2. A 25-year-old man with type 1 diabetes mellitus comes to the physician because of poor diabetic control for 3 months. He has had ketones in his urine, and his blood glucose concentrations have been in the 200—400 mg/dL range, particularly after exercise. He has been receiving two injections of insulin daily. Physical examination shows no abnormalities. His hemoglobin A1 is 12%. Following exercise on a treadmill for 45 minutes, the patient has an increase in his serum glucose concentration from 175 mg/dL to 225 mg/dL. Which of the following hepatic enzymes is most likely activated initially by exercise in this patient?
A) Debranching enzyme
B) Glycogen synthase
C) Phospholipase C
D) Phosphorylase kinase
E) Protein kinase B
F) Protein kinase G
G) Receptor protein-tyrosine kinase


3. A 25 yr old man has acute lymphocytic leukemia that improves after the administration of chemotherapy including methotrexate. The beneficial effect of this drug is most likely the result of inhibition of which of the following enzyme activities?

A. adenosine deaminase
B. DNA polymerase
C. Hypoxanthine-guanine phosphoribosyltransferase
D. thymidylate synthase
E. xanthine oxidase


4. A 2 month old boy is brought to the physician b/c of failure to thrive and poor feeding since birth. He was recently adopted from Romania and has been fed cow's milk. He is below the 5th percentile for length and weight. Physical exam shows jaundice, cataracts, and hepatomegaly. Serum studies show a decreased glucose conc. The urine shows a positive reaction to a copper reduction test and a negative reaction to a test agent that contains glucose oxidase. Deficiency of which of the following hepatic enzymes is the most likely cause of the disorder in this pt?

A. fructokinase
B. fructose 1, 6 bisphosphate aldolase
C. galactokinase
D. galactose 1 phosphate uridyltransferase
E. glucose 6 phosphatase


5. A 12 yr old boy is admitted to the hospital b/c of lethargy, hip pain, and a temp of 39.4C. He has been hospitalized several other times b/c of pneumonia. His neonatal period was normal. Complete blood counts are within normal limits, and a test of HIV antibody is negative. Blood cultures grow Staph sureus. Serum electrophoresis is most likely to show which of the following patterns?

 

[tasar1898]

Hb right shift --- F

Glucagon -- Gs --cAmp --protein kinase A - glycogen phosphorylase kinase--activates glycogen phosphorylase , so D

Check FA mechanism MTX - D

D --- Classic galactosemia

D -- agammaglobulinemia

Keep em coming!!

 

[MudPhud20XX]

Here are some cardio qs I got wrong.

1. A previously healthy 71 yr old man comes to the physician b/c of a 1 day hx of pain and swelling of his Rt. leg. Physical exam shows diffuse edema of the Rt. lower extremity and calf tenderness. Doppler ultrasonography shows a DVT in the Rt. loswer extremity. After starting heparin therapy immediately, it is most appropriate to initiate a 6 month course of a medication with which of the following mech of action?

A. binds to the active site on the thrombin molecule
B. interferes with the carboxylation of coagulation factors
C. irreversibly inactivates cyclooxygenase
D. potentiates the action of antithrombin III
E. selectively inhibits factor Xa


2. A 35 yr old woman with leiomyomata uteri undergoes an experimental treatment that involves instillation of an embolizing agent directly into the vessels that feed the leiomyomata. During this procedure, in order to reach the involved vessels, which of the following is the most direct course of the catheter after entering the femoral artery?

A. aorta --> gonadal artery --> uterine artery
B. external iliac artery --> internal iliac artery --> uterine artery
C. external iliac artery --> superior gluteal artery --> uterine artery
D. internal iliac artery --> inferior vesical artery --> uterine artery
E. internal iliac artery --> superior vesical artery --> uterine artery


3. An 88 yr old man loses consciousness when his neck is palpated during a routine health maintenance exam. He has a 40 yr hx of hypertension that has been well controlled with hydrochlorothiazide and a 20 yr hx of degenerative osteoarthritis, for which he occasionally takes anti-inflammatory drugs. Which of the following is the most likely cause of the syncope?

A. complete heart block
B. laryngospasm
C. peripheral arteriole constriction
D. peripheral arteriole dilation
E. sinus bradyarrhythmia
F. ventricular tachyarrhythmia


4. A 56 yr old woman has recently diagnosed carcinoma of the breast. An x-ray of the chest shows a tumor next to the Rt. side of the heart. An enhanced CT scan with the tumor invading the pericardium is shown. Which of the following structures is most likely involved?

A. coronary sinus
B. greater splanchnic vein
C. Rt. phrenic nerve
D. Rt. vagus nerve
E. thoracic duct

 

[MudPhud20XX]

Hb right shift --- F

Glucagon -- Gs --cAmp --protein kinase A - glycogen phosphorylase kinase--activates glycogen phosphorylase , so D

Check FA mechanism MTX - D

D --- Classic galactosemia

D -- agammaglobulinemia

Keep em coming!!

Thanks man!

So I checked the mech of MTX in FA and it says MTX inhibits dihydrofolate reductase, but I guess that eventually blocks thymidylate synthase right? Dang... They don't make it easy...

For #4 I was thinking fructose intolerance. Do you get hypoglycemia in classic galactosemia?

 

[MudPhud20XX]

More qs I got wrong : (

1. During an experiment, the US11 gene product of cytomegalovirus is expressed constitutively after stable transfection in an experimental tumor cell line. It is found that this gene product causes translocation of nascent class I MHC molecules from the endoplasmic reticulum into the cytosol. Which of the following is most likely to occur regarding the class I MHC products?

A. association with invariant chain
B. binding of peptides from the endocytic pathway
C. degradation by the proteasome
D. formation of class I MHC/class II MHC hybrid molecules
E. interaction with the T-lymphocyte receptor


2. During a study, a healthy 35 yr old woman and a 35 yr old woman with Crohn dz are given an oral solution of radiolabeled lactulose. The appearance of radioactivity in their urine is monitored over the next 24 hrs. Urinay excretion of radioactivity in the pt with Crohn dz is much greater than that of the healthy subject. This finding is most likely due to inflammation-associated changes in the integrity of which of the following epithelial structures?

A. adherens junctions (zonulae adherents)
B. basement membrane
C. desmosomes (maculae aderetns)
D. gap junctions
E. tight junctions (zonulae occludentes)


3. An outbreak of multidrug-resistant E. coli in an intensive care unit is being investigated. The determinants of antibiotic resistance are thought to be carried on a plasmid that has been transferred among different bacterial strains. Which of the following observations from in vitro studies best supports this hypothesis?

A. lysogeny must precede transfer
B. transfer is susceptible to DNase
C. transfer requires a bacteriophage
D. transfer requires cell to cell contact
E. transfer requires transformation competent recipient strain


4. An 18 yr old man develops a fever 6 days after returning to Wisconsin from a trip to India. He did not take antimalarial prophylaxis. A peripheral blood smear shows numerous intraerythrocytic forms of Plasmodium vivax. He is treated with chloroquine, and his symptoms resolve. Six months later, he again develops fever, and his blood smear again shows intraerythrocytic forms of P. vivax. He has not traveled since his trip to India. Which of the following is the most likely explanation for the recurrence of symptoms in this patient?

A. activation of exoerythrocytic forms
B. dual infection with P. falciparum
C. poor compliance with antimicrobial therapy
D. reinfection
E. resistance to chloroquine


5. A 45 yr old man has a partial colectomy for carcinoma. Which of the following scenarios indicates the highest likelihood for survival for 5 yrs after resection of the lesion?

A. moderately differentiated carcinoma invading the muscularis
B. mucin-producing carcinoma invasive to the serosal surface
C. mucin-producing carcinoma metastatic to two regional lymph nodes
D. poorly differentiated carcinoma confined to the mucosa
E. well-differentiated carcinoma with hepatic metastasis


6. An 18 yr old woman sustains second-degree burns over her right thigh and lower leg after spilling hot grease while working at a fast-food restaurant. Six weeks later, the surface area of the wound has markedly decreased. Which of the following processes best explains the wound contracture in this pt?

A. cross-linking of type II collagen fibers
B. inhibition of stromelysin-1 (matrix metalloproteinase-3)
C. myofibroblast activity
D. P-selectin activity
E. respiratory burst in macrophages


7. A 3 week old newborn is brought to the physician b/c of recurrent vomiting after feeding since birth. The mother says that her child is eager to feed even after vomiting. There is no fever. Abdominal exam shows a firm, 1 to 2 cm mobile mass in the epigastrium to the Rt of the midline. If this condition has a lower threshold of liability in males than in females, which of the following relatives of this pt is at greatest risk for also developing this disorder?

A. brother, if newborn is female
B. brother, if newborn is male
C. fraternal male twin, if newborn is male
D. sister, if newborn is female
E. sister, if newborn is male


8. A 22 yr old woman volunteers for a phase 1 clinical trial of the pharmacokinetics of a new drug. She receives a single intravenous bolus of the drug in her Lt. upper extremity. Blood samples are then drawn at different times from the Rt. upper extremity. The concentration of the drug is measured by a specific assay, and the results are shown (log of plasma conc [Cp] versus time). Which of the following best explains the two-phase results obtained?

A. normal elimination followed by saturation of liver enzymes
B. rapid absorption followed by binding to plasma proteins
C. rapid absorption followed by slower elimination
D. rapid distribution to tissues followed by normal elimination
E. rapid excretion by kidneys followed by metabolism in liver

 

[MudPhud20XX]

Hb right shift --- F

Glucagon -- Gs --cAmp --protein kinase A - glycogen phosphorylase kinase--activates glycogen phosphorylase , so D

Check FA mechanism MTX - D

D --- Classic galactosemia

D -- agammaglobulinemia

Keep em coming!!

For #1, what is wrong with D. increase in erythrocyte 2,3-BPG conc? That's the one I chose.

 

[tasar1898]

Increase in 2,3 BPG is just another reason of right shift , the acidosis causes right shift on its own , not through increased 2,3 big

Cardio q's

1)B hep-followed by 6mo warfarin standard of care for all PE

2)B , check the anatomy of uterine a.

3)E , palpating neck makes baroreceptors fire more --> Increased vagus---> sinus brady

4)C , phrenic nerve is at the side of pericardium

Other q's

1) C degradation by proteasome , since MHC should go to RER , its ''junk'' to the cytosol

2)E tight junctions prevent paracellular movement of stuff between cells in epithelial barriers

3)D transfer of plasmid require contact of bacteria + sex pilus

4)A , p.vivax/ovale forms hypnozoites in liver , give primaquine ( i think ) to eradicate

5)D , tests if u know grade vs stage --> Stage >>>> Grade for prognosis

6)C , myofibroblasts are fibroblasts with contractile element whose function is to reduce the ''exposure'' of the wound to outside world

7)stupid q , don't care about it

8)D , all anesthetics are highly lipid soluble , so termination of their effects is through redistribution to muscle/fat and not through metabolism AT FIRST. This is true for any lipid soluble drug and this curve is classic

 

[MudPhud20XX]

Here are some anatomy/embryology qs I got wrong. Any help is greatly appreciated.

1. A 41 yr old woman is brought to the emergency department by her husband b/c of pelvic pain for 6 hours. She also has had heavy menstrual periods during the past 3 months. A CT scan of the abdomen shows a tumor in the Lt. ovary. An oophorectomy is scheduled. During the procedure, which of the following structures immediately deep to the infundibulopelvic (suspensory) ligament must be protected while isolating and ligating the ovarian vessels in this ligament?

A. hypogastric nerve
B. lumbosacral trunk
C. round ligament
D. sympathetic trunk
E. ureter


2. A 70 yr old man is admitted to the hospital b/c of painless jaundice for the past 2 weeks. He has had dark urine and white stools for the past 7 days. Exam of the abdomen discloses no abnormalities. A CT scan of the abdomen shows a large poorly defined soft tissue density in the head of the pancreas. Which of the following is the most likely cause of the jaundice?

A. cholelithiasis
B. common bile duct obstruction
C. liver metastases
D. pancreatic duct obstruction
E. porta hepatis metastases


3. A 20 yr old man is brought to the emergency department 4 hours after receiving a gunshot wound to his forearm during a hunting accident. An exploratory operation shows that the tendon of the flexor carpi radialis is severed, and there is a comminuted fracture of the distal radius, all other structures are intact. Due to the extent of the injury, an attempt to suture the severed ends carpi radialis tendon is unsuccessful. The tendon of which of the following muscles is most likely to be used to surgically bridge the gap between the severed ends of the injured tendon b/c functional loss would be insignificant?

A. flexor carpi ulnaris
B. flexor digitorum profundus
C. flexor digitorum superificialis
D. palmaris longus
E. pronator teres


4. A 24 yr old man comes to the physician b/c of a 3 month hx of inability to obtain an erection and occasional penile pain. He also has had mild chronic back pain for 2 years and hemorrhoids that bleed on occasion. He is married and has a 2 yr old son. He enjoys his job, and he and his wife have a good relationship. He lifts weights regularly and trains on his bicycle. He usually rides for 2 hours daily during the week and 5 to 6 hours daily on the weekend. On questioning, he does not recall having spontaneous nocturnal erections. Physical exam shows no abnormalities except for back tenderness and external hemorrhoids. Which of the following is the most likely cause of this pt's erectile dysfunction?

A. compromised blood flow from the pampiniform plexus
B. damaged blood and nerve supply to the erectile tissue
C. lumbosacral strain
D. obturator nerve compression
E. pressure of hemorrhoids on the erectile tissue


5. A 46 yr old man is brought to the emergency department 2 hours after he fell headfirst into the water while attempting to water ski. He says that he has pain when he tries to move his left arm. Physical exam shows that the patient is unable to abduct the Lt. upper extremity due to pain. Which of the following muscle is most likely injured in this pt?

A. infraspinatus
B. subscapularis
C. supraspinatus
D. teres major
E. teres minor


6. One day after a total abdominal hysterectomy with salpingo-oophorectomy for stage III cervical cancer, a 42 yr old woman has abdominal distention. She has passed only 200 mL of urine since the operation. Ultrasonography shows an accumulation of fluid in the abdominal cavity, the physician suspects that the fluid is urine. This pt most likely sustained injury to the ureter during intraoperative ligation of which of the following arteries?

A. internal iliac artery
B. ovarian artery
C. pudendal artery
D. superior vesicle arteries
E. ureteric branches of the renal artery


7. A 23 yr old primigravid woman 18 weeks' gestation comes to the physician b/c she has felt minimal fetal movement during the past 2 weeks. There is no family hx of congenital anomalies. Physical exam shows a uterus consistent in size with an 18 week gestation. Ultrasonography shows decreased amniotic fluid and normal sized fetal kidneys, but the fetal bladder and ureters bilaterally appear markedly distended. The fetus appears to be male. Which of the following abnormalities best explains these findings?

A. penile hypospadias
B. placental insufficiency
C. polycystic kidney dz
D. posterior urethral valves
E. prostatic nodular hyperplasia


8. A previously healthy 20 yr old primigravid woman at 12 weeks' gestation comes to the physician 2 days after she noticed a painful swelling on the Rt. side of her chest. Physicial exam shows a 2X2 cm skin colored mass with nipple in the center on the chest wall just inf. to the Rt. breast. If a biopsy specimen of the mass were obtained, it would most likely show a predominance of which of the following cell types?

A. epithelial cells
B. lymphocytes
C. macrophages
D. mast cells
E. neutrophils


9. A 5 yr old boy with asthma is brought to the physician b/c of 3 month hx of recurrent cough, intermittent wheezing, and difficulty breathing. He has been admitted to the hospital twice for pneumonia during the past 12 months. He is at the 60th percentile for height and the 50th percentile for weight. His respirations are 25/min. Wheezing and crackles are heard between only the 4th to the 6th intercostal spaces on the Rt. side of the chest. Diminished tactile fremitus and dullness are present over the Rt. anterior section of the chest between the 4th and 6th ribs. Results of a PPD test are negative. A lateral chest x-ray shows a wedge-shaped density extending anteriorly and inferiorly from the hilum. A CT scan of the chest is most likely to show obstruction of which of the following bronchi?

A. Lt. main-stem
B. Lt. upper lobe
C. Rt. lower lobe
D. Rt. main-stem
E. Rt. middle lobe

 

[MudPhud20XX]

Here are some more. Many thanks in advance.

1. Nitrogen dioxide inhalation in humans causes loss of type I pneumocytes in those alveoli exposed to high concentrations of the gas. Within 2 weeks, the affected alveoli are re-epithelialized with type 1 pneumocytes. Which of the following is the most likely immediate precursor of the new type 1 pneumocytes?

A. alveolar macrophages
B. capillary endothelial cells
C. interstitial cells
D. type I pneumocytes
E. type II pneumocytes


2. A 1 yr old boy is brought to the emergency department b/c of a 6 day hx of temp to 39.4C and a 2 day of severe diaper rash and swelling of his hands and feet. His temp is now 39.4C. A photograph of the genital area is shown. The face and lips appear red and the conjunctivae appear injected. There is bilateral cervical lymphadenopathy. The lungs are clear to ascultation. Cardiac exam shows an S3 gallop with no murmur. There is edema and erythema of the hands and feet. Which of the following pathologic findings is most likely in this pt?

A. acute arteritis with aneurysms in coronary arteries
B. epidermal hyperplasia with epidermal microabscesses and parakeratosis
C. granulomas with caseous necrosis in cervical lymph nodes
D. granulomatous arteritis in cervical and temporal arteries
E. paracortical lymphoid hyperplasia with eosinophilic intranuclear inclusions in perihilar lymph nodes


3. A 60 yr old man develops pain, erythema, and swelling of the Rt. great toe. Serum uric acid concentration is three times normal. Which of the following findings is most common in patients with this condition?

A. absence of aminotransferase
B. absence of glucose 6 phosphatase
C. absence of glutathione peroxidase
D. absence of hypoxanthine guanine phosphoribosyltransferase
E. no specific enzyme or renal defect


4. During an experiment using adult rats, bone formation and resorption are studies. The addition of compound X causes a decrease in bone resorption. Compound X is most likely which of the following?

A. calcitonin
B. parathyroid hormone
C. prednisone
D. thyroxine (T4)
E. tumor necrosis factor


5. A 41 yr old man comes to the physician's office b/c of recurrent headaches, flushing, and palpitations for the past 3 months. Blood pressure measurements have ranged from 130/76 mm Hg to 200/120. CT scan of the abdomen shows a Rt. suprarenal mass. An increase in the serum concentration of which of the following hormones is the most likely cause of the episodic hypertension in this pt?

A. aldosterone
B. angiotensin II
C. cortisol
D. endothelin
E. epinephrine


6. A 45 yr old woman comes to the physician b/c of a 3 month hx of decreased energy and impaired concentration. She has had tingling in both hands, constipation, and a 2 kg weight gain over the past 2 months. She appears apathetic. Her skin has a doughy consistency and her hair is coarse. Tapping the median nerves over the volar surface of the wrist elicits paresthesias in the index and middle fingers. The relaxation phase of the muscle stretch reflexes is slowed. Which of the following is the most likely diagnosis?

A. addison dz
B. hyperparathyroidism
C. hypoparathyroidism
D. hypopituitarism
E. hypothyroidism


7. A 23 yr old woman comes to the physician for prenatal care. On exam, she appears euthyroid and the thyroid gland is not palpable. Uterine size is consistent with dates, and fetal pulse is normal. Serum thyroid tests show:

Thyroxine (T4): 14 ug/dL
Thyroid-stimulating hormone: 2uU/ml

Changes in which of the following hormones during pregnancy is primarily responsible for the thyroid test results?

A. androgens
B. corticosteroids
C. estrogen
D. progesterones
E. prolactins


8. A 63 yr old man comes to the physician b/c of a 3 month hx of abdominal pain that is only partially relieved by antacids. He states that he has also tried fasting, but it has had little to no effect on the pain. Palpation of the abdomen shows exquisite tenderness focused to the Rt. of the midline. Lab studies show a fasting serum gastrin concentration of 800 pg/ml (N<100) and no evidence of H. pylori infection. Secretin infusion after the pt has fasted increases serum gastrin concentration to 1150 pg/ml. Secretion of which of the following is also most likely increased in this pt as the result of this infusion?

A. ghrelin
B. glucagon-like peptide 1
C. hepatic bile secretion
D. pancreatic bicarbonate
E. saliva

 

[MudPhud20XX]

Increase in 2,3 BPG is just another reason of right shift , the acidosis causes right shift on its own , not through increased 2,3 big

Cardio q's

1)B hep-followed by 6mo warfarin standard of care for all PE

2)B , check the anatomy of uterine a.

3)E , palpating neck makes baroreceptors fire more --> Increased vagus---> sinus brady

4)C , phrenic nerve is at the side of pericardium

Other q's

1) C degradation by proteasome , since MHC should go to RER , its ''junk'' to the cytosol

2)E tight junctions prevent paracellular movement of stuff between cells in epithelial barriers

3)D transfer of plasmid require contact of bacteria + sex pilus

4)A , p.vivax/ovale forms hypnozoites in liver , give primaquine ( i think ) to eradicate

5)D , tests if u know grade vs stage --> Stage >>>> Grade for prognosis

6)C , myofibroblasts are fibroblasts with contractile element whose function is to reduce the ''exposure'' of the wound to outside world

7)stupid q , don't care about it

8)D , all anesthetics are highly lipid soluble , so termination of their effects is through redistribution to muscle/fat and not through metabolism AT FIRST. This is true for any lipid soluble drug and this curve is classic

Thanks man.

1. A previously healthy 71 yr old man comes to the physician b/c of a 1 day hx of pain and swelling of his Rt. leg. Physical exam shows diffuse edema of the Rt. lower extremity and calf tenderness. Doppler ultrasonography shows a DVT in the Rt. loswer extremity. After starting heparin therapy immediately, it is most appropriate to initiate a 6 month course of a medication with which of the following mech of action?

A. binds to the active site on the thrombin molecule
B. interferes with the carboxylation of coagulation factors
C. irreversibly inactivates cyclooxygenase
D. potentiates the action of antithrombin III
E. selectively inhibits factor Xa

So you are saying B is the answer, but if you look at FA, Xa inhibitors are the drug of choice right? Is it b/c of the 6 month duration that makes B a better choice?

 

[MudPhud20XX]

what's the diagnosis of the below q?

A 16 yr old boy who frequently goes fishing is brought to the physician of a 1 month hx of a lesion on the front of his right shoulder. He has blond hair and fair skin. Physical exam shows an 0.8 cm ulcerated, slightly raised nodule that is variably brown to black. Exam of a biopsy specimen of the nodule confirms a superficially invasive melanoma with features of regression. Which of the following best explains the lesion's regression in this pt?

A. antibody-dependent cellular reaction
B. antibody-mediated cellular dysfunction
C. arthus reaction
D. complement and Fc receptor mediated response
E. T lymphocyte mediated cytotoxity

 

[tasar1898]

Will answer them all at night after i finish my FA for the day

 

[MudPhud20XX]

Will answer them all at night after i finish my FA for the day

Thank you so much tasar. Take your time.

 

[MudPhud20XX]

Does anyone know the diagnosis?

A 30 yr old woman comes to the physician for an initial evaluation. She has a hx of illicit intravenous drug use and is now completing a methadone maintenance program. Physical exam shows scars in the antecubital fossae. A chest x-ray shows small nodules in the perihilar lung fields. A biopsy specimen from the perihilar regions will most likely show small foreign particles surrounded by which of the following?

A. granulation tissue
B. granulomatous inflammation
C. hemosiderin-laden macrophage
D. neutrophilic abscess
E. proliferated capillaries

 

[tasar1898]

Did 70 pages FA today , took up all my day .. this is truly torture… anyways to the answers

anatomy/embryo

1)probably ureter , check it in FA

2)D , pancreatic head tumor blocks pancreatic duct

3) D , palmaris longus .. I got this one by chance , just memorize that this muscle/tendon is useless

4)B , saddle injury

5)C , supraspinatus is main abductor of rotator cuff

6)probably ovarian , again check FA , i suck at anatomy

7)D , posterior urethral valves --> this is something like urethra atresia , MCC of oligohydramnios in male babies

8)A , supernumerary nipple

9)E, right middle lobe , classic lung surface anatomy

Next set

1) E , type 2 pneumocytes are stem cells of lungs

2)A , Classic Kawasaki , pic is probably diaper rash or something to confuse us

3) E , MCC of gout = idiopathic

4) A , calcitonin inhibits osteoclasts

5) E , classic pheo

6)E , hypothyroid --> ''apathetic '' , ''doughy consistency '' , ''weight gain '' , ''constipation '' , ''decreased energy - apathy '' , everything else is just to confuse you with hypocalcemia

7)C , Estrogen increases all hormone binding globulins --> Increases total hormone , but pts are ''euhormonic''

8)D , secretin makes pancreas secrete bicarb


for the old man with DVT q , all DVT's / PE gets heparin initially and warfarin for 6 months , only give factor 2 or 10 inhibitor if problem with warfarin

1)E , melanoma got destroyed by CD8 Cytotoxic cells that probably saw weird MHC 1 molecules on the cancerous cells


2)B --> particles injected IV --> right heart --> dislodge to lungs --> reaction to foreign body = always granuloma


If I may ask , how many did you get correct and what was the score conversion?? Just interested in the scale

 

[MudPhud20XX]

Thanks man. Really appreciate this. I got 54 questions wrong and that gave me 380 --> 202.

 

[MudPhud20XX]

C -- typical kernicterus

B-- from low to high , your pons will die

F-- TB mandatory reportable to health department

For the 2nd question, since the sensation is intact, we are ruling out cerebral hemisphere right?

 

[tasar1898]

No you could have bilateral cerebral motor cortex strokes but the chance is 0,00001% .Given the HX of the patient , the most obvious is osmotic demyelination syndrome ( central pontine myelinolysis)

Also in the q with the pancreatic cancer the answer is common bile duct , NOT pancreatic duct , I had a brain fart

 

[Pushtothestars]

Hb right shift --- F

Glucagon -- Gs --cAmp --protein kinase A - glycogen phosphorylase kinase--activates glycogen phosphorylase , so D

Check FA mechanism MTX - D

D --- Classic galactosemia

D -- agammaglobulinemia

Keep em coming!!

tasar why is the answer F??