nanitch

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I tried to edit it the most I can to not have it the same as written in the exam. Can someone please give me the answer but with explanations because I want to really understand why its one and not the other. For some reason when people explain it in forums its more easier than in medical terms. lol. Thank you for your time by the way.



42) Diagnosis of cancer, weight loss, cachexia and significant muscle wasting. The breakdown of muscle proteins in the patient was most likely preceded by conjugation of the porteins with?


A) BCl2

D) Cytochrome C

E) Lysozyme

F) Phospholipase A2

G) Ubiquitin


***The reason its not ubiquitin its because ubiquitin has to do with going to proteins that are already damaged like broken? cytochrome c binds to proteins that aren't damaged but want to degrade??I got confused and put ubiquitin


30) 13 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration. Photo of tissue biopsy given. Dx?

a. Granuloma

b. Granulation tissue

e. Neutrophilic infiltrate


**I keep confusing granuloma and granulation tissue. Can someone explain in simple terms the different regarding a question to differentiate them.


24) Case control study. 100men with bladder cancer compared to 100 controls.Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder cancer to EtOH consumption. Interpretation?


a. The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6.

b. There is a 95% chance that the true odds ratio is 3.00

c. At least 5% of consumers of alcohol will develop cancer of the bladder.

d. Men who drink alcohol are 5 times more likely to develop bladder cancer than those who do not drink alcohol


**Im confused regarding this, can someone explain me this on how you would conclude and say what is this like these options in simple words VS. relative risk


32) 32 yo woman with fecal incontinence after child birth. Dx?

a. Damage to anal sphincter

b. Spastic contraction of puborectalis muscle

c. spastic external anal spinchter

d. achalasia of internal anal sphincter


**I assumed puborectalis muscle damaged by levator anti because was pregnant



54) 3 tests evaluate children with diarrhea for rotavirus. Sensitivity and specificity are summarized. If only treat children actually have disease because of toxicity of treatment, which tests should be run?


Test 1 Sensitivity 70 and Specificity 100

Test 2 Sensitivity 90 and Specifiticity 95

Test 3 Sensitivity 95 and Specificity 70


A. Test 1 followed by test 3 if test 1 is positive

B Test 3 followed by test 1 if test 3 is positive

C. Test 2 only

D. Test 2 followed by test 3 if test 2 is negative

E. Test 2 followed by test 3 if test 2 is positive


**This one I have NO IDEA, i hate biostats. not my thing.


47) 62 yo woman, abdominal aortic aneurysm repaird. 48 hr later right distal leg dusky, cool and dark purple to black necrotic lesions on several toes. Biopsy of lesion shows occluded small arteries with needle shaped clefts. Dx?


A. Arterioal narrowing

B. Septic emboli

C. Cholesterol emboli

D. Vasospasm

E. Venous thrombosis


40 yo woman lump in neck became larger recently. 8x10mm mass lateral to midline over thyroid cartilage. Soft, mobile and moves upward when patient protrudes tongue. Whats structure?


A. Hygroma

B. Thyroglossal cyst

B. Dermoid cyst

C. Lymph node


***So because of the protrudes her tongue it moves i thought thyroglossal cyst but should thyroglossal cyst be midline not lateral? I'm confused



44) 53 yo woman w/ GERD. Dietary change and stress reduction no effect symptoms. Physical exam shows mild epigastric tenderness. Tx?


A. Omeprazole

B. Misoprostol


**I dont know why I saw healing esophageal mucosa thought of protection to barrier and put stupidly misoprostol....


8) 62 yo woman weakness of left leg. Left lower extremity shows muscle strength of 1/5 and deep tendon reflexes of 3+. When eyes closed, she cannot tell left great toe is raised or depressed. Embolism of what arteries?


A. Right anterior cerebral

B. Right radicular branches of the posterior spinal


**Yup, I put B. Im so stupid... I put it thinking about propiocpetion Idk lol.


26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal. Whats effected?


A. Decreases amplitude of action potential

B. Decreases maximum frequency of action potential production

C. Increases conduction velocity of axon

D. Increases input resistance of axon

E. Increases rate of depolarization of action potential


***Whats the answer and why


31) 5 yo boy pain in right eye at night. No Fx of neoplasia. Exam shows strabismus and tenderness in eye. Left eye normal. Retina show presence of mass. Physician explain unlikely to develop other neoplasms. Mutation occurs?


A. Retinal cells

B. Somatic cells of parents

C. Somatic cells of child

D. Germ cells


**Why not somatic cells?? whats the answer and why, like how to differentiate



46) 30yo man with urinary incontinence after tx of left pelvis fracture. Physical exam show distended bladder, absence of micturition reflex. After bladder fills to capacity, overflow of urine occurs through urethra by few drops. What other nerve injury?


A. Pelvic nerves

B. Pudendal nerves

C. External urinary sphincter


**Explain which one and why not the others


29) 35yo man want to donate kidney to his sister who is T1DM and chronic renal failure. Healthy, physical exam normal. How likely his HLA type is a match?


A. 1:1

B. 1:2

C. 1:4

D. 1:6


**Which one and why?


21) Mouse thymocyte obtained from normal active bone marry was altered to express bcl-2 and combined with normal marrow cells was injected into mice w/ destroyed active marrow. Control mouse with destroyed marrow was injected w/ normal marrow only. After recovery, whats different between mouse?


A. Decrease cell death in thymic cortex

B. Increase number circulating plasma cells

C. Decrease number of circulating lymphocytes

D. Decrease overall risk of autoimmunity

E. Increase formation of lymphoid nodules in thymic cortex

F. Decrease naive B lymphocytes production by reconstituted marrow


**I put increase number of circulating plasma cells, why its wrong??



49) 1 day old newborn tested for anti-HIV antibodies. Western blot confirm presense of IgG antibodies which react with virus envelope and core glycoproteins. Dx?


A. Both newborn and mother infected

B. The mother is infected, status newborn uncertain

C. Newborn is infected; infection occurred at birth

D. Newborn infected; infection occurred in utero

E. Newborn infected; status of mother is uncertain


**What is the answer and why?


32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated?

So apparently its Na and Glucose cotransport :/ I got it wrong. Im confused...... can someone explain.


50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small bile ducts and increased portal fibrosis. If not treated, what develops?

A. Budd Chiari syndrome

B. End stage cirrhosis

C. Hepatocellular carcinoma

D. Recurrent episodes of hepatitis


**I didn't even mark this one.. i put hepatocellular carcinoma because in FA and DIT it mentioned it so I just put it fast seeing that it was antitrypsin deficiency. What is the answer and why


28) 60yo woman 1 yr involuntary rhythmic jerking of right leg and foot. Increased right ankle jerk reflex. Babinski sign + on right. MRI shows 2cm round lesion at interhemispheric fissure at the central sulcus. Dx?


Why not lymphoma?

Other options

A. Metastatic carcinoma

B. Meningioma

C. Oligodendroglioma


24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive. Further observation shows CD8 T cells bind to antigens resulting in liver injury. Where’s antigen from?

A. Hepatocytes

B. Ito cells

C. Stellate cells

D. Kupffer cells

E. Bile duct epithelium


3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?

A. Hormones derived from 7-dehyrocholesterol

B. Cyclic AMP generated in the enterocytes in response to PTH

C. Calcium binding proteins in goblet cells


20) 23 yo woman DVT at 6 months pregnant. IV heparin started. 7 days later platelet count: 44,000. Dx?

A. Antimegakaryocyte antibodies

B. Antiplatelet antibodies

C. Heparin induced hemodilution


***Which is the answer and why???


42) 26yo woman 3m pain and stiffness of both hands. Physical exam shows swelling and redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP joints spared. Biopsy show?


A. Necrotizing granulomas

B. Neutrophilic infiltrates

C. Pigmented villonodular synovitis

D. Synovial pannus formation

E. Urate crystals


**So since it doesn't include DIP i assumed its not rheumatoid arthritis?? so not pannus??? so which one is it??? and why??



76) yo man 30mins severe substernal chest pain while arguing with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG ST elevation at leads I, aVl, and V4-V9. What happened during argument with brother?

A. Coronary vasospasm due to a1

B. Coronary vasospasm due to B1 adrenergic

C. Increase after load for left ventricle due to B1

D. Negative chronotropc effect of a1


**I have no idea, i assumed increase sympathetic stimulation and for some reason was in between coronary vasospasm due to B1 and after load of B1 but now thinking about it sympathetic stimulates NE release which causes a1 stimulation so I'm an idiot, its that one right?? or which one and why




8) 30 yo man and 24 yo woman genetic counseling. Man’s brother has type 1 oculocutaneous albinism (AR). Single gene disorder 1/40,000 in population. Pedigree shown. What are the odds?
A. 1:600
B. 1:100
c. 1:200
d. 1: 40,000
e. 1:4

**Which is the answer and how u got to it??



21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What substance cause new symptoms?

A. NO
B. Serotonin
C. Histamine

**NO Vs. Histamine???



46) Isolated skeletal muscle is isolated w/ glucose bath. Muscle is contracted w/ electrical stimulation. What intracellular increase indicates fatigue?

A. ADP
B. Inorganic phosphate
C. Inosine monophosphate
D. Lactate
E. pH

**WHYY
 
Last edited:
Mar 30, 2017
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42) are you sure that ubiquitin is not the correct answer. It's what I chose and it was correct
30) granuloma--->try to contain an infection by creating a big "wall" around it, granulation tissue--> wound repair, in very simple words
24) A---> a condifence interval is the probability that a value lies between the two extremes. If you know the mean and the standard deviation you will have 95% confidence that a value will lie between Mean+- 2SD. (ex: average weight in a population is 70 kg, standard deviation is 10kg. If you go out the street and you talk to first person you meet you will be 95% confident that his weight will lie between 50Kg (70-2SD) and 90Kg (70+2SD)
32) I put damage to the anal sphincter. Didn't come up.
54) Test 3 followed by test 1 if test 3 is positive. with test 3 you find 95% of the people with the disease, but since you are gonna have a lot of false positives you use test 1 which is always negative in false positive
47) cholesterol emboli
40) i think thyroglossal cyst
44) also put misoprostol... this question was very tricky, don't know the answer
26) decreased action potential amplitude
31) it seems like a local problem. I put retinal cells--> it's not retinoblastoma, that was the trick I think
46) A. Just guessed I suck at anatomy lol. But seriously I think that's a typical case of atonic bladder. on Uworld is explained much better than how I would explain it
29) 1:4. I guess that you inherit one allele from each parent, 4 different combinations
21) decrease cell death. Bcl2 has to do with apoptosis, mutated in follicular lymphoma
49) B I think
32) I got it wrong :(
50) I think you read it wrong, antitrypsin has been ruled out and the patient is just few weeks old. I unfortunately got it wrong because I put budd-chiari syndrome :(
28) Meningioma... I just read central sulcus and 60 year old woman
24) got it wrong, let me know if you find the solution
3) got it wrong... I think A
20) B. Written in first aid
42) Pannus. RA-->PIP, osteoarthritis-->DIP
76) A--> B1 is not present in vessels
8) 1/600. Her brother is diseased and she is clearly not. We can assume that she has 2/3 probability to be a carrier. Disease prevalence 1/40000, then just use Handy weinberg and you'll come up to the results. The other options were very unlikely, I didn't do any calculation
21) I put NO and I got it wrong, i think it's histamine
46) pH decreases during exercise as a lot of lactic acid is formed

Hope that I was helpful. When I have time I'll post the questions that I got wrong
 
Mar 30, 2017
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by the way in the other thread you mentioned that your native language is spanish... you are not from spain right? Because if you are I might want to ask you something about the spanish test
I tried to edit it the most I can to not have it the same as written in the exam. Can someone please give me the answer but with explanations because I want to really understand why its one and not the other. For some reason when people explain it in forums its more easier than in medical terms. lol. Thank you for your time by the way.



42) Diagnosis of cancer, weight loss, cachexia and significant muscle wasting. The breakdown of muscle proteins in the patient was most likely preceded by conjugation of the porteins with?


A) BCl2

D) Cytochrome C

E) Lysozyme

F) Phospholipase A2

G) Ubiquitin


***The reason its not ubiquitin its because ubiquitin has to do with going to proteins that are already damaged like broken? cytochrome c binds to proteins that aren't damaged but want to degrade??I got confused and put ubiquitin


30) 13 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration. Photo of tissue biopsy given. Dx?

a. Granuloma

b. Granulation tissue

e. Neutrophilic infiltrate


**I keep confusing granuloma and granulation tissue. Can someone explain in simple terms the different regarding a question to differentiate them.


24) Case control study. 100men with bladder cancer compared to 100 controls.Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder cancer to EtOH consumption. Interpretation?


a. The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6.

b. There is a 95% chance that the true odds ratio is 3.00

c. At least 5% of consumers of alcohol will develop cancer of the bladder.

d. Men who drink alcohol are 5 times more likely to develop bladder cancer than those who do not drink alcohol


**Im confused regarding this, can someone explain me this on how you would conclude and say what is this like these options in simple words VS. relative risk


32) 32 yo woman with fecal incontinence after child birth. Dx?

a. Damage to anal sphincter

b. Spastic contraction of puborectalis muscle

c. spastic external anal spinchter

d. achalasia of internal anal sphincter


**I assumed puborectalis muscle damaged by levator anti because was pregnant



54) 3 tests evaluate children with diarrhea for rotavirus. Sensitivity and specificity are summarized. If only treat children actually have disease because of toxicity of treatment, which tests should be run?


Test 1 Sensitivity 70 and Specificity 100

Test 2 Sensitivity 90 and Specifiticity 95

Test 3 Sensitivity 95 and Specificity 70


A. Test 1 followed by test 3 if test 1 is positive

B Test 3 followed by test 1 if test 3 is positive

C. Test 2 only

D. Test 2 followed by test 3 if test 2 is negative

E. Test 2 followed by test 3 if test 2 is positive


**This one I have NO IDEA, i hate biostats. not my thing.


47) 62 yo woman, abdominal aortic aneurysm repaird. 48 hr later right distal leg dusky, cool and dark purple to black necrotic lesions on several toes. Biopsy of lesion shows occluded small arteries with needle shaped clefts. Dx?


A. Arterioal narrowing

B. Septic emboli

C. Cholesterol emboli

D. Vasospasm

E. Venous thrombosis


40 yo woman lump in neck became larger recently. 8x10mm mass lateral to midline over thyroid cartilage. Soft, mobile and moves upward when patient protrudes tongue. Whats structure?


A. Hygroma

B. Thyroglossal cyst

B. Dermoid cyst

C. Lymph node


***So because of the protrudes her tongue it moves i thought thyroglossal cyst but should thyroglossal cyst be midline not lateral? I'm confused



44) 53 yo woman w/ GERD. Dietary change and stress reduction no effect symptoms. Physical exam shows mild epigastric tenderness. Tx?


A. Omeprazole

B. Misoprostol


**I dont know why I saw healing esophageal mucosa thought of protection to barrier and put stupidly misoprostol....


8) 62 yo woman weakness of left leg. Left lower extremity shows muscle strength of 1/5 and deep tendon reflexes of 3+. When eyes closed, she cannot tell left great toe is raised or depressed. Embolism of what arteries?


A. Right anterior cerebral

B. Right radicular branches of the posterior spinal


**Yup, I put B. Im so stupid... I put it thinking about propiocpetion Idk lol.


26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal. Whats effected?


A. Decreases amplitude of action potential

B. Decreases maximum frequency of action potential production

C. Increases conduction velocity of axon

D. Increases input resistance of axon

E. Increases rate of depolarization of action potential


***Whats the answer and why


31) 5 yo boy pain in right eye at night. No Fx of neoplasia. Exam shows strabismus and tenderness in eye. Left eye normal. Retina show presence of mass. Physician explain unlikely to develop other neoplasms. Mutation occurs?


A. Retinal cells

B. Somatic cells of parents

C. Somatic cells of child

D. Germ cells


**Why not somatic cells?? whats the answer and why, like how to differentiate



46) 30yo man with urinary incontinence after tx of left pelvis fracture. Physical exam show distended bladder, absence of micturition reflex. After bladder fills to capacity, overflow of urine occurs through urethra by few drops. What other nerve injury?


A. Pelvic nerves

B. Pudendal nerves

C. External urinary sphincter


**Explain which one and why not the others


29) 35yo man want to donate kidney to his sister who is T1DM and chronic renal failure. Healthy, physical exam normal. How likely his HLA type is a match?


A. 1:1

B. 1:2

C. 1:4

D. 1:6


**Which one and why?


21) Mouse thymocyte obtained from normal active bone marry was altered to express bcl-2 and combined with normal marrow cells was injected into mice w/ destroyed active marrow. Control mouse with destroyed marrow was injected w/ normal marrow only. After recovery, whats different between mouse?


A. Decrease cell death in thymic cortex

B. Increase number circulating plasma cells

C. Decrease number of circulating lymphocytes

D. Decrease overall risk of autoimmunity

E. Increase formation of lymphoid nodules in thymic cortex

F. Decrease naive B lymphocytes production by reconstituted marrow


**I put increase number of circulating plasma cells, why its wrong??



49) 1 day old newborn tested for anti-HIV antibodies. Western blot confirm presense of IgG antibodies which react with virus envelope and core glycoproteins. Dx?


A. Both newborn and mother infected

B. The mother is infected, status newborn uncertain

C. Newborn is infected; infection occurred at birth

D. Newborn infected; infection occurred in utero

E. Newborn infected; status of mother is uncertain


**What is the answer and why?


32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated?

So apparently its Na and Glucose cotransport :/ I got it wrong. Im confused...... can someone explain.


50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small bile ducts and increased portal fibrosis. If not treated, what develops?

A. Budd Chiari syndrome

B. End stage cirrhosis

C. Hepatocellular carcinoma

D. Recurrent episodes of hepatitis


**I didn't even mark this one.. i put hepatocellular carcinoma because in FA and DIT it mentioned it so I just put it fast seeing that it was antitrypsin deficiency. What is the answer and why


28) 60yo woman 1 yr involuntary rhythmic jerking of right leg and foot. Increased right ankle jerk reflex. Babinski sign + on right. MRI shows 2cm round lesion at interhemispheric fissure at the central sulcus. Dx?


Why not lymphoma?

Other options

A. Metastatic carcinoma

B. Meningioma

C. Oligodendroglioma


24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive. Further observation shows CD8 T cells bind to antigens resulting in liver injury. Where’s antigen from?

A. Hepatocytes

B. Ito cells

C. Stellate cells

D. Kupffer cells

E. Bile duct epithelium


3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?

A. Hormones derived from 7-dehyrocholesterol

B. Cyclic AMP generated in the enterocytes in response to PTH

C. Calcium binding proteins in goblet cells


20) 23 yo woman DVT at 6 months pregnant. IV heparin started. 7 days later platelet count: 44,000. Dx?

A. Antimegakaryocyte antibodies

B. Antiplatelet antibodies

C. Heparin induced hemodilution


***Which is the answer and why???


42) 26yo woman 3m pain and stiffness of both hands. Physical exam shows swelling and redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP joints spared. Biopsy show?


A. Necrotizing granulomas

B. Neutrophilic infiltrates

C. Pigmented villonodular synovitis

D. Synovial pannus formation

E. Urate crystals


**So since it doesn't include DIP i assumed its not rheumatoid arthritis?? so not pannus??? so which one is it??? and why??



76) yo man 30mins severe substernal chest pain while arguing with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG ST elevation at leads I, aVl, and V4-V9. What happened during argument with brother?

A. Coronary vasospasm due to a1

B. Coronary vasospasm due to B1 adrenergic

C. Increase after load for left ventricle due to B1

D. Negative chronotropc effect of a1


**I have no idea, i assumed increase sympathetic stimulation and for some reason was in between coronary vasospasm due to B1 and after load of B1 but now thinking about it sympathetic stimulates NE release which causes a1 stimulation so I'm an idiot, its that one right?? or which one and why




8) 30 yo man and 24 yo woman genetic counseling. Man’s brother has type 1 oculocutaneous albinism (AR). Single gene disorder 1/40,000 in population. Pedigree shown. What are the odds?
A. 1:600
B. 1:100
c. 1:200
d. 1: 40,000
e. 1:4

**Which is the answer and how u got to it??



21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What substance cause new symptoms?

A. NO
B. Serotonin
C. Histamine

**NO Vs. Histamine???



46) Isolated skeletal muscle is isolated w/ glucose bath. Muscle is contracted w/ electrical stimulation. What intracellular increase indicates fatigue?

A. ADP
B. Inorganic phosphate
C. Inosine monophosphate
D. Lactate
E. pH

**WHYY
 
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nanitch

2+ Year Member
Aug 13, 2016
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i put
42) are you sure that ubiquitin is not the correct answer. It's what I chose and it was correct
30) granuloma--->try to contain an infection by creating a big "wall" around it, granulation tissue--> wound repair, in very simple words
24) A---> a condifence interval is the probability that a value lies between the two extremes. If you know the mean and the standard deviation you will have 95% confidence that a value will lie between Mean+- 2SD. (ex: average weight in a population is 70 kg, standard deviation is 10kg. If you go out the street and you talk to first person you meet you will be 95% confident that his weight will lie between 50Kg (70-2SD) and 90Kg (70+2SD)
32) I put damage to the anal sphincter. Didn't come up.
54) Test 3 followed by test 1 if test 3 is positive. with test 3 you find 95% of the people with the disease, but since you are gonna have a lot of false positives you use test 1 which is always negative in false positive
47) cholesterol emboli
40) i think thyroglossal cyst
44) also put misoprostol... this question was very tricky, don't know the answer
26) decreased action potential amplitude
31) it seems like a local problem. I put retinal cells--> it's not retinoblastoma, that was the trick I think
46) A. Just guessed I suck at anatomy lol. But seriously I think that's a typical case of atonic bladder. on Uworld is explained much better than how I would explain it
29) 1:4. I guess that you inherit one allele from each parent, 4 different combinations
21) decrease cell death. Bcl2 has to do with apoptosis, mutated in follicular lymphoma
49) B I think
32) I got it wrong :(
50) I think you read it wrong, antitrypsin has been ruled out and the patient is just few weeks old. I unfortunately got it wrong because I put budd-chiari syndrome :(
28) Meningioma... I just read central sulcus and 60 year old woman
24) got it wrong, let me know if you find the solution
3) got it wrong... I think A
20) B. Written in first aid
42) Pannus. RA-->PIP, osteoarthritis-->DIP
76) A--> B1 is not present in vessels
8) 1/600. Her brother is diseased and she is clearly not. We can assume that she has 2/3 probability to be a carrier. Disease prevalence 1/40000, then just use Handy weinberg and you'll come up to the results. The other options were very unlikely, I didn't do any calculation
21) I put NO and I got it wrong, i think it's histamine
46) pH decreases during exercise as a lot of lactic acid is formed

Hope that I was helpful. When I have time I'll post the questions that I got wrong


i put ubiquitin and got it wrong :O
 

nanitch

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WOWWWWW.... i noticed i do that a lot, i dont read the whole question, you're right! alpha 1 antitrypsin was ruled out lol :O
 

nanitch

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the enhancing thing was what cought my eye with lymphoma since i know ring enhancing lesions is lymphoma vs toxoplasma, damn......
 

nanitch

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by the way in the other thread you mentioned that your native language is spanish... you are not from spain right? Because if you are I might want to ask you something about the spanish test
nop, I'm from puerto rico, there is a spanish test?! i didn't even know about that :O
 
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the enhancing thing was what cought my eye with lymphoma since i know ring enhancing lesions is lymphoma vs toxoplasma, damn......

I think it said diffusely enhancing which is characteristic of meningiomas, while ring enhancing is typical of lymphomas. In any case CNS lymphomas are very rare without a history of immunosuppression so you can rule it out.
 
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nop, I'm from puerto rico, there is a spanish test?! i didn't even know about that :O
okok... yes there is a spanish test which is a graduatory and not a standardized test. People put preferences and they get into specialties until places are full. I'm thinking about taking it since I really love Spain, even though the salaries are nothing compared to the U.S.

But I'm european and my degree would be already valid as soon as I graduate, for you it would be more difficult.
 
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thats the thing, it says it spares DIP, so why would it be panes -- arthritis, arthritis doesn't have DIP
Rheumatoid arthritis is characterized histologically by pannus formation and it usually spares DIP (Ddx with osteoarthritis), hence pannus formation is the correct answer, it didn't come up to me
 

nanitch

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Rheumatoid arthritis is characterized histologically by pannus formation and it usually spares DIP (Ddx with osteoarthritis), hence pannus formation is the correct answer, it didn't come up to me

wowwww... are u noticing how much I'm contradicting myself? i know the answer and i even explain it but i say something else? wow i think i should probably sleep like 24 hours before the exam on friday. I think I'm losing it officially. lol
 

nanitch

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I'm like not reading the questions properly, i hope that does not happen in the exam now I'm worried
 
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wowwww... are u noticing how much I'm contradicting myself? i know the answer and i even explain it but i say something else? wow i think i should probably sleep like 24 hours before the exam on friday. I think I'm losing it officially. lol

Yes please, just do it. On thursday if I were you I would just relax all the time, go out, drink a beer with friends and try to distract yourself.

Studying like crazy the day before won't affect your score more than 1-2 points (if you'are lucky), while going to the exam in your best mental condition might help you to achieve the best result possible.
 

TaroBubbleTea

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why would inactivating sodium channels decrease amplitude of action potential? I thought it is all or nothing

I have the same question. I put decrease maximum frequency of action potential production, but that was wrong as well. Can someone who got this correct explain their reasoning?
 
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Hopefully this thread isn't dead..

Anyone want to explain the difference between myogenic reflexes and distention and recruitment of microvessels?
Q: Women doing strenuous exercise. Which describe the total x-sectional area of the pulm circulation?
a. Increased, as a result of distention of and recruitment of micro-vessels
b. Increased, as a result of myogenic reflexes

Q: The graph showing Vo vs . There are two curves one with no effect (lower) and one with
+AMP (higher_. It asks which describes the action of AMP.
a. Allosteric Activator b. Allosteric Inhibitor c. Catabolite activator d. Catabolite repressor E. covalent modifier of the enzyme F. Covalent modifer of phosphorylase kinase

Q: the one with the graph of Airflow out, Phrenic nerve activity and Abdominal P. Why is it tubocurarine?

Q> Guy has pain in butt radiating down his posterior leg to heel. Elicited with flexion of hip beyond 30. Power decreased in plantar flexion. Left Achilles reflex absent. All others are good. Decreased pinprick over the lateral left foot and 4th/5th toes. What nerve roots? T12, L2, L4, S1, S3
I thought it would be around the Sciatic N (L4-S3) since it starts in his butt. But clearly that's wrong.

Q: How do you tell the difference between Lead Poisoning and Sideroblastic Anemia? They both are a function of the Heme synthesis pathway..

Q: Giardia vs E. Histolytica: I know Giardia causes steatorrhea and foul smelling stool, and Histolytica causes Bloody diarrhea and Ulcers. The Question stem included fever, frequent slimy stools, emigrated from Uganda. Mild RUQ tenderness, stool shows mucus and multiple ulcers seen on Colonoscopy. I guess this supports Histolytica besides the Slimy stool?

Q: Guy can't maintain erections. He has fatigue and difficulty sleeping and concentration + cerebral infarct that resolved. How will this affect his Libido and Nocturnal Erections? I figured if he can't have a regular erection he wouldn't be able to have nocturnal ones? But his libido should be okay...Clearly this is wrong..

Q: Guy who fell of a ladder with a cracked rib. Sharp pain when he coughs or takes a deep breath. No pneumothorax. How does this affect RR, TV, Airway Resistance? My only issue here was whether his RR would be increased or decreased...i finally said decreased because i figured since it hurts to breath he'd try to limit it lol..sounds silly now when I type it. I assume he's taking rapid short breaths in this scenario?

Q: I got this one right but it was a guess. The lady who is pregnant and they indicated the size of her uterus at 10 weeks..I believe it said something like uterus located below the umbilicus. The answer was hydatidiform mole, my Q is what would a normal pregnancy at 10 weeks look like/be described as?

Q: Can someone explain the calculation for the AR type I oculocutaneous albinism? It occurs 1/40,000 in gen pop. The man's brother has it. What's the likelihood that their kid will have it?
1 in 4, 1 in 100, 1 in 200, 1 in 600, 1 in 40,000

Q: Asking about Cardiac Index TPR and something else. I got it right by luck. What is cardiac index?

Q; The Arachadonic acid pathway asking where the protection of gastric mucosa is inhibitied. would that just be where COX-1/COX-2 would work?

Q: Old guy, dementia. Things not looking good because he's coughing during his meals and takes long to finish food. He has haspiration pneumo and compromised swalling function. N oadvanced directives. How do you approach the issue of a feeding tube?
a. encourage the family to come to a consensus based on their perception of pt's wishes b. Explain that feeding tube is difficult to monitor and may not prevent aspiration c. follow wishes of wife d. help the adult children encourage wife to start to withdraw from pt e. Recommend a tube, because feeding be more efficient and prevent starvation.

Q: Guy exercising what do you expect for Arteriolar Diameter, Tissue Adenosine Conc, Vascular conductance. The first 2 are increased, but the last one, what is vascular conductance?

Q: Lady has lung cancer, given cisplatin, what else should you give her? I assume this was to prevent Chemo-induced vomiting. I thought metoclopramide was used for this, I think the answer is Ondansetron. Why one over the other?
 

pre med 2014

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Hopefully this thread isn't dead..

Anyone want to explain the difference between myogenic reflexes and distention and recruitment of microvessels?
Q: Women doing strenuous exercise. Which describe the total x-sectional area of the pulm circulation?
a. Increased, as a result of distention of and recruitment of micro-vessels
b. Increased, as a result of myogenic reflexes

I said (a), got it right, vasodilation in upper lobes with exercise and V/Q ration approaches one uniform across all lung segements.

Q: The graph showing Vo vs . There are two curves one with no effect (lower) and one with
+AMP (higher_. It asks which describes the action of AMP.
a. Allosteric Activator b. Allosteric Inhibitor c. Catabolite activator d. Catabolite repressor E. covalent modifier of the enzyme F. Covalent modifer of phosphorylase kinase

Q: the one with the graph of Airflow out, Phrenic nerve activity and Abdominal P. Why is it tubocurarine?

i think it's tubocurarine. I picked something else cause tubocurarine is one of the weird non-depolarizing (I think it's banned by FDA). If I remember the Q animal had phrenic nerve paralysis and increased intrabdominal pressure. Not sure how you you distinguish drug as depolarizing vs non-depolarizing I think both paralyze diaphragm this is a tough concept for me still

Q> Guy has pain in butt radiating down his posterior leg to heel. Elicited with flexion of hip beyond 30. Power decreased in plantar flexion. Left Achilles reflex absent. All others are good. Decreased pinprick over the lateral left foot and 4th/5th toes. What nerve roots? T12, L2, L4, S1, S3
I thought it would be around the Sciatic N (L4-S3) since it starts in his butt. But clearly that's wrong.

S1-2 buckle my shoe = loss of achilles reflex so S1 or 2 lesion

Q: How do you tell the difference between Lead Poisoning and Sideroblastic Anemia? They both are a function of the Heme synthesis pathway..

need more info about the question. Pretty much lead poisoning is a problem w/ ferrocheletase or ALA dehydrogenase. Sidero is a problem with ALA synthase. I think ringed sideroblasts and basophilic stipling is the same thing except ringed sideblasts are seen in bone marrow smear and basophilic stippling on regular blood smear. Someone correct me if I'm wrong but it is Iron buildup in mitochondria cause without the enzyme you can't make heme so Iron backs up.

Q: Giardia vs E. Histolytica: I know Giardia causes steatorrhea and foul smelling stool, and Histolytica causes Bloody diarrhea and Ulcers. The Question stem included fever, frequent slimy stools, emigrated from Uganda. Mild RUQ tenderness, stool shows mucus and multiple ulcers seen on Colonoscopy. I guess this supports Histolytica besides the Slimy stool?

i picked histolytica and got it right, i had the same issue with this one. The ulcer gave it away for me, remember flask shaped ulcers on histology for ent histolytica

Q: Guy can't maintain erections. He has fatigue and difficulty sleeping and concentration + cerebral infarct that resolved. How will this affect his Libido and Nocturnal Erections? I figured if he can't have a regular erection he wouldn't be able to have nocturnal ones? But his libido should be okay...Clearly this is wrong..

i got it wrong, did some personal research on google. Libido is for sure down, and I think ability to achieve erection also goes down. Don't know if this is correct for usmle purposes however

Q: Guy who fell of a ladder with a cracked rib. Sharp pain when he coughs or takes a deep breath. No pneumothorax. How does this affect RR, TV, Airway Resistance? My only issue here was whether his RR would be increased or decreased...i finally said decreased because i figured since it hurts to breath he'd try to limit it lol..sounds silly now when I type it. I assume he's taking rapid short breaths in this scenario?

cause it hurts to breathe you increase RR to take small shallow breaths

Q: I got this one right but it was a guess. The lady who is pregnant and they indicated the size of her uterus at 10 weeks..I believe it said something like uterus located below the umbilicus. The answer was hydatidiform mole, my Q is what would a normal pregnancy at 10 weeks look like/be described as?

should be 10cm for 10wks (it's basically 1cm per week) (not sure if 10cm means to umbilicus) , bhCG was borderline. I assumed they were trying to hint uterus was small for gestational age and thus molar pregnancy. Plus i think it said there was some vaginal bleeding or some other clues something might be abnormal

Q: Can someone explain the calculation for the AR type I oculocutaneous albinism? It occurs 1/40,000 in gen pop. The man's brother has it. What's the likelihood that their kid will have it?
1 in 4, 1 in 100, 1 in 200, 1 in 600, 1 in 40,000

it's AR so square root of 40,000 = 200 so q = 1/200 so 2pq = 2/200= 1/100 = frequency of heterozygosity in gen pop.

Since male does not have disease he has 2/3 chance of being a heterozygote (he is either AA, Aa or Aa. Can't be aa)

so 2/3 (chance he is heterozygote) multiply by 1/100 (chance that wife is a heterozyte) multiply by 1/4 (chance that they make a homozygote baby) = 1/600



Q: Asking about Cardiac Index TPR and something else. I got it right by luck. What is cardiac index?

need more of the question

Q; The Arachadonic acid pathway asking where the protection of gastric mucosa is inhibitied. would that just be where COX-1/COX-2 would work?

prostaglandins protect gastric mucosa, inhibit gastric acid secretion.

Q: Old guy, dementia. Things not looking good because he's coughing during his meals and takes long to finish food. He has haspiration pneumo and compromised swalling function. N oadvanced directives. How do you approach the issue of a feeding tube?
a. encourage the family to come to a consensus based on their perception of pt's wishes b. Explain that feeding tube is difficult to monitor and may not prevent aspiration c. follow wishes of wife d. help the adult children encourage wife to start to withdraw from pt e. Recommend a tube, because feeding be more efficient and prevent starvation.

a

Q: Guy exercising what do you expect for Arteriolar Diameter, Tissue Adenosine Conc, Vascular conductance. The first 2 are increased, but the last one, what is vascular conductance?
vascular conductance increased

Q: Lady has lung cancer, given cisplatin, what else should you give her? I assume this was to prevent Chemo-induced vomiting. I thought metoclopramide was used for this, I think the answer is Ondansetron. Why one over the other?
post op N/V control knee jerk ondansetron for usmle
 
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Thanks for the response @premed2014

For the Achilles tendon question, do we just simply ignore the radiating pain from the butt? I think that's where I got tripped up

- For the Pb poisoning Q, they had lab values indicating microcytosis, everything else normal, with a low HgB. Pt was a police officer with 6mths of headache, muscle aches and fatigue + bilateral distal motor weakness of th extremities and impaired concentration. I guess those findings should indicate Pb Poisoning...but got tripped up since Sideroblastic Anemia lists Pb poisoning as one of its causes. However, re-reading the question it said Peripheral smear and as you pointed out ringed sideroblasts are seen in the BM..ugh

For the pedigree: Wife did not have disease. The guy's brother had the AR disease @1/40,000. Woman's family hx is negative for the disorder. What is the best estimate that their child will be affected? The answer is 1/600. So 2/3 chance the father has the allele, and q = 1/200. So how do we get the child's estimated chance of having the disease? Sorry, I need a bit of hand holding here..


- For Molar pregnancy Uterus should be larger for gestational age I thought? Regardless it was a molar pregnancy just was curious about uterus size.

- For the erection problem, Why do you think the libido is for sure down?

Also, still not sure what they meant by vascular conductance
 

pre med 2014

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Thanks for the response @premed2014

For the Achilles tendon question, do we just simply ignore the radiating pain from the butt? I think that's where I got tripped up

- For the Pb poisoning Q, they had lab values indicating microcytosis, everything else normal, with a low HgB. Pt was a police officer with 6mths of headache, muscle aches and fatigue + bilateral distal motor weakness of th extremities and impaired concentration. I guess those findings should indicate Pb Poisoning...but got tripped up since Sideroblastic Anemia lists Pb poisoning as one of its causes. However, re-reading the question it said Peripheral smear and as you pointed out ringed sideroblasts are seen in the BM..ugh

For the pedigree: Wife did not have disease. The guy's brother had the AR disease @1/40,000. Woman's family hx is negative for the disorder. What is the best estimate that their child will be affected? The answer is 1/600. So 2/3 chance the father has the allele, and q = 1/200. So how do we get the child's estimated chance of having the disease? Sorry, I need a bit of hand holding here..


- For Molar pregnancy Uterus should be larger for gestational age I thought? Regardless it was a molar pregnancy just was curious about uterus size.

- For the erection problem, Why do you think the libido is for sure down?

Also, still not sure what they meant by vascular conductance


- police officer w/ NEUROLOGICAL SYMPTOMS = lead poisoning. (Also child with new neuro symptoms lives in old house = lead poisoning) thats the differential there, sideroblastic anemia won't have neuro symptoms

- because even if both are heterozygotes they still only have 1/4 chance of making a homozygote so don't forget to multiply by 1/4 at the end.

- you are right molar is supposed to be larger for gest age, my mistake. Honestly I can't remember why I chose it other than having a feeling something was 'off' as opposed to normal so went with molar. that bhCG I don't think was obviously high (like 300,000 at 10 weeks) and it can be normal to have vaginal bleeding in pregnancy. I can't remember the Q maybe they said no fetal heartbeat or something else but yea I don't think based only on that hCG and vaginal bleeding we can conclude molar preg (there has to be snowstorm on u/s or something else to confirm it)

-stroke and libido is just based on a google search, I don't know for sure. Test pirates says both are decreased (doesn't mean it's nec correct though)

- yea absent ankle reflex I'd ignore everything else cause then S1-2 has to have a lesion no matter what so it can't be a wrong answer
 
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- police officer w/ NEUROLOGICAL SYMPTOMS = lead poisoning. (Also child with new neuro symptoms lives in old house = lead poisoning) thats the differential there, sideroblastic anemia won't have neuro symptoms

- because even if both are heterozygotes they still only have 1/4 chance of making a homozygote so don't forget to multiply by 1/4 at the end.

- you are right molar is supposed to be larger for gest age, my mistake. Honestly I can't remember why I chose it other than having a feeling something was 'off' as opposed to normal so went with molar. that bhCG I don't think was obviously high (like 300,000 at 10 weeks) and it can be normal to have vaginal bleeding in pregnancy. I can't remember the Q maybe they said no fetal heartbeat or something else but yea I don't think based only on that hCG and vaginal bleeding we can conclude molar preg (there has to be snowstorm on u/s or something else to confirm it)

-stroke and libido is just based on a google search, I don't know for sure. Test pirates says both are decreased (doesn't mean it's nec correct though)

- yea absent ankle reflex I'd ignore everything else cause then S1-2 has to have a lesion no matter what so it can't be a wrong answer
Got it, Thanks mate.

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dempty

Q: Guy can't maintain erections. He has fatigue and difficulty sleeping and concentration + cerebral infarct that resolved. How will this affect his Libido and Nocturnal Erections? I figured if he can't have a regular erection he wouldn't be able to have nocturnal ones? But his libido should be okay...Clearly this is wrong..
I put decreased for both and got it wrong, so that can't be right either. Maybe its decreased and normal?
 

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I put decreased for both and got it wrong, so that can't be right either. Maybe its decreased and normal?

Answer is decreased libido, normal nocturnal erections.

He has decreased libido because of depression. His nerves are intact though so nocturnal erections will be normal.
 

testt

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Dang he was was depressed? Twist..

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Yeah, first concept is that strokes/brain injuries are associated with depression in the elderly. Also I believe in the question stem they mentioned he lost weight, had poor concentration, wasn't sleeping well, etc. Second concept is that depression can decrease libido.

I believe the nocturnal erections part was just to see if you could knew that his autonomic nerves were ok but I think it's a dumb question since depression and being elderly causes changes in REM sleep which would affect nocturnal erections. I suppose you could argue that depression and old age have competing effects and cancel each other out but it's just wishy washy at that point.
 
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Did anyone get this question?

While Scuba diving, a 46 yo man ascends without normal decompression. As part of developing decompression sickness, small gas bubbles form in the spinal vessels supplying the dorsal white matter of the upper thoracic spinal cord. The most likely neurological outcome is loss of which of the following?

A) Discriminative sensation in LE (is it this?)
B) Motor and Reflex Activity and all sensation in LE
C) Motor and Reflex in LE
D) Motor and Reflex in UE
E) Pain and Temperature in UE (Wrong)

Thanks!
 
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Did anyone get this question?

While Scuba diving, a 46 yo man ascends without normal decompression. As part of developing decompression sickness, small gas bubbles form in the spinal vessels supplying the dorsal white matter of the upper thoracic spinal cord. The most likely neurological outcome is loss of which of the following?

A) Discriminative sensation in LE (is it this?)
B) Motor and Reflex Activity and all sensation in LE
C) Motor and Reflex in LE
D) Motor and Reflex in UE
E) Pain and Temperature in UE (Wrong)

Thanks!
Yep it's A. My reasoning..Dorsal columns affected @ the level of the thoracic cord. Immediately removes anything motor. Then DC is an ascending pathway so everything below would be affected, and above will be ok.

Also spinothalamic is in the anterior portion of the spinal cord

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dempty

Did anyone get this question?

While Scuba diving, a 46 yo man ascends without normal decompression. As part of developing decompression sickness, small gas bubbles form in the spinal vessels supplying the dorsal white matter of the upper thoracic spinal cord. The most likely neurological outcome is loss of which of the following?

A) Discriminative sensation in LE (is it this?)
B) Motor and Reflex Activity and all sensation in LE
C) Motor and Reflex in LE
D) Motor and Reflex in UE
E) Pain and Temperature in UE (Wrong)

Thanks!
discriminative sensation in LE worked for me.
 
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Asking about Cardiac Index TPR and something else. I got it right by luck. What is cardiac index?

Would also like an explanation for this, I got it wrong, do you remember what you put down?

30 yo woman with marfan syndrome with tearing chest pain. ECG one year ago showed arotic root to be 5.5 cm (N< 4.0). Stopped taking her perscribed propranolol 1 yr ago because of fatigue. pulse 120 BP 80/40. JVD 6cm above the sternal angle does not decrease with inspiration. The point of maximum impulse is not palpable, heart sounds cannot be distinguished. Asks about which represents the cardiac catheterization?

Cardiac Index (N= 2.5-4.2), Right atrial pressure (N=0-8), Pulmonary Capillary wedge pressure (5-16) Pulmoary diastolic arterial pressure (N= 12-30), Systemic vascular Resistance (N=770-1500)
Answers in order of CI, RAP, PCWP, PDAP, SVR
A) 2,2,5,6,600
B) 2,5,15,15,1200
C) 2,18,18,20,2000
D) 4,2,5,6,600
E) 4,5,15,15,1200
F) 4, 18,18,20, 2000

Thank you!!
 
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Yep it's A. My reasoning..Dorsal columns affected @ the level of the thoracic cord. Immediately removes anything motor. Then DC is an ascending pathway so everything below would be affected, and above will be ok.

Also spinothalamic is in the anterior portion of the spinal cord

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Ahh thank you. that makes sense. I was thinking dorsal column but for some reason thought upper thoracic and upper extremity, without considering everything below.
 
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Would also like an explanation for this, I got it wrong, do you remember what you put down?

30 yo woman with marfan syndrome with tearing chest pain. ECG one year ago showed arotic root to be 5.5 cm (N< 4.0). Stopped taking her perscribed propranolol 1 yr ago because of fatigue. pulse 120 BP 80/40. JVD 6cm above the sternal angle does not decrease with inspiration. The point of maximum impulse is not palpable, heart sounds cannot be distinguished. Asks about which represents the cardiac catheterization?

Cardiac Index (N= 2.5-4.2), Right atrial pressure (N=0-8), Pulmonary Capillary wedge pressure (5-16) Pulmoary diastolic arterial pressure (N= 12-30), Systemic vascular Resistance (N=770-1500)
Answers in order of CI, RAP, PCWP, PDAP, SVR
A) 2,2,5,6,600
B) 2,5,15,15,1200
C) 2,18,18,20,2000
D) 4,2,5,6,600
E) 4,5,15,15,1200
F) 4, 18,18,20, 2000

Thank you!!

Hey so This is just how I thought about it, It's probably not the right way but it got me to the answer

I went with the easiest thing first, She has increased JVP therefore RAP is increased that leaves answer choices C and F
From those everything is the same, so it comes down to that BS cardiac index, I think I checked the units which was something like L/min/something else
So from that I pretended it was CO and figured CO would be decreased in this lady looking at her BP and the fact that she stopped propanolol.
 
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@YouScrewedup Thanks for the response!
yeah, I got stuck on the cardiac index, thats definitely a smart way to figure out it though.
Yea, too bad I couldn't figure out a smart way for the other questions
Also I'm guessing they don't actually expect us to know what cardiac index is? But I could be wrong..I've never seen it before tho

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Iceandmedicine

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Cardiac index is just CO adjusted for body weight or something. Basically, I think the looking at the unit thing was super smart, and that's the kind of thinking that will probably go a much longer way on the test than knowing every obscure thing they could possibly spring at us!
 
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Yea, too bad I couldn't figure out a smart way for the other questions
Also I'm guessing they don't actually expect us to know what cardiac index is? But I could be wrong..I've never seen it before tho

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Hahahaha, hopefully we'll both build those instincts for test day!
I don't think we have to know too much about it either, but just in case, I googled it and its basically what you said, cardiac output per minute. So now we know lol
 
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For the pedigree: Wife did not have disease. The guy's brother had the AR disease @1/40,000. Woman's family hx is negative for the disorder. What is the best estimate that their child will be affected? The answer is 1/600. So 2/3 chance the father has the allele, and q = 1/200. So how do we get the child's estimated chance of having the disease? Sorry, I need a bit of hand holding here..

1:600 is the correct answer (I got this question right).
This is the explanation:

Women has a brother affected by type 1 oculocutaneus albinism (AR). So she must have 2 carrier parents (Aa). Her chance to be a carrier (we know she is not affected) is therefore 2/3 (she can be AA, Aa, Aa but not aa).
The man from the general population so to calculate his chance to be a carrier we should use the Hardy-Weinberg equilibrium:

p² + 2pq + q² =1
p + q = 1

When:
  • p²- homozygous for the normal allele (not carrier-AA)
  • 2pq- heterozygous (carrier state-Aa)
  • q² = homozygous for the mutated allele (affected-aa)
We know that the occurrence of the disease in the general population is 1/40,000. So q²= 1/40,000, q= 1/200 we can calculate the chance that the man is a carrier (we know he is not affected): 2pq=1/100 (we can consider p≈1 because p =1-1/200= 199/200)

In order for the child of the man and the women to be affected both the man and the woman have to be carriers and he needs to receive the mutated allele from both of them (chance of 1/4). So: (2/3)x(1/100)x(1/4) = 1:600
 
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24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive. Further observation shows CD8 T cells bind to antigens resulting in liver injury. Where’s antigen from?

A. Hepatocytes

B. Ito cells

C. Stellate cells

D. Kupffer cells

E. Bile duct epithelium

The correct answer to this is A. Hepatocytes (I got this question right and it is actually B on the exam). HBV infect and replicates in hepatocytes. CD8+ T cells are responsible for most of the liver damage by killing the infected cells and by producing cytokines.
 
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21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What substance cause new symptoms?

A. NO
B. Serotonin
C. Histamine

**NO Vs. Histamine???

The Correct answer is Histamine (I got this question right). I found this article on-line:
Histamine release during morphine and fentanyl anesthesia. - PubMed - NCBI

From the article:"Patients in the morphine group had an average 750 per cent peak increase in plasma histamine accompanied by a significant decrease in mean arterial pressure"
 
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pshant

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A few questions I can't seem to figure out.
A 24 year old man is evaluated because of sharp left-sided chest pain and dyspnea that occurred suddenly 4 hours ago. An X-ray of the chest is shown. Which of the following is the most likely cause of the x-ray findings.

Bronchoconstriction
Diaphragmatic paralysis
Loss of negative intrapleural pressure
mucus obstruction of the left main bronchus
respiratory muscle fatigue
I put mucus obstruction but honestly I can't tell. The x-ray looked to have missing lung markings on the left so maybe a collapsed lung?

A 45 year old patient with chronic alcohol dependence comes to the emergency department because of foul smelling brownish sputum for the past 3 days. The patient has had several episodes of unconsciousness following bouts of heavy drinking over the past month. Which of the following x-rays of the chest most likely represents this patient?
Cick below to see the X-rays
I was between B and C since both had densities in the lower right lung fields and went with B because I thought alcoholics have cardiomegaly. But I'm seeing the answer may be D?

A 32 year old woman comes to the physician because her sister recently died of melanoma. Other first degree family members have been similarly affected and other family members also have large pigmented skin lesions. Which of the following lesions is most likely on both sun-exposed and non-sun exposed ares of the patients skin?

Acanthosis nigircan
Basal Cell carcinoma
Blue Nevi
Dysplastic nevi
Pigmented seborrheic keratosis
I literally have no idea. I'm assuming it's not BCC and from there I just guessed acanthosis nigricans since that's not associated with sunlight.
 
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piscopuma

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why would inactivating sodium channels decrease amplitude of action potential? I thought it is all or nothing

I have the same question. I put decrease maximum frequency of action potential production, but that was wrong as well. Can someone who got this correct explain their reasoning?

I assumed threshold was still reached, so an AP still occurred. Thus the AP amplitude would just be stunted.
 
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piscopuma

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Nov 9, 2016
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A few questions I can't seem to figure out.
A 24 year old man is evaluated because of sharp left-sided chest pain and dyspnea that occurred suddenly 4 hours ago. An X-ray of the chest is shown. Which of the following is the most likely cause of the x-ray findings.

Bronchoconstriction
Diaphragmatic paralysis
Loss of negative intrapleural pressure
mucus obstruction of the left main bronchus
respiratory muscle fatigue
I put mucus obstruction but honestly I can't tell. The x-ray looked to have missing lung markings on the left so maybe a collapsed lung?

He has a pneumothorax, so he had a loss of negative intrapleural pressure to keep that lung patent.

A 45 year old patient with chronic alcohol dependence comes to the emergency department because of foul smelling brownish sputum for the past 3 days. The patient has had several episodes of unconsciousness following bouts of heavy drinking over the past month. Which of the following x-rays of the chest most likely represents this patient?
Cick below to see the X-rays
I was between B and C since both had densities in the lower right lung fields and went with B because I thought alcoholics have cardiomegaly. But I'm seeing the answer may be D?

I can't see the image, but it's the one with a cavitary lesion in the middle lobe.

A 32 year old woman comes to the physician because her sister recently died of melanoma. Other first degree family members have been similarly affected and other family members also have large pigmented skin lesions. Which of the following lesions is most likely on both sun-exposed and non-sun exposed ares of the patients skin?

Acanthosis nigircan
Basal Cell carcinoma
Blue Nevi
Dysplastic nevi
Pigmented seborrheic keratosis
I literally have no idea. I'm assuming it's not BCC and from there I just guessed acanthosis nigricans since that's not associated with sunlight.

Pretty sure it's dysplastic nevi. They can be a precursor to melanoma. Additionally, I think about people of African descent that often get melanomas and dysplastic nevi on the soles of their feet (out of sunlight).

Answers are in bold.
 
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piscopuma

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Nov 9, 2016
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The Correct answer is Histamine (I got this question right). I found this article on-line:
Histamine release during morphine and fentanyl anesthesia. - PubMed - NCBI

From the article:"Patients in the morphine group had an average 750 per cent peak increase in plasma histamine accompanied by a significant decrease in mean arterial pressure"

Also - histamine generally causes flushing. Think about a generalized allergic reaction that results in histamine release.
 
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mymembernames

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Anyone get the spirochete question right? Not sure why it is Obliterative endarteritis w/ lymphocytes and plasma cells?

Also for the propranolol question, why does TPR go up? TIA!
 
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chromuffin

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Can anyone please help with the two above questions? TIA!
Not sure about what the first question asks because I haven't taken it but propranolol increases TPR because it acts at beta receptors, right? So then you lose the beta2 vasodilator effects. Theoretically, all nonselectice beta blockers will cause this.
 
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GI Guy

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Anyone get the spirochete question right? Not sure why it is Obliterative endarteritis w/ lymphocytes and plasma cells?

Also for the propranolol question, why does TPR go up? TIA!
Syphillis causes an inflammation of the small arterioles that supply the aorta (endarteritis of the vaso vasorum), leading to inflammation that eventually obliterates the vessels. This will lead to ischemia of the tunica media and subsequent dilation of the thoracic aorta due to cystic medial necrosis. This will give the "tree bark" appearance.
 
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