NBME 16 help

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conan31 said:
A 2-year-old boy is brought to the physician because of developmental delay. There is a history of hearing loss in his mother and delayed speech in his older sister. His maternal uncle had stroke-like episodes at the age of 25 years. Physical examination shows ophthalmoplegia and hypotonia. His serum lactic acid concentration is increased. Which of the following best explains the findings in this family?

A) Autosomal dominant inheritance
B) Decreased penetrance
C) Heteroplasmy
D) Imprinting
E) X-linked recessive inheritance

What is the correct answer?

What is the diagnosis? So many diseases in the relatives... i have no idea 🙁
Click to expand...

Answer = C, Heteroplasmy. It's a mitochrondially inherited disorder - the stroke-like episodes and lactic acidosis scattered throughout a family history tip you off. See page 86 of FA 2014.

The specific disorder is probably MELAS -- Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes.
 
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Oh, thanks for explanation. I'm a bit down in this period, this exam is really too demanding! 🙁 every day I learn new things
 
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conan31 said:
Oh, thanks for explanation. I'm a bit down in this period, this exam is really too demanding! 🙁 every day I learn new things
Click to expand...

Sorry to hear. Just keep absorbing the info and make it through each day.

Another quick point on that question: "Stroke-like episodes" and "ragged red fibers" are the two biggest buzzwords for mitochondrial inheritance disease. Lactic acidosis is highly indicative too, but can be confused with other disorders. But any time you see one of those two buzzwords, the answer is "Heteroplasmy" or "Mitochondrial inheritance". They may also ask you which process would be impaired in a person with one of these diseases, then give you some biochemical processes -- only one of which takes place in the mitochondria.
 
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conan31 said:
A 43-year-old woman comes to the physician because of progressive difficulty walking during the past 3 months. Neurologic examination shows weakness and decreased muscle bulk of the lower extremities. Patella and Achilles tendon reflexes are diminished. Sensations of join position, pain, and temperature in the lower extremities are normal. Which of the following is the most likely cause of the findings in this patient?

A) Acute peripheral neuropathy
B) Degeneration of motoneurons of the lumbar cord
C) Demyelination of the corticospinal pathways
D) Loss of afferent la axons innervating muscle spindles
E) Myotonic muscolar dystrophy

I put C and it's wrong, What is the right answer?
Click to expand...

it's either polio or ALS with only LMN signs. either way, the decreased muscle mass gives it away as being B since denervation -> muscle atrophy.
 
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A 49 year old lady with breast cancer develops increased numbness of both hands and feet during the 3 week interval between her third and fourth rounds of chemotherapy. Sensation to pinprick and fine touch is decreased over the hands, wrists, ankles and feet. The doc suspects that the distribution of sensory loss is most likely due to chemotherapy. Whas most likely disrupted in this patient due to the chemo? Is the answer microtubules for axonal transport???

other choices were myelin sheaths for saltatory conduction of action potentials, neurofilaments for sturural support of axons, sodium channels for membrane depolarization, synaptic vesicles for synaptic transmission.
 
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25 year old man brought to the er because of 2 hour history of nausea, vomiting, abdominal cramping, difficulty passing flatus. Face shows lesions in the photograph(honestly looks like hereditary hemorrhagic telangiectasia of the lips); similar lesions on fingers and toes. Lab show hypo chromic microcytic anemia,. Test of stool occult blood is positive. Whats the diagnosis?

cowden disease, gardner syndrome, muir tore syndrome, neurofibromatosis, peutz jeghers syndrome?
 
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afrothunderman1 said:
25 year old man brought to the er because of 2 hour history of nausea, vomiting, abdominal cramping, difficulty passing flatus. Face shows lesions in the photograph(honestly looks like hereditary hemorrhagic telangiectasia of the lips); similar lesions on fingers and toes. Lab show hypo chromic microcytic anemia,. Test of stool occult blood is positive. Whats the diagnosis?

cowden disease, gardner syndrome, muir tore syndrome, neurofibromatosis, peutz jeghers syndrome?
Click to expand...

Obstructive Sx + GI bleeding = possible polyps. Hyperpigmented macules + polyposis = Peutz-Jeghers.

http://en.wikipedia.org/wiki/Peutz–Jeghers_syndrome
 
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35 y/o man with burning abdominal pain after meals. epigastric tenderness and abdominal CT shows pancreatic mass. Immunohistochemical labeling of neoplastic cell has antibodies against?
a. amylase b. gastrin c. glucagon d. human pancreatic polypeptide e. insulin f. lipase g. serotonin h. somatostatin i. VIP


78 y/o man. fever, chills, sob. Urinary catheterization for prostatic obstruction. Soft S1, normal S2. Diastolic mumur in 2nd left intercostal accentuated when leans forward.
a. bacterial endocarditis b. peritonitis c. prostatitis d. pulm embolus e. viral pneumo
(Is it B)

62 y/o man who had MI 2 weeks ago and says he knows he needs to make changes but doesn't have to willpower
a. precontemplation b.contemplation c. preparation d. action e. maintenance
 
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42 yr old dude w Hep C undergoes liver biopsy...path exam shows lymphocytic infiltration and collagen deposition. These findings are characteristic of what? Chronic inflammation right? since lymphocytes are involved(not a specific rule but a general classification that usually works for me) and mostly cuz of the collagen deposition.

other choices are abcess formation, granuloma formation, purulent exudate, tissue necrosis
 
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kween said:
35 y/o man with burning abdominal pain after meals. epigastric tenderness and abdominal CT shows pancreatic mass. Immunohistochemical labeling of neoplastic cell has antibodies against?
a. amylase b. gastrin c. glucagon d. human pancreatic polypeptide e. insulin f. lipase g. serotonin h. somatostatin i. VIP

Gastrin, excess gastrin from a gastrinoma is causing ulcers (hinted by epigastric tenderness)

78 y/o man. fever, chills, sob. Urinary catheterization for prostatic obstruction. Soft S1, normal S2. Diastolic mumur in 2nd left intercostal accentuated when leans forward.
a. bacterial endocarditis b. peritonitis c. prostatitis d. pulm embolus e. viral pneumo
(Is it B)

Sounds like bacterial endocarditis. Was that what you picked?

62 y/o man who had MI 2 weeks ago and says he knows he needs to make changes but doesn't have to willpower
a. precontemplation b.contemplation c. preparation d. action e.maintenance
Click to expand...

Precontemplation. He's not ready to make changes.
 
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Missorleans said:
Precontemplation. He's not ready to make changes.
Click to expand...

I actually put "Contemplation" and this question wasn't in my incorrect's. Precontemplation would be if he denied there was even a problem...so I suppose since he's saying he knows something's wrong but isn't ready for change, it's Contemplation.

kween said:
35 y/o man with burning abdominal pain after meals. epigastric tenderness and abdominal CT shows pancreatic mass. Immunohistochemical labeling of neoplastic cell has antibodies against?
a. amylase b. gastrin c. glucagon d. human pancreatic polypeptide e. insulin f. lipase g. serotonin h. somatostatin i. VIP

78 y/o man. fever, chills, sob. Urinary catheterization for prostatic obstruction. Soft S1, normal S2. Diastolic mumur in 2nd left intercostal accentuated when leans forward.
a. bacterial endocarditis b. peritonitis c. prostatitis d. pulm embolus e. viral pneumo
(Is it B)
Click to expand...

1. Gastrin. They wanted your thought process to be: Gastritis + pancreatic mass = Zollinger-Ellison --> Neoplastic cells have an abundance of gastrin.
2. Bacterial endocarditis with Enterococcus. Recall that Enterococcus faecalis is associated with endocarditis post-GU procedures.

YeahNoMind said:
You're killing it man!
Click to expand...

Hahaha thanks! Just enjoy helping. 🙂

afrothunderman1 said:
42 yr old dude w Hep C undergoes liver biopsy...path exam shows lymphocytic infiltration and collagen deposition. These findings are characteristic of what? Chronic inflammation right? since lymphocytes are involved(not a specific rule but a general classification that usually works for me) and mostly cuz of the collagen deposition.

other choices are abcess formation, granuloma formation, purulent exudate, tissue necrosis
Click to expand...

Yep, chronic inflammation. I actually think chronic inflammation is defined by the presence of a lymphocytic infiltrate as opposed to neutrophilic/monocytic haha. Like you were thinking the fibrosis also hints towards chronic.
 
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A few more qqq . Thanks for your help. 🙂

Did anyone get the children of foundry workers question. I can post more details if need be.

60 y/o guy. no bleeding hx. coagulation test shows increased PTT. What is abnormal.
C5a generation. Histamine release. Kallikrein formation. Phagocytosis. Platelet aggretion (wrong)
(Is it Kallikrein)

70 y/o AA woman with sudden back pain. Worked pt as cashier for 30yrs. Low income. Smokes 1.5 pack for 50yrs. She has vertebral compression fracture and decreased bone mineral density. Greatest predisposing RF?
Ethnicity (wrong). Gender. Occupation. Occupation. Smoking. SE status
(I jumped the jump on this q. was pressed for time, saw the first line with African american woman and just assumed they were asking sarcoidosis smh, anyway it is gender or occupation)
This is osteoporosis right?

85 y/o female with fracture treated with morphine. 3 days later has pinpoint pupils. what causes clinical deterioration.
decreasing bioavailability. increasing bioavailability (wrong). mu-receptor downregulation. metabolism inhibition. metabolism to active metabolites that accumulates

67 y/o. what's the strongest predisposing RF for pancreatic cancer? Is it smoking?
here are the options. BMI = 34, cigarette, hx of gallstone (wrong), hypercalcemia, DM type 1
 
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osteoporosis one is smoking for sure. It goes Smoking. Menopause then steroid use, as the top 3 risk factors for osteoporosis.

morphine one sounds like it would be mu-receptor downregualtion. I think because she has pinpoint pupils. Miosis and constipation are the 2 symps of morphine toxicity that do not change due to tolerance development.

pancreatic cancer is for sure smoking. 2nd to that risk factor would be long standing chronic pancreatitis (esp for more than 20 yrs) FA pg 369.
 
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kween said:
A few more qqq . Thanks for your help. 🙂

Did anyone get the children of foundry workers question. I can post more details if need be.

The answer was where the control group did NOT have the exposure. I've seen this question somewhere else...I think it was the UWorld Subject Review for biostats. Think of it this way: how would you be able to compare odds of having the risk factor to that of not having the risk factor (i.e. odds ratio) if you only had a group of people with the risk factor? You need to fill in c and d into your 2x2 table.

60 y/o guy. no bleeding hx. coagulation test shows increased PTT. What is abnormal.
C5a generation. Histamine release. Kallikrein formation. Phagocytosis. Platelet aggretion (wrong)
(Is it Kallikrein)

Kallikrein. This question seemed very obscure to me, I think the diagnosis was anti-Hageman factor antibodies (covered briefly in Pathoma). You wouldn't know it was Hageman factor in particular, you just had to deduce that from the elevated PTT. By the way, platelet aggregation has nothing to do with PT/PTT.

70 y/o AA woman with sudden back pain. Worked pt as cashier for 30yrs. Low income. Smokes 1.5 pack for 50yrs. She has vertebral compression fracture and decreased bone mineral density. Greatest predisposing RF?
Ethnicity (wrong). Gender. Occupation. Occupation. Smoking. SE status
(I jumped the jump on this q. was pressed for time, saw the first line with African american woman and just assumed they were asking sarcoidosis smh, anyway it is gender or occupation)
This is osteoporosis right?

Yeah, osteoporosis. Answer = Gender. Also a side note from UWorld: Greatest determinant of peak bone density = genetics.

85 y/o female with fracture treated with morphine. 3 days later has pinpoint pupils. what causes clinical deterioration.
decreasing bioavailability. increasing bioavailability (wrong). mu-receptor downregulation. metabolism inhibition. metabolism to active metabolites that accumulates

Metabolism to active metabolites. Google "morphine-6-glucuronide" -- it's actually more potent than morphine itself. I've only seen this covered in Kaplan Pharm.

67 y/o. what's the strongest predisposing RF for pancreatic cancer? Is it smoking?
here are the options. BMI = 34, cigarette, hx of gallstone (wrong), hypercalcemia, DM type 1

Smoking. This is high-yield -- from my experience, it's as clear-cut an association as HPV for cervical cancer in questions.
Click to expand...

Happy to help. Answers in quote.
 
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Hey Kirby, i get why the answer would be gender for primary RF of osteoporosis in that question. decreased estrogen = apoptosis of osteoblasts and inhibition of apoptosis in osteoclast. But i got this world question with a graph about bone mass vs age in two healthy, fracture free women. and the educational objective had the List of Risk factors for osteoporosis. going from Smoking being #1. then menopause # 2 and steroids #3. Is this wrong?
 
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A few questions of mine, I skimmed over the previous posts but I might have missed some so sorry for repeats. I got these wrong while taking the test and even after seeing my incorrect I am still not sure of the answers or rationale on these.

1-1
Woman only wants occult blood test; no colonoscopy. The doc is worried about what for the occult blood test?
Answers: A. low sensitivity, B. low specificity, C. potential for false positive, D. uncertain NPV, E. uncertain PPV
I picked B. Next answer I would think of is C or E, but I don't see why B is incorrect. Is it because B is only testing for blood and not for cancer? Actually I'm not even sure between C and E either.

1-14
Systolic CHF
Someone posted this before and I understand the sildenafil/nitrate relationship. But what about diltiazam? Are non dihydropyridine CCBs not contraindicated in CHF?

2-2
Fish oil and high triglycerides. Mechanism?
Answers: A. antagonize VDL cholesterol secretion, B. increase catabolism of LDL cholesterol, C. inhibit cholesterol uptake, D. inhibit HMG COA, E. stimulate PPAR a receptors
I thought D sounded reasonable. Or even B. But I had no idea really.

2-5
What increases pulmonary lymph flow?
Answers: A. endothelin-1, B. phenylephrine, C. decrease O2, D. increase CO2, E. .9% saline, F. IV 20% albumin
Picked F thinking of osmotic pressure gradient. I don't see how increasing or decreasing vessel size would change anything.

2-47
1 year hx of abdominal pain after meals, better with small meals. History of atherosclerosis. Abdominal bruit.
Answers: A. greater pancreatic, B. hepatic, C. right gastric, D. SMA, E. supraduodenal
I picked C, thinking of some kind of ischemia to stomach, especially due to the small meal alleviation of pain. I was also considering B for ischemia to gallbladder. Kind of vague presentation, other than the bruit. What is going on here?

3-12
4 mo boy has auto recessive skeletal dysplasia with abnormal endochondral bone formation. Null mutations in gene for protein that controls traffic of vesicles to golgi. EM shows?
Answers: A. dec RER, B. dec SER, C. dilated RER, D. inc SER, E. large lysosomes, F. small lysosomes
I thought just based on golgi, it would either be backwards (RER) or forward (vesicles). I picked E. I'm guessing the answer is D then, but I don't know how you can reason the correct answer between the two.

3-16
70 yo man, wife recently died, difficulty sleeping/cries, enjoys grandchildren visits/bowling. No other depressive sx/suicidal ideation.
Answers: A. schedule appts to monitor patient; B. obtain neuropsych testing; C. order sleep testing; D. prescribe antidepressant; E. prescribe diphenhydramine
I picked E; he does not seem to have all the symptoms for depression. It seems A might be the next best choice, unless we're saying he actually has depression...

4-10
32 yo, G4, P0, A3. Newest baby has congenital defects. Why?
Answers: A. auto dom, B. auto rec, C. gonadal mosaicism, D. submicroscopic deletion, E. unbalanced chromosome rearrangement
Someone also mentioned this question. I picked C; the other answers don't make sense to me why the mom would have multiple abortions!

4-36
VSD and persistent truncus arteriosus, what cells were absent in development?
Answers: A. ectodermal neural crest, B. extraembryonic mesoderm, C. mantle layer neuroblasts, D. Mesothelial cells, E. splanchnopleuric mesoderm
I picked D. No idea what some of these are (not very strong on embryo).

4-43
Fever, N/V/D. Little urine production past 12 hours. Supine: pulse 92, BP 110/70. Standing: pulse 110, BP 80/60. Dry mucous membranes. WBC 7200. Na 146, Inc urea, creatinine, uric acid. Urine shows no protein, specific gravity of 1.03, no RBC, Na 10, Creatinine 19.
Answers: A. ATN, B. bladder outlet obstruction, C. interstitial nephritis, D. membranous GM, E. volume depletion
I picked A. Could the answer have been E? What distinguishes the two here?

4-44
Neutrophils that contain gram pos diplococci. What enzymes intiate killing?
Answers: A. catalase, B. COX, C. lysosomal hydrolases, D. NADPH oxidase, E. superoxide dismutase
I picked C, though A, D, and E all seemed just as likely. Not sure of the takeaway here or why C would be incorrect.

Thanks!!!
 
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EazyE1907 said:
Hey Kirby, i get why the answer would be gender for primary RF of osteoporosis in that question. decreased estrogen = apoptosis of osteoblasts and inhibition of apoptosis in osteoclast. But i got this world question with a graph about bone mass vs age in two healthy, fracture free women. and the educational objective had the List of Risk factors for osteoporosis. going from Smoking being #1. then menopause # 2 and steroids #3. Is this wrong?
Click to expand...

Haha wow you're totally right. How annoying. Looking at that list of risk factors in the UWorld question, I can only think that they're referring to risk factors in women...The only consolation I can give you is that I put Gender and it wasn't in my incorrects.

Going by the "simplest answer is usually right" idea, one would expect a postmenopausal woman to be most at risk because she's a postmenopausal woman anyway.
 
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Haha
kirbymiester said:
Haha wow you're totally right. How annoying. Looking at that list of risk factors in the UWorld question, I can only think that they're referring to risk factors in women...The only consolation I can give you is that I put Gender and it wasn't in my incorrects.

Going by the "simplest answer is usually right" idea, one would expect a postmenopausal woman to be most at risk because she's a postmenopausal woman anyway.
Click to expand...

Haha ok. I see what you're saying. I'll keep the "simplest answer is usually right" notion in my head during these exams. Maybe the NBME question was pointing at non-modifiable risk factors w/o mentioning it. but who knows. thanks for the reply!
 
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tartrate said:
A few questions of mine, I skimmed over the previous posts but I might have missed some so sorry for repeats. I got these wrong while taking the test and even after seeing my incorrect I am still not sure of the answers or rationale on these.

1-1
Woman only wants occult blood test; no colonoscopy. The doc is worried about what for the occult blood test?
Answers: A. low sensitivity, B. low specificity, C. potential for false positive, D. uncertain NPV, E. uncertain PPV
I picked B. Next answer I would think of is C or E, but I don't see why B is incorrect. Is it because B is only testing for blood and not for cancer? Actually I'm not even sure between C and E either.

Low sensitivity. When asked about a screening test (occult blood test), all you care about is the sensitivity. B is wrong because occult blood tests have terrible specificity (what if it's dysentery or angiodysplasia causing the blood) but are still valuable.

1-14
Systolic CHF
Someone posted this before and I understand the sildenafil/nitrate relationship. But what about diltiazam? Are non dihydropyridine CCBs not contraindicated in CHF?

You're right that diltiazem is contraindicated, but sildenafil/nitrate is an even bigger baddie. Kind of a sucky question.

2-2
Fish oil and high triglycerides. Mechanism?
Answers: A. antagonize VDL cholesterol secretion, B. increase catabolism of LDL cholesterol, C. inhibit cholesterol uptake, D. inhibit HMG COA, E. stimulate PPAR a receptors
I thought D sounded reasonable. Or even B. But I had no idea really.

This question asked what the MOA of the vitamin supplement he would be put on was right? If I remember correctly, you assumed he was going on Niacin, so it was answer choice A.

2-5
What increases pulmonary lymph flow?
Answers: A. endothelin-1, B. phenylephrine, C. decrease O2, D. increase CO2, E. .9% saline, F. IV 20% albumin
Picked F thinking of osmotic pressure gradient. I don't see how increasing or decreasing vessel size would change anything.

According to the person who answered my Q, it's E because that's the only one that will increase capillary hydrostatic pressure. Others would only increase arterial pressure or not do anything filtration-promoting.

2-47
1 year hx of abdominal pain after meals, better with small meals. History of atherosclerosis. Abdominal bruit.
Answers: A. greater pancreatic, B. hepatic, C. right gastric, D. SMA, E. supraduodenal
I picked C, thinking of some kind of ischemia to stomach, especially due to the small meal alleviation of pain. I was also considering B for ischemia to gallbladder. Kind of vague presentation, other than the bruit. What is going on here?

Ehhh don't remember this well enough with the info you're giving. I think it was SMA, mesenteric angina. History of atherosclerosis + abdominal pain after meals = mesenteric angina / ischemic colitis.

3-12
4 mo boy has auto recessive skeletal dysplasia with abnormal endochondral bone formation. Null mutations in gene for protein that controls traffic of vesicles to golgi. EM shows?
Answers: A. dec RER, B. dec SER, C. dilated RER, D. inc SER, E. large lysosomes, F. small lysosomes
I thought just based on golgi, it would either be backwards (RER) or forward (vesicles). I picked E. I'm guessing the answer is D then, but I don't know how you can reason the correct answer between the two.

Yeah, D. I picked E too, thought it was too big an assumption to make. Guess you were supposed to think COPII was down.

3-16
70 yo man, wife recently died, difficulty sleeping/cries, enjoys grandchildren visits/bowling. No other depressive sx/suicidal ideation.
Answers: A. schedule appts to monitor patient; B. obtain neuropsych testing; C. order sleep testing; D. prescribe antidepressant; E. prescribe diphenhydramine
I picked E; he does not seem to have all the symptoms for depression. It seems A might be the next best choice, unless we're saying he actually has depression...

Schedule appointments. Normal grief reaction. You can actually have some really severe Sx in the stem ("intrusive thoughts about loved one", "wish I died in the car accident with them"), but it's usually still normal grief if the patient denies suicidal ideation and it's within a reasonable time frame.

4-10
32 yo, G4, P0, A3. Newest baby has congenital defects. Why?
Answers: A. auto dom, B. auto rec, C. gonadal mosaicism, D. submicroscopic deletion, E. unbalanced chromosome rearrangement
Someone also mentioned this question. I picked C; the other answers don't make sense to me why the mom would have multiple abortions!

Unbalanced chromosomal rearrangement. See witzelsucht's explanation on page 5. Gonadal mosaicism would be unable to produce a live birth after consistent stillbirths (no variation in oocyte chromosomes).

4-36
VSD and persistent truncus arteriosus, what cells were absent in development?
Answers: A. ectodermal neural crest, B. extraembryonic mesoderm, C. mantle layer neuroblasts, D. Mesothelial cells, E. splanchnopleuric mesoderm
I picked D. No idea what some of these are (not very strong on embryo).

A, ectodermal neural crest. High yield to know that septal defects and persistent truncus = neural crest migration defect.

4-43
Fever, N/V/D. Little urine production past 12 hours. Supine: pulse 92, BP 110/70. Standing: pulse 110, BP 80/60. Dry mucous membranes. WBC 7200. Na 146, Inc urea, creatinine, uric acid. Urine shows no protein, specific gravity of 1.03, no RBC, Na 10, Creatinine 19.
Answers: A. ATN, B. bladder outlet obstruction, C. interstitial nephritis, D. membranous GM, E. volume depletion
I picked A. Could the answer have been E? What distinguishes the two here?

I made the same mistake. It's E. Dry mucous membranes always means dehydration in a Q stem, and I can't think of a time I've seen orthostatic hypotension in a patient that wasn't volume depleted. Better answer than ATN.

4-44
Neutrophils that contain gram pos diplococci. What enzymes intiate killing?
Answers: A. catalase, B. COX, C. lysosomal hydrolases, D. NADPH oxidase, E. superoxide dismutase
I picked C, though A, D, and E all seemed just as likely. Not sure of the takeaway here or why C would be incorrect.

NADPH oxidase. It wouldn't be A or E because those are lower in the pathway of oxidative killing. But I'm not sure why it wouldn't be lysosomal hydrolases...a quick Wiki search revealed that NADPH oxidase is actually in the phagosome too. I picked it because it because it seemed like what they wanted me to know, but it would be ridiculous if they truly wanted you to know that NADPH oxidase is in the phagosome too.

Thanks!!!
Click to expand...

Answers in quote.
 
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kirbymiester said:
Answers in quote.
Click to expand...

Thanks a lot kirbymeister, I appreciate the response.

To question 1-1 however, your reasoning would make sense if that's what they were asking. It seems though that the question is asking more why the occult blood test is inappropriate in this situation. And since occult blood tests have low specificity as stated in your response, it seems like it should be the correct answer.

And about 4-10, it's still odd to me. I guess I don't understand what unbalanced chromosomal translocation means...why would all her eggs be affected? It seems with mosaicism, at least some of her eggs would be viable. Still, this is one of the oddest presentations I've seen.

And I made a pretty cool connection from reading your explanation and thinking about the endocardial cushion question. A lot of the internal Down syndrome pathology can actually be explained by impaired neural crest migration! I don't think I've read this as an explanation in FA/Pathoma/Goljan... but it makes sense 😀
 
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15 yr old female ingested Vit D in a suicide attempt. Follow up 1 month later show Ca [C] 10.4 (slightly elevated) What is the mechanism of increased Ca.

A. Decreased Excretion of Ca from GIT
B.Decreased osteoclast activity in bone
C.Increased absorption of ca in GIT
D.Increased 1 Hydroxylase activity in kidney
E.Increased Ostoblast activity in bone



Why is it not D? Is the answer C?
 
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afrothunderman1 said:
15 yr old female ingested Vit D in a suicide attempt. Follow up 1 month later show Ca [C] 10.4 (slightly elevated) What is the mechanism of increased Ca.

A. Decreased Excretion of Ca from GIT
B.Decreased osteoclast activity in bone
C.Increased absorption of ca in GIT
D.Increased 1 Hydroxylase activity in kidney
E.Increased Ostoblast activity in bone



Why is it not D? Is the answer C?
Click to expand...
The simple answer here is correct, C. Remember kidney induces increase in 1, 25 D, not the other way.
 
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study designed to evaluate relationship b/w ambient noise and hearing loss in auto manufacturing plant...different locations in the plant have different levels of ambient noise.....each employee given test for hearing acuity, and then ambient noise level is measured at his workstation. Whats the study design?

case series, cohort, crossover, cross sectional, randomized clinical trial? Is it cohort?
 
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old lady with hypertension has 3 hour history of headache, chest pain, shortness of breath. Her meds are aspirin, furosemide, lisinopril. Respirations are 20/min and bp is 230/110. Physician plans to begin treatment w nonselective antagonist that blocks a1 and b adrenoreceptors...which drug is it?

hydralazine, labetalol?, phenoxybenzamine?, phentolamine?, trimethaphan
 
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girl has progressive fatigue, generalized weakness for the past 5 months. Phys exam shows erythematous, maculopapular rash over both elbows and proximal muscle weakness. She has difficult lifting her upper extremities but she can move her fingers w precision. She has trouble standing from seated position. Serum studies show an increased creatinine kinase activity' a serum antinuclear antibody assay is positive. Whats the diagnosis?

Dermatomyositis right?

Other choices are juvenile rheumatoid arthritis, mucocutaneous lymph node kawasaki syndrome, muscular dystrophy, SLE, viral cardiomyopathy and failure
 
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afrothunderman1 said:
study designed to evaluate relationship b/w ambient noise and hearing loss in auto manufacturing plant...different locations in the plant have different levels of ambient noise.....each employee given test for hearing acuity, and then ambient noise level is measured at his workstation. Whats the study design?

case series, cohort, crossover, cross sectional, randomized clinical trial? Is it cohort?
Click to expand...

Cross sectional - data from disease at particular point in time "what is currently happening"
 
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45 year old man admitted to the hospital due to vhf..first degree relatives died in their 40s from dilated cardiomyopathy and cirrhosis. Phys exam shows cardiac enlargement and generalized hyper pigmentation. Serum glucose of this dude is 320 mg/dl. Histo exam of endomyocardial tissue is most likely to show an excess of which of the following? Amyloid, a1 antitrypsin, cerebroside, copper, eosinophils, iron, lysosomal glycogen, mucupolysaccaride?
 
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kween said:
Cross sectional - data from disease at particular point in time "what is currently happening"
Click to expand...
Thank you. I was thinking what if this was cohort, since theres a risk factor "noise" and the result of that is "hearing loss" so I thought maybe they were going forward in time and measuring the effect of the risk factor...although now that i think about it there was no mention of following them forward in time lol..sigh.
 
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afrothunderman1 said:
old lady with hypertension has 3 hour history of headache, chest pain, shortness of breath. Her meds are aspirin, furosemide, lisinopril. Respirations are 20/min and bp is 230/110. Physician plans to begin treatment w nonselective antagonist that blocks a1 and b adrenoreceptors...which drug is it?

hydralazine, labetalol?, phenoxybenzamine?, phentolamine?, trimethaphan
Click to expand...

Labetalol
 
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afrothunderman1 said:
45 year old man admitted to the hospital due to vhf..first degree relatives died in their 40s from dilated cardiomyopathy and cirrhosis. Phys exam shows cardiac enlargement and generalized hyper pigmentation. Serum glucose of this dude is 320 mg/dl. Histo exam of endomyocardial tissue is most likely to show an excess of which of the following? Amyloid, a1 antitrypsin, cerebroside, copper, eosinophils, iron, lysosomal glycogen, mucupolysaccaride?
Click to expand...

Iron, symptoms describe hemochromatosis.
 
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afrothunderman1 said:
girl has progressive fatigue, generalized weakness for the past 5 months. Phys exam shows erythematous, maculopapular rash over both elbows and proximal muscle weakness. She has difficult lifting her upper extremities but she can move her fingers w precision. She has trouble standing from seated position. Serum studies show an increased creatinine kinase activity' a serum antinuclear antibody assay is positive. Whats the diagnosis?

Dermatomyositis right?

Other choices are juvenile rheumatoid arthritis, mucocutaneous lymph node kawasaki syndrome, muscular dystrophy, SLE, viral cardiomyopathy and failure
Click to expand...

yea dermatomyositis, the fact that its a little girl was kind of a shocker tho

afrothunderman1 said:
old lady with hypertension has 3 hour history of headache, chest pain, shortness of breath. Her meds are aspirin, furosemide, lisinopril. Respirations are 20/min and bp is 230/110. Physician plans to begin treatment w nonselective antagonist that blocks a1 and b adrenoreceptors...which drug is it?

hydralazine, labetalol?, phenoxybenzamine?, phentolamine?, trimethaphan
Click to expand...

i believe my answer was labetalol = nonselective alpha and beta blocker (FA pg 238)

afrothunderman1 said:
45 year old man admitted to the hospital due to vhf..first degree relatives died in their 40s from dilated cardiomyopathy and cirrhosis. Phys exam shows cardiac enlargement and generalized hyper pigmentation. Serum glucose of this dude is 320 mg/dl. Histo exam of endomyocardial tissue is most likely to show an excess of which of the following? Amyloid, a1 antitrypsin, cerebroside, copper, eosinophils, iron, lysosomal glycogen, mucupolysaccaride?
Click to expand...

Iron - hemachromatosis causing DCM and bronze skin
 
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1) 25 y/o woman w/ history of irregular menstrual periods, deep voice, hirsutism, acne. Serum studies of insulin, testosterone, and lutenizing hormone show what?
PCOS so fasting insulin, testosterone, and LH all increased right?


2) Thrombosis of the SMA. Ischemia caused by thrombosis is most likely to affect directly which of the following structures?
descending colon, first part of the duodenum, jejunum(perhaps), sigmoid colon, stomach



3) man comes to doc becuz of 2 hr episode of loss of vision in his right eye 2 days ago. He underwent a left femoral popliteal bypass 3 months ago for peripheral vascular diseases. normal vital signs. Funduscopic exam shows cholesterol emboli. Most likely cause of his condition is an embolus in which of the following arteries?
abdominal aorta, left common carotid, right anterior cerebral, right middle cerebral, right opthalmic(perhaps)



4) 55 yr old woman gets headache, temperature of 104 F, stiff neck, and confusion. Her spleen was removed cuz of injuries from her car accident 7 months. Which organisms will be cultured from her csf?
borrelia burgdorferi, crytococcus neoformans, h. influenza, mycobacterium tuberculosis, strep pneumonia?
 
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afrothunderman1 said:
1) 25 y/o woman w/ history of irregular menstrual periods, deep voice, hirsutism, acne. Serum studies of insulin, testosterone, and lutenizing hormone show what?
PCOS so fasting insulin, testosterone, and LH all increased right?


2) Thrombosis of the SMA. Ischemia caused by thrombosis is most likely to affect directly which of the following structures?
descending colon, first part of the duodenum, jejunum(perhaps), sigmoid colon, stomach

Jejunum. Question is testing concept of bloody supply to midgut structures from the superior mesenteric artery. Descending colon and sigmoid colon are supplied by the inferior mesenteric artery. The first part of the duodenum and the stomach are supplied by branches of the celiac.

3) man comes to doc becuz of 2 hr episode of loss of vision in his right eye 2 days ago. He underwent a left femoral popliteal bypass 3 months ago for peripheral vascular diseases. normal vital signs. Funduscopic exam shows cholesterol emboli. Most likely cause of his condition is an embolus in which of the following arteries?
abdominal aorta, left common carotid, right anterior cerebral, right middle cerebral, right opthalmic(perhaps)

Right ophthalmic. The central retinal artery is a branch of the ophthalmic artery.

4) 55 yr old woman gets headache, temperature of 104 F, stiff neck, and confusion. Her spleen was removed cuz of injuries from her car accident 7 months. Which organisms will be cultured from her csf?
borrelia burgdorferi, crytococcus neoformans, h. influenza, mycobacterium tuberculosis, strep pneumonia?

Older asplenic person with meningitis --> knee jerk Strep pneumo
Click to expand...

see bold.
 
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1) 18 year old dude brought to the er becuz of anxiety and confusion for 6 hours. He has not had visual or auditory hallucinations. He appears cachectic and older than his age. Temperature is 100.8 F, pulse is 130/min, respirations are 14/min, and bp is 180/110 mm hg. Phys exam shows diaphoresis, pupillary dilation, and muscle weakness. The patient undergoes gastric emptying followed by charcoal treatment. Toxicology screening will most likely be positive for what? is it amphetamines because of the pupillary dilation and confusion?

amphetamines, barbiturates, benzodiazepines, marijuana, opiates?



2) a teen brought to the er 1 hour after he ate jimsonweed broth. He has hallucinations. Pulse is 128/min. Phys exam shows flushing and dry mouth. He’s disoriented to person, place, and time. Antidote must be carefully titrated to avoid potential cardiac effects. which of the following drugs is appropriate? So I’m guessing this mimics atropine toxicity, also cuz they mention the cardiac effects in the passage. So is the answer physostigmine?

carbachol, neostigmine, physostigmine, pilocarpine, trimethaphan



3) a few days after admission into hospital cuz of sickle cell crisis, a 24 year old kid suddenly develops blood in his urine and flank pain. Lab studies during admission shows his hematocrit was decreased to 11 % from baseline of 25%. Urinalysis shows gross blood, rare WBC’s and no WBC casts. Whats the cause of hematuria in this guy?

glomerulonephritis(?), nephrolithiasis, prostatitis, renal papillary necrosis, transitional cell carcinoma?



4) (You may need to look at pic for this. Don’t know how to attach it). 4o yr old lady diagnosed with immune thrombocytopenic purport resistant to corticosteroid trtmnt will undergo operation to fix this condition. What organ should be removed? So the spleen pretty much. It’s B right?

a,b,c, d, e



5) (also need to look @ pic) 22 yr old man comes to the doc cuz of infertility. Photomicrograph shows tissue optainied on biopsy of scrotal testes. whats the genetic abnormality? looks like fibrosis or something…Is it klinefelters?

A) 45,x/46,xy B) 46,xx C) 46,xy D) 47,xxx E) 47,xxy



6) 20 yr old guy comes to doc due to a 6 mo history of diarrhea and 35 lb weight loss. he’s 6’1 and is now 166lbs. BMI is 22 kg/m^2. Phys exam shows pallor and pitting edema of lower extremities. lab studies show microcytic hypo chromic anemia, hypoalbuminemia, and increased fat concentration in stool.Serum anti endomysium Iga and anti tissue transglutaminase IgA antibodies are positive. A biopsy specimen of small intestine will show what? So this is celiac disease so I’m thinking its the one w/ loss of villi?

eosinophil infiltration of lamina propria and mucosa, granulomas in bowel wall and serosa, loss of villi and increased number of intraepithelial lymphocytes, macrophages containing periodic acid schiff positive bacilli in lamina propria, normal villi with epithelial cells vacuolated with fat
 
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afrothunderman1 said:
1) 18 year old dude brought to the er becuz of anxiety and confusion for 6 hours. He has not had visual or auditory hallucinations. He appears cachectic and older than his age. Temperature is 100.8 F, pulse is 130/min, respirations are 14/min, and bp is 180/110 mm hg. Phys exam shows diaphoresis, pupillary dilation, and muscle weakness. The patient undergoes gastric emptying followed by charcoal treatment. Toxicology screening will most likely be positive for what? is it amphetamines because of the pupillary dilation and confusion?

amphetamines, barbiturates, benzodiazepines, marijuana, opiates?

yea its amphetamines

2) a teen brought to the er 1 hour after he ate jimsonweed broth. He has hallucinations. Pulse is 128/min. Phys exam shows flushing and dry mouth. He’s disoriented to person, place, and time. Antidote must be carefully titrated to avoid potential cardiac effects. which of the following drugs is appropriate? So I’m guessing this mimics atropine toxicity, also cuz they mention the cardiac effects in the passage. So is the answer physostigmine?

carbachol, neostigmine, physostigmine, pilocarpine, trimethaphan

yea, it is atropine toxicity.
Physostigmine is the only one that cross blood brain barrier and can fix CNS problems
(Mneumonic from DIT = PHYsostigmine PHIXES (fixes) atropine overdose)

3) a few days after admission into hospital cuz of sickle cell crisis, a 24 year old kid suddenly develops blood in his urine and flank pain. Lab studies during admission shows his hematocrit was decreased to 11 % from baseline of 25%. Urinalysis shows gross blood, rare WBC’s and no WBC casts. Whats the cause of hematuria in this guy?

glomerulonephritis(?), nephrolithiasis, prostatitis, renal papillary necrosis, transitional cell carcinoma?

Renal Papillary necrosis triggered by sickle cell disease, DM, pyelonephritis and chronic acetaminophen (FA pg 496)

4) (You may need to look at pic for this. Don’t know how to attach it). 4o yr old lady diagnosed with immune thrombocytopenic purport resistant to corticosteroid trtmnt will undergo operation to fix this condition. What organ should be removed? So the spleen pretty much. It’s B right?

a,b,c, d, e

Not sure, got this one wrong. (i put E)

5) (also need to look @ pic) 22 yr old man comes to the doc cuz of infertility. Photomicrograph shows tissue optainied on biopsy of scrotal testes. whats the genetic abnormality? looks like fibrosis or something…Is it klinefelters?

A) 45,x/46,xy B) 46,xx C) 46,xy D) 47,xxx E) 47,xxy

don't remember the pix, but i think I put 47xxy and it wasn't in my incorrects

6) 20 yr old guy comes to doc due to a 6 mo history of diarrhea and 35 lb weight loss. he’s 6’1 and is now 166lbs. BMI is 22 kg/m^2. Phys exam shows pallor and pitting edema of lower extremities. lab studies show microcytic hypo chromic anemia, hypoalbuminemia, and increased fat concentration in stool.Serum anti endomysium Iga and anti tissue transglutaminase IgA antibodies are positive. A biopsy specimen of small intestine will show what? So this is celiac disease so I’m thinking its the one w/ loss of villi? yea its celiac

eosinophil infiltration of lamina propria and mucosa, granulomas in bowel wall and serosa, loss of villi and increased number of intraepithelial lymphocytes, macrophages containing periodic acid schiff positive bacilli in lamina propria, normal villi with epithelial cells vacuolated with fat
Click to expand...

Answers in blue
 
Last edited:
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53 yo alcoholic, homeless man comes to ed by police. appears cachectic, fever. clubbing of fingers, breath smells, missing teeth, numerous cavities. has increased fremitus, dullness to percussion, and tubular breath sounds in right lower lung. leukocyte count 11.4k. sputum grows purulence, gram + cocci in chains, and gram - bacilli. x ray shows cavitation in right lower lung lobe with surrounding infiltrate. sputum will likely grow which of the following?

chlamydophila pneumonia, haemophilus influenza, mycoplasma pneumonia, strep pneumon, normal oral flora
 
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