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NBME 12 discussion

Discussion in 'Step I' started by titan25, May 5, 2011.

  1. peedeeaye

    peedeeaye

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    May 7, 2011
    I'm pretty sure it was squamous cell ca. I just saw vocal cord and went w/ that (although I think only true vocal cords are squamous).

    And that was the first time I'd heard of the word "viscus" too...
     
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  3. Altruist

    Altruist Hoodledooer 5+ Year Member

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    Apr 5, 2008
    2) Yeah there was definitely air under the right hemidiaphragm on the film, thus ruptured bowel. I'm not sure if it's the free air, or if it's the spilled abdominal contents that do the irritating... Probably only of academic interest anyway. Effect is the same.

    9) UTI's can cause confusion in older folks, for sure. Could also (maybe) be uremia from the pressure back-up. Would depend on the question stem I suppose, if there was any indication of infection.

    This kind of thing is, from the war stories, standard on the boards. They'll describe it in a way you haven't heard before, or use an old term (small non-cleaved cell lymphoma instead of Burkitt's, for example) that throws you off. I don't know how much you can prepare for that without doing a ton of low-yield reading, so just accept that you may have to puzzle out some answer choices and/or move on.
     
  4. bobsagat

    bobsagat 5+ Year Member

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    Dec 19, 2007
    Still looking for a solid answer on this one...
     
  5. Regarding the Hardy Weinberg:

    The question asked about the WIFE... who was perfectly normal... (all that stuff about the husband's sister was irrelevant)

    The normal population frequency of disease is 1/40,000

    A short cut you use whenever disease frequency < 1/1000

    Is that

    HETEROZYGOUS carrier rate = 2q

    Therefore, square root of 1/40,000 = 1/200

    2q = 1/100= the answer.



    The other one regarding the NNT was 100

    The question asked "how many women need to have babies and treated to prevent a woman from getting ANY development disorder"

    Using trace metals as the control group, it would have been"

    2.3% - 1.3% = 1.0% absolute risk reduction

    Then 1/0.01 = 100
     
  6. kastle6797

    kastle6797 5+ Year Member

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    Dec 5, 2007
    The answer was squamous cell carcinoma. The histology showed that the cancer was invasive, kind of hard to interpret, but the histology just didn't look organized enough to be in-situ or benign. Also, I think (memory is iffy) there were pink keratin pearls in the pic, indicating squamous cell origin as opposed to adenocarcinoma.
     
  7. Answered
     
    Last edited: May 24, 2011
  8. kastle6797

    kastle6797 5+ Year Member

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    Dec 5, 2007
    Question: 13 YO boy with pruritic rash on right foot. No fever, chills, cold. Patient's family spent weekend at a lake. (Rash is on top of foot and moving sort of linearly). Treat with a. clindamyin, b. fluconazole, c. mebendazole, d. metronidazole, or e. prednisone?

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

  9. That serpiginous tunneling is probably scabies.

    Thus mebendazole.
     
  10. ScubaStarved

    ScubaStarved 2+ Year Member

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    May 10, 2010
    Posting photos and exact question stems will at the very least get you an email from SDN. It also makes it impossible for others to quote your post if they don't want to receive the same email. Finally, many of the questions being asked are answered on this page and the previous page (if they thread were longer, then fine, don't read anything yourself, but this one is 2 pages).

    Slave:

    1. If you've done clinical work, this is tough because low fecal elastase is the best (?) confirmation of chronic pancreatitis. However, the pain and malabsorption is from insufficient neutralization of stomach acid by the pancreas. (Whatever enzymes are secreted by the pancreas are inactive at low pH.)
    2. Serum CK. It's Duchenne's.
    3. Malrotation
    4. UGT deficiency. All babies have this initially and negative Coombs rules out immune mediated hemolysis.
    5. G. It IS the anterior horn, but the intrinsic hand muscles are located laterally.
     
  11. bobsagat

    bobsagat 5+ Year Member

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    Dec 19, 2007
    I put D as well, since it was my best guess about why he would have weight loss and foul-smelling stool. But if we're to exclude D, I think the best answer would be C. A tumor in the head of the pancreas would obstruct the gall bladder and pancreas from secreting bicarb into the lumen of the duodenum. Admittedly the duodenum also has brunner's glands, but maybe that's the etiology of epigastric tenderness in pancreatitis/pancreatic tumor? I don't understand why that would cause you to lose weight, though...
    No idea on this one.
    I think C. Gastroschisis is obviously not correct because he's a grown dude, same with B and D. E isn't right because you can see the stomach on the correct side of the film.
    I went with C because it looks like a large part of his abdomen is absent of bowel, which could be because of malrotation. The malrotation can predispose to volvulus, which looks right because there is clearly air on the left side of the film without any contrast in it.
    Physiologic jaundice of the newborn is an unconjugated hyperbilirubinemia due to deficiency of the enzyme in answer E. I don't know if the bilirubin level fits, but the rest of the presentation seems to. Nml LFT's rules out C, lack of bilious vomiting rules out A. As for ruling out jaundice from viral hepatitis or classic galactosemia, I'm not really sure... someone else jump in.
    I put F here, too. Isn't atrophic weakness a sx of an LMN lesion?
     
  12. bobsagat

    bobsagat 5+ Year Member

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    Dec 19, 2007
    Isn't G the IMLCC?
     
  13. Point taken. Thank you for the help
     
  14. ScubaStarved

    ScubaStarved 2+ Year Member

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    May 10, 2010
    I got this question wrong also and another poster explained this to me on the first page of this thread, so it's kind of funny that I'm now answering it 30 posts later:

    (Disclaimer: I suck at neuro.) The IML column is more pointy, and the ventral horn has "bulbs" at the cord levels corresponding to control of distal muscles (e.g. arm, leg, hand, foot). The more medial section of the ventral horn is present at all levels and innervates trunk muscles.
     
  15. bobsagat

    bobsagat 5+ Year Member

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    Dec 19, 2007
    Just talked through it with a friend. The IMLCC starts at T1, and this is almost certainly the cervical cord. Facepalm.
     
  16. Makes sense since the sympathetics arise from the thoracic cord.

    However, T1 is still controls medial arm. However, that would not exactly fit 'intrinsic hand muscle" which would be more C7 C8
     
  17. There was a beta thalassemia genetics question:

    Basically they gave you the coding strand, bolded the exons then asked for a mutation where would lead to beta thalasemia.

    None of the proposed changes would have lead to a nonsense mutation.

    I narrowed it down to G-->A at codons 270ish and 670ish. (It had to be within the exons)

    Apparently I chose the 270ish one and it was correct. I'm not entirely sure why though. Does anyone reclal this question?
     
  18. bobsagat

    bobsagat 5+ Year Member

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    Dec 19, 2007
    Beta thal isn't due to a nonsense mutation, it's due to a mutation in "splicing sites or promoter sequences," according to FA pg 349.

    The DNA NAs available to mutate were
    A the very first one
    B the one at the beginning of the first intron
    C one in the middle of the second intron
    D one at the end of the gene well after the third and final exon

    (A)..exon/(B)intron/exon/int(C)ron/exon/intro(D)n

    So, we're looking to introduce errors in promoters or splice sites. So, anything in the actual translated part of the gene is right out. (excludes C)
    The tricky thing in looking back at this one is that I don't know for sure where transcription starts, but I can say that B is probably the best choice. You have to remember how introns are spliced out, looping out DNA in a lasso shape. Since either end of the intron contains the important sequence for that, you have to go with B.
    I don't think you can necessarily exclude A or D because promoters can actually be within the coding region, but B is the best answer.
     
  19. ScubaStarved

    ScubaStarved 2+ Year Member

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    May 10, 2010
    This was a splice site mutation. Certain pairs of AA are well conserved and have some function in the spliceosome. FA covers this somewhat in the 2010 edition, but it is very subtle. QBank had another question about it. I would offer more help, but have forgotten so much in the last two weeks it's not funny. Basically an A, a G, or an AG pair is required somewhere.. :confused:
     
  20. oh right. 5'AG GU3'

    Therefore this must have been beta+ then.
     
  21. Altruist

    Altruist Hoodledooer 5+ Year Member

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    Apr 5, 2008
    I got this one wrong on the day, but talking to a friend steered me to the right answer. The drug they're asking for is mebendazole (of the choices given), but it's cutaneous larva migrans, not scabies. This free article from the AAFP on pet-related infections includes a familiar-looking picture:
    http://www.aafp.org/afp/2007/1101/p1314.html#afp20071101p1314-f1

    This goes along with the question stem, which mentions the family just having come back from a trip to the lake. Cutaneous larva migrans is associated with playing barefoot on sand where dogs/cats have pooped.
     
  22. Ah yes. Acyclostoma and Necator then
     
  23. hurdlepup

    hurdlepup Surviving Intern Year 7+ Year Member

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    On Country Roads
    Can alanines be N-glycosylated too? b/c that was my concern... Also, how the heck do you remember this? Is this in FA somewhere that I have missed? Is there a pattern? Thanks!
     
    Last edited: Jun 1, 2011
  24. hurdlepup

    hurdlepup Surviving Intern Year 7+ Year Member

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    Feb 11, 2010
    On Country Roads
    actually, i might have just partially answered my own question... it was that serines can be glycosylated and you lose a serine for an alanine in my concern...

    still don't know if there is a pattern though...
     
    Last edited: Jun 1, 2011
  25. ScubaStarved

    ScubaStarved 2+ Year Member

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    May 10, 2010
    I don't think you're remembering the answer correctly, because the "N" of N-linked glycosylation stands either for Nitrogen or Asparagine (Asn, N). (I'm not actually sure which to be honest, but AFAIK only Asn in the sequence NXS or NXT can be glycosylated.)

    This is in FA on the page about the Golgi network and post-translational modification. Most medical schools will lecture on the basis of enzyme active sites and membrane-bound receptor phosphorylation (multiple times each at my school) and should also explain a bit about the post-translational modification of proteins. I remember a little more about this topic because I spent one summer working on gp120's variable loops' N-glycosylation.
     
  26. kastle6797

    kastle6797 5+ Year Member

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    Dec 5, 2007
    Thanks for your help
     
  27. Reach back to your college biochemistry for this one...

    As Scuba mentioned, the Nitrogen that is being glycosylated is on the side chain group. Thus Asn (and Gln in theory, but not sure if it happens in the cell)

    LIkewise, Serine and Threonine have the side chain -OH groups be to -O glycosylated
     
  28. hurdlepup

    hurdlepup Surviving Intern Year 7+ Year Member

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    Feb 11, 2010
    On Country Roads
    we had this stuff way back at the Fall of MS-1. and i'm not actually sure what AFAIK means...

    so, I guess I see how losing a serine, which could be O-glycosylated, for an alanine, which cannot be glycosylated would result in losing glycosylation


    Thanks! I see the pattern now--all to do with the R-group!
     
    Last edited: Jun 1, 2011
  29. Scean

    Scean whats a goon to a goblin? 7+ Year Member

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    1. Metaphyseal dysplasia due to single gene disorder caused my mutation in PTH receptor gene. Phenotype is "similar to that of acquired hyperparathyroidism." Mechanism?

    Haploinsufficiency - wrong
    Dominant Negative
    Gain of function
    Pleiotropy
    Anticipation

    I think i missed "aquired hyperparathryoidism" meaning here. I assumed that meant secondary; as in low calcium due to something (renal osteodystorphy) promoting PTH levels. So with that in mind I figured insufficient receptor, PTH doesnt work well, more out there. Insight?


    2. So aripiprazole has what action compared to haloperidol on the dopamine receptors?

    Reversible antagonism - wrong - didn't feel to good about it
    Agonism
    antagonism
    inverse agonism
    irreversible antagonist
    partial agonism


    3. Why is there reduced tactile fremitus in asthma kid?


    4. Chronic peripheral neuropathy; enzyme histochemical staining shows fiber grouping. Most likely cause?

    Altered trophic substance form innervating neuron - wrong
    Altered muscle enzyme exprerssion due to damaged nerve fibers - correct?
    Regeneration of muscle fibers
    Re innervation of muscle fibers by regenerating axons
    Selective loss of nerve fibers to type II muscle fibers


    5. 73 year old w/ BPH, UTI +fever + chills +pain in flank + WBC + 100,000 colonies of gram + what is the causal organism?

    Staphyloccus aureus - wrong
    Streptococcus pyogenes
    Enterococcus faecalis - would need a fistula and you'd see lots of other nasty stuff yea?


    6. Lady with TIA's, cannot tolerate aspirin. Appropriate alternative?

    Dipyramidal - wrong
    Clopidogrel? -these were the two i narrowed
    Acetaminophen
    Ibuprofen
    Tissue plasminogen activator


    7. Lady gets to 10,000 ft ski resort. Dizzy, nausea, headache. Acetazolamide helps, how?

    Stimulation of ion pumps in BBB - wrong
    Direct action on resp centers, depressing ventilation
    Direct action on resp centers, stimulate ventilation
    Induction of metabolic acidosis, stimulate ventilation
    Induction of metabolic alkalosis, depress ventilation
    Stimulation of EPO

    This one kid of bothered me. So her initial problem is alkalosis due to major reduction in PO2 at altitiude and subsequent increased RR blowing off CO2 = alkaline. Acetazolamide will help by creating some metabolic acidosis, but then what? Stimulating further respiration would be counter productive right? EPO would take a while. Direct action seemed a bit off to me. So i was left with ion pumps; I dunno.


    8. Another carbonic anhydrase question - not my day. Didnt read this question fully though. CA deficiency in erythrocytes only; whats elevated in venous blood?

    K+ wrong; i thought systemically, acidosis = H/K exchange
    Ca
    Cl
    HCO3
    Mg
    Na



    9. Lady with UMN issues. What helps?

    Inhibit nicotinic-R in Renshaw - wrong
    Activate GABA-R in muscle spindle afferents
    Activate glutamate-R in gamma motoneurons
    Activate serotonin-R in alpha motoneurons
    Inhibit glycine-R in Golgi tendon afferents
    Inhibition of (a)2-R in excitatory interneurons



    10. Guy on steroids hurts his arm. Antecubital swelling and ecchymoses from antecubital fossa to mid forearm on anterior side, tender there also. Able to flex elbow actively, but unable to flex elbow or supinate against resistance. Injured muscle-tendon unit innervated by what?

    Radial - wrong; i was thinking brachioradialis
    Anterior interosseous
    Median
    Musculocutaneous
    Ulnar



    11. Still unclear on what would improve the lady taking a thiazide with improved BP but low K+

    Atenolol - wrong
    Furosemide
    Losartan
    Nifedipine
    Prazosin


    12. Septic arthritis in 18 year old kid; gram + stain picture shows what I think look like intracellular bugs

    Ceftiraxone
    Doxycycline - wrong
    Genatmicin
    Metronidazole
    Vancomycin


    13. Apparently autistic kid? 3 years old, 20 word vocab. Doesn't speak in sentences, points alot, no physical abnormalities. Kid is looking at reflex hammer instead of acknowledging mom's presence.

    Inform her that the child will need special education - wrong
    Further evaluation to determine cause of language delay
    MRI
    Reassure that this is normal
    Advise to enroll in preschool early


    14. Guy smokes 2 packs a day lives in basement apartment. Dizzie, headache, nausea for 4 hours. No physical abnormalities; what explains it?

    Acidosis with heme dissociation shift right
    Activation of nicotinic-R in locus caeruleus
    Cerebral arteriolar constriction due to increased CO2 in blood
    Competative inhibition of oxyhemeoglobin formation
    Inactiation of cytochrome oxygenase by cyanide - wrong; seemed like a lot of cigs :rolleyes:

    Probably competitive inhibition - CO poisoning. I skimmed over the part that said it was WINTER - and basement apartments i guess only have space heaters right? Sure.



    15. What else would you give to someone w/ acute hep C already receiving (a)IFN?

    IL-2 - wrong
    Infliximab
    Levamisole
    Ribavirin
    Thlidomide


    16. Guy with prostate cancer; Low back pain. Most appropriate drug MoA:

    Activation of GnRH receptors - probably correct if given CONTINUOUSLY
    Activation of LH receptors
    Blockade of estrogen receptors
    Blockade of FSH receptors -wrong, convinced myself T --> DHT was FSH stimualted
    Inhibition of 11-B hydroxylase



    Thoughts, or some scolding to get me motivated welcome :thumbup:
     
  30. sincity college

    sincity college 2+ Year Member

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    May 27, 2008
    Had a quick couple questions:

    1.) 6th rib fracture and insert chest tube through which muscle? pec minor, rhomboid major, or serratus anterior

    2.) Different isolates of influenza recovered than previous year. where is mutation? point mutation in matrix protein/ ribonucleoprotein. reassortment involving hemagglutin/ matrix protein / ribonucleoprotein

    3) Breast mets, which protein when dysfunctional allows this? CD44, E-caherin, pepsin, RNAse

    4) Quickest way to decrease sudden cardiac deaths? anti-smoking campaign, exercise program, water supply with aspirin, automatic defibrillators in public places, free stress management programs

    5) How does dexamethasone promote differentiation of surfantant-producting cells? Is it nuclear receptors???

    6) 26 yo F with 3 mo amenorrhea. Mom died. 15 lb weight loss. Cause? Altered GnRH pulses, increased E and P, decreased cholestrol, premature ovarian failure

    7) 48 yo F pw 3d hx of fever 2wk hx of colicky lower abd pn. tender LLQ. Normo anemia with left shift. IV ab subside pain and fever. doc should recommend? avoid alcohol, find others in support group, yoga to decrease stress, high fiber diet

    THANKS in advance!!! you guys are rockstars!
     
  31. Scean

    Scean whats a goon to a goblin? 7+ Year Member

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    Jan 2, 2007

    1. serratus anterior. Level is above split of trachea (corina/carina?) so its pretty high and very lateral. Too lateral for pec, rhomboid not around there.

    2. Influenzae have segmented genomes for reassortment. hemmaglutinin is a major source of immune defense (and subsequently, variation by the virus). H1N1 = hemagglutinin # Neuroaminidase #. hemagglutin is the ADHESION one; so yea immunity to that halts the infection before it starts. A change = lots of ppl infected.

    3. E Cadherin --> cadherins are calcium dependent components of Demosomes which are cell-cell adhesions (vs hemidesmosomes which use integrins and are cell-BM adhesion)

    4. Defibrillators all over the place. Effect almost immediate. excercise, stress, smoking all help; but more long term/big picture.

    5. yea, steroid = nuclear receptor

    6. I actually cant remember what I put; there were a couple quesitons on this. Maybe grief/depression --> low dopa/sertonin --> more prolactin --> less GnRH? or was it primary ovarian (i think there was a question for each)

    7. High fiber. normo-Anemia = GI bleed, colicky due to ischemic large bowel (splenic flexure), necrotic tissue infected for fever. Large bowel infarct - local pain vs small bowel is diffuse. Alcohol would be cirrhosis RUQ instead of LLQ


    My thoughts. I'm pretty confident on most of em', ha.
     
  32. sincity college

    sincity college 2+ Year Member

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    May 27, 2008
    Scean,

    1) Gain of function - not really sure why, its right though - my reasoning what that if you have acquired hyperparaT, there was something in the genetics that causes up regulation of the gene which is usually a gain of function mutation?
    2) partial agonism - it doesnt bind the D2 receptors as tightly and has fast dissociation from them
    3) asthma because wheezing and its a kid. only thing i know of that has increased tactile fremitus is pneumonia
    4) Re innervation of muscle fibers by regenerating axons ( i think)
    5) E.faec causes UTIs, other listed G+s dont
    6) Clopidogrel, dipyramidal is used for intermittment claudication by inhibiting PDE and increasing cAMP; clopidogrel inhibits aggregation like aspirin
    7) Induction of metabolic acidosis, stimulate ventilation to comp for resp alkalosis, your body is normally going to do this, but drug as prophalaxsis does it quicker by eliminating HCO3. You want to stimulate your resp drive to get more oxygen in blood
    8) Cl, venous blood as more CO2, if no CA, then it cant be converted into HCO3 which is transported out of RBC in exchange for Cl (Chloride shift), if this doesnt occur, CL builds up
    9) Activate GABA-R in muscle spindle afferents, not sure why, my reasoning was GABA is inhibitory and want relaxation?
    10) Musculocutaneous, its the flexor
    11) losartan - diuretic + ARB/ACE is first line
    12) ceftriaxone - for N gonorrhea diplocci
    13) Further evaluation to determine cause of language delay - should be at 900 words, seems a bit early to Dx mental retardation
    14) Competative inhibition of oxyhemeoglobin formation, i believe from CO buildup
    15) Ribavirin - standard treatment in inf + ribavirin
    16) I got this one wrong
     
    Last edited: May 26, 2011
  33. 16. Guy with prostate cancer; Low back pain. Most appropriate drug MoA:

    Activation of GnRH receptors - probably correct if given CONTINUOUSLY
    Activation of LH receptors
    Blockade of estrogen receptors
    Blockade of FSH receptors -wrong, convinced myself T --> DHT was FSH stimualted
    Inhibition of 11-B hydroxylase
    [/QUOTE]

    Leuprolide continuously because prostate cancer is sensitive to testosterone.

    Eliminate that signaling.

    MOreover, this was NOT marked WRONG on expanded feedback for me
     
  34. Scean

    Scean whats a goon to a goblin? 7+ Year Member

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    Jan 2, 2007
    alright, alright, alright - thank for the responses
     
  35. Scean

    Scean whats a goon to a goblin? 7+ Year Member

    435
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    Jan 2, 2007
    Some additional thought about that PTH receptor mutation quesiton:

    I guess the fact that it is a metaphyseal dysplasia indicates that calcium is being rapidly reabsorbed from it and not staying put from the epiphyseal growth out towards the metaphysis?

    My real problem is that I was thinking acquired hyperparahthyriod means calcium is LOW but in this case calcium must be HIGH due to a gain of function, highly active, receptor that is reabsorbing any calcium laid down in that plate causing the dysplasia.
     
  36. SpunkySpunk

    SpunkySpunk

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    Girl with horner's and neck mass resection. Post synaptic sym fibers from sup cerv ganglion dmged?

    Alzheimer woman, forgetful, problems with learning/naming. Lesion where? Hippocampal formation?

    Chronic periph neuropathy: enzyme staining shows fiber grouping. What the deal is?
    I put selective loss of n fibers --> T2 mm fibers.
    is it: altered musc enzyme expresion due to dmg n fibers
    or altered trophic substance from innerv n.

    Chick with MS. Resp acidosis. Aspiration pna?

    That alcoholic with chronic pancreatitis, severe stomach pain and malabsorption was a bitch.
     
  37. ThereHeIs

    ThereHeIs

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    May 17, 2011
    Ontario, Canada
    From above...

    2. So aripiprazole has what action compared to haloperidol on the dopamine receptors?

    Reversible antagonism - wrong - didn't feel to good about it
    Agonism
    antagonism
    inverse agonism
    irreversible antagonist
    partial agonism


    The answer is partial agonism. Reference baby katzung 9th ed. pg 252 in the chart.
     
  38. MsKrispyKreme

    MsKrispyKreme The "Hot" sign is on... 7+ Year Member

    1,020
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    Jun 11, 2008
    I have a few questions, guys.

    -funky prevalence graph --> was the answer 2?
    -pic of glomerulus stained with elastin --> was it chronic graft rejection?
    -lost in the desert for 2 weeks --> what happens to F-2,6-BP, glucose-6-phosphatase, PEPCK, and pyruvate kinase? (arrows question)
    -chlordiazepoxide overdose and alcohol (slow reacting pupils & decreased bowel sounds) --> what happens to PO2, PCO2, and pH?
    -graph of insulin-stimulated vs. unstimulated (?) transport of glucose in myocytes --> which graph was correct?

    Thanks!

    Altered GnRH pulses is correct. :thumbup:


    -yes, post-synaptic sympathetic neurons from the superior cervical ganglion
    -hippocampal formation
    -reinnervation of mm. fibers by regenerating axons
    -i didn't get this one correct. (i chose upper airway obstruction for some reason.) now that i think about it, it might be opioid overdose --> pain management for MS. i dunno.
     
  39. kstreet

    kstreet 7+ Year Member

    190
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    Jan 29, 2007
    Question from the test

    A 22 yo man who is a militar recruit is brought to the doc 15 min after fainting while waiting in line to receive vaccinations. Immediately after he fainted, his pulse was 45/min and his systolic was 50 mmHg. His pulse is now 88/min and bp is 100/70. Physical exam shows no abnormalities. What was the cause of the syncope?

    A. Aortic Stenosis
    B. Hypertrophic Cardiomyopathy
    C. Increased Parasympathetic Tone
    D. 3rd degree AV block
    E. Ventricular Tachycardia
     
  40. kstreet

    kstreet 7+ Year Member

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    Jan 29, 2007
    A 54 yo woman comes to the doc for a follow up exam. 2 months ago she was dx'd with hypertension and rx'd with hydrochlorothiazide. BP today is 150/100 compared with 165/108 two months ago, and serum K is 3.2 vs 4.5 two months ago. Addition of which of the following medications is most likely to further decrease bp and restore K to normal?

    A. Atenolol
    B. Furosemide
    C. Losartan
    D. Nifedipine
    E. Prazosin


    A 25 yo man is lost in the desert for 1 week with plenty of water but no food, what changes in enzyme activity and molecule concentrations in live is most likely in this pt.

    Up and Down arrows for

    Fructose 2,6, bisphosphate
    Glucose 6-phosphatase
    PEP Carboxykinase
    Pyruvate Kinase


    Thanks for the help!
     
  41. Sheldor

    Sheldor 5+ Year Member

    1,082
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    May 21, 2011
    Parasympathetic tone! Presumably afraid of shots, so the thought of receiving one activated the PSNS --> Vagus --> Bradycardia and syncope

    So they have lost potassium and they need to lower the blood pressure more. So you want a drug that will both lower BP and raise potassium. I believe the answer is Losartan beacuse you block ANG II, which means less aldosterone which means a lower BP, and less K+ secretion.
     
  42. kstreet

    kstreet 7+ Year Member

    190
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    Jan 29, 2007
    One more question:

    A 30 yo woman has unusually heavy menstrual bleeding and intermittent gingival hemorrhages. She has multiple bruises. LAb studies show

    Hemoglobin 13.3
    Hematocrit 40%
    Leukocytes 5000
    Platelets 25,000
    PT 12 sec
    PTT 34 sec

    Peripheral blood smear shows normochromic normocytic erythrocytes w/o anisopoikilocytosis. A photo is shown. What's the most likely dx?

    A. Acquired aplastic anemia
    B. Acute leukemia
    C. DIC
    D. ITP
    E. TTP
     
  43. hypnix

    hypnix 10+ Year Member

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    Jan 2, 2008
    I believe D. PT and PTT normal. Platelet count low.
     
  44. kstreet

    kstreet 7+ Year Member

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    Jan 29, 2007
    Def makes sense. Thank you! During the test, got thrown off by the pic and ignored the values in the lab.
     
  45. whoknows2012

    whoknows2012 7+ Year Member

    714
    107
    May 15, 2008
    Its gotta be ITP because...

    aplastic anemia will present with pancytopenia

    acute leukemia you will see blasts in the smear

    DIC has prolonged PT and PTT

    Also with normal PT and PTT, and vastly decreased platelets (along with easy bruising and bleeding) it seems to be the only answer choice that fits the clinical vignette. Im too lazy to look up how TTP presents but I'd assume also with elevated PT and PTT?
     
  46. kstreet

    kstreet 7+ Year Member

    190
    2
    Jan 29, 2007
    TTP would be decreased PC and increased BT with schistocytes and increased LDH with renal, CNS, fever, microangiopathic hemolytic anemia, thrombocytopenia
     
  47. winkleweizen

    winkleweizen 5+ Year Member

    802
    43
    Apr 10, 2011
    question...lady with jaundice and mass at head of pancreas. Which procedure releaves the jaundice?

    Cholecystectomy
    stent into common bile duct
    stent into hepatic duct
    stent into main pancreatic duct
    Stent into cystic duct
    placement of transjugular portosystemic shunt

    Had no clue..

    Also the one where The guy was stroked out with a CT of the head. I put Cholesterol plaque. Was the Most predisposing factor Hypertension?

    And finally

    THe guy undergoes a laparscopic cholecystectomy. Which thing cant the surgeon inspect?

    Ileum
    Jejunum
    Pancreas
    stomach
    transverse colon(wrong).

    I originally had pancreas but changed it.
     
  48. kstreet

    kstreet 7+ Year Member

    190
    2
    Jan 29, 2007
    Head of the pancreas obstructs CBD.

    I think the other question is asking about what is retroperitoneal. Pancreas is mostly retroperitoneal.
     
  49. winkleweizen

    winkleweizen 5+ Year Member

    802
    43
    Apr 10, 2011
    THanks ya


    Mother F. I knew it was getting at retroperitoneal but for some reason i was thinking transverse was retro and the ascending and descending werent. Got it mixed up
     
  50. Scean

    Scean whats a goon to a goblin? 7+ Year Member

    435
    0
    Jan 2, 2007

    on the fasting one, this is liver specific right? I'm gonna go with:

    At a week you are pretty well spent and mostly using keto acids yea?
    Hmm so you definitely are NOT doing glycolysis - so

    F2,6BP down
    Pyruvate kinase down

    But are you doing gluconeogenesis? I think you still are.

    G6Pase up
    PEPCK up


    opinions welcome
     
  51. RapplixGmed

    RapplixGmed Looking for the Ether 7+ Year Member

    709
    15
    Nov 27, 2007
    Section 1:
    29. Women doesn't have menstral period for 3 months. Lost 20lbs weight since mother's death. Is it altered GnRH hormone pulses or premature ovarian failure?

    Section 2:
    9. 30 weeks Pregnant women with lower left sternal border murmur and splitting of S2 that is more pronounced with inspiration. What is the best explanation? Is this a normal physiologic response? (sounds normal to me... like a high output cardiac murmur and a normal split S2)

    21. Boy has coughing, wheezing and rapid breathing? Upper respiratory infection 2 days ago. Inspiratory/Expiratory wheezes. Decreased tactile fremitus. Asthma or Bronchitis? Leaning towards post-infectious bronchitis but not sure.


    Section 3:
    43. How does nictine stimulate pleasure and addition? Via the opiod receptors in the midbrain or dopmaine in the nucleus accumbens?

    Section 4:
    18. A 6 hour old female newborn has a harsh systolic murmur at the left upper sternal border. Findings on physical examination are otherwise unremarkable. Three hours later, the murmur has a diastolic component. Twelve hours later, there is no murmur, and ultrasonography discloses no cardiac abnormalities. Whcih fo the following is the most likely cause of the murmur.
    Is this typical of PDA? What explains the switch between the systolic and diastolic if so?
     

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