Uworld 18
**Holoproscencaphaly** =
** Field defect**
**Asterixis**
***Increased load of nitrogenous substances absorbed by the gut**
***Type 1 Hypersensitivity***
***Tryptase***
***Urticaria**
***Tryptase***
**Disseminated intravascular Coagulopathy**
**AML**
**Organophosphate poisoning**
**Acetylcholinesterase inhibitor**
F) "Thank you very much, but I have a policy of not accepting valuable gifts from patients. Would you mind if I offer them to the office staff?"
**B) "I appreciate your thoughtfulness and will treasure the card you have made for me. However, it would not be right for me to accept the tickets.**
**AML**
**Disseminated intravascular coagulopathy**
**II, III & avF**
**Inferior wall MI**
*II, III, & avF* means?
**Inferior wall MI**
*V1 - V4*
**LAD**
*V5 & V6*
**LCX**
How to check if patient has *Asthma* if all the values are *Normal*. Here FEV1, FVC and the ratio everything is normal, so we want to check what the actual problem is?
**Methacholine** challenge test
e) E
**Organophosphate** is an *acetylcholinesterase inhibitor**
**Lower lobe** of lung, which nerve is likely to be involved?
**Phrenic nerve** - *Diaphragm* is most involved when there effusion in the lower lobe
Left ventricular *Inferior wall* supply?
**Posterior Descending branch** of *RCA*
D) Messenger RNA transcript containing BCR and ABL exons
**mRNA**
How does *Potassium* change as it flows through the kidney?
*100-35-10-110*
D) Increased load of nitrogenous substances absorbed by the gut
*Asterixis* why is the answer not a) Accumulation of blood urea nitrogen. Because remember that *BUN* is always associated with *Kidney*
*hCG* mimics
*LH*
d) Phrenic
*Lower lobe* of lung affects the *diaphragm* which affects the Phrenic nerve
13) A 59-year-old African American male presents to the emergency room with crushing chest pain, sweating, and lightheadedness. His blood pressure is 90/60 mm Hg and his heart rate is 48 beats per minute.
Electrocardiogram (ECG) shows sinus bradycardia and ST segment elevation in leads II, III, and aVF. Occlusion of which of the following coronary arteries is most likely responsible for this patient's symptoms?
4) A healthy 32 year old man has been consuming a high-potassium diet rich in bananas and avocados for the past 2 weeks. He is found to have a urine potassium concentration that is higher than his plasma potassium concentration.
In a normal individual with high dietary potassium intake, which of the following describes the amount of potassium in the tubular fluid as it flows along the nephron in comparison to filtered potassium load?
10) A 55-year-old farmer is brought to the emergency department after his daughter found him confused and disoriented in the tool shed at home. He has been otherwise healthy and does not take any medications.
On physical examination, blood pressure is 110/70 mm Hg and pulse is 50/min. The patient's pupils are symmetric, 2 mm, and reactive to light. His eyes are tearing considerably. There are scattered wheezes bilaterally on lung auscultation.
Drugs contra-indicated in *Mycoplasma* ?
**Penicillin/ Vancomycin**
**CD8+ lymphocyte infiltration**
**Polymyositis**
**Glossopharyngeal nerve**
**Posterior 1/3 taste** sensation**
why is *Flushing* caused with *Niacin* ?
**Prostaglandins**
**Inferior wall** is supplied by?
**RCA**
*II, III & avF*
**RCA**
C) LDL receptor density
**Statins**
A) Epidermal basal cells
**Telomerase activity**
Anything that requires *Continuous proliferation* requires?
**Telomerase activity**
**3' end of Chromosome** =
**Telomerase**
**3' end of chromosome** =
**Telomerase**
**Protein has reverse transcriptase activity that functions to add TTAGGG repeats to the 3' end of chromosomes** what protein is being described here?
**Telomerase**
**Niacin** =
**Uric acid** stones
*D-alanine-D-alanine* (Penicllin/Vancomycin) analogue targets?
*Cell wall*
what is *Adenomyosis*?
*Endometrial tissue in the myometrium*
you *Increase in lung volumes*
*Increase in lung volumes** means?
what is *Emphysema* ?
*Interalveolar wall destruction*
why can *D-alanine-D-alanine* drugs not be used against *Mycoplasma* ?
*Mycoplasma* lacks a *Cell-wall*
C) Cobalamin deficiency
*Neurological problems* = B12 deficiency
if you remember that the *aci* in. Ni*aci*n stands for
*aci* in uric *Aci*d stones
C) LH surge
*hCG*
**RTPCR** =
*mRNA*
**Reverse Transcriptase Polymerase Chain Reaction** =
*mRNA*
c) Interalveolar wall destruction
- *Emphysema*
D) Endometrial tissue in the myometrium
- Adenomyosis
Type 1 Hypersensitivity
- Anaphylaxis **Skin rash- Urticaria** **Wheezing** - Shock **Low Blood pressure** **High Heart Rate**
b) 0.2
- Just find the corresponding GFR and RPF from the graph given the Mean Blood pressure as 120 mm Hg. if you go up from 120 mmHg, you will find that GFR = 0.1, RBF = 0.50
A) Amniotic fluid in the maternal circulation B) Bacterial infection of the endometrium C) Reduction of clotting factors from fatty infiltration of hepatocytes
D) Release of tissue factor into the maternal circulation E) Rupture of the uterine endometrium, myometrium, and Serosa
A) Left main coronary artery B) Left anterior descending artery C) Left circumflex artery D) Right coronary artery E) Intramural arteries
D) Right coronary artery
why do *Epidermal basal cells** require *Telomerase* activity?
Because they undergo *Continous proliferation*
what says that this patient has *DIC* ?
Bleeding from everywhere
so what are the values for *Potassium* as it travels along the Kidney?
Bowman's - 100% PCT- 35% TAL- 10% Collecting duct- 110%
**Mycoplasma** lacks?
Cell-wall
Hepatitis D and B superinfection, requires?
Coating of Hep *D* by Hep *B*
A) Decreased conversion of T4 to T3 B) Decreased free T4 level C) Increased free T3 level D) Increased total T4 pool E) Increased thyroid iodine uptake
D) Increased total T4 pool
Erythrocytes - Blood - *Completed division * Myocardial cells - Heart - *Completed division* Neurons - Central Nervous system - *Completed division* Pancreatic Beta cells - Pancreas - *Completed division*
Epidermal basal cells - the *ONLY* cell type that has not yet been differentiated into a specific *Organ system* - *Not completed division*
**Guillain Barre** syndrome, you see?
Endo*Neural* inflammatory infiltration
What do you see in *Guillain Barre Syndrome* ?
Endo*Neural* inflammatory infiltration
A) Dilated cardiomyopathy B) Hemolytic anemia C) Hypertrophic cardiomyopathy D) Ischemic heart disease E) Long-standing hypertension F) Normal aging
F) Normal aging
40) A 60-year-old professor is brought to the emergency department after developing right-sided weakness and numbness during a lecture an hour ago. He also has nausea and confusion. The patient smoked a pack of cigarettes daily for 20 years but quit 10 years ago.
He does not drink alcohol. His father died of myocardial infarction at age 70. Blood pressure is 190/100 mm Hg, and pulse is 60 /min. On physical examination, there are no signs of head trauma.
14) A 34-year-old woman with polycystic ovary syndrome comes to the office with her husband for treatment of infertility. The patient has been unable to conceive despite having unprotected sexual intercourse several times a week for the past 2 years.
Her menses are irregular and occur every 2-3 months, consistent with chronic anovulation. She does not use tobacco, alcohol, or illicit drugs. The patient takes no medications and has no allergies. BMI is 32 kg/m2. Physical examination shows coarse hair on her chin and abdomen.
19) A 65-year-old man is brought to the emergency department due to acute onset right-sided weakness and slurred speech. He also reports severe headache and nausea His medical history is significant for poorly controlled hypertension and chronic tobacco use.
His blood pressure is 240/120 mm Hg and pulse is 104/min. On physical examination, the patient is lethargic with right flaccid hemiplegia and lower facial weakness, right hemisensory loss, and dysarthria. Non-contrast head CT scan findings are shown in the image below
The plates are then inverted and incubated for 18 hours alongside control plates with the same organisms but no antimicrobial disks. The control plates all show organism growth.
In the plates with the diffusion disks, resistance to drug X is determined by measuring the zone of complete growth inhibition around the disk. Which of the following bacteria is most likely to be resistant to drug X?
Increase in **Estrogen** causes?
Increase *Steroid binding globulin** - Increase *Thyroid* binding globulin
9) A 54-year-old man comes to the emergency department with a 3-month history of fatigue and exertional dyspnea. He has early satiety and frequent upper abdominal discomfort. On physical examination, the patient has palpable splenomegaly but no lymphadenopathy.
Laboratory tests are as follows: Complete blood count -Hemoglobin 9.2 mg/dL -Platelets 80,000/mm3 -Leukocytes 56,000/mm3
**Glossopharyngeal nerve**
Loss of general sensation at the tonsillar lining
**Carbolfuchsin stain** =
Mycolic acid
29) A 56-year-old man comes to the emergency department with severe right foot pain. The pain began acutely, and there is no history of recent trauma. The patient has associated redness and swelling but no fever. He has had no similar symptoms in the past.
Past medical history is significant for mixed hyperlipidemia treated with lifestyle modifications and several medications. Physical examination shows a swollen, tender first metatarsophalangeal joint.
6) This applies to the next 2 items. A 52-year-old woman comes to the emergency department with pain and redness affecting her left leg. The patient's symptoms began 2 days ago and have progressed to the point where she cannot walk without experiencing severe pain.
Physical examination shows a large, erythematous area with indistinct margins over her left leg. The area feels hot and indurated and is exquisitely tender. She is admitted to the hospital for severe left leg cellulitis and is started on intravenous cefazolin.
a) Bowman's: 100% PCT: 35% TAL: 10% Collecting duct: 110%
Potassium is Filtered and reabsorbed But the *Only* place where potassium is excreted is *Collecting duct* where *Aldosterone* acts.
What do you see in *DIC* ?
Release of **Tissue Factor**
E) Sertraline
SSRI causes *Mania*
Laboratory studies show normal hepatic and pancreatic enzyme levels, but the patient again has a severely elevated triglyceride level. The physician prescribes the appropriate medications and explains that the patient is likely to experience skin flushing and warmth after taking the pills.
Which of the following is the primary agent mediating these side effects? A) Histamine B) Platelet-activating factor C) Prostaglandin D) Serotonin E) Substance P
39) A 42-year-old woman, gravida 4, para 4, comes to the clinic due to heavy and painful menstrual bleeding over the past 3 months. Her last menstrual period was 4 weeks ago. Menarche was at age 10, and menstrual periods last for 3-5 days and occur every 30 days.
She is sexually active with her husband and does not have pain with intercourse. The patient had a bilateral tubal ligation 3 years ago after the birth of her last child. She takes no medications and has no allergies. BMI is 24 kg/m2. Vital signs are normal. On bimanual examination, the uterus is uniformly enlarged.
37) Autopsy of a 78-year-old man demonstrates decreased left ventricular cavity size and a sigmoid-shaped ventricular septum. Light microscopy shows increased collagen content within the ventricular wall. Some myocardial cells also have brownish perinuclear cytoplasmic inclusions.
The changes described are most consistent with which of the following conditions?
30) A 62-year-old man comes to the emergency department due to severe colicky upper abdominal pain, nausea, and vomiting. He reports several episodes of similar abdominal discomfort in the past.
The patient does not use tobacco, alcohol, or illicit drugs and immigrated to the United States from Vietnam several years ago. Physical examination shows right upper quadrant abdominal tenderness. An imaging study shows several gallstones in the common bile duct and gallbladder.
2 *stone* side effects for Cholesterol drugs?
Uric *aci*d stones = Ni*aci*n Gall stones = Fibrates
34) A 45-year-old man comes to the hospital with acute onset of severe chest pain and diaphoresis. The patient describes the pain as "squeezing," different from any discomfort he has ever had. He has a past medical history of hypertension, and his father undewent coronary artery
bypass grafting at age 50. The patient is diagnosed with acute ST-elevation myocardial infarction and undergoes an urgent coronary intervention with stent placement into the right coronary artery He is also started on high-intensity atorvastatin therapy; along with antiplatelet therapy and
31) A 65-year-old woman is concerned about her risk for fracture as her mother was recently hospitalized for osteoporotic hip fracture. The patient walks her dog for a mile on most days of the week and has no problems with balance or falling. She has a history of hypertension,
hyperlipidemia, coronary artery disease, migraine, and gastroesophageal reflux disease. The patient underwent menopause at age 52. She has smoked a pack of cigarettes daily for 24 years but does not drink alcohol. Her weight is 56 kg (123.2 1b).
Ni*aci*n =
uric *aci*d stones
When can Hepatitis *D* cause an infection?
when it *COATED* by Hep *B*
What drugs *CANNOT* be used against *Mycoplasma* ?
*D-alanine-D-alanine* analogues
- Bleed from her vagina, - Bleeding from gums - Bleeding from intravenous line sites - Blood in Foley catheter*
*DIC*
**Heavy and painful** menstrual bleeding in a *Middle aged woman* with an *Enlarged endometrial surface*
*Endometrial tissue in the myometrium*
anything that targets *Cell-wall* CANNOT be used on?
*Mycoplasma*
e) Charcot-Bouchard aneurysm
**Hypertension** + **Basal ganglia**
**Emphysema** =
**Interalveolar wall destruction**
**Increase in lung volumes** =
**Interalveolar wall destruction**
What is formula for **RPF**?
**RBF (1- Hematocrit**
**Decreased left ventricular cavity size**
**Left ventricular hypertrophy** is due calcification of the *Aorta*
**Hypertension** =
**Lenticulostriate arteries**
**Brownish perinuclear cytoplasmic inclusions**
**Lipofuscin**
**Epidermal basal cells** can undergo *Continuous proliferation* so requires?
**Telomerase**
D-alanine-D-alanine analogues do NOT work on?
**mycoplasma**
**Decreased left ventricular cavity size** **Brownish perinuclear cytoplasmic inclusions**
**Normal aging**
**Lipofuscin**
**Normal aging**
**Dark gallstones** are due to?
**Organisms/ bacteria/ infections**
F) Omeprazole
**PPI's** cause *Osteoporosis*
C) Prostaglandin
**Flushing** is due to **Prostaglandins*
**Fibrates** =
**Gall** stones
then you can remember that the other drug Fibrate is for?
**Gall-stones**
D) Loss of general sensation at the tonsillar lining
**Glossopharyngeal nerve**
E) Niacin
**Gout**
*weakness which is getting worse every day**
**Guillain Barre** syndrome
**B**
**Pancreatitis**
**IgE receptor** aggregation leads to?
**Histamine release**
C) Receptor aggregation
**Histamine release**
**Fused cerebral hemispheres**
**Holoproscencephaly**
E) Field defect
**Holoproscencephaly**
what do you see with *Estrogen* replacement in post-menopausal woman?
***Increased total T3/T4 pool***
what do you see with *Estrogen* replacement in post-menopausal woman?
***Increased total T3/T4 pool*** NOT **decreased free T3/T4**
main clue for *Telomerase* activity in this question?
**3' end of chromosome**
-*Heavy menstrual bleeding* -*Middle aged women* -*Increase in endometrial surface* -*Painful menstrual bleeding*
**Adenomyosis**
**Dark gallstones** are caused due to?
**Beta-glucoronidase**
**Organisms/infections** release
**Beta-glucoronidase**
F) Polymyositis
**CD8+ lymphocyte infiltration**
D) Mycolic acid =
**Carbolfuchsin stain**
C) Beta-glucuronidase
**Dark Gall stones**
D) Release of tissue factor into the maternal circulation
**Disseminated Intravascular Coagulopathy** related to pregnancy
**Obstructive disease** , such as?
**Emphysema**
28) Bacteria isolated from the lung tissue of a 32-year-old Caucasian male fail to decolorize with hydrochloric acid and alcohol after staining carbolfuchsin. Which of the following cell wall components is most likely responsible for this staining phenomenon?
A) N-acetylmuramic acid B) Teichoic acid C) Lipopolysaccharide D) Mycolic acid E) Ergosterol
appropriate medications to control blood pressure. Four weeks later, the patient's total cholesterol level is 140 mg/dL, down from 200 mg/dL before discharge. Which of the following has most likely increased as the result of the therapy?
A) ApoB-100 concentration B) Biliary excretion of cholesterol C) LDL receptor density D) Plasma free fatty acids E) VLDL concentration
Long-term use of which of the following of the following medications will increase her risk of osteoporosis and hip fracture?
A) Atorvastatin B) Chlorthalidone C) Levetiracetam D) Metoprolol E) Nitroglycerin F) Omeprazole
Aspiration reveals a high leukocyte count, negative Gram stain, and numerous needle-shaped negatively birefringent crystals. Which of the following drugs is most likely to have precipitated this patient's condition?
A) Atorvastatin B) Cholestyramine C) Ezetimibe D) Gemfibrozil E) Niacin
A) Coating of viral particles B) Integration into host genome C) Intracellular survival D) Replication of viral RNA E) Translation of viral transcripts
A) Coating of viral particles - Hepatitis *D* is *COATED* by hep B
This protein has reverse transcriptase activity that functions to add TTAGGG repeats to the 3' end of chromosomes. Which of the following cell types was most likely studied in this experiment?
A) Epidermal basal cells B) Erythrocytes C) Myocardial cells D) Neurons E) Pancreatic Beta cells
35) A 53-year-old female treated with high-dose folic acid for anemia experiences a moderate increase in her hemoglobin level. She returns to clinic complaining of bilateral foot numbness and difficulty in walking. The latter symptoms are most likely related to which of the following?
A) Folate overdose B) Iron deficiency C) Cobalamin deficiency D) Hemolysis E) Aplastic anemia
24) Drug X, a laboratory-synthesized antimicrobial agent, is a D-alanine-D-alanine analog that blocks bacterial peptidoglycan cross-linking and resists degradation by bacterial enzymes.
Antimicrobial diffusion disks with drug X are added to several agar plates, each of which contains colonies of a single organism with the appropriate growth medium.
B) "I appreciate your thoughtfulness and will treasure the card you have made for me. However, it would not be right for me to accept the tickets.'
C) "Thank you; my family will certainly enjoy the game. Please know that I will always provide you with the best care possible, just like I do for all my patients"
Urine B-hCG is negative. Biopsy shows secretory endometrium. Which of the following is the most likely cause of this patients symptoms? A) Benign myometrial smooth muscle cell proliferation B) Blastocyst implantation in the fallopian tube
C) Deficiency of von Willebrand factor D) Endometrial tissue in the myometrium E) Greater increase in endometrial gland proliferation compared to stroma F) Hyperplastic growth of tissue from endometrial surface
A) Actinomyces israelii B) Borrelia burgdofferi C) Helicobacter pylori D) Mycoplasma hominis E) Pasteurella multocida
D) Mycoplasma hominis - **Lacks cell wall**
Increase in *TBG* leads to a?
Decrease in Free T3/T4 initially, Now the body thinks there is a deficiency and starts producing more thyroid hormone, which leads to an *Increased total T3/T4 pool*
8) Physiologists are investigating renal autoregulatory mechanisms in an animal species that closely mimics human physiology.
During one of their experiments, renal blood flow and glomerular filtration rate are measured in an anesthetized animal in response to changes in mean arterial pressure. The data they obtain is shown on the graph.
38) A 24-year-old woman, gravida 1 para 0, comes to labor and delivery triage at 28 weeks gestation due to intense abdominal pain, vaginal bleeding, and decreased fetal movements. Her temperature is 36.7 C (98 F) and blood pressure is 170/96 mm Hg.
Examination shows a tense abdomen and a firm, tender uterus. Ultrasound shows a hematoma between the placenta and uterine wall and no fetal cardiac activity.
D) "Thank you very much. I do not normally accept valuable gifts for ethical reasons. However, since they were free and you are unable to attend, I would be happy to accept them."
E) "Thank you very much but I cannot accept the tickets; please know that I give all my patients the best care whether or not they bring a gift.'
A) 5-hydroxyindoleacetic acid B) Alkaline phosphatase C) Calcitonin D) Myeloperoxidase E) Tryptase
E) Tryptase - Anaphylactic shock
36) A 34-year-old man comes to the emergency department due to 5 days of progressive anorexia, nausea, and abdominal pain. The patient is a known hepatitis B carrier. He admits to using IV drugs and has shared needles with other drug users on several occasions.
Examination shows scleral icterus and mild, tender hepatomegaly. Laboratory studies are notable for highly elevated levels of liver aminotransferases and serum bilirubin and also show the following results:
32) A 57-year-old man is seen in the office after an episode of acute pancreatitis. Hospital evaluation found no evidence of gallstones. The patient does not consume alcohol, but he does have a history of severe hypertriglyceridemia.
He was treated with a fibrate medication in the past but could not tolerate it due to liver toxicity He has no history of diabetes mellitus or hypertension. On examination, the patient has no abdominal tenderness.
so what is the buzzword in this question?
Hepatitis D = *Coating* by Hep B
15) A 24-year-old woman comes to the office due to low energy, decreased appetite, and insomnia. She has lost 3.6 kg (8 1b) over the last month. The patient has no past psychiatric history, but her mother suffers from severe "mood swings."
Medical history, physical examination, and laboratory evaluation are unremarkable. Treatment with medication is initiated. Three weeks later, the patient is brought to the emergency department after not sleeping for 5 nights. She does not feel tired despite her lack of sleep.
While listening with the stethoscope over the right midback, the examiner has the patient say the letter "E, " and the sound is perceived by the examiner as a loud letter "A". A chest x-ray is obtained and is shown in the image.
Pain experienced by this patient is carried by which nerve? a) Accessory b) Intercostal c) Long thoracic d) Phrenic e) Vagus
11) A 35-year-old previously healthy woman comes to the hospital due to several days of productive cough associated with chills and fever. Her sputum is purulent with faint pink streaks of blood. Patient has sharp pain over right shoulder and neck area brought on by deep inspiration.
Past medical history is unremarkable. Her temperature is 38.3 C (101 F), blood pressure is 130/70 mm Hg, pulse is 98/min, and respirations are 22/min. Examination reveals crackles and dullness over the right lower pulmonary lobe.
1) A 32-year-old male is brought to the physician's office because of weakness and tingling that started in his feet and is now at his knees. The weakness started a week ago and is getting worse every day.
Physical examination shows strength of 2/5 in both legs and absent deep tendon reflexes in his knees. His past medical history is insignificant except for a mild respiratory infection two weeks ago. This patient's condition is most likely associated with which of the following?
cause of *Bleeding* in DIC?
Release of **Tissue Factor**
25) A cell biologist is studying the role of ribo-nucleoproteins in normal cellular function. He prepares a cell extract using a specific cell type obtained from a 73-year-old man.
Ribonucleoproteins are separated and purified from the cell extract for structural and functional analyses. These cells are found to express higher amounts of a particular protein in comparison to other cell types.
33) A 52-year-old woman comes to the office for follow-up of menopausal symptoms. She has been on a combination estrogen and progesterone medication to treat severe hot flashes, which began at the onset of menopause 6 months ago. She now has no significant symptoms and feels well
The patient has a history of diet-controlled hypertension but takes no other medications. Her laboratory tests show a normal serum TSH level. Which of the following is most likely to occur in this patient as a long-term effect of her medication use?
26) A 43-year-old man comes to the office with muscle weakness. His symptoms began 6 weeks ago and are worst in the hips and shoulders. The weakness has had a progressive course so that he is now having difficulty rising from chairs and combing his hair.
The patient has had to reduce his regular exercise regimen due to weakness and has requested a modified work schedule for his job as a building maintenance manager. He has no history of spinal injury and no neck pain.
21) A 43 year old man comes to the office reporting occasional nighttime dyspnea that awakens him. His symptoms started approximately a year ago after a severe upper respiratory tract infection, and he now has noticed a new episodic cough.
The patient has no other medical problems and no history of allergies, but his older brother has atopic dermatitis. Vital signs are normal. Physical examination shows no abnormalities.
Laboratory results are as follows: Hemoglobin 9.2 Platelets 60,000 Aspartate aminotransferase 12 Alanine aminotransferase 24
The patient is hospitalized and begins to bleed from her vagina, gums, and intravenous line sites. Blood is seen in her Foley catheter. Which of the following is the most likely cause of her bleeding?
Hepatitis B surface antigen- Positive Hepatitis C virus antibody- Negative HIV-I antibody- Negative Hepatitis D RNA - Positive
This patients chronic infection assists which of the following life cycle aspects of the current infectious agent?
why is the answer NOT *b) Decreased free T4 level* ?
This will happen *Initially* but not later. Decrease in *Free T3/T4* initially, Now the body thinks there is a deficiency and starts producing more thyroid hormone, which leads to an *Increased total T3/T4 pool*
2) A 23-year-old woman with a broken nose comes to the emergency department accompanied by her boyfriend. With the boyfriend present, she explains that she tripped and fell in the bathroom, hitting her face on the countertop.
When asked privately if she feels unsafe with her boyfriend, the patient says, "No, everything is fine. He just gets a little crazy now and then when he has too much to drink."
The stones are removed endoscopically, and a cholecystectomy is also performed. The gallstones are dark brown, soft, and composed primarily of calcium bilirubinate with variable amounts of cholesterol.
Which of the following enzymes most likely played an important role in the pathogenesis of this patients condition? A) 7-alpha-hydroxylase B) Aromatase C) Beta-glucuronidase D) Desmolase E) HMG-CoA reductase
Past medical history is in significant, and the patient takes no medications. Muscle biopsy reveals major histocompatibility complex class I molecule overexpression on the sarcolemma with CD8+ lymphocyte infiltration.
Which of the following is the most likely cause of this patient's condition? A) Diffuse systemic sclerosis B) Eaton-Lambert syndrome C) Myasthenia gravis D) Polyarteritis nodosa E) Polymyalgia rheumatica F) Polymyositis
a) (20 x 30) / (70 x 40) b) (20 x 40) / (70 x 30) c) (20 x 70) / (30 x 40) d) (20 x 50) / (70 x 110) e) (20 x 90) / (30 x 70)
b) (20 x 40) / (70 x 30)
a) A b) B c) C d) D e) E
b) B - **Pancreatitis**
a) A b) B c) C d) D e) E
b) B Puffer fish/ Tetrodotoxin affects *Sodium* channels
Which of the following proteins is most likely to be abnormal in the hematopoietic cells of this patient? a) Epidermal Growth factor receptor b) GTP-binding protein c) Platelet-derived growth factor receptor d) Retinoblastoma gene product e) Retinoic acid receptor
e) Retinoic acid receptor = ***AML***
There is diminished right-sided strength (1/5) and an upgoing plantar reflex. Brain CT without contrast is obtained immediately. The image is shown below
which of the following is the most likely cause of this patient's condition? a) Arteriovenous malformation b) Cardiac embolism c) carotid artery atherosclerosis d) Cerebral amyloid angiopathy e) Charcot-Bouchard aneurysm f) Hypertensive encephalopathy g) Hypoxic encephalopathy h) Large vessel arteritis
27) A 57-year-old man is being evaluated for progressive shortness of breath. His respiratory flow-volume curve is shown in red below.
which pathological findings is present in this patient? a) Alveolar hyaline membranes b) Compression atelectasis c) Interalveolar wall destruction d) Intraalveolar hemorrhage e) Pulmonary fibrosis f) Thromboembolic disease
17) A 48-year-old man is evaluated for abdominal pain and diarrhea. The patient characterizes his stool as voluminous and foul smelling. He has no significant past medical history. The patient drinks 6 cans of beer daily. On examination, he has normal bowel sounds and mild epigastric tenderness.
A 72-hour stool collection shows excessive excretion of fecal fat. A CT scan of the abdomen is shown in the image below Involvement of which of the following structures is most likely causing this patients symptoms?
12) A 16-year-old obese primigravida girl comes to the emergency department in active labor. In an attempt to conceal the pregnancy from her family, the patient did not receive prenatal care or take prenatal vitamins.
A fetal heartbeat is undetectable, and she delivers a stillborn boy via vaginal delivery. Examination of the stillborn shows several dysmorphic features including closely set eyes and a midline mass consistent with a proboscis.
When questioned further about how she sustained her broken nose, she says, "He pushed me and I fell, but I'm sure it won't happen again." Which of the following is the most appropriate response to the patient?
A) "Can you help me understand why you remain in the relationship?" B) "Do you have a safe place to go in an emergency?" C)"I am concerned that you are in denial about your abuse.
Repetitive flicking motions of the hands are seen when the patient is asked to outstretch his arms and dorsiflex his wrists. Which of the following events is the most likely precipitant of this patient's altered mental status?
A) Accumulation of blood urea nitrogen B) Bacterial infection of the meninges C) Decreased concentrations of g-aminobutyric acid D) Increased load of nitrogenous substances absorbed by the gut E) Occlusion of the middle cerebral artery
A fetal autopsy reveals fused cerebral hemispheres with an absent forebrain fissure and a single intracranial ventricle. Which of the following is the most likely mechanism for these findings?
A) Agenesis B) Association C) Deformation D) Dysplasia E) Field defect
7) The patient's anaphylactic reaction is determined to be mediated by antigen-specific lgE antibodies attached to high-affinity receptors on the surface of mast cells and basophils. Which of the following mechanisms is most likely to trigger vasoactive substance release by these cells?
A) Antibody-receptor covalent binding B) Antibody-receptor dissociation C) Receptor aggregation D) Receptor detachment from the cell surface E) Receptor internalization
She spent a large amount of money on a boat and plans to travel the globe to promote world peace. This patient was most likely started on which of the following medications 3 weeks ago?
A) Carbamazepine B) Lamotrigine C) Lithium D) Olanzapine E) Sertraline F) Valproate
Reverse transcription polymerase chain reaction is used to diagnose chronic myelogenous leukemia in this patient. Which of the following is most likely to be detected by this test?
A) Chromosomal position of the BCR and ABL genes B) DNA rearrangement in the BCR promoter region C) Fusion protein containing BCR and ABL domains D) Messenger RNA transcript containing BCR and ABL exons E) Point mutation in the ABL enhancer region
A) Endoneural inflammatory infiltration B) Toxin penetration through blood-nerve barrier C) Endoneurial arteriole hyalinization D) Mutations of a muscle structural protein gene E) Endomysial inflammatory infiltration
A) Endoneural inflammatory infiltration - *Guillain Barre* syndrome
Administration of which of the following medications would be most helpful during the remainder of this patient's diagnostic workup?
A) Ipratropium bromide B) Levalbuterol C) Methacholine D) Phenoxybenzamine E) Scopolamine
what causes *Histamine* release?
Aggregation of *IgE*
D) "I know this is difficult, but it is important that you tell me the extent of the abuse. E) "May I have permission to discuss these issues with your boyfriend?"
B) "Do you have a safe place to go in an emergency?"
why does *Asterixis* NOT involve *BUN* but involve *Nitrogen*?
Because *BUN* is related to the *kidney* but asterixis is a *Liver* problem.
23) a 32 year old man comes to the office due to progressive fatigue, easy bruising, and recurring episodes of gum bleeding. Laboratory studies are as follows:
Bone marrow biopsy is performed and fluorescence in situ hybridization studies reveal a balanced translocation between the long arms of chromosomes 15 and I7.
18) A 66-year-old man develops transient, painless vision loss in the left eye. He has a history of hypertension, hyperlipidemia; and type 2 diabetes mellitus. Evaluation reveals significant stenosis of the left internal carotid artery due to atherosclerotic plaque.
Carotid endarterectomy is performed. During the surgery, the left glossopharyngeal nerve is accidentally transected. Which of the following is most likely to be seen due to the nerve injury?
Temperature is 38.1 C (100.6 F), blood pressure is 135/75 mm Hg, and pulse is 95/min. The right foot is swollen with some erythema around the injury site. Radiographic imaging reveals gas in the tissues. On urgent surgical exploration, extensive tissue necrosis is present.
Culture from the site reveals gram-positive rods. Which of the following best describes the mechanism of action of the toxin responsible for the necrotic effects seen in this patient?
A) Deviation of the protruded tongue toward the left B) Hoarseness due to left vocal cord dysfunction C) Impaired taste sensation from the anterior two-thirds of the tongue
D) Loss of general sensation at the tonsillar lining E) Reduced salivary secretion from the submandibular gland
A) Actin depolymerization B) Carbohydrate degradation C) Elongation factor ribosylation D) Phospholipid splitting E) Plasminogen activation F) Presynaptic acetylcholine release G) T cell hyperstimulation
D) Phospholipid splitting Clostridium Perfirengens
22) A 54-year-old man with a history of hepatitis C infection is brought to the emergency department by his wife after several episodes of vomiting bright red blood. He is admitted to the hospital and the appropriate treatment is initiated.
During morning rounds the next day, the patient is disoriented and cannot identify the month or his current location. Physical examination shows significant abdominal distention and gynecomastia.
3) A study is conducted to assess the effect of beta-blocker therapy in patients with acute myocardial infarction (MI). The study found that 20 patients out of 90 who took a beta-blocker during the week prior to developing an MI had a major arrhythmia event during hospitalization.
The study also determined that 30 patients out of 70 who did not take any beta-blocker developed a major arrhythmia. What was the odds ratio of developing major arrhythmia in patients who took beta-blockers compared to those who did not take beta-blockers?
The patient is initially prescribed clomiphene therapy but fails to conceive. She then receives ovulation induction therapy with a short course of menotropins followed by a single injection of human chorionic gonadotropin (hCG).
The use of hCG therapy primarily mimics which of the following physiologic events? A) Estrogen surge B) FSH surge C) LH surge D) Progesterone surge E) Prolactin surge
16) A 27-year-old man comes to the emergency department due to several hours of right foot pain and swelling. Last night, he was working in the barn and stepped on an old nail.
This morning, the patient awoke with right foot pain near the injury site that has increased throughout the day and is accompanied by progressive swelling. He has no significant past medical history and takes no medications.
5) A 34 year old man comes to the emergency department complaining of weakness, dizziness, and paresthesias involving his face and extremities. He has never had symptoms like this before.
Two hours earlier, he ate fish at a new Japanese restaurant. Neurological examination shows reduced muscle strength and decreased deep tendon reflexes. Which of the following parts of the action potential curve is most likely impaired in this patient?
Several minutes after the infusion is started, she experiences shortness of breath, diffuse itching; and dizziness. Her blood pressure is 64/38 mm Hg and heart rate is 130/min. On examination, there is a diffuse erythematous skin rash and bilateral wheezing is heard on lung auscultation.
Which of the following is most likely to be elevated in this patient's serum as a result of her medication reaction?
everything that you've done. Please accept these tickets and enjoy the game." He tells the physician not to worry about the expense, saying, "I receive free season tickets through my company but haven't felt well enough to make it to the games.
You have been such a wonderful doctor, and I wanted to give you something to express my gratitude." Which of the following responses by the physician is most appropriate? A) "I am touched by your very kind gesture. My family and I love basketball and we'll certainly enjoy the game."
The patients skin is clammy and he is sweating profusely. Impairment of which of the following steps at the neuromuscular junction is most likely responsible for his presentation?
a) A b) B c) C d) D e) E
Which cerebral blood vessels is affected in this patient? a) Cortical branches b) Inferior division of middle cerebral artery c) Lenticulostriate arteries d) Pontine arteries e) Posterior cerebral artery f) Superior division of middle cerebral artery
c) Lenticulostriate arteries
20) An internist is treating a 61 -year-old man who has been hospitalized repeatedly over the last 6 months due to a recent myocardial infarctiom. The patient's condition has slowly improved, although his clinical course was complicated by a pulmonary embolus, urinary tract
infection, and hip fracture from a fall during cardiac rehabilitation. During an outpatient clinic appointment, the patient gives the physician a handmade thank-you card containing 4 courtside tickets to a professional basketball playoff game. He says, "I would like to thank you for
C) Methacholine
to check if patient has *Asthma*
