Nbme 6

[combat]

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A 35 year old woman comes to physician because of 2 week history of fever and headaches that see, to occur everyday. She recently returned from 1 month camping expedition in Cambodia. Her temp is 105.1F. Physical examination shows diaphoresis and splenomegaly. A peripheral blood smear shows Plasmodium vivax, and treatment with chloroquine is started and followed with course of primaquine. which of the following is best explanation for the inclusion of primaquine in this patient's medication regimen?

a) Cerebral Involvement.
b) Hemolysis.
c) High parasite load on the blood smear.
d) Minimal Toxicity.
e) Prevention of recurrence of malaria.

I chose E and i got it wrong, i thought primaquine is added to prevent further occurence, but it was wrong. Only option i can think from above is Hemolysis but not sure. Any one

 

[FML]

So ~72% on this thing barely gets me a pass? that seems harsh.

 

[peace zealot]

A 43yr old female with slow relaxation of stretch reflexes and hoarse voice. Plasma TSH level is low that increases in concentration after she is given TRH. The cause of hypothyroidism in what?

I thought it is Hypothalamus (tertiary hypothyroidism), but the correct answer is Pituitary gland. Please someone explain this, I am missing some point.

 

[FML]

A 43yr old female with slow relaxation of stretch reflexes and hoarse voice. Plasma TSH level is low that increases in concentration after she is given TRH. The cause of hypothyroidism in what?

I thought it is Hypothalamus (tertiary hypothyroidism), but the correct answer is Pituitary gland. Please someone explain this, I am missing some point.

umm I put pituitary gland and got it marked wrong... I thought it was hypothalamus.

what are we both missing?

 

[peace zealot]

Oh thanks for confirming. I used the offline version that definitely has a lot of wrong answers (can't complain after using pirated stuff).

 

[yaparqa]

i think that's over thinking it. if they didn't have pancytopenia then yea definitely. the time frame of aplastic anemia vs a leukemia is different. when i read this i thought it was more emergent, but they really don't specify. still, the pancytopenia pretty much rules out leukemia i think this is the most i've ever posted on sdn in a day. i REALLY don't want to study neuro, ugh.

read wiki, benzene causes aplastic anemia and leukemia. I selected lymphocytes in the marrow causing the pancytopenia - but I suppose in a leukemic situation there would be a cell like high in number... but then again, in an MDS type of situation this scenario is plausible, however, I don't hear benzene being talked about much as far as MDS goes

 

[jpudge12]

...Thp cells polarize to Th2, release IL-4 which cause isotype switching of B cells from IgM to IgE. Soluble IgE bind irreversibly and with high affinity to mast cells.Upon second reexposure, the IgE on the mast cells crosslink when two of them find an Antigen, and the mast cell degranulates, releasing Histamine and IL-4, among other things, causing polarization of Thp to Th2...

Initial polarization of Thp cells probably depend on Mast Cell or B cell Ag presentation to T cells. IL-4 is needed for Isotype Switching to IgE (that's the T->B stimulation).

IgE definitely does not stimulate anything, so B and C are out. T lymphocytes need to be induced to activate B cells (IL2,4,5, costimulatory molecules), so B can't come before T, and especially there can't be class-switching before T cells, so A is out.[/QUOTE]

Cool man thanks!

 

[Bbon]

Not a lot of action on this one. I'd be very appreciative of some help on a few of these.

1. Compared w/ freshly secreted bile, the proportion of what is decreased in bile stored in the gallbladder?
Bilirubin, Ca, cholesterol, potassium, water (Is it cholesterol?)

2. 46 year old woman with a chronic illness and a picture of a gigantic heart. What disorder did she have?
alcoholic cardiomyopathy, ASD, mitral stenosis, primary pulmonary HTN, systemic HTN (systemic HTN?)

3. Norepinephrine solution bathing cardiac myocytes. An increase in what leads to an increased work by the muscle?
overlap of thin and thick filaments, sarcoplasmic Ca concentration, sarcoplasmic phosphocreatine, stiffness of the series elastic elements

4. 17 year old girl with episodes of visual loss. There's a picture of her optic disc. What is the problem?
optic atrophy, optic neuritis, papilledema, retinal infarction, retrobulbar infarction

Thanks in advance!

 

[Aclamity]

Been a week since i did this, but here goes:

Not a lot of action on this one. I'd be very appreciative of some help on a few of these.

1. Compared w/ freshly secreted bile, the proportion of what is decreased in bile stored in the gallbladder?
Bilirubin, Ca, cholesterol, potassium, water (Is it cholesterol?)

Gall bladder dehydrates bile (answer is water)

2. 46 year old woman with a chronic illness and a picture of a gigantic heart. What disorder did she have?
alcoholic cardiomyopathy, ASD, mitral stenosis, primary pulmonary HTN, systemic HTN (systemic HTN?)

Alcoholics -> wet beri beri -> dilated cardiomyopathy (systemic HTN causes concentric hypertrophy which doesn't increase the size of the heart... just decreases ventricular volume)

3. Norepinephrine solution bathing cardiac myocytes. An increase in what leads to an increased work by the muscle?
overlap of thin and thick filaments, sarcoplasmic Ca concentration, sarcoplasmic phosphocreatine, stiffness of the series elastic elements

NE -> b1 receptor -> inc cAMP -> inc Ca2+ -> contraction (answer is sarcoplasmic Ca conc)

4. 17 year old girl with episodes of visual loss. There's a picture of her optic disc. What is the problem?
optic atrophy, optic neuritis, papilledema, retinal infarction, retrobulbar infarction

Headaches + visual loss = I thought it was papilledema from the pic

Thanks in advance!

 

[Bbon]

Awesome, thanks a lot. It's nice to see even my second guess was wrong. Are you sure about the heart one though? I know you said it's been a week, so maybe you're thinking of a different picture, although I guess it's possible I'm just completely misunderstanding it. It looks massively concentrically hypertrophied with a narrowed lumen if anything. Guess it doesn't help too much without seeing the picture again.

 

[NewYorkDoctors]

B. Alcoholic, aspirated oral secretions = klebsiella

while klebsiella is assocaited with alcoholics


this answer specifically said "mixed oral flora" and anaerobes fit this description more accurately. (peptostreptoccoccus, fusiform, etc..)

 

[Convalaria]

2. 46 year old woman with a chronic illness and a picture of a gigantic heart. What disorder did she have?
alcoholic cardiomyopathy, ASD, mitral stenosis, primary pulmonary HTN, systemic HTN (systemic HTN?)

Alcoholics -> wet beri beri -> dilated cardiomyopathy (systemic HTN causes concentric hypertrophy which doesn't increase the size of the heart... just decreases ventricular volume)

Heart on picture is not just huge, there is concentric hypertrophy, and the question tells that patient had "chronic illness affecting her cardiopulmonary function", that made me think of primary pulmonary hypertension, and that turned out wrong. If it is systemic hypertension, then why they put "cardiopulmonary function"?
And another question: when they show heart in horizontal section do they mean that anterior surface of the heart at the upper part of picture, right chamber - at the right, left - at the left?


I know that this one is probably silly to make mistake in..but I got it wrong: 22yo marathon women with stress fracture and decreased bone density. Is it due to estrogen def? If yes, then why is it deficient in 22 yo girl?

I guess I'm overthinking with this one:
49 yo woman hasn't slept 2 wks, denies previous history of sleep difficulty, drunk 1 bottle of wine for the past week, but hasn't drunk in the past. Demands to be seen by the head of the department. Speech is rapid, pressured, she is irritable. She got major depressive disorder 6 years ago. What's her Dx now?
-alcohol withdrawal
-alcohol halucinosis
-alcoholism
-bipolar disorder
-cyclothymic disorder

Biostat (hate it):
Fish oil/olive oil in preventing of renal disease in patients with IgA nephropathy. Over the next 5 years: incidence of end-stage renal disease significantly lower in group that took fish oil. What is the design study?

Another biostat:
4 columns with UTI in children, what is the median number?

Question about mannitol: so will it cause only decrease of water reabsorption? Na will be reabsorbed in kidneys and this is why osmolarity goes up, right?

Read this thread, but still didn't get what the correct answer is in question with the married 78 yo man who took 10 temazepam pills. Which one is the most important in assessing his risk for suicide?
-early morn awakening with decr.appetite
-family history of suicides
-male gender
-marital status
-his belief that temazepam would kill him.
The last one?

Thanks!

 

[HelpPleaseMD]

I didn't do form 6 but I can tell you what I think of the questions you posted.

estrogen def should be the answer. I have always heard that extreme female atheletes / malnutrition can cause anovulatory cycles. I do not know the mechanism behind it though... maybe the whole axis gets messed up.

this person has bipolar. Cant sleep / thinks hes really important + many became manic after being treated for a misdiagnosed MDD

3) Cohort - these patients are being tested for the development of a disease. If it was case control then one of the patients would have had the disease

4) belief that the drug will kill him

5) not sure what ure asking for with the mannitol question

 

[Convalaria]

I didn't do form 6 but I can tell you what I think of the questions you posted.

estrogen def should be the answer. I have always heard that extreme female atheletes / malnutrition can cause anovulatory cycles. I do not know the mechanism behind it though... maybe the whole axis gets messed up.

this person has bipolar. Cant sleep / thinks hes really important + many became manic after being treated for a misdiagnosed MDD

3) Cohort - these patients are being tested for the development of a disease. If it was case control then one of the patients would have had the disease

4) belief that the drug will kill him

5) not sure what ure asking for with the mannitol question

I put cohort answer for the same reason you described, but it turned out to be wrong

And about bipolar. I chose cyclothymic, because I thought ''major depr.disorder 6 years ago'', that sounds like she has long history. But I guess these two are not related to each other

thanks!

 

[heli0x]

for the study, it was randomized trial because there was an intervention group and a control group. As for the mannitol Q, mannitol is an osmotic diuretic (so volume goes down and sodium concentration up), and for the median value there were 4 bars for 0-3, the 0 and 3 bars were similar in size, so median value was the larger bar (either 1 or 2).
It was systemic hypertension, with concentric hypertrophy (which led to pulm symptoms)

 

[Bbon]

Here's what I got

Heart on picture is not just huge, there is concentric hypertrophy, and the question tells that patient had "chronic illness affecting her cardiopulmonary function", that made me think of primary pulmonary hypertension, and that turned out wrong. If it is systemic hypertension, then why they put "cardiopulmonary function"?
And another question: when they show heart in horizontal section do they mean that anterior surface of the heart at the upper part of picture, right chamber - at the right, left - at the left?
Good question. I think they should have labeled right vs. left. Not really sure. The left side looked like the right heart though. I don't know which was anterior vs. posterior.


I know that this one is probably silly to make mistake in..but I got it wrong: 22yo marathon women with stress fracture and decreased bone density. Is it due to estrogen def? If yes, then why is it deficient in 22 yo girl?
It has something to do with GnRH dysfunction with extreme exercise. So loss of normal GnRH excretion ultimately leads to lack of estrogen.

I guess I'm overthinking with this one:
49 yo woman hasn't slept 2 wks, denies previous history of sleep difficulty, drunk 1 bottle of wine for the past week, but hasn't drunk in the past. Demands to be seen by the head of the department. Speech is rapid, pressured, she is irritable. She got major depressive disorder 6 years ago. What's her Dx now?
-alcohol withdrawal
-alcohol halucinosis
-alcoholism
-bipolar disorder
-cyclothymic disorder
Bipolar disorder - pressured speech, irritability, lack of sleep, etc. (DIG FAST)

Biostat (hate it):
Fish oil/olive oil in preventing of renal disease in patients with IgA nephropathy. Over the next 5 years: incidence of end-stage renal disease significantly lower in group that took fish oil. What is the design study?
The key is that the researchers made the patients take either fish oil or olive oil. So it's a randomized trial or whatever the choice said. Things like cohort studies and case-control don't involve any manipulation by the experimenters. The people being studied do whatever they want and the researchers just observe and record what happens.

Another biostat:
4 columns with UTI in children, what is the median number?
Pretty sure it was 1. Don't have the exact question, but wasn't it 100 people total, 30 without a UTI and 25 with 1 UTI. So the median value would be the 50th value. Since values 31-55 (when placed in sequential order) are all 1 UTI, the answer is 1.

Question about mannitol: so will it cause only decrease of water reabsorption? Na will be reabsorbed in kidneys and this is why osmolarity goes up, right?
Mannitol causes loss of free water. So think about there being essentially no change in any electrolytes. If you just lose water, then your serum osmolality will increase.

Read this thread, but still didn't get what the correct answer is in question with the married 78 yo man who took 10 temazepam pills. Which one is the most important in assessing his risk for suicide?
-early morn awakening with decr.appetite
-family history of suicides
-male gender
-marital status
-his belief that temazepam would kill him.
The last one?
Yeah, it's the last one. If he just took a bunch of temazepam because he was stressed out, rather than trying to kill himself, that would definitely make you think he's not planning on committing suicide, at least not intentionally.
Thanks!

 

[Convalaria]

Here's what I got

thank you!

 

[ijn]

I put cohort answer for the same reason you described, but it turned out to be wrong

And about bipolar. I chose cyclothymic, because I thought ''major depr.disorder 6 years ago'', that sounds like she has long history. But I guess these two are not related to each other

thanks!

Was randomized control trial an option? Cohort studies don't typically study positive interventions. They study **** people do to themselves - like smoking.

For cyclothymia they 100% have to tell you she's been having minor mania and depression bouts for at least 2 years. Same thing with dysthymia (minor depression for 2 years). There's no other way to ask that disease fairly. It's pretty rare so I wouldn't jump on it as an answer unless you're completely sure it matches the criteria. Er on the side of the more common rare disease rather than the extremely rare disease when you're unsure.

 

[Convalaria]

Was randomized control trial an option? Cohort studies don't typically study positive interventions. They study **** people do to themselves - like smoking.

For cyclothymia they 100% have to tell you she's been having minor mania and depression bouts for at least 2 years. Same thing with dysthymia (minor depression for 2 years). There's no other way to ask that disease fairly. It's pretty rare so I wouldn't jump on it as an answer unless you're completely sure it matches the criteria. Er on the side of the more common rare disease rather than the extremely rare disease when you're unsure.

yes, it was, thanks!
I gotta do smth with biostat, otherwise I'm gonna just fail it...🙁
Is there other good resources? I read FA, Kaplan, Biostat chapter in HY Behav.Science. My biggest problem is that sometimes I just can't recognize what the study design is given in the question.

 

[ButterIsMagical]

Hokay, here are mine!

2) 6 y/o girl with dark urine and periorbital edema, noted in the morning after waking, for the past 3 days. Physical exam shows mild HTN and ankle swelling. Urinalysis shows the prsence of RBCs, red blood cell tubular casts, and increased protein concentration. Over the next few days, urine output is diminished despite adequate fluid intake. Which of the following is the most likely location of the dz process?
A) Glomerular
B) Interstitial
C) Postrenal
D) Prerenal
E) Tubular

I thought it sounded like PNH, so I chose prerenal. But, now it kind of sounds like IgA nephropathy (which would be glomerular)... but they didn't mention hx of a a URI.

42) A 31 y/o woman has had several episodes of retrosternal chest pain while at rest during the past 6 months. The most recent episode occurred while she was asleep and produced several minutes of ST segment elevation on a home cardiac monitor. She has no known cardiac risk factors. Which of hte following events in a large eicardial artery is most likely responsible for the chest pain?
A) Endothelial cell dysfunction
B) Formation of a thin fibrous-capped plaque
C) Neutrophilic infiltration within the intima
D) Plaque rupture and coronary embolization
E) Plaque rupture and mural hemorrhage

Sounds like prinzmetal's, but I don't see vasospasm on there. Would endothelial cell dysfunction be it? "Vasospasm" says smooth muscle to me -- is the vascular smooth muscle IN the endothelial cells? (Feels like a zoolander comment -- the files are IN the computer!)

1) Four days after admission to the hospital with multiple fractures sustained in a motor vehicle collision, a 27 year old man has the sudden onset of shortness of breath. His respirations are 30/min. Doppler ultrasonography of the lower extremities shows a DVT, and a spiral CT scan of the chest shows evidence of multiple subsegmental pulmonary emboli. Anticoagulant therapy is begun. One week later, a follow up CT scan of the chest is done to evaluate atypical chest pain. Results show no abnormalities, and the pain was considered to be MSK. Collateral circulation from which of the following best explains the lack of identifiable pulmonary parenchymal infarcts in this patient?
A) Bronchial arteries
B) Bronchial veins
C) Pulmonary arteries
D) Pulmonary veins
E) SVC

It's bronchial arteries, isn't it? Because it's about parenchymal infarcts.

48) Certain chromosomal abnormalities can result in rudimentary development of the cerebral hemispheres. Which of the following labeled structures in the xsection of a nl brain stem is expected to be most underdeveloped as a result of such an anomaly?

(Pic attached)

I get that it's Pateau's syndrome... Could it be E for the CST?

Thanks, guys!!

 

[iCY]

Hokay, here are mine!

2) 6 y/o girl with dark urine and periorbital edema, noted in the morning after waking, for the past 3 days. Physical exam shows mild HTN and ankle swelling. Urinalysis shows the prsence of RBCs, red blood cell tubular casts, and increased protein concentration. Over the next few days, urine output is diminished despite adequate fluid intake. Which of the following is the most likely location of the dz process?
A) Glomerular
B) Interstitial
C) Postrenal
D) Prerenal
E) Tubular

A. sounds like post-strep glomerulonephritis. nephRITIC syn because of the RBC casts. PNH?!?!? you are in the wrong organ system buddy. Please look up the symptoms for PNH (mostly intravascular hemolysis with hemoglobin in the urine, NOT RBCs/casts. also signs of low WBCs & platelets). the presence of a cast indicates you are dealing with a problem in the kidney

I thought it sounded like PNH, so I chose prerenal. But, now it kind of sounds like IgA nephropathy (which would be glomerular)... but they didn't mention hx of a a URI.

42) A 31 y/o woman has had several episodes of retrosternal chest pain while at rest during the past 6 months. The most recent episode occurred while she was asleep and produced several minutes of ST segment elevation on a home cardiac monitor. She has no known cardiac risk factors. Which of hte following events in a large eicardial artery is most likely responsible for the chest pain?
A) Endothelial cell dysfunction
B) Formation of a thin fibrous-capped plaque
C) Neutrophilic infiltration within the intima
D) Plaque rupture and coronary embolization
E) Plaque rupture and mural hemorrhage

A - prinzmetals angina. complete occlusion of the artery can produce ST elevation. Plus young patient (31 yo) with no cardiac risk factors (only thing to really consider @ this age is hypercholesterolemia w/ early MI, but the question stem says no cardiac risk factors)


Sounds like prinzmetal's, but I don't see vasospasm on there. Would endothelial cell dysfunction be it? "Vasospasm" says smooth muscle to me -- is the vascular smooth muscle IN the endothelial cells? (Feels like a zoolander comment -- the files are IN the computer!)

1) Four days after admission to the hospital with multiple fractures sustained in a motor vehicle collision, a 27 year old man has the sudden onset of shortness of breath. His respirations are 30/min. Doppler ultrasonography of the lower extremities shows a DVT, and a spiral CT scan of the chest shows evidence of multiple subsegmental pulmonary emboli. Anticoagulant therapy is begun. One week later, a follow up CT scan of the chest is done to evaluate atypical chest pain. Results show no abnormalities, and the pain was considered to be MSK. Collateral circulation from which of the following best explains the lack of identifiable pulmonary parenchymal infarcts in this patient?
A) Bronchial arteries
B) Bronchial veins
C) Pulmonary arteries
D) Pulmonary veins
E) SVC


It's bronchial arteries, isn't it? Because it's about parenchymal infarcts.
yes

48) Certain chromosomal abnormalities can result in rudimentary development of the cerebral hemispheres. Which of the following labeled structures in the xsection of a nl brain stem is expected to be most underdeveloped as a result of such an anomaly?

(Pic attached)

I get that it's Pateau's syndrome... Could it be E for the CST?

Thanks, guys!!

no problemo

 

[Go Ducks]

Some of these were already asked but never answered fully or not at all:

1. 51-year-old woman has 9 lb weight loss over past 6 mo. Smoked 2 packs cigarrettes per day for 20 yrs. No meds, normal vitals. Labs:
Hemoglobin - 17
Hematocrit - 52%
Leukocytes - 5100
urea - 17
creatinine - 1
RBC/hpf in urine - 14

What's her problem?
endometrial carcinoma
polycythemia vera
renal carcinoma
renal vein thrombosis

2. You inject 2L isotonic saline. How much ends up extracellular?
I thought the answer would be 0.6L as usually fluid volume is 2/3 intracellular and 1/3 extracellular, but that was not even an answer choice...

 

[Boardz]

Some of these were already asked but never answered fully or not at all:

1. 51-year-old woman has 9 lb weight loss over past 6 mo. Smoked 2 packs cigarrettes per day for 20 yrs. No meds, normal vitals. Labs:
Hemoglobin - 17
Hematocrit - 52%
Leukocytes - 5100
urea - 17
creatinine - 1
RBC/hpf in urine - 14

What's her problem?
endometrial carcinoma
polycythemia vera
renal carcinoma
renal vein thrombosis

2. You inject 2L isotonic saline. How much ends up extracellular?
I thought the answer would be 0.6L as usually fluid volume is 2/3 intracellular and 1/3 extracellular, but that was not even an answer choice...

1. Renal cell carcinoma. RCC paraneoplastic syndrome is increased EPO which would explain the increased hematocrit and hemoglobin. Hematuria is also a clinical feature of RCC. Smoking is also risk factor for RCC. RCC is most common in 50-70 year old men so at least she's in the age range.

2. If you inject 2L of isotonic saline, 2L of it will end up in the extracellular compartment. Since it's isotonic, it won't move into intracellular compartment.

 

[thinker]

a 2-year-old boy is brought to the physician's office for a follow-up examination because of recurrent bilateral otitis media. He is at the 50th percentile for height, weight, and head circumference. He is almost toilet trained, pretends to help care for his younger sibling, and can form three to four-word sentences. Which of the following best describes his development?

I picked (D): Cognitive Delayed, Social Normal, Motor Normal ... but it's incorrect. Any idea what's the correct answer?

 

[RedSoxSuck]

a 2-year-old boy is brought to the physician's office for a follow-up examination because of recurrent bilateral otitis media. He is at the 50th percentile for height, weight, and head circumference. He is almost toilet trained, pretends to help care for his younger sibling, and can form three to four-word sentences. Which of the following best describes his development?

I picked (D): Cognitive Delayed, Social Normal, Motor Normal ... but it's incorrect. Any idea what's the correct answer?

I think the answer was all parameters were normal. I did it yesterday.

 

[RedSoxSuck]

I just did this last week, ill help you out..

1. Its A, i also put the same answer you did and got it wrong, found the right answer on discussion forums like this one

2. D

3. E...its right under glycolosis in first aid

4. F

5. D

6. B...exactly, the only cyp inhibitor on that list is cimetidine

7. C

8 . A (had gotten this wrong but searched online for correct answer)

9. yup E

10. C

11. D

12. E

13. E...yes it does change to bicarb in the erythrocytes but key word here is carried

14.. B...stones, moans and groans

15. B...

16. Social phobia

Can you please explain #4. Why is it vaccine. I eliminated it becasue vaccine is normally given as a preventive measure before the spread of the disease. Since disease is already present and is spreading wouldn't you want to treat?

And number 5?

Number 12...Whats the organism if you remember?

number 16: why is it social phobia. I mean i thought he has a specific problem meaning suffering from phobia of presentations which is not necessarily "social". May be i am reading way too much into it.

 

[EaglesAllDay]

4..http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm check under vaccine efficacy

5.Hydroxylase =hydroxylations and dealkyliations are reaction of modification performed by liver P450 enzymes.These enzymes shows genetic polymorphisam within the P4502C and P4502d group.Basicly this means that patients will react different on the same dose of drug,cause their biotransformation will be differente.. (got this from another forum)

12. The organism was Borrelia recurrentis

16. Check first aid...social phobia- excessive fear of embarrassment in a social situation (public speaking, using public restroom)

 

[Boardz]

Can you please explain #4. Why is it vaccine. I eliminated it becasue vaccine is normally given as a preventive measure before the spread of the disease. Since disease is already present and is spreading wouldn't you want to treat?

And number 5?

Number 12...Whats the organism if you remember?

number 16: why is it social phobia. I mean i thought he has a specific problem meaning suffering from phobia of presentations which is not necessarily "social". May be i am reading way too much into it.

#4 is a vaccine b/c the question asks about "controlling spread" NOT how do you treat smallpox.

 

[dragon529]

Time to bring the dead back alive... Would like some explanations on these if possible 😍

1. 68 yo woman with lower back pain after carrying groceries. Took no meds or HRT. Tenderness over lumbosacral spine, neuro exam normal.

2. This one got a graph so I'm just gonna explain it.. Newborn with respiratory distress syndrome asking which cell is secreting surfactant. How can you tell which 1 is type2 pneuomocyte!?

3. Biostat Q comparing surgery done at tertiary center vs community care facility. I put unequal sample sizes but it's wrong. Any thoughts?

4. X-ray of the humerus asking which nerve is in danger. I put median N because it looks like the fracture was near medial olecranon? But guess that isn't the case...

5. A slice image of the pons asking where the substantia nigra pars compacta is. Anyone got a good source where I can review these brain slices?

6. which of the following receptor classes are found in both presynaptic and postsynatic terminals


7. 74yo man unable to repeat phrases and name objects after left sided stroke. Reading comprehension preserved but difficult reading aloud and writing. Speech is fluent, comprehension normal. Which of following is damaged


8. A slice image of the pons/medulla asking certain chromosomal abnormalities can result in rudimentary development of the cerebral hemispheres. What and which spot is this?

9. Long stem asking what best describes result of loss of PTH on vitD metabolism. I put decreased intestinal absorption of dietary vitD... and it's wrong =/

10. 52yo man with gout, treated w/ indomethacin and now still has uric acid of 800mg/day(N300-600). Which drug is most appropriate to decrease uric acid concentration for this guy?

I was debating between allopurinol and colchicine and colchicine is wrong. I thought allopurinol is mostly for long term controlling and he still needs to lower his uric acid lvl first...? Is colchicine obsolete now due to its side effects and better drugs we have now?

11. AIDS+ man treated on HAART started treatment w/ a hematopoietic growth factor and started having dyspnea, muscle pain, vomiting. sinus tach. Which of following could cause this?


Ppl online say it's filgrastim..?

 

[coolforschool]

Time to bring the dead back alive... Would like some explanations on these if possible 😍

1. 68 yo woman with lower back pain after carrying groceries. Took no meds or HRT. Tenderness over lumbosacral spine, neuro exam normal.

compression fracture L4

It's an old lady who is post-menopause, so she's at risk for osteoporosis --> she's not on any meds or HRT --> increased risk of fractures. Side note: I think L4 is the most commonly fractured vertebra, but I don't think you had to know that for this question.

2. This one got a graph so I'm just gonna explain it.. Newborn with respiratory distress syndrome asking which cell is secreting surfactant. How can you tell which 1 is type2 pneuomocyte!?

It's D, the cell that's within the interstitium instead of outside of it like that alveolar macrophage (E). A is the endothelial cell, B is the RBCs, and C is the type I pneumocyte making its thin epithelium.

3. Biostat Q comparing surgery done at tertiary center vs community care facility. I put unequal sample sizes but it's wrong. Any thoughts?

I believe I put lack of control of case complexity for this one. You can sort of rule out all of the other ones because they're either not true or not relevant to the study. It kind of makes sense because you're dealing with mortality, which can happen for a lot of reasons, but I don't have a definite or clear explanation for you.

4. X-ray of the humerus asking which nerve is in danger. I put median N because it looks like the fracture was near medial olecranon? But guess that isn't the case...

It's the radial nerve, and it was a midshaft fracture of the humerus, which tends to injure that nerve.

5. A slice image of the pons asking where the substantia nigra pars compacta is. Anyone got a good source where I can review these brain slices?

No good source, but the answer was C, as seen here: http://www.upright-health.com/images/substantia-nigra3.png

6. which of the following receptor classes are found in both presynaptic and postsynatic terminals


alpha2


Remember the alpha-2 receptors that sit on the presynaptic terminals? When NE is released, they bind some of that NE and inhibit its release.

7. 74yo man unable to repeat phrases and name objects after left sided stroke. Reading comprehension preserved but difficult reading aloud and writing. Speech is fluent, comprehension normal. Which of following is damaged

arcuate fasiculus

Speech fluent, comprehension normal. That eliminates Broca's and Wernicke's right off the bat. Repetition impaired --> arcuate fasciculus.

8. A slice image of the pons/medulla asking certain chromosomal abnormalities can result in rudimentary development of the cerebral hemispheres. What and which spot is this?

It's alluding to the medullary pyramids, which should be the most anterior structures.

9. Long stem asking what best describes result of loss of PTH on vitD metabolism. I put decreased intestinal absorption of dietary vitD... and it's wrong =/

PTH increases the intestinal absorption of calcium and phosphate. The more correct answer is decreased renal conversion of 25-OH-vitD to 1,25-OH-vitD (PTH activates 1-alpha-OHase in the PCT of the kidneys).

10. 52yo man with gout, treated w/ indomethacin and now still has uric acid of 800mg/day(N300-600). Which drug is most appropriate to decrease uric acid concentration for this guy?

I was debating between allopurinol and colchicine and colchicine is wrong. I thought allopurinol is mostly for long term controlling and he still needs to lower his uric acid lvl first...? Is colchicine obsolete now due to its side effects and better drugs we have now?

Allopurinol is used for chronic gout and for suppressing the overproduction of uric acid, which is the more correct answer here. Colchicine is used in acute gout ATTACKS since it has anti-inflammatory effects, at least that's how I think of it.

11. AIDS+ man treated on HAART started treatment w/ a hematopoietic growth factor and started having dyspnea, muscle pain, vomiting. sinus tach. Which of following could cause this?

Sargramostim

Ppl online say it's filgrastim..?

It's not filgrastim because that's what I put and it was wrong. It's sargramostim; I looked it up and the side effects showed up in some obscure PubMed article.

I'll edit this post and post the answers to the rest of them when I can.

Edit: answered all of them, I think.

 

[Bonne Chance]

^To the post above

PTH function that was posted was wrong. PTH increases Phosphate excretion at the Proximal tubule and increases Ca2+ re-absorption @ the distal. Albeit, the post was correct in stating that it increases Vitamin D hydroxylation as well.

Sargramostim side-effect upon first infusion leads to fevers/chills/tachycardia. This occurs upon first infusion I believe (can't find the mechanism to see if it was due to Histamine release).

Post above answered almost all of them spot on

 

[coolforschool]

^To the post above

PTH function that was posted was wrong. PTH increases Phosphate excretion at the Proximal tubule and increases Ca2+ re-absorption @ the distal. Albeit, the post was correct in stating that it increases Vitamin D hydroxylation as well.

Sargramostim side-effect upon first infusion leads to fevers/chills/tachycardia. This occurs upon first infusion I believe (can't find the mechanism to see if it was due to Histamine release).

Post above answered almost all of them spot on

Yep, you're right about the PTH actions in the kidneys, but PTH also acts to increase Ca2+ and phosphate reabsorption in the gut (indirectly via 1,25-OH-vitD action).

Sargramostim side effects are definitely due to first infusion. I remember finding that but forgot to add that in. Thanks!

 

[dragon529]

Thanks guys.

 

[223556]

A 23-year old woman has a 6-year hx of intermittent episodes of fever, crampy abdominal paint...etc. They show a pic of the resected bowel.

A) Acute appendicitis
B) Adenocarcinoma (what I put but I guess it didn't say weight loss...)
C) Celiacs
D) Crohns (right one I bet)
E) Ulcerative colitis

 

[hardee17]

A 23-year old woman has a 6-year hx of intermittent episodes of fever, crampy abdominal paint...etc. They show a pic of the resected bowel.

A) Acute appendicitis
B) Adenocarcinoma (what I put but I guess it didn't say weight loss...)
C) Celiacs
D) Crohns (right one I bet)
E) Ulcerative colitis

adenocarinoma wouldn't give you fever

crohns is the correct answer

 

[startswithb]

8 year old boy has edema for 2 months, 4+ proteinuria with oval fat bodies. Disorder involves which of the following:
a. afferent arterioles only
b, afferent and efferent arterioles
c. glomerular capillary loops
d. glomerular mesangial region
e. tubulo-interstitial region

I guess the answer is glomerular capillary loops? I don't understand.

 

[VCorp]

8 year old boy has edema for 2 months, 4+ proteinuria with oval fat bodies. Disorder involves which of the following:
a. afferent arterioles only
b, afferent and efferent arterioles
c. glomerular capillary loops
d. glomerular mesangial region
e. tubulo-interstitial region

I guess the answer is glomerular capillary loops? I don't understand.

4+ proteinuria = nephrotic syndrome
8 year old boy = mcc of nephrotic syndrome in a 8 year old boy is what? 😉

 

[CaptainSSO]

8 year old boy has edema for 2 months, 4+ proteinuria with oval fat bodies. Disorder involves which of the following:
a. afferent arterioles only
b, afferent and efferent arterioles
c. glomerular capillary loops
d. glomerular mesangial region
e. tubulo-interstitial region

I guess the answer is glomerular capillary loops? I don't understand.

oval fat bodies + albuminuria = nephrotic, most likely MCD, which is just effacement of the podocytes. i didn't really like the answer as it was worded, but through process of elimination you can rule out arterioles, tubulo-interstitial would be interstitial nephritis which would be result in eosinophilia, and mesangial would be nephritic

can someone help me on the ones i missed?

1. peptide hormones,

cytoplasmic receptor, are they considered fast or slow?




44. systolic ejection murmur at base that radiates to neck. ecg = LVH

a. dissection
b. bicuspid aortic valve
c. mitral insufficiency
d. mitral stenosis
e. tricuspid stenosis

this threw me off b/c they said "at base," which i assumed was the apex of the heart & mitral valve. what do they mean by "base" exactly?

 

[startswithb]

oval fat bodies + albuminuria = nephrotic, most likely MCD, which is just effacement of the podocytes. i didn't really like the answer as it was worded, but through process of elimination you can rule out arterioles, tubulo-interstitial would be interstitial nephritis which would be result in eosinophilia, and mesangial would be nephritic

can someone help me on the ones i missed?

1. peptide hormones,

cytoplasmic receptor, are they considered fast or slow?




44. systolic ejection murmur at base that radiates to neck. ecg = LVH

a. dissection
b. bicuspid aortic valve
c. mitral insufficiency
d. mitral stenosis
e. tricuspid stenosis

this threw me off b/c they said "at base," which i assumed was the apex of the heart & mitral valve. what do they mean by "base" exactly?

I figured it was MCD. The capillary vs mesangium thing threw me off.
Peptide hormones are fast bc, unlike steroid hormones, their action is direct instead of requiring transcription of genes to exert their action.
44. Is bicuspid aortic valve. When I read systolic ejection murmur that radiates toward neck I just thought aortic stenosis. Some of these questions have terrible wording but you really have to think "what is the most obvious thing, bc that is what they are testing."

 

[stronghold]

A 20 y.ol woman with difficulty breathing for 2 hrs. Overdistended chest marked restriction of expansion. Increased blood eosinophils and eosinophils in sputum. Which is most likely sequence of events for initial sensitization of to allergen causing these findings?

a) cytokine release...IgE production....T-lymphocyte induction
b) IgE production......B lymphocyte activation...T-lymphocyte induction
c) IgE production...T-lymphocyte induction...cytokine release
d) T-lymphocyte induction...cytokine release...IgE production

What is the answer, please? C is wrong.

 

[Myxedema]

A 20 y.ol woman with difficulty breathing for 2 hrs. Overdistended chest marked restriction of expansion. Increased blood eosinophils and eosinophils in sputum. Which is most likely sequence of events for initial sensitization of to allergen causing these findings?

a) cytokine release...IgE production....T-lymphocyte induction
b) IgE production......B lymphocyte activation...T-lymphocyte induction
c) IgE production...T-lymphocyte induction...cytokine release
d) T-lymphocyte induction...cytokine release...IgE production

What is the answer, please? C is wrong.

In type I hypersensitivity, naive T-helper cells must be sensitized first for the synthesis of IgE. Since the allergen is an exogenous antigen, it follows the same template as other exogenous antigens: Get recognized by APCs --> Present it to naive T-helper cells (Th0) on MHC class II molecules and synthesize IL-4 --> Th0 cells turn into Th2 cells --> Th2 cells secrete IL-4, IL-5 and IL-13 --> IL-4 induces plasma cells to switch from IgM to IgE. Therefore, the answer should be choice D.