nbme 5 question

[firstaid2012]

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A 25-year-old primigravid woman at 3 months gestation comes to the physician for her first prenatal visit. She requests an aminocentesis "to make me feel better that everything is all right with my baby". There is no family history of genetic disorders. Physical examinations and laboratory studies show no abnormalities. The likelihood of finding an abnormality is low. The physician needs to balance which of the following ethical principles when deciding whether to grant this patient's request?

a) Autonomy versus maleficence

b) Autonomy versus utilitarianism

c) Beneficence versus deontology

d) Beneficence versus maleficence

e) Deontology versus utilitarianism


please explain

 

[firstaid2012]

During bacteriophage T7 infection of a single E.coli cell, 1000 bacteriophage particles are released. One of these particles contains a fragment of the E.coli chromosome rather than the T7 chromosome. Will this phage be able to inject its DNA into an E.coli cell, and, if so, how many T7 particles will be produced by this cell?

A. Yes, 1000
B. Yes, 100
C. Yes, 1
D. Yes, 0
E. No, 0

plz explain

 

[firstaid2012]

17. A 69-year-old woman is brought to the emergency department 1 hour after the sudden onset of crushing, substernal chest pain and nausea. Physical examination shows
pallor and diaphoresis An ECG and an evaluation of serum cardiac enzyme activity confirm a diagnosis of a myocardial infarction of the anterior wall Activation of platelets
and segmented neutrophils during thrombogenesis in this patient caused the release of cytokines, including platelet-derived growth factor. The mitogenic signal provided by
this cytokine to smooth muscle cells at sites of vascular injury in this patient is most likely to be inhibited by which of the following intracellular enzymes?

a.Aminotransferase
b.Glycosylhydrolase
c.Kinase
d.Lipase
e.Peroxidase
f.Phosphatase


please explain C and F

 

[firstaid2012]

26 A 54-year-old man with alcoholism is brought to the emergency department because of a 10-day history of weakness, confusion, and shortness of breath He drinks approximately three fourths of a liter of liquor daily. He appears wasted, and there is an odor of alcohol on his breath. His respirations are 32/min. Physical examination shows jaundice abdominal distention spider angiomata, and Tanner stage 2 gynecomastia Laboratory studies show hypoalbuminemia and an increased serum estrogen-to-androgen ratio. The development of gynecomastia in this patient is mediated primarily by which of the following signal transduction pathways?
A) Aclivation of phospholipaseA2 and generation of arachidonic acid
8) Activation of phosphotipase C and generation of inositol 145 diphosphate
C) G protein-coupled activation of adenylyl cyclase
D) Receptor dimenzaOon and autophosphorylatJon of tyrosine residues
E) Transmembrane diffusion and binding of signaling molecule to transcription factor



please explainn

 

[firstaid2012]

hich of the following neurotransmitters is released in excess following ischemia and can initiate receptor mediated calcium influx that leads to neuronal death?


a = gaba
b = glutamate
c = glycine
d = histamine
e = Norepinephrine

 

[firstaid2012]

47 yo man cames to the emergency department because he felt a sudden loss of sensations and ability to move left side of the body. His father died of a stroke at the same age. Physical examination shows no neurologic defects. The patient seems unconcerned about his symptoms. Which of the folowing is the most likely diagnosis?

A. acute stress disorder
B. conversion disorder
C. generalised anxiety disorder
D. hypocondriasis
E. Panic disorder
F. somatization disorder
G. silent cerebral infarction

 

[firstaid2012]

new drug has been developed that selectively blocks calcium channels at the synapse. Which of the following is the step in chemical transmission that is most likely to be disrupted?
A ) Binding of the neurotransmitter to the postsynaptic receptor
B ) Propagation of the action potential into the synapse
C ) Release of calcium from intracellular stores
D ) Release of the neurotransmitter into the cleft
E ) Synthesis and packaging of the neurotransmitter

 

[firstaid2012]

homeless 45-year-old man comes to the emergency department because of pain in his right foot for the past week and difficulty walking for the past 2 days, A painful subcutaneous swelling is present in the righl groin His sock is blood encrusted A 5-cm (2-in) wound surrounded by swelling is present on the ball of the foot A purulent exudate containing some blood is expressed on palpation of the wound. Which of the following is the most likely cause of the groin swelling?
A) Cellular proliferation in an inguinal lymph node
B) Localized edema from a protein-deficient diet
C) Obstruction of lymphatic drainage in vessels near the knee
D) Obstruction of venous return from the right leg
E) Recirculation of neutrophils from the wound site


y is it A please explain

 

[RedSoxSuck]

hich of the following neurotransmitters is released in excess following ischemia and can initiate receptor mediated calcium influx that leads to neuronal death?


a = gaba
b = glutamate
c = glycine
d = histamine
e = Norepinephrine

It's glutamate. It's binds to NMDA receptor. This interaction is the cause of neuronal death in huntingtons.

 

[RedSoxSuck]

47 yo man cames to the emergency department because he felt a sudden loss of sensations and ability to move left side of the body. His father died of a stroke at the same age. Physical examination shows no neurologic defects. The patient seems unconcerned about his symptoms. Which of the folowing is the most likely diagnosis?

A. acute stress disorder
B. conversion disorder
C. generalised anxiety disorder
D. hypocondriasis
E. Panic disorder
F. somatization disorder
G. silent cerebral infarction

It's b. Patient is indifferent to his symptoms. It's in psych section of first aid under somatoform disorders.

 

[RedSoxSuck]

26 A 54-year-old man with alcoholism is brought to the emergency department because of a 10-day history of weakness, confusion, and shortness of breath He drinks approximately three fourths of a liter of liquor daily. He appears wasted, and there is an odor of alcohol on his breath. His respirations are 32/min. Physical examination shows jaundice abdominal distention spider angiomata, and Tanner stage 2 gynecomastia Laboratory studies show hypoalbuminemia and an increased serum estrogen-to-androgen ratio. The development of gynecomastia in this patient is mediated primarily by which of the following signal transduction pathways?
A) Aclivation of phospholipaseA2 and generation of arachidonic acid
8) Activation of phosphotipase C and generation of inositol 145 diphosphate
C) G protein-coupled activation of adenylyl cyclase
D) Receptor dimenzaOon and autophosphorylatJon of tyrosine residues
E) Transmembrane diffusion and binding of signaling molecule to transcription factor

It's E. My reasoning might be slightly off because I'm under the influence of zzquil (lol). It is talking about gynecomastia due to estrogen. Estrogen is a steroid so it works via steroid receptor and then translocating to nucleus and binding to transcription factor to transcribe whatever it will. First aid endocrine section. There is a table ( atleast in 2010 version)

 

[Ronin786]

homeless 45-year-old man comes to the emergency department because of pain in his right foot for the past week and difficulty walking for the past 2 days, A painful subcutaneous swelling is present in the righl groin His sock is blood encrusted A 5-cm (2-in) wound surrounded by swelling is present on the ball of the foot A purulent exudate containing some blood is expressed on palpation of the wound. Which of the following is the most likely cause of the groin swelling?
A) Cellular proliferation in an inguinal lymph node
B) Localized edema from a protein-deficient diet
C) Obstruction of lymphatic drainage in vessels near the knee
D) Obstruction of venous return from the right leg
E) Recirculation of neutrophils from the wound site


y is it A please explain

Seeing as its a wound the lymph nodes are enlarged reactively. All of the answers other than A and E would involve swelling of the whole foot not just two points.

Neutrophils aren't recirculated in the lymph nodes as they just die and form pus (which was expressed from the wound). Thus the enlargement is due to lymphocyte proliferation in the lymph node to come and fight the wound.

 

[Ronin786]

new drug has been developed that selectively blocks calcium channels at the synapse. Which of the following is the step in chemical transmission that is most likely to be disrupted?
A ) Binding of the neurotransmitter to the postsynaptic receptor
B ) Propagation of the action potential into the synapse
C ) Release of calcium from intracellular stores
D ) Release of the neurotransmitter into the cleft
E ) Synthesis and packaging of the neurotransmitter

D would be the answer. When Calcium levels increase in the presynaptic cleft it causes flow of calcium into the cell, which then causes a release of neurotransmitter. It doesn't cause the release of intracellular calcium.

Therefore it would prevent the release of neurotransmitter.

 

[Ronin786]

17. A 69-year-old woman is brought to the emergency department 1 hour after the sudden onset of crushing, substernal chest pain and nausea. Physical examination shows
pallor and diaphoresis An ECG and an evaluation of serum cardiac enzyme activity confirm a diagnosis of a myocardial infarction of the anterior wall Activation of platelets
and segmented neutrophils during thrombogenesis in this patient caused the release of cytokines, including platelet-derived growth factor. The mitogenic signal provided by
this cytokine to smooth muscle cells at sites of vascular injury in this patient is most likely to be inhibited by which of the following intracellular enzymes?

a.Aminotransferase
b.Glycosylhydrolase
c.Kinase
d.Lipase
e.Peroxidase
f.Phosphatase


please explain C and F

Cytokines work through a Receptor Associated Kinase JAK/STAT pathway. Since they have to use a kinase to have their effect, the opposite would be a phosphatase that cleaves the phosphate and inactivates them.

 

[Ronin786]

It's glutamate. It's binds to NMDA receptor. This interaction is the cause of neuronal death in huntingtons.

Huntington's or Alzheimer's?

 

[RedSoxSuck]

Huntington's or Alzheimer's?

Huntington's as far as I'm aware of.

 

[The Anhedonia]

A 25-year-old primigravid woman at 3 months gestation comes to the physician for her first prenatal visit. She requests an aminocentesis "to make me feel better that everything is all right with my baby". There is no family history of genetic disorders. Physical examinations and laboratory studies show no abnormalities. The likelihood of finding an abnormality is low. The physician needs to balance which of the following ethical principles when deciding whether to grant this patient's request?

a) Autonomy versus maleficence

b) Autonomy versus utilitarianism

c) Beneficence versus deontology

d) Beneficence versus maleficence

e) Deontology versus utilitarianism


please explain

A. Autonomy (the patient's sense of agency and right to choose their medical care) vs maleficence (the risk of the doctor doing harm - there's ~2% (?) chance of harming the fetus during this procedure). Since she's healthy and there are no abnormalities, this test is not indicated.

 

[firstaid2012]

ops i ment for

26 A 54-year-old man with alcoholism is brought to the emergency department because of a 10-day history of weakness, confusion, and shortness of breath He drinks approximately three fourths of a liter of liquor daily. He appears wasted, and there is an odor of alcohol on his breath. His respirations are 32/min. Physical examination shows jaundice abdominal distention spider angiomata, and Tanner stage 2 gynecomastia Laboratory studies show hypoalbuminemia and an increased serum estrogen-to-androgen ratio. The development of gynecomastia in this patient is mediated primarily by which of the following signal transduction pathways?
A) Aclivation of phospholipaseA2 and generation of arachidonic acid
8) Activation of phosphotipase C and generation of inositol 145 diphosphate
C) G protein-coupled activation of adenylyl cyclase
D) Receptor dimenzaOon and autophosphorylatJon of tyrosine residues
E) Transmembrane diffusion and binding of signaling molecule to transcription factor

i get the E but h about D can u explain it
and



homeless 45-year-old man comes to the emergency department because of pain in his right foot for the past week and difficulty walking for the past 2 days, A painful subcutaneous swelling is present in the righl groin His sock is blood encrusted A 5-cm (2-in) wound surrounded by swelling is present on the ball of the foot A purulent exudate containing some blood is expressed on palpation of the wound. Which of the following is the most likely cause of the groin swelling?
A) Cellular proliferation in an inguinal lymph node
B) Localized edema from a protein-deficient diet
C) Obstruction of lymphatic drainage in vessels near the knee
D) Obstruction of venous return from the right leg
E) Recirculation of neutrophils from the wound site

still not getting them

 

[Ronin786]

ops i ment for

26 A 54-year-old man with alcoholism is brought to the emergency department because of a 10-day history of weakness, confusion, and shortness of breath He drinks approximately three fourths of a liter of liquor daily. He appears wasted, and there is an odor of alcohol on his breath. His respirations are 32/min. Physical examination shows jaundice abdominal distention spider angiomata, and Tanner stage 2 gynecomastia Laboratory studies show hypoalbuminemia and an increased serum estrogen-to-androgen ratio. The development of gynecomastia in this patient is mediated primarily by which of the following signal transduction pathways?
A) Aclivation of phospholipaseA2 and generation of arachidonic acid
8) Activation of phosphotipase C and generation of inositol 145 diphosphate
C) G protein-coupled activation of adenylyl cyclase
D) Receptor dimenzaOon and autophosphorylatJon of tyrosine residues
E) Transmembrane diffusion and binding of signaling molecule to transcription factor

i get the E but h about D can u explain it
and



homeless 45-year-old man comes to the emergency department because of pain in his right foot for the past week and difficulty walking for the past 2 days, A painful subcutaneous swelling is present in the righl groin His sock is blood encrusted A 5-cm (2-in) wound surrounded by swelling is present on the ball of the foot A purulent exudate containing some blood is expressed on palpation of the wound. Which of the following is the most likely cause of the groin swelling?
A) Cellular proliferation in an inguinal lymph node
B) Localized edema from a protein-deficient diet
C) Obstruction of lymphatic drainage in vessels near the knee
D) Obstruction of venous return from the right leg
E) Recirculation of neutrophils from the wound site

still not getting them

E is right because thats the mechanism of action of Estrogen. Go to First Aid page 321 on the bottom (2012 version). It lists all the different cellular receptors.

Estrogen, which is responsible for the gynaecomastia, acts by transmembrane diffusion and binding of the molecule. Transient dimerization and autophosphyrolation of Tyrosine is how Insulin and other growth factors work.

As for the other question, like I stated previously the swelling in two different parts is due to reactive lymphocytes forming against the wound. The lymph node swell due to proliferation of T/B cells that are going to go out and fight the infection. Protein deficient diet causes generalized edema, and obstruction of lymphatic obstruction and venous return would cause generalized swelling and wouldn't affect the groin region. Also neutrophils don't recirculate, they go to the site of the wound, phagocytose the bacteria/debris and then die as pus.