Uworld 13
7) A 6-year-old boy is brought to the offce due to a persistent facial ulcer for the past 2 months. His mother reports that the patient has extreme sensitivity to sunlight and has developed freckles on his face, neck, and limbs since infancy.
On physical examination, the skin in sun-exposed areas is dry and rough with numerous freckles and erythematous macules. There is an ulcerated plaque on the left face; a biopsy reveals squamous cell carcinoma.
An abdominal CT scan reveals pancreatic tissue encircling the duodenum. Which of the following is the most likely cause of this patient's condition? A) Aberrant differentiation of the midgut structures B) Abnormal migration of the ventral pancreatic bud
C) Ectopic rests not connected to the pancreas D) Failure of apoptosis in the dorsal pancreatic bud E) Failure of the ventral and dorsal pancreatic bud to fuse
Which of the following lipid-lowering agents would be most effective for preventing future cardiovascular events in this patient? A) Absorption inhibitor B) Cationic exchange resin C) Enzyme inhibitor D) Essential fatty acids E) Pharmacologic vitamin F) Transcription factor ligand
C) Enzyme inhibitor - Statins for treating *Hypercholesterolemia*
B) Abnormal migration of the ventral pancreatic bud
- Annular pancreas
C) Neuronal amyloid precursor protein
***Downsyndrome**
Major clue for *ileocolic fistula*?
**Air in gallbladder**
**Benzodiazepines** bind?
**Allosterically** to GABA receptor
C) Binds allosterically to the GABA receptor
**Benzodiazepine**
D) Loratadine
**Chlorpheniramine & Diphenhydramine**- 1st generation **Loratidine* - 2nd generation
A) Epithelial
**Cytokeratin**
Xeroderma Pigmentosum =
**Endonuclease**
**G6PD**
**Fatty-Acid synthesis**
PSGN
**Immune complex deposition**
**Beta-oxidation** defect
**Malonyl-CoA** increases
A) FEV1- Decreased FVC- Decreased ERV- Decreased RV- Normal TLC- Decreased
**Obesity** is a *Restrictive disease** in Both obstructive and restrictive diseases, FEV1 and FVC *decrease*, but the Ratio is what increases depending on which one decreases more. But you can get this question based on *TLC*. *TLC* has to decrease in a *Restrictive* disease
e) Immune complex deposits
**PSGN** Whenever given to chose between *Hematuria* and *Proteinuria* always pick *Hematuria* = HOAR-PRIMA PSGN RPGN IgA nephropathy MPGN Alport syndrome
Pain on **extension**
**Quadriceps** muscle damaged
so what did you basically have to know to answer this question?
**Restrictive diseases** FEV1- decreases FVC- decreases *TLC*- decreases FEV1/FVC ratio- increases
**Annular** pancreas
**Ring-shaped**(Annular) - *Ventral pancreas* circles around the duodenum causing *Obstruction*
A) **Accelerates cell proliferation**
**Tyrosine Kinase**
Ulnar nerve
**Wrist adduction**
**Quadriceps** insert into?
**tibial tuberosity**
early onset *Alzheimer's* in a *Downsyndrome* patient
*APP* is located on chromosome 21
B) Competitive binding to heme
*Carbon Monoxide* Poisoning -Headaches -Dizziness -Gastrointestinal symptoms
E) Increased FSH
*Kleinfilter syndrome* Small testes- Decreased testosterone Gynaecomastia- Decreased testosterone & Increased estrogen Height 95th percentile - Tall Special education class- cognitive impairment
**Annular pancreas**
*Ventral* pancreas circles around duodenum-> *duodenal obstruction*--> *Bilious vomiting*
a) Distension and obstruction of pancreatic ducts
- *Absence of Vas deferens* = Cystic fibrosis
B) Epstein-Barr virus
- *Malignant B-lymphocyte* proliferative AIDS- Due to multiple sexual partners EBV- Primary CNS lymphoma
E) Do not allow the patient to leave the emergency department and reassess when sober
Do not trust the patient's judgement while he is still intoxicated. Wait for till he becomes Sober, to see what he actually prefers to do.
****Air in gallbladder**** Gall stone goes into ileum via gravity and Air moves from Ileum/intestine to the gallbladder
-Abdominal pain and vomiting -Abdomen is distended with bowel sounds - This indicates an *Abdominal* problem : an *Ileal** pathology
Patient was given a drug for her diabetes, and this graph was obtained, which drug was given?
-Incretin (Glucagon-Like peptide
Laboratory studies are ordered to confirm the diagnosis. Which of the following points on the graph below best corresponds to this patient's acid-base status?
a) Point A b) Point B c) Point C d) Point D e) Point E
The substance generated during this conversion is necessary for which of the following biochemical processes? A) ADP phosphorylation B) Fatty acid synthesis C) Glycogen storage D) Ketone body synthesis E) Protein degradation
B) Fatty acid synthesis **Fava beans** = *G6PD* deficiency G6PD = Used in *Fatty acid* synthesis
A) Haloperidol B) Physostigmine C) Diazepam D) Neostigmine E) Edrophonium
B) Physostigmine - Atropine antidote
Microscopy of the tissue specimen shows clumps of cells that have positive immunohistochemical staining for cytokeratin. These cells most likely belong to which of the following lineages?
A) Epithelial B) Lymphoid C) Mesenchymal D) Myeloid E) Neuroendocrine
Which of the following factors most likely precipitated this patient's symptoms? A) Exercise B) Moderate to severe pain C) Respiratory infection D) Sleep deprivation E) Weight gain
A) Exercise - *Hypoglycemia* aggravated by *Exercise*
His caregiver reports that the patient keeps wandering in the group home and has become lost on several occasions. Which of the following is most likely to be increased in this patient?
A) Extracellular transthyretin B) Gene-specific CAG trinucleotide repeats C) Neuronal amyloid precursor protein D) Presynaptic acetylcholine E) Serum apolipoprotein E
A) Increased antihistamine effect B) Sodium channel inhibition C) Synaptic norepinephrine accumulation D) Synaptic serotonin accumulation E) Uncontrolled presynaptic dopamine release
B) Sodium channel inhibition Prime Numbers are Cute *QT prolongation* - *Sodium* and *Potassium* channels
13) A research scientist studying the metabolic pathways that contribute to obesity feeds experimental animals a high-carbohydrate, high-protein diet for a prolonged period.
A sample of liver tissue is then obtained from the animals, and the activity of various enzymes involved in fatty acid metabolism is measured and recorded. It is determined that beta-oxidation of fatty acids is inhibited within these cells as a result of the diet.
(Cont of previous q) 37) The cells identified by the special immunohistochemical stain are shown to overexpress a 185 kD glycoprotein that spans the cell membrane and has tyrosine kinase activity in the intracellular domain. Which of the following is the most likely function of this protein?
A) Accelerates cell proliferation B) Acts as a sex hormone receptor C) Governs intercellular binding D) Induces cytokine release E) Mediates endocytosis
The patient is diagnosed with panic disorder. She receives medication and feels better within an hour. Which of the following best describes the mechanism of action of the medication she received?
A) Affects G protein signal transduction B) Alters GABA metabolism C) Binds allosterically to the GABA receptor D) Competes with GABA at its binding site E) Physically blocks the ion channel lumen F) Upregulates GABA receptor density
Physical examination is unremarkable. The substance responsible for this patient's condition most likely impairs hemoglobin function through which of the following mechanisms?
A) Alteration of the partial pressure of oxygen B) Competitive binding to heme C) Deactivation of a reductase enzyme D) Denaturation of the globin chains E) Irreversible linking to heme F) Oxidation of the porphyrin ring
Besides the bladder wall, which of the following structures is most likely to be penetrated by the trocar and cannula during the procedure? A) Anterior abdominal aponeurosis B) Parietal peritoneum C) Perineal membrane D) Ureter E) Visceral peritoneum
A) Anterior abdominal aponeurosis Urinary catheterization directly to *Bladder* - Passes via *Anterior abdominal aponeurosis*
Vaginal wet mount with potassium hydroxide shows budding yeast with pseudohyphae. The patient is at greatest risk of developing a malignant B-lymphocyte proliferation associated with which of the following?
A) BK virus B) Epstein-Barr virus C) Helicobacter pylori D) Hepatitis B virus E) Human T lymphotropic virus
The patient also has occasional dizziness when standing up and a history of frequent falls. Which of the following would be the most appropriate medication to treat this patient's acute symptoms?
A) Chlorpheniramine B) Diphenhydramine C) Hydroxyzine D) Loratadine E) Promethazine
The discrepancy the overall results and the stratified results is best explained by which of the following? A) Confounding B) Effect modification C) Measurement bias D) Meta-analysis E) Observer bias F) Recall bias
A) Confounding
Symmetrical glandular tissue is palpated under both nipple-areolar complexes. His sense of smell is normal and his testicles are small and firm. Laboratory evaluation would most likely show which of the following findings?
A) Decreased estradiol B) Increased androstenendione C) Increased B-hCG D) Increased creatinine E) Increased FSH F) Increased prolactin G) Prolonged prothrombin time
18) A 78-year-old male inpatient about to undergo bronchoscopy is premedicated with intramuscular atropine and becomes acutely restless, disoriented, and combative. On physical examination, his pupils are widely dilated and non-reactive to light.
An EKG monitor shows sinus tachycardia. Which of the following agents will reverse all of this patient's symptoms and signs.
Inorder to prevent back flow of blood or increase forward flow of blood. The amount of blood that flows forward is determined by Left ventricular after load. In case the after load decreases, there won't be much blood for through the aorta.
As after load is decreased, resistance to blood flow in aorta is reduced.
A) Vibrio B) Campylobacter C) Salmonella D) Shigella E) Escherichia F) Clostridium
B) Campylobacter - Guillain Barre Syndrome: Progressive difficulty walking
A) Decreasing heart rate B) Decreasing left ventricular afterload C) Decreasing left ventricular preload D) Increasing left ventricular contractility E) Increasing left ventricular volume
B) Decreasing left ventricular afterload Holosystolic murmur: Mitral Regurgitation
Which of the following is the most appropriate course of action? A) Arrange for an involuntary psychiatric hospitalization B) Arrange to send the patient to an alcohol treatment center
C) Discharge the patient against medical advice D) Discharge the patient but arrange for discharge medication and safe transportation home E) Do not allow the patient to leave the emergency department and reassess when sober
In response to any sugar containing meal, insulin will be stimulated because of incretin, because incretin is present in the Gut mucosa.
But in IV glucose, it goes directly into blood, so insulin doesn't increase much because there is *No* stimulation of incretin in the Gut mucosa.
Osteoporosis, How does calcium, phosphate and PTH change?
Calcium Phosphate PTH - **Normal**
On examination, she is lethargic and has patchy lung crackles with normal heart sounds and no focal neurological deficit Her leukocyte count is 14,000/mm3.
Chest x-ray reveals several nodules but no parenchymal infiltrate. Brain MRI shows a 1.2-cm ring-enhancing focal lesion with surrounding edema in the right frontal lobe. Sputum Gram stain is shown in the image below.
A) Decreased Leydig cell stimulation by LH B) Decreased Leydig cell androgen synthesis C) Decreased peripheral androgen aromatization D) Decreased peripheral androgen 5-alpha-reduction E) Impaired androgen-receptor interaction F) Impaired second messenger action
D) Decreased peripheral androgen 5-alpha-reduction - Finasteride
Abdominal x-ray reveals air in the gallbladder and biliary tree. This patients gallstone has most likely lodged in which of the following sites? A) Common bile duct B) Cystic duct C) Duodenum D) Ileum E) Jejunum
D) Ileum - Iliocolic fistula
An increase in which of the following substances is most likely responsible for the observed effect? A) Acetoacetate B) Carnitine C) Citrate D) Malonyl-CoA E) NADPH
D) Malonyl-CoA when there is a defect in your beta-oxidation, **Malonyl-CoA** is accumulated.
Physical examination is unremarkable. Which of the following is the best treatment for this patient's condition? A) Carbamazepine B) Clonazepam C) Melatonin D) Modafinil E) Zolpidem
D) Modafinil - Narcolepsy
Dextrose infusion most likely improved this patient's condition by affecting which of the following pathways? A) Gluconeogenesis B) Fatty acid synthesis C) Ketone body formation D) Porphyrin synthesis E) Protein catabolism F) Purine degradation
D) Porphyrin synthesis Brown Urine - *Acute Intermittent Porphyria* *Porphobilinogen* Deaminase
A) Elbow flexion B) Shoulder abduction C) Wrist abduction D) Wrist adduction E) Wrist extension
D) Wrist adduction - Ulnar nerve
e) Point E
DKA- Metabolic acidosis
How to increase *Forward flow* in Mitral Regurgitation?
Decrease the pressure required for the ventricle to pump against inorder to push blood into the aorta.
40) A nephrology researcher conducts a clinical study to determine risk factors for the development of renal calculi. He recruits a number of patients with a history of idiopathic calcium oxalate kidney stones, and age- and sex-matched healthy subjects.
Detailed medical, surgical, and nutritional histories are obtained, and several serum and urine laboratory tests are performed. Which of the following is most likely to be seen in affected patients compared to healthy individuals in this study?
A) Chronic granulomatous disease B) Phenylketonuria C) DiGeorge syndrome D) Wiskott-Aldrich syndrome E) Chédiak-Higashi syndrome F) Albinism
E) Chédiak-Higashi syndrome - Not *Albinism* because person has a *Skin* infection - Albinism + *Skin* infections => Chediak Higashi
A) Arrange for medical hospitalization to ensure the child's safety B) Bring in another physician as a secondary witness to the injury C) Confront the parents about suspected child abuse D) Consult social work services
E) Contact Child Protective Services immediately F) Obtain full-body x-rays of the child G) Seek permission from the parents to interview the child alone
A) Higher dietary calcium B) Higher fluid intake C) Higher urine pH D) Lower dietary oxalate E) Lower urinary citrate
E) Lower urinary citrate **Calcium oxalate** stones - treatment is *Citrate*
Which of the following is the most likely insertion site of the involved muscle tendon? A) Anterior intercondylar area of tibia B) Anteromedial tibia shaft C) Fibular head D) Medial condyle of tibia E) Tibial tuberosity
E) Tibial tuberosity - *Quadriceps* responsible for *Extension*
36) A 36-year-old woman comes to the office after she noticed some lumps under her arm while getting dressed. She says she feels fine and has no other symptoms. Her medical history is significant for hypothyroidism. Family history is negative.
On physical examination, her body mass index is 24 kg/m2. Breast examination shows nontender left axillary lymphadenopathy. The patient is sent for an ultrasound-guided biopsy.
9) A 30-year-old Caucasian male with adult polycystic kidney disease presents to the emergency department with sudden onset of severe headache and confusion. Neurological examination reveals no meningeal signs or focal neurological deficits.
Emergency CT shows blood in subarachnoid space. On the fifth day after admission, the patient begins to complain of weakness in his right arm and leg. Which of the following drugs could most likely have prevented this patient's neurological sequelae?
The patient has had several male sexual partners in the last 3 years and uses condoms inconsistently. Her temperature is 36.8 C (98.2 F) and BMI is 18 kg/m2.
Examination shows generalized lymphadenopathy and white plaques in the oropharynx that can be easily scraped off with a tongue depressor.
Quadriceps are used for?
Extension
A) Beta-adrenergic blocker B) Central sympatholytic C) ACE inhibitor D) Thiazide diuretic E) Osmotic diuretic F) Calcium channel blocker G) Nitrate
F) Calcium channel blocker - Subarachnoid Hemorrhage: Nifedipine for *Vasospasm*
What is forward flow?
Increase blood flow from *Ventricle to Aorta*
29) A 20-year-old college student comes to the physician's office complaining of falling asleep at inappropriate times. He says that he has "naps" occur unpredictably, sometimes at the start of class or during exams. He sleeps 6 to 7 hours per night and feels refreshed when he wakes up.
He also experiences frightening auditory hallucinations before falling to sleep. On further questioning, he reports he was in a motor vehicle collision recently, which resulted in only a minor sprain of his wrist. He denies smoking, drinking alcohol, and using illicit drugs.
17) A 53-year-old man is evaluated for discomfort in his right hand. A month ago he started developing an intermittent "pins and needles" sensation in the right hand that is worse at nighttime. He has no swelling, redness, or warmth in the hand.
He also has no neck pain or history of trauma to the right upper extremity. The patient has smoked 1 pack of cigarettes daily for 20 years. He has worked as an accountant for the past 30 years. On physical examination, there is loss of sensation over the right fifth digit.
38) A 60-year-old man is found to be confused at home. Emergency medical services responders are called and he is brought to the emergency department. The patient's daughter, who accompanies him, says that she found an empty bottle of amitriptyline next to his bed.
He has not been taking any other medications. In the emergency department, the patient is delirious and sees small animals running around in the corner of the room. He appears flushed. He has a brief seizure and becomes unconscious.
Temperature is 37.2 C (99 F), blood pressure is 70/40 mmHg, and pulse is 120/min. Both pupils are dilated and equally reactive to light and his skin and mucous membranes are dry. The patient's initial ECG shows QRS widening and QTc prolongation.
He is transferred to the intensive care unit but dies despite resuscitation attempts. The patient's death is most likely related to which of the following?
12) A 41 -year-old man with Down syndrome is evaluated in the clinic due to cognitive decline. The patient has a history of moderate intellectual disability, but his higher cognitive functions have become progressively impaired in the past several years.
He previously volunteered at a community library but recently lost his position as he could no longer perform his duties. The patient is now completely dependent on a caregiver for assistance with his activities of daily living such as getting dressed, bathing, and using the toilet.
23) A 75-year-old man comes to the urgent care center with acute onset of a pruritic rash after eating strawberries. The patient has no associated swelling in or around the mouth, no wheezing, and no difficulty breathing. Past medical history is notable for coronary artery disease.
He takes atorvastatin, lisinopril, aspirin, and metoprolol. He also has a history of allergy to dog and cat dander. The patient does not use alcohol or tobacco. His family reports that he lives alone and his functional status has been declining.
24) A 32-year-old male presents to the emergency room with progressive difficulty walking over the last two days accompanied by tingling in his feet. Physical examination reveals decreased muscular strength in the bilateral lower extremities with absent deep tendon reflexes.
His review of systems and past medical history are unremarkable except for a bout of diarrhea two weeks ago that resolved spontaneously. Which of the following agents is most likely associated with this patient's condition?
31) A 13-year-old boy is brought to the office due to right knee pain. He started having a mild ache in the lower part of the right knee several weeks ago that has gradually worsened and causes him to limp. The pain has significantly limited his participation in basketball practice.
It is relieved by rest and can be reproduced when the patient straightens out the right knee while seated in a chair. Further evaluation reveals avulsion of the secondary ossification center of the tibia due to repetitive muscle contraction and traction on the bone.
10) A 35-year-old man comes to the office with progressively worsening fatigue associated with dark urine and back pain. Two days ago, the patient ate some large, flat beans brought home by his wife after a business trip to Egypt. Physical examination shows jaundice and pallor.
Laboratory results reveal a hemoglobin level of 8 g/dL. Further evaluation reveals deficiency of an enzyme involved in the conversion of glucose-6-phosphate to ribulose-5-phosphate.
11) A 65-year-old man comes to the emergency department due to severe lower abdominal pain and nausea. He also has not been able to urinate for the past 24 hours. The patient has a history of hypertension and benign prostatic hyperplasia.
On examination, a large mass is palpable in the suprapubic area. Multiple attempts at urethral catheterization are unsuccessful, and an ultrasound-guided midline suprapubic cystostomy is planned.
c) C
Osteoporosis - Calcium, phosphate & PTH are *Normal*
Kid Treated with *Antibiotic* and develops Renal problems - Means that the kid had a prior *Bacterial* infection
PSGN
1) A 4-week-old boy is hospitalized with persistent vomiting, fussiness, and feeding intolerance. The emesis was initially clear but became bilious in the last few hours. The infant had been breastfeeding exclusively. His temperature is 37.2 C (99.0 F). Blood pressure and pulse are normal.
Physical examination shows a normal abdomen with no rebound or guarding. An upper gastrointestinal series is obtained urgently to evaluate for malrotation and volvulus and shows normal rotation but constriction of the duodenum.
30) A 65-year-old man comes to the physician complaining of a 6-month history of difficulty urinating with frequent straining and dribbling. His symptoms have increased over time and affect his quality of life significantly.
The physician proceeds with drug therapy, which gives the patient moderate symptomatic relief. However, he also notices an increase in hair growth over his scalp. Which of the following is the best description of this drug's mechanism of action?
28) A 28-year-old woman comes to the emergency department with acute-onset abdominal pain, nausea, and confusion. She has no significant past medical history and does not use tobacco or alcohol as they have made her feel sick in the past.
Serum lipase and liver function tests are within normal limits. CT scan of the abdomen shows no abnormalities. A sample of her urine is reddish in color and darkens on standing for 24 hours. Intravenous dextrose is administered and her symptoms improve significantly.
20) A 68-year-old woman comes to the emergency department due to a 2-day history of crampy abdominal pain and vomiting. The patient has had no hematemesis, melena, or hematochezia. She has a history of hypertension, type 2 diabetes mellitus, and coronary artery disease.
Several months ago, the patient had an episode of acute calculous cholecystitis that was managed non-operatively. Physical examination shows a distended, tympanic abdomen with high-pitched bowel sounds.
15) A 72-year-old Caucasian woman comes to the emergency department after several hours of severe upper back pain. The patient developed the pain after experiencing a sudden bump while driving over a pothole. She has no previous history of back pain or major trauma.
She has a long history of COPD with exacerbations requiring glucocorticoid use in the past, though she has been stable since she quit smoking 5 years ago. The patient drinks 1 glass of wine daily. Her BMI is 18.4 kg/m2. On examination, she has point tenderness over T10 vertebra.
2) A 9-year-old girl is brought to the office due to a 2-day history of face and eye puffiness. The mother reports that the child was treated for a rash on the leg with an antibiotic about 3 weeks ago. The girl's temperature is 37.2 C (99 F) and blood pressure is 150/90 mm Hg.
She has generalized edema but no skin rash. Urinalysis reveals proteinuria and hematuria. Renal biopsy is performed and results of electron microscopy are shown in the image.
14) A 27-year-old man comes to the office to follow up type 1 diabetes mellitus. He was diagnosed 15 years ago and has been on a stable insulin regimen for the last 4 years. He currently takes long-acting insulin glargine once daily and short-acting regular insulin with each meal.
Since his last visit, the patient has experienced frequent episodes of disorientation, palpitations, tremulousness, and excessive sweating, all of which resolve quickly after drinking some honey dissolved in water.
19) An 18-year-old man is admitted to the hospital with cough, fever, and hypoxemia. Despite multiple intravenous antibiotics and frequent chest physiotherapy, the patient decompensates and is transferred to the intensive care unit for mechanical ventilation.
Sputum cultures grow colony-forming units of a non-lactose-fermenting gram-negative rod. After several days, the patient dies of ovenwhelming pneumonia complicated by respiratory failure. Since age 1, he had recurrent episodes of multi-lobar pneumonia, sinusitis, and poor growth.
** Glucagon-Like peptide/ Incretin** what is the function?
Stimulate *Insulin* release - in the *GUT*
The patient says angrily, "There's nothing wrong with me; I don't want anymore of your worthless treatment." In a slurred voice, he says that he does not believe that he has pancreatitis because "all you doctors are liars."
The physician receives a call from the patient's wife, who says, "His drinking has gotten out of control; he needs help but won't accept it."
8) A 48-year-old woman comes to the emergency department with headache, dizziness, and nausea for the past several hours. She has no fever, nasal congestion, or cough but reports that her husband has also been complaining of headache.
The patient has been burning wood in the fireplace to warm her house after losing electricity during a snowstorm. Her temperature is 37 C (986 F), blood pressure is 135/70 mm Hg, and pulse is 94/min and regular.
35) A 38-year-old man comes to the office with reports of dyspnea on exertion and decreased exercise tolerance. His medical history is unremarkable, and he has no history of childhood asthma or cough. He has never smoked and has no known occupational exposures.
The patient has gained almost 100 1b over the past 4 years since leaving the military due to a sedentary lifestyle. He currently weighs 135 kg (297.6 1b) and has a BMI of 41 kg/m2. His respiratory rate is 22/min and pulse oximetry is 93% on room air at rest.
16) A 23-year-old man comes to the emergency department due to abdominal pain and nausea for the last few hours. He also reports an episode of vomiting and has noticed that his urine has a fruity odor.
The patient has had increased thirst and urination for the past several days along with weight loss. He has no known medical problems and takes no medications. Physical examination reveals pallor with cool extremities. The abdomen is soft, without tenderness to palpation.
33) A 23-year-old woman comes to the emergency department due to chest pain, dyspnea, palpitations, perioral numbness, and sweating. She is extremely anxious and explains that her symptoms came on suddenly for no apparent reason.
The patient has had similar episodes 2 or 3 times a week for the past several months. Her blood pressure is 150/90 mm Hg, pulse is 100/min, and respirations are 28/min. Cardiac enzymes are normal, and an ECG shows normal sinus rhythm with no ST-segment or T-wave abnormalities.
39) A 17-year-old boy is brought to the office for evaluation of bilateral breast enlargement. He first noticed it a few months ago and says that it is slightly painful. His parents are concerned that his breasts are gradually becoming more prominent.
The patient is in special education classes due to a long-standing history of learning disabilities. His father has type 2 diabetes mellitus and is on dialysis for chronic renal failure. Height is at the 95th percentile, and weight is at the 25th percentile for age and sex.
3) A 4-year-old Caucasian male is evaluated in your clinic for recurrent skin and respiratory infections. He has light skin and silvery hair. Horizontal nystagmus is present on eye examination. Peripheral blood smear demonstrates giant cytoplasmic granules in neutrophils and monocytes.
The patient most likely suffers from which of the following disorders?
34) A 44-year-old man is brought to the emergency department after vomiting at a party. The patient has been drinking heavily but insists he has a high tolerance and is "perfectly fine to go home." Initial evaluation indicates that he has acute pancreatitis.
The patient remains intoxicated with a blood alcohol level of 245 mg/dL (0.245% blood alcohol content). When informed of the diagnosis and the risks of not being treated, he says that he hates hospitals and will sue the physicians for touching him.
22) A 54-year-old woman comes to the hospital due to a week of progressive fever and headache. She also had dyspnea, productive cough, fatigue, and night sweats.
The patient underwent a renal transplant 2 years ago and is on immunosuppressive therapy Her temperature is 38.3 C (101.F), blood pressure is 130/80 mm Hg, pulse is 901min, and respirations are 18/min.
32) A 53-year-old man comes to the physician for a follow-up visit after an acute myocardial infarction. His medications include metoprolol and low-dose aspirin. He used to smoke 2 packs of cigarettes daily but quit after his myocardial infarction.
The patient's father has hypertension and his mother has type 2 diabetes mellitus. He currently weighs 100 kg (220 1b) and is 178 cm (70 in) tall. Examination shows an obese male. Total serum cholesterol level is 155 mg/dL, with an HDL level of 27 mg/dL and a triglyceride level of 92 mg/dL.
Further testing leads to a diagnosis of xeroderma pigmentosum. A defect in which of the following enzymes is most likely causing this patient's condition?
a) 3'-5' Exonuclease b) DNA ligase c) Endonuclease d) Helicase e) Topoisomerase
Here they are measuring association between alcohol and Bladder cancer, but all of a sudden, they are bringing in a new variable called smoking.
The third variable *smoking* will confound the association between *Alcohol* and *Bladder* cancer
26) A 46-year-old woman comes to the physician with easy fatigability and exertional dyspnea. Cardiac auscultation reveals a diminished first heart sound and an apical holosystolic murmur radiating to the axilla. Diffuse pulmonary crackles are heard bilaterally.
There is no elevation of jugular venous pressure or peripheral edema. Which of the following would most likely increase the ratio of forward flow volume to regurgitant flow volume in this patient?
27) Researchers conduct a prospective study that demonstrates an association between alcohol consumption and transitional bladder carcinoma, with a relative risk (RR) of 1.81 and a p-value of 0.03.
They then divide the study subjects into 2 groups, smokers and non-smokers, and again examine the association between alcohol consumption and bladder cancer.
21) A 24-year-old woman comes to the physician due to persistent white plaques on her tongue as well as recurrent episodes of genital itching and vaginal discharge. She has also had unintentional weight loss and diarrhea recently. The patient's past medical history is unremarkable.
Vaccinations are up to date and she recalls no recurrent or prolonged illnesses as a child. She smokes a pack of cigarettes daily and drinks alcohol socially She has experimented with recreational drugs in the past but not recently.
The neurologic examination is unremarkable. X-ray of the spine reveals a TI0 compression fracture. On the graph, area C shows the normal relationship between the serum concentrations of calcium and parathyroid hormone.
a) A b) B c) C d) D e) E
The area marked by the white arrow most likely represents which of the following?
a) Albumin b) Eosinophil enzymes c) Fibrin deposition d) Hyaline accumulation e) Immune complex deposits f) Lipid droplet g) Neutrophil enzymes
Which of the following is the initial for this patient? a) Cefepime b) Ceftriaxone c) Doxycycline d) Moxifloaxacin e) Trimethoprim-sulfamethoxazole
a) Cefepime - Pseudomonas: *Burn patient* you picked *Ceftriaxone* thinking this is *Neisseria* but that was WRONG. This is a *Burn* patient so treat with *Cefepime*
On autopsy, both vas deferens are absent. Which of the following findings is also likely to be present on autopsy?
a) Distension and obstruction of pancreatic ducts b) Lobar sequestration c) Lymphocytic infiltrate of pancreatic islet cells d) Nodular lymphoid hyperplasia in the intestine e) Situs inversus
5) A 6-year-old boy is brought to the emergency department by his parents for an asthma exacerbation. During the examination, the physician discovers a well-demarcated, round burn mark on his thigh.
When asked about the burn, the patient says, "That happens every time I'm bad." His mother corrects him and says that it was an accident resulting from the boy "playing with the cigarette lighter in the car." Which of the following is the best next step in management of this patient?
Physical examination is notable for central obesity. Lungs are clear on auscultation bilaterally.
Which of the following changes in forced expiratory volume in 1 second (FEV-1), forced vital capacity (FVC), expiratory reserve volume (ERV), residual volume (RV) and total lung capacity (TLC) are most likely to be seen on pulmonary function testing in this patient?
25) Researchers measure the serum insulin levels of healthy volunteers after equivalent loads of oral and intravenous glucose. Following curves are observed.
Which of the following endogenous substances best explains the difference between the curves? A) Insulin-like growth factor-I B) Glucagon-like peptide-I C) Somatostatin D) Secretin E) Cholecystokinin
6) The immune response observed in an apparently healthy 12-year-old Caucasian male after recurrent exposure to a bacterial antigen is characterized by rapid increase in serum IgG level. Some immunoglobulin molecules are attached to the surface of macrophages, neutrophils & B-lymphocytes.
Which of the following is the cell attachment site for the immunoglobulin molecule shown on the slide below?
so put Glucose into Reshmi's vein (IV) and put glucose into Ramya's mouth (Oral). Reshmi's insulin level is NOT increasing but Ramya's insulin level is increasing.
Why is there more insulin release in response to Oral glucose rather than IV glucose? Glucagon-Like peptide
c) Endonuclease
Xeroderma Pigmentosum
****Avulsion of the secondary ossification center of the tibia due to repetitive muscle contraction and traction on the bone****
all the muscles in the upper part of the thigh insert into the *Tibial tuberosity*
4) A 65-year-old man is admitted to the intensive care unit with second and third degree burns over 25% of his total body surface area. Intravenous fluids and analgesics are administered, and his wounds are cleaned and debrided. After 7 days, the patient develops a fever and his leukocyte
count rises to 16,000 cells/pL. Examination of the burns on his left leg shows surrounding warmth, erythema, and induration. Gram stain of his wound tissue is shown in the image. Culture on MacConkey agar grows oxidase-positive colonies that do not ferment lactose.
a) A b) B c) C d) D e) E
e) E
What caused disease? a) Actinomyces Israelii b) Aspergillus fumigateurs c) Candida tropicalis d) Crypotococcus neoformans e) Listeria monocytogenes f) Mycobacterium tuberculosis g) Nocardia asteroides h) Streptococcus pneumoniae i) Toxoplasma Gondi
g) Nocardia asteroides - Gram-positive filamentous branching rods :Nocardia & Actinomyces - there are no sulphur granules/ jaw lesion here, so it is NOT *Actinomyces*
