Uworld 16
D) IgG
**Anti-Rh (D) = IgG**
**Synthesis of an extracellular polysaccharide matrix**
**Biofilm**
**Staphylococcus epidermidis**
**Biofilm** production
why is the *Urge incontinence* caused in *Multiple sclerosis* ?
**Bladder hypertonia**
**Multiple sclerosis**
**Bladder hypertonia***
**Headaches** =
**Coarctation of the aorta**
Death due to *Hypertensive complications*
**Coarctation of the aorta**
**CMV** (Herpes virus
**Enveloped double-stranded DNA virus**
what to use for *Long-term* control of Asthma?
**Fluticasone**
***Methylation*** =
**Imprinting*
**Ischemic myocardium**
**Lidocaine**
what drug binds to *Ischemic myocardium* ?
**Lidocaine**
**Nucleic Acid Amplification testing** positive
**Neisseria Gonorrhea**
E) Uroporphyrinogen decarboxylase
**Night-guard** - has no exposure to sunlight
If this *Night guard* goes into sunlight, then he will get Rash due to lack of **Uroporphyrinogen decarboxylase**.
**Porphyria cutanea Tarda**
**Faint, erythematous maculopapular lesions** =
**Rose spots**
**Rose spots**
**Salmonella**
Baby has *Difficulty* eating
**Trachealesophgeal fistula**
C) Failure of primitive foregut to separate from airway
**Tracheoesophageal fistula**
D) Tyrosine kinase receptor
**Trastu**zumab
**Multiple sclerosis**
**Upper Motor Neuron** lesion
**Night-guard**
**Uroporphyrinogen decarboxylase** deficiency
C) Myelomeningocele
**Valproate** causes *Neural Tube defects*
Transcriptional **repression**
**de-acetylation**
**Pyruvate kinase deficiency** leads to ?
**splenomegaly** via *Red pulp hyperplasia**
What are the 2 things that *Bacteria* produce in the *small intestine* after a gastro-jejunostomy in gastric bypass surgery?
**vitamin K* and *Folate* - here they asked about *Folate* but on the exam they might ask about *Vitamin K*
a) Chronic arteriovenous fistula
*Arterio-venous fistula* leads to more return of blood to the heart. Increase in venous return, then leads to increase in Cardiac output.
D) Prolonged atrioventricular node refractory period
*Carotid sinus massage*
B) Fluticasone
*Corticosteroids* for *Long-term* control of Asthma
Lipids *D*igestion?
*D*uodenum - D for D
E) Coarctation of the aorta
*Death in adult patients due to *HYPER*tensive complications.
D) Jejunum
*Digestion* of dietary lipids = Duodenum *Absorption* of dietary lipids = Jejunum - Irrespective of whether or not you have a gallbladder, your site of absorption for Lipids is always the *Jejunum*
E) Reduced sensation over right upper lip
*Infraorbital nerve damage* - *Orbital floor fracture*
Lipids *Absorption* ?
*Jejunum*
**Infraorbital nerve** damage will cause?
*Parasthesias* to - Upper *lip* - Upper *cheek* - Upper *gingiva*
**Carotid sinus massage**
*Prolongs AV node refractory period*
E) Red pulp hyperplasia
*Pyruvate kinase deficiency*-> leads to *decreased ATP* -> erythrocytes get damaged so that leads to hemolysis-> these hemolysis RBC are removed by splenic red pulp.
**Pyruvate kinase deficiency** leads to ?
*Red pulp hyperplasia**
*Splenic artery* gives rise to?
*Short gastric*
PSGN
*Subepithelial humps*
*Monoclonal* antibody treatment for Breast cancer?
*Trastu*zumab
*Monoclonal* antibody treatment for Breast cancer targets?
*Tyrosine kinase* receptor
*Trastu*zumab
*Tyrosine kinase* receptor receptor inhibitor
What is Mechanism of Action of *Trastu*zumab?
*Tyrosine kinase* receptor receptor inhibitor
**Oribital Floor Fracture** will cause *Parasthesias* to?
*Upper lip** due to *Infraorbital nerve damage*
D) Ureter
*Ureter* most commonly injured during *Hysterectomy* - She is *able to urinate* without any difficulty because, she still has one functional ureter. so don't let this statement throw you off.
25) A 45-year-old man comes to the emergency department due to urinary incontinence. He was diagnosed with multiple sclerosis a year ago after he developed transient acute vision loss in his right eye.
A few weeks ago, he began having difficulty with his balance and had several episodes of urinary incontinence. The patient's walking has improved since, but he continues to urinate involuntarily. He has noticed increasing urinary frequency and cannot control the urge to urinate.
A) A2-to-opening snap time interval B) Audible S3 C) Audible S4 D) Diastolic murmur intensity E) Presystolic accentuation of the murmur
A) A2-to-opening snap time interval **Mitral stenosis = Opening snap**
CT scan of the head reveals an orbital floor fracture. Which of the following additional findings is most likely to be seen in this patient?
A) Absent right corneal reflex B) Bruising over the mastoid process C) Impaired olfaction D) Inability to puff out right cheek E) Reduced sensation over right upper lip
When the infant attempts to breastfeed, however, several bouts of coughing and perioral cyanosis develop with oxygen saturation of 85% on room air. Which of the following is the most likely cause of this patients condition?
A) Atresia of small intestine B) Collapse of supraglottic structures during respiration C) Failure of primitive foregut to separate from airway D) Obstruction of posterior nasal passages F) Thoracic herniation of abdominal viscera
Postoperatively, she has a fever and right- sided back pain. She has been able to urinate without any difficulty. Injury to which of the following structures is the most likely explanation for this patients postoperative symptoms?
A) Bladder B) External iliac artery C) Ovarian artery D) Ureter E) Uterine artery
A) Bladder hypertonia B) Delayed bladder emptying C) Elevated urethral pressure D) Large residual volume of urine E) Reduced urine flow
A) Bladder hypertonia - Due to *UMN* lesion in *Multiple sclerosis* - *UMN* lesion - *Hyper*tonia
Microscopy of the discharge demonstrates abundant neutrophils, and nucleic acid amplification testing is positive. If left untreated, the patient's condition could lead to which of the following complications?
A) Cervical cancer B) Cervical insufficiency C) Endometrial hyperplasia D) Infertility E) Ovarian cancer
Which of the following medications is most appropriate for short-term control of her symptoms without causing excessive daytime fatigue and impaired judgment?
A) Chlordiazepoxide B) Diazepam C) Flurazepam D) Lorazepam E) Zolpidem
A jejunal aspirate shows bacterial count of >10 ^ 5 organisms/mL, consistent with small intestinal bacterial overgrowth. Which of the following serum substance levels is most likely to be increased in this patient?
A) Cobalamin B) Folate C) Iron D) Vitamin D2 E) Zinc
The physician reassures her that she can start adding fatty foods back into her diet as tolerated. In this patient, dietary lipids will most likely be absorbed from which of the following sites?
A) Colon B) Duodenum C) Ileum D) Jejunum E) Stomach
Which of the following mechanisms is most likely responsible for the decreased gene expression seen in this patient?
A) DNA hypomethylation B) Histone deacetylation C) Loss of normal huntingtin protein function D) Mutation of homeodomain genes E) Thymidine dimerization
His blood pressure is now 120/80 mm Hg and pulse is 75/min. Which of the following mechanisms is responsible for improvement of this patients condition?
A) Decreased baroreceptor firing rate B) Increased sympathetic output to the sinoatrial node C) Increased systemic vascular resistance D) Prolonged atrioventricular node refractory period E) Prolonged ventricular myocardium refractory period
A) Dihydrobiopterin reductase B) Dopamine B-hydroxylase C) Phenylalanine hydroxylase D) Phenylethanolamine N-methyltransferase E) Tyrosinase
A) Dihydrobiopterin reductase
If the patient conceives now, which of the following is most likely to develop in her offspring?
A) Epiphyseal stippling B) Hypothyroidism C) Myelomeningocele D) Nail hypoplasia E) Renal dysgenesis F) Short palpebral fissures G) Tricuspid valve malformation
Adjuvant therapy with a monoclonal antibody is started. Which of the following is the most likely target of this drug?
A) Estrogen receptor B) Peripheral aromatase enzyme C) Receptor activator of nuclear factor kappa-B ligand D) Tyrosine kinase receptor E) Vascular endothelial growth factor
After reviewing the results of her laboratory evaluations, the physician administers an injection of anti-Rh(D) immunoglobulin.. The administered antibodies most likely belong to which of the following immunoglobulin classes?
A) IgA B) IgD C) IgE D) IgG E) IgM
Enzyme assays performed on circulating blood cells demonstrate low pyruvate kinase activity. Which of the following is the most likely cause of this patient's splenomegaly?
A) Inflammatory infiltration B) Myeloproliferative disorder C) Passive splenic congestion D) Presence of circulating immune complexes E) Red pulp hyperplasia F) Undegraded metabolite accumulation
This patient is most likely to have sensory loss over which of the following areas? A) Lateral forearm B) Medial forearm C) Posterior arm D) Posterior forearm E) Thenar eminence
A) Lateral forearm Difficulty *Flexing* means *Musculocutaneous* injury Musculocutaneous = *Loss of sensation on Lateral forearm*
Physical examination shows vesicles and erosions on the dorsum of both hands. Which of the following enzymes is most likely deficient in this patient?
A) ö-Aminolevulinate dehydratase B) ö-Aminolevulinate synthase C) Bilirubin glucuronyl transferase D) Porphobilinogen deaminase E) Uroporphyrinogen decarboxylase
27) A 45-year-old woman who recently immigrated to the United States is hospitalized with exertional dyspnea and fatigue. She has no significant past medical history and takes no medications. The patient's blood pressure is 110/80 mm Hg and heart rate is 90/min and regular.
After cardiopulmonary examination, the physician suspects mitral stenosis. Which of the following is the most useful measure for assessing the degree of mitral stenosis?
In an experiment, the abnormal cells from the patient are purified and cultured in 2 different plates, one with a vitamin A derivative (plate 1) and the other with control (plate 2).
After several days of incubation, cells in plate 1 are well differentiated compared to those in plate 2, and clonal proliferation is inhibited. This patient most likely has which of the following conditions?
4) A 28-year-old woman comes to the gynecologist, who has provided routine care for the past 10 years. She has not menstruated for 2 months and had a positive home pregnancy test last week.
Although she hopes to have children in the future, she has been under "a lot of stress lately" and caring for a child is "the last thing I need right now."
His vital signs are normal. On examination, the patient has mild spastic paraparesis with increased reflexes in the lower extremities; bilateral Babinski sign; and a thoracic sensory level to pain, temperature, and vibration.
An MRI of the spine reveals a new demyelinating lesion in the mid-thoracic spinal cord. Which of the following abnormalities will most likely be found on this patients urodynamic studies?
26) A 6-hour-old boy is in the newborn nursery with feeding difficulties. The patient was born at 39 weeks gestation to a 33-year-old primigravida via cesarean delivery due to failure to progress and late decelerations seen on fetal heart tracing.
Apgar scores were 8 and 9, but examination shows an infant with excessive drooling and occasional coughing. Cardiac, respiratory, and abdominal examinations are otherwise normal at rest.
A) Acute lymphocytic leukemia B) Acute myeloid leukemia C) Chronic lymphocytic leukemia D) Chronic myeloid leukemia E) High-grade non-Hodgkin lymphoma
B) Acute myeloid Leukemia Vitamin A treatment = AML
A) CD8+ T lymphocytes and NK cells B) CD4+ T lymphocytes and macrophages C) Lymphocytes and macrophages D) CD4+ T lymphocytes and neutrophils E) CD8+ T lymphocytes and B lymphocytes
B) CD4+ T lymphocytes and macrophages TH1 = IL-2, IL-12, & IFN-gamma From knowing that IFN-Gamma is a part of TH-1, you can tell that TH-1/ CD4+ T lymphocytes is the answer.
A) Ephedrine B) Methyltestosterone C) Chewing tobacco D) Ultraviolet light E) Excessive perspiration
B) Methyltestosterone - Steroid abuse causes *Acne*
**Salmonella typhi**
Bloody Diarrhea + Rose spots
A) Agree to perform the abortion as the procedure is within the physician's scope of practice and training B) Encourage the patient to reconsider as she wants to have children someday and future fertility is not guaranteed
C) Encourage the patient to take additional time to consider her options D) Explain that, on moral grounds, the physician is unable to either perform or refer the patient for the procedure
A) Aneuploidy B) Epistasis C) Imprinting D) Meiotic nondisjunction E) Pleiotropy
C) Imprinting
A) Hydroxymethylglutaryl COA reductase B) Lysyl oxidase C) Metalloproteinases D) Procollagen peptidases E) Prolyl hydroxylase
C) Metalloproteinases
what do you see in *PSGN*?
C3b & IgG
what helps keep TB sequestered?
CD4+ T lymphocytes & macrophages
a) Enveloped double-stranded DNA virus
CMV - part of herpes family - Transplant patient
1) A 43-year-old woman is brought to the emergency department because of a sudden and severe headache. Her blood pressure is 160/90 mm Hg and pulse is 90/min. Her pupils are symmetric and reactive to light and she can move all four extremities without weakness.
CT of her head is shown below. This patients condition is most likely caused by which of the following?
35) A 44-year-old man is evaluated in the clinic for occasional chest discomfort that is not consistently related to exertion. The patient's past medical history is significant for hypertension and hyperlipidemia. His grandfather experienced a myocardial infarction at age 50.
Coronary CT angiography reveals several nonobstructive atherosclerotic plaques in the coronary arteries. One plaque in the proximal left anterior descending artery appears extensive, has a large hypodense core and occupies 40% of the lumen. No intervention is performed.
A) Adrenocorticotropic hormone B) FSH C) Growth hormone D) Prolactin E) TSH
D) Prolactin - Pituitary Adenoma causes *Bitemporal Hemianopsia*
18) A 32-year-old woman comes to the emergency department with severe shortness of breath. She has no chest pain and does not use tobacco. Her temperature is 36.7 C (98 F), blood pressure is 132/81 mm Hg, pulse is 102/min, and respirations are 30/min.
During physical examination, her condition deteriorates and she is emergently intubated due to acute respiratory failure. Shortly after intubation, she goes into cardiac arrest and dies despite resuscitation efforts.
A) Adenosine B) Digoxin C) Diltiazem D) Ibutilide E) Lidocaine F) Metoprolol G) Procainamide
E) Lidocaine
E) Provide the patient with resources for providers who will perform abortions F) Recommend psychological counseling to help the patient cope with stress and sort through her feelings about abortion
E) Provide the patient with resources for providers who will perform abortions
Tissues supplied by which of the following arteries would most likely be affected by compression of the splenic artery? A) Gastroduodenal B) Left gastroepiploic C) Right gastric D) Right gastroepiploic E) Short gastric
E) Short gastric Celiac trunk gives rise *3 arteries* Left- Hepatic artery Middle- Left gastric Right- splenic **Short gastric** comes of *splenic*
Which of the following is the most important virulence mechanism by which this bacterium causes disease? A) Intracellular existence B) Outer polysaccharide capsule C) Presence of protein A on the cell wall D) Release of exotoxins E) Synthesis of an extracellular polysaccharide matrix
E) Synthesis of an extracellular polysaccharide matrix - *Biofilm* production caused by *Staph Epidermidis*
Which of the following is the most likely side effect of the treatment prescribed for this patients depression? A) Cardiac arrhythmias B) Nausea C) Orthostatic hypotension D) Seizures E) Serotonin syndrome F) Sexual dysfunction G) Urinary hesitancy
F) Sexual dysfunction **SSRI** = **Sexual dysfunction**
**Tranchealesophgeal fistula**
Failure of primitive foregut to separate from airway
10) A 41 year old previously healthy woman comes to the office due to weakness and easy fatigability She also has had several episodes of epistaxis and gum bleeding. Physical examination reveals mucosal pallor.
Further evaluation demonstrates that the patient has a clonal proliferation of white blood cells containing an abnormal protein.
Several months later, laboratory test results indicate that the infant has a normal serum phenylalanine level. Careful examination, however, reveals some neurological abnormalities, including axial hypotonia and microcephaly.
Further workup is notable for elevated prolactin, and his physician suspects a cofactor deficiency. Which of the following enzymes is most likely deficient in this patient?
A. Carotid artery atherosclerosis B. Cardiac embolism C. Hypoxic encephalopathy D. Hypertensive encephalopathy E. Large vessel arteritis F. Hypertensive arteriolar sclerosis G. Cerebral amyloid antipathy H. Rupture of saccular aneurysm I. Charcot-bouchard aneurysm
H. Rupture of saccular aneurysm **Subarachnoid hemorrhage**
11) 55 year old man comes to the office for a checkup. His medical history is significant for major depression treated with sertraline for the past 4 months, hypertension controlled with lisinopril, and diabetes mellitus controlled with diet.
He does not use tobacco and drinks a glass of wine with dinner a few times a week. The patients vital signs are all within normal limits and no abnormalities are noted on physical examination. His HbA1c is within normal limits.
34) A 23-year-old man comes to the emergency department with sudden onset of heart palpitations that started while he was at his desk at work. The patient has no known medical problems and does not use tobacco or illicit drugs.
He drinks alcohol occasionally on the weekends Initial blood pressure is 110/70 mm Hg and pulse is 160/min and regular. Gentle neck massage just below the angle of the right mandible provides immediate improvement of his condition.
9) A 22-year-old man comes to the office due to recurrent blistering on the back of his hands and forearms for the past several years. The patient usually develops small itchy spots but lately has had large blisters that heal with hyperpigmentation after rupturing.
He has used over-the- counter topical hydrocortisone and emollients, but the symptoms have not improved. The patient works as a night security guard and has had no exposure to chemicals or animals. He drinks 2-3 cans of beer daily.
17) A 53-year-old man comes to the emergency department due to progressively worsening shortness of breath, nonproductive cough, and low-grade fevers over the past 2 weeks. He has not had a runny nose or sore throat and does not recall any sick contacts.
He received a lung transplant for idiopathic pulmonary fibrosis 4 months ago. His medications include immunosuppressants and trimethoprim-sulfamethoxazole. His temperature is 37.8 C (100 F). Chest x-ray reveals diffuse interstitial infiltrates bilaterally.
15) A 24-year-old obese woman comes to the office due to spotting after vaginal intercourse. She also has some yellow vaginal discharge. The patient has taken oral contraceptive pills for the past 3 years and no other medications.
Her paternal grandmother was diagnosed with cervical cancer at age 67. The patient's BMI is 35 kg/m2. On examination, the abdomen is soft and nontender. Speculum examination reveals purulent discharge from the cervical os. The cervix is friable.
One year later, the patient comes to the emergency department with acute severe chest pain and is found to have thrombotic occlusion of the proximal left anterior descending artery.
High intraplaque activity of which of the following enzymes most likely resulted in this patients myocardial infarction?
29) A 45-year-old man comes to the physician because of involuntary movements and behavioral disturbance. He has frequent, jerky, irregular movements of his upper extremities that have progressively worsened over the past month.
His family and friends also say that he has become increasingly irritable over the past year. Genetic testing shows a mutation affecting the huntingtin protein that causes transcriptional repression of a number of other genes.
2) A 32-year-old man comes to the office due to visual problems. Over the last 6 weeks, he has had several "near-misses" while driving, being nearly hit by cars coming from both the right and left sides. He also reports frequent headaches that respond to acetaminophen.
His past medical history is unremarkable. Examination shows decreased lateral peripheral vision. Cranial nerves are othewise intact. Which of the following hormones is most likely elevated in this patient?
A) Campylobacter jejuni B) Entamoeba histolytica C) Escherichia coli D) Haemophilus influenzae E) Helicobacter pylori F) Klebsiella pneumoniae G) Proteus mirabilis H) Salmonella Enteritidis I) Salmonella Typhi J) Schistosoma haematobium K) Shigella flexneri L) Vibrio cholerae
I) Salmonella Typhi - Bloody Diarrhea - Rose spots
You need *B4* for conversion of *Phenylalanine* to *Tyrosine*.
In case phenylalanine, cannot be converted to Tyrosine due to lack of cofactor *B4*, then there will *Lack of Dopamine* because *Dopamine* comes from *Tyrosine*.
This question is not really asking about if which part of the stomach/ small intestine is removed, what deficiency you will have.
Its asking more about the *Bacterial* growth in the *small intestine*. Its important that bacteria in the small intestine produces 2 things *Folate and Vitamin K*
Where are *Lipids* absorbed from?
Jejunum
Review of the patient's medical records shows that she had been prescribed multiple medications but had a history of noncompliance. An autopsy is performed and shows hyperinflated lungs, airway mucus plugging, and cellular infiltration of the bronchial wall.
Long-term use of which of the following drugs would have best prevented the cellular reaction in this patients airways? A) Albuterol B) Fluticasone C) Ipratropium D) Magnesium sulfate E) Montelukast F) Theophylline
D) Infertility
Neisseria Gonorrhea- Pelvic inflammatory Disease
6) A 10-year-old boy comes to the office for a first visit. His family recently came to the United States as political refugees. The patient's mother says that he has required several blood product transfusions due to anemia, but she does not have prior records available with her.
On examination, the patient's temperature is 37.1 C (98.8 F). BMI is 21 kg/m2. Examination is notable for conjunctival pallor and moderate splenomegaly. Laboratory results are as follows: Hemoglobin 9.4 g/dL Platelets 240,000/mm3
39) A 1-year-old boy is brought to the emergency department by his mother because of high fever, irritability, and photophobia. He recently underwent ventriculoperitoneal shunt placement for congenital hydrocephalus.
On physical examination, his temperature is 38.3' C (101 F), and passive flexion of the neck results in spontaneous flexion of the hips and knees. Blood cultures grow coagulase-negative Staphylococcus.
31) A 56-year-old man comes to the physician complaining of early satiety, nausea, and vague epigastric pain for the past 4 months. He has a 36-pack-year smoking history and admits to drinking alcohol daily for the past 15 years.
On physical examination, the patient appears thin and cachectic. Palpation of his abdomen reveals splenomegaly. Abdominal CT scan shows a large irregular mass extending posteriorly from the greater curvature of the stomach, impinging on the splenic artery and vein as they pass below.
The blockage is immediately opened, but after the intervention, she experiences recurrent and sustained episodes of ventricular arrhythmia. She is treated with antiarrhythmic agents.
One of the agents used in this patient preferentially binds to rapidly depolarizing and ischemic ventricular myocardial fibers and has minimal effect on normal ventricular myocardium. Which of the following agents was most likely used in this patient?
30) A pharmaceutical researcher is evaluating a nuclear enzyme inhibitor for the treatment of an inherited disorder. During an experiment, he extracts and purifies nuclear enzymes from skin cells of an affected patient.
One of these enzymes is found to catalyze the methylation of cytosine residues in DNA using S-adenosyl-methionine (SAM) as the methyl donor. This enzyme most likely plays a crucial role in which of the following genetic processes?
37) A 26-year-old male presents to clinic complaining of a persistent "skin rash." He is a minor league baseball player and practices outdoors for long hours. He chews tobacco and drinks alcohol on weekends. He says he is otherwise healthy.
Physical examination reveals a comedonal and inflammatory nodular eruption on the patient's face, chest, and back. Which of the following is the most likely cause of this patient's skin findings?
8) A 28-year-old primigravid woman comes to the physician for a routine prenatal checkup at 28 weeks gestation. She is doing well and comes with a list of questions regarding her diet, exercise, and lifestyle.
Physical examination shows a uterine size concordant with ultrasound dates, and fetal cardiac activity is in the normal range.
24) A 46-year-old missionary who just returned from a trip to Latin America comes to the clinic with fever, headache, abdominal pain, and a 1-week history of watery diarrhea that has recently become bloody. His temperature is 38.9 C (102 F).
Physical examination shows hepatosplenomegaly and several faint, erythematous maculopapular lesions on the chest and abdomen. Blood cultures are pending. Which of the following is the most likely cause of this patient's symptoms?
14) A 34-year-old woman comes to the office for a follow-up visit. The patient was hospitalized a month ago for acute calculous cholecystitis and had an uncomplicated laparoscopic cholecystectomy. She has no abdominal pain or nausea.
Physical examination shows well-healed abdominal incisions. The abdomen is soft and nontender. The patient has been avoiding fatty foods since the surgery for fear that the pain may develop again.
*Uroporphyrinogen decarboxylase* deficiency =
Porphyria Cutanea Tarda
23) A 13 year old caucasian female has urine discolouration. She had been treated for facial impetigo three weeks ago. Urinalysis shows hematuria, mild proteinuria and occasional red blood cell casts.
Renal biopsy is most likely to demonstrate : a) Basement membrane splitting on light microscopy b) Diffuse capillary wall thickening on light microscopy c) Linear IgG and C3 deposits on immunofluorescent microscopy
B) Folate
SIBO: Small Intestinal Bacterial Overgrowth Bacteria produces- **Folate and Vitamin K***
36) A 64-year-old man comes to the emergency department due to flank discomfort and red urine. He has a history of hypertension and type 2 diabetes mellitus. Three months ago, the patient had an ischemic stroke and has mild residual right-sided weakness.
Serum creatinine is 0.9 mg/dL, and serum lactate dehydrogenase is elevated. Urine microscopy shows many red blood cells. CT scan of the abdomen with contrast is performed, and the findings are shown in the image below.
The patient is diagnosed with generalized anxiety disorder and initiated on a low dose of a selective serotonin reuptake inhibitor. She returns to the office a week later and reports worsening of her anxiety symptoms.
She also has difficulty falling asleep at night and is not able to concentrate at her work as a 911 emergency dispatch operator.
40) A 27-year-old nulligravid woman comes to the office for a routine visit. Her past medical history is significant for epilepsy that is well controlled with valproate and chronic hypertension for which she takes labetalol.
She is hoping to conceive in the next few months and planning to start prenatal vitamins soon. The patient takes no other medications and does not use tobacco, alcohol, or illicit drugs. Blood pressure is 120/80 mm Hg. Physical examination findings are within normal limits.
19) A 20-year-old man is evaluated in the clinic for right arm weakness and numbness. He is a competitive baseball pitcher and says that he played a lot more innings than usual last week because his team made the playoffs.
Since then, the patient has had difficulty using the right arm, particularly when lifting objects. He has no known history of head, neck, or upper extremity trauma. On physical examination, there is diminished strength on right elbow flexion and an absent biceps reflex.
Any placement of foreign objects on the *Skin*
Staph *Epidermidis*
**Synthesis of an extracellular polysaccharide matrix**
Staphylococcus **Epidermidis**
**Ventriculoperitoneal-shunt placement** - Any placement of foreign objects on the *Skin*
Staphylococcus **Epidermidis**
D) Lorazepam
Temporary relief of symptoms - Short acting Benzo/ intermediate TOM is TAL Fukin DiCk Triazolam. - Short acting Oxazepam Midazolam Temazepam - intermediate acting Alprazolam Lorazepam Fukin DiCk - Long acting Flurazepam Chlordiazepoxide Diazepam No need to know the T in intermediate acting. just know the T in short acting.
3) A residency program organized a barbecue at the beginning of the academic year to welcome the new class of first-year residents. The total number of attendees was 100, including faculty, administrative staff, and residents Hamburgers, hotdogs, and potato salad were served.
The following day, 28 of the attendees had diarrhea and vomiting. All of the attendees were questioned about what they had eaten, and the following table was obtained:
A qualitative beta-hCG pregnancy test confirms she is pregnant and the patient requests that the gynecologist terminate the pregnancy as soon as possible.
The gynecologist prefers not to perform abortions on moral grounds but does have training in the procedure. Which of the following is the most appropriate course of action by the gynecologist?
18) A 39-year-old woman, gravida 2, para 2, is evaluated in the hospital after a total abdominal hysterectomy for symptomatic uterine fibroids. Hysterectomy was performed due to a history of heavy menses, abdominal fullness, and urinary incontinence.
The largest fibroid, measuring 8 cm in diameter, was located in the lower aspect of the uterus at the level of the cardinal ligaments, compressing the bladder anteriorly. The patient has no other medical problems and no prior surgeries.
12) In an experiment investigating vasoconstriction of the arterial wall, two samples of isolated porcine arterial vessels are studied. Vascular tone is measured in the control vessel during infusion of increasing doses of norepinephrine.
The other vessel is pretreated with experimental drug A prior to infusion of norepinephrine. A graph of the study results is depicted below.
20) A 1-day-old boy is diagnosed with hyper phenylalanemia by newborn screening. He is placed on a special phenylalanine-restricted diet with tyrosine supplementation.
The parents are extensively counseled on the boy's condition and informed of the necessary dietary restrictions. They are also instructed to return to his physician for regular follow-up visits.
13) A 32-year-old woman comes to the office due to long-standing anxiety. She reports being excessively worried about everyday events and constantly feeling tense, restless, and unable to relax.
The patient also has occasional attacks in which her heart pounds and races and her hands feel sweaty and clammy. She has no mood symptoms or any other psychiatric history.
5) A 32-year-old woman comes to the clinic due to 6 weeks of bloating and non-bloody diarrhea. She describes having multiple watery bowel movements a day without visible blood. She underwent gastric bypass surgery for morbid obesity 3 years ago.
The patient has no other medical conditions. She is a lifelong nonsmoker and does not drink alcohol. Her vital signs are within normal limits. Physical examination is unremarkable.
27) A 16-year-old boy is brought to the emergency department after an eye injury during a baseball game. He was batting for his high school team when the opposing pitcher made a wild throw and the baseball hit him in the right eye.
The patient has since been having diplopia that worsens when he looks up. On physical examination, he has mild periorbital ecchymosis, enophthalmos, and limited vertical movement of the right eye. Visual acuity and left eye examination are normal.
21) A 49-year-old woman is brought to the emergency department with squeezing chest pain and profuse sweating for the last 2 hours. Past medical history includes diet-controlled type 2 diabetes mellitus. ECG reveals ST-segment elevation in leads I, aVL, and VI-V4.
The patient is immediately taken to the cardiac catheterization laboratory where she is found to have complete occlusion of the left anterior descending coronary artery.
38) A 51 -year-old woman comes to the office for a follow-up visit. Three weeks ago, she had a screening mammogram that was suspicious for malignancy. An ultrasound-guided needle aspiration was performed and showed invasive ductal carcinoma.
The patient underwent a lumpectomy with axillary dissection and was found to have no metastatic disease. Immunohistochemical analysis of the tumor specimen was significant for the following:
33) A 22-year-old Caucasian male presents to the emergency room complaining of severe headaches and vomiting. Soon after, he slips into a coma and dies. Autopsy shows a ruptured cerebral aneurysm with extensive intracranial hemorrhage.
This patient's condition is most likely associated with: A) Primum-type atrial septal defect B) Secundum-type atrial septal defect C) Ventricular septal defect D) Patent ductus arteriosus E) Coarctation of the aorta F) Tetralogy of Fallot
***Ischemic stroke***
Thromboembolism has caused blockade of renal artery so there is hypo density only in one corner or the picture, because the thrombus is occluding the *right* renal artery.
Lack of sunlight =
Uroporphyrinogen decarboxylase deficiency
7) A 26-year-old medical student is exposed to a patient who suffers from active pulmonary tuberculosis infection. Two years later, the asymptomatic medical student presents with a chest radiograph finding of a small calcified lesion in the right lung field.
Which of the following cells contributed most to the containment of the infection in this patient?
A decrease in pulmonary function is noted on testing. A lung biopsy specimen is shown below
Which organism is responsible? a) Enveloped double-stranded DNA virus b) Enveloped single- stranded RNA virus c) Filamentous gram-positive rods d) Nonenveloped double-stranded DNA virus e) Nonenveloped single-stranded RNA virus f) Trophic and cystic fungal forms
Which of the following is the most likely cause of this patient's symptoms? a) Atrial fibrillation b) Deep venous thrombosis of the lower extremities c) Focal segmental glomerulosclerosis d) Hypersensitivity interstitial nephritis e) Pulmonary hypertension
a) Atrial fibrillation so the patient had an ischemic stroke and that went to lodge into the *renal artery* causing a wedge shaped infarction of the right kidney.
16) The cardiac and venous return curves of a healthy person are shown below in solid lines. Which of the following is the most likely cause of the change depicted by the dashed lines?
a) Chronic arteriovenous fistula b) Acute gastrointestinal bleed c) Phenylephrine infusion d) Myocardial infarction e) Anaphylaxis
You can get this answer by looking at it in the form of *Pheochromocytoma* where there is excessive production of catecholamines such as Epinephrine and *Norepinephrine*.
and the treatment for *Pheochromocytoma* is *Phenoxybenzamine* which is vasodilator which then relieves the Hypertension due to Norepinephrine
The fluorescent areas on the slide most likely indicate the presence of which of the following substances? a) Albumin b) C1q c) C3b d) Fibrin e) IgE f) M protein
c) C3b PSGN = C3b & IgG
Drug A is most similar to which of the following agents? a) Atropine b) Labetalol c) Phenoxybenzamine d) Phentolamine e) Propranolol
c) Phenoxybenzamine Norepinephrine - alpha 1 agonist Phenoxybenamine- alpha 1 antagonist
function of *metalloproteinases*?
destruction of *Plaques*
d) Glomerular basement membrane disruptions and fibrin deposition on electron microscopy e) Discrete subepithelial humps on electron microscopy
e) Discrete subepithelial humps on electron microscopy HOAR-PRIMA PSGN- *Subepithelial humps*
Which of the following best describes the attack rate among all of the attendees who had potato salad? a) 8% b) 11% c) 13% d) 20% e) 28% f) 30% g) 34% h) 47%
g) 34% (3+ 5 + 3 + 14)/ (10 + 25 + 8 + 30) = 25/73 = 0.34 = 34%
28) An 8-year-old boy is brought to the office due to facial puffiness. His mother reports that the child is easily fatigued and has cola- colored urine. A review of the patient's medical record shows that he was treated for a skin infection 3 weeks ago but has no chronic medical
problems. His temperature is 36.1 C (97 F), blood pressure is 134/85 mm Hg, and pulse is 88/min. After appropriate workup, a kidney biopsy is performed, and the immunofluorescence findings are shown on the slide below.