Uworld 24
***Gallbladder immobility** =
**Biliary sludge**
C) Hemisection of the right side of the cord
**Brown-sequard syndrome**
*Ipsilateral motor paralysis* *Contralateral Pain and temperature*
**Brown-sequard syndrome** = ***Hemisection***
**Animal - Human transmission**
**Campylobacter**
1st puppy had diarrhea and then the child had diarrhea. so this is *Puppy to boy* transmission?
**Campylobacter**
An organism that causes *Animal to human* transmission?
**Campylobacter**
**Last to disappear as the epithelium changes along the respiratory tube?**
**Cilia**
Present throughout the respiratory tract =
**Cilia**
**Dipyridamole** MOA?
**Coronary arteriolar dilatation**
**Cardiac point of maximal impulse that is palpated at the right 5th intercostal space** =
**Dextrocardia**
**Isoniazid** =
**Drug induced SLE**
**Anti-histone antibody positive** =
**Drug-induced SLE**
F) Pica
**Eating ice** leads to *Pica* which causes Anemia
**Hemolytic uremic syndrome** =
**Elevated indirect bilirubin**
**Shiga-like toxin**
**Inactivates ribosomal subunits**
A) Liver acetylation
**Isoniazid**
**Cardiac point of maximal impulse that is palpated at the right 5th intercostal space** =
**Kartagener's syndrome**
A) Bacillary angiomatosis
**Lymphadenopathy** = Cat scratch disease
F) Papillary carcinoma
**Nuclear grooves**
***T-cells*** =
**Paracortex**
**Fell while holding hands and walking with his older sister 2 hours earlier**
**Radial head subluxation** = **Annular ligament** is displaced
so in this question what was the answer, for calculating *Cardiac output* ?
**Rate of oxygen consumption**
what should you check for with *Metformin*?
**Serum creatinine**
again one buzzword you needed to answer this question, is that during *Left-sided heart failure* what will accumulate in the lungs?
**TRANSUDATE**
what will accumulate in lungs during *left-sided heart failure*?
**TRANSUDATE**
**Left -sided heart failure** leads to ?
**TRANSUDATE** accumulation in the lungs
How to treat *gynaecomastia*?
**Tamoxifen**
**Left-sided heart failure** leads to accumulation of fluid in the *Lungs*
**Transudate accumulating in the alveolar lumen**
*Codons* producing *same amino acids*.
**Wobble**
Female non-smoker =
*Adenocarcinoma*
A) Cilia
*Cilia are present throughout the respiratory tract* from top to bottom, hence they are the *Last to disappear*
C) Clindamycin
*Gardenerella* treatment
*Anterior Pituitary* comes from=
*Surface ectoderm*
**Thyroid drugs** cause?
**Agranulocytosis**
After instruction on dietary modification and exercise, it is decided that the patient would benefit from metformin therapy. Which of the following tests should be obtained before initiation of metformin?
A) 3-hour oral glucose tolerance test B) 24-hour urinary vanillylmandelic acid excretion C) Complete blood count D) Serum creatinine E) Serum potassium level F) Serum TSH level
Stool cultures reveal an Escherichia coli strain that does not produce glucuronidase and does not ferment sorbitol on sorbitol-containing MacConkey agar. Which of the following best describes the mechanism of action of the toxin produced by these bacteria?
A) Activates adenylate cyclase B) Activates guanylate cyclase C) Disrupts the cellular cytoskeleton D) Inactivates elongation factor-2 E) Inactivates ribosomal subunits
Wet mount of the discharge shows large, atypical vaginal epithelial cells and no protozoa. Application of potassium hydroxide (KOH) solution to the discharge yields a strong fishy odor. Which of the following is the best treatment option for this patient?
A) Acyclovir B) Azithromycin C) Clindamycin D) Fluconazole E) penicillin
A) Adenosine B) Aldosterone C) Angiotensin II D) Glucagon E) Glycine F) Norepinephrine
A) Adenosine Adenosine = increasing the Refractory period
She has a fine hand tremor on examination. Chest auscultation reveals mild expiratory wheezing. Her serum theophylline levels are markedly elevated. Treatment with which of the following agents most likely precipitated her current symptoms?
A) Amoxicillin B) Cephalexin C) Ciprofloxacin D) Haloperidol E) Nitrofurantoin
A) Annular ligament B) Biceps tendon C) Interosseous membrane D) Radial collateral ligament E) Ulnar collateral ligament
A) Annular ligament
The patient was prescribed twice-daily iron for anemia but does not take it.She does not use tobacco. Uterine fundus is consistent with a 16-week pregnancy. Fetal heart tones are in the 140s. The patients other vital signs are within normal limits. What is the diagnosis?
A) Anorexia nervosa B) Bulimia nervosa C) Hyperemesis gravidarum D) Normal pregnancy craving E) Olfactory craving F) Pica
Several scratch marks are seen on the right arm. The organism responsible for the lymphadenopathy is also associated with which of the following conditions?
A) Bacillary angiomatosis B) Bladder cancer C) Condylomata acuminata D) Hemolytic uremic syndrome E) Malignant external otitis F) Toxic shock syndrome
A) Biliary sludge B) Black pigment stones C) Brown pigment stones D) Cystine stones E) Uric acid stones
A) Biliary sludge Gall bladder immobility -> leads to *stasis* of gall juice = Biliary sludge
7) Molecular biologists studying signal transduction apply an agent to human cells that activates G-protein- dependent phospholipase C. Which of the following intracellular substances is most likely to increase immediately after exposure to this agent?
A) Ca2+ B) cAMP C) cGMP D) Cl- E) mRNA F) NO
22) Bronchi are lined with pseudostratified epithelium. As the airways continue distally, the epithelium changes. Which of the following features is last to disappear as the epithelium changes along the respiratory tube?
A) Cilia B) Goblet cells C) Mucous glands D) Serous glands E) Cartilage
MRI of this patient's spine will most likely reveal which of the following?
A) Complete transection of the spinal cord B) Damage to the cervical dorsal roots on the right side C) Hemisection of the right side of the cord D) Lesion of the dorsal columns on the right side E) Lesion of the medial longitudinal fasciculus on the right side
Laboratory evaluation shows anemia, thrombocytopenia, and elevated blood urea nitrogen and serum creatinine. Which of the following findings is most likely to be seen in this patient?
A) Elevated haptoglobin level B) Elevated serum indirect bilirubin C) Elevated thrombin and prothrombin time D) Low fibrinogen and elevated D-dimer level E) Positive Coombs test F) Positive Streptozyme test
Which of the following best describes the virus most likely responsible for this patient's current condition?
A) Enveloped double-stranded DNA virus B) Enveloped negative-sense RNA virus C) Enveloped positive-sense RNA virus D) Nonenveloped double-stranded DNA virus E) Nonenveloped positive-sense RNA virus F) Nonenveloped single-stranded DNA virus
However, when the light is immediately moved to the right eye, her pupils appear to dilate. This patient's symptoms are most likely due to a left-sided lesion involving which of the following structures?
A) Frontal eye fields B) Lateral geniculate nucleus C) Meyer's loop D) Optic radiation E) Optic tract F) Visual cortex
Which of the following histologic features is most likely to be newly present in this patient's lung tissue?
A) Transudate accumulating in the alveolar lumen B) Scattered necrosis with alveolar hemorrhage C) Numerous hemosiderin-laden macrophages in alveoli D) Prominent interstitial infiltration with mononuclear cells E) Alveolar fluid rich in neutrophils F) Fat microglobules in pulmonary arterioles
The only option left to fill in additionally to the AV oxygen gradient is *Rate of oxygen consumption* .
so now you additionally need the *Rate of oxygen consumption* to calculate the *Cardiac output*
35) A new test to diagnose urinary tract infections in women is being evaluated. plus urine culture. The comparison gold standard is positive urine dipstick plus urine culture. Results of the study are given below.
what is the new test's specificity? a) 10% b) 30% c) 50% d) 70% e) 90%
32) A 78-year-old woman is brought to the hospital due to 2 days of nausea, vomiting, abdominal pain, and headache. The patient has a history of chronic obstructive pulmonary disease for which she takes theophylline.
She was recently hospitalized for a stroke which was complicated by a urinary tract infection and delirium. The patient appears agitated and restless. Her temperature is 37 C (98.6 F), blood pressure is 110/70 mm Hg, pulse is 118/min, and respirations are 22/min.
*Right sided hemiparesis* *Left loss of pain and temperature*
= ***Hemisection***
Watchman does not check Ramya's ID and allows her into the college thinking she is Reshmi. Ramya goes into Reshmi's college and collects her grade sheet.
Alanine goes to take cysteine's mark sheet and now has cysteine's grade with which she gets a job as cysteine.
40) A researcher develops 2 functional mRNA sequences composed of CUC and CUU trinucleotide repeats, respectively. He subsequently incubates these mRNAs in a solution containing functional ribosomes and tRNAs charged with the appropriate amino acids.
After several hours, it is found that both mRNA sequences produce polypeptide chains containing leucine repeats. This observed finding is due to which of the following genetic principles?
Patient is interested in decreasing her chances of developing new polyps and colon cancer. Physician discusses exercise, healthy weight, and dietary factors associated with reduction of colon cancer risk, including increased fiber intake.
Also recommended Reduced consumption of refined sugars and fat. Which of the following enzymes could be inhibited with medication to further reduce this patient's risk of developing recurrent adenoma?
15) A 56-year-old Caucasian male presents to the emergency department with a six-hour history of burning substernal pain. His past medical history is unremarkable and he takes no medications. He smokes two packs of cigarettes every day and consumes alcohol occasionally.
An ECG performed in the emergency department reveals ST segment elevation in leads I and V3-V6. During the next several hours, the patient develops progressive shortness of breath. He is unable to lie still in the bed and insists on sitting up.
The patient has no other significant past medical or family history. His examination is unremarkable. Laboratory results are as follows:
An abnormality in which of the following metabolic processes most likely underlies this patients current condition? A) Liver acetylation B) Liver hydrolysis C) Liver hydroxylation D) Liver sulfate conjugation E) Plasma hydrolysis F) Unchanged excretion
**Prolactinoma** comes from =
Anterior Pituitary
F) Nonenveloped *single-stranded DNA virus*
Aplastic Anemia - Parvovirus
3) A 54-year-old man is admitted to the hospital due to cough, shortness of breath, and chest discomfort. He has a known history of coronary artery disease and underwent coronary artery bypass graft surgery 3 years ago.
As a result of drug therapy, the left ventricular pressure-volume loop changes from a solid to a dashed line as shown on the graph below.
9) An 8-year-old male is brought to the ER with a two day history of fever, abdominal pain and diarrhea. Careful history taking reveals that the patients pet puppy had diarrhea one week ago.
Aside from the present episode, the patient has no significant past medical history and all of his vaccinations are up-to-date. His stool is negative for ova and parasites. Which of the following is the most likely cause of this patient's symptoms?
A) Sodium B) Calcium C) cAMP D) DAG E) cGMP
B) Calcium
A) Epicardial vessel dilation B) Coronary arteriolar dilation C) Systemic venous dilation D) Systemic arterial dilation E) Mixed arterial and venous dilation
B) Coronary arteriolar dilation - Dipyridamole : Coronary steel phenomenon
so again why is the answer here *Increased stroke volume*?
Because the distance between *Aortic valve opening* and *Aortic valve closing* has increased which indicates increased *stroke volume*
why is the answer not A) Arteriovenous difference in oxygen content ?
Because they have already given the values for *Arterial oxygen content* and *Venous oxygen content* separately in the question, from which we can calculate the Arteriovenous gradient.
E) Inactivates ribosomal subunits
Bloody diarrhea: EHEC **Shiga-like toxin**
A) "I am very concerned because uncontrolled diabetes can result in dangerous medical complications." B) "I can understand how it might be difficult to take medication daily when you're feeling good.'
C) "It seems that you don't understand the risks of untreated diabetes. Let me explain more about it." D) "Its very important to take your medication regularly, even when you are feeling good." E) "You must try to be more responsible in taking your medication."
A) Staphylococcus aureus B) Shigella C) Campylobacter D) Bacillus cereus E) Vibrio parahemolyticus F) Giardia lamblia
C) Campylobacter - *Animal- Human transmission*
A) Angiotensin-converting enzyme B) Caspase C) Cyclooxygenase-2 D) Glutamate dehydrogenase E) Phenylalanine hydroxylase F) Xanthine oxidase
C) Cyclooxygenase-2
Which of the following is most likely to be dysfunctional in this patient? A) Cl complement component B) Chloride channels C) Dynein arms D) IL-2 receptors E) Immunoglobulin gene rearrangement F) NADPH oxidase
C) Dynein arms - Kartagener's syndrome
Which of the following medications is most likely to prevent recurrent stone formation in this patient? A) Acetazolamide B) Furosemide C) Hydrochlorothiazide D) Mannitol E) Spironolactone F) Triamterene
C) Hydrochlorothiazide Hyper GLUC - Hypo KMN Hyper glycemia, Lipidemia, urecemia, Calcemia Hypo Kalemia, Magnesimia, Natremia
Which of the following is most likely to occur to this alanine residue during polypeptide synthesis of alpha-hemoglobin? A) It will be incorporated into the polypeptide chain at a site requiring alanine B) It will be incorporated into the polypeptide chain at a site requiring cysteine
C) It will be randomly incorporated into the polypeptide chain, halting chain elongation D) It will be rapidly cleaved off tRNA by the enzyme glycosylase E) It will never be incorporated into the polypeptide chain and will remain attached to tRNA
A) Charged tRNA B) Elongation factor 2 C) Releasing factor 1 D) snRNP E) Transcription factor Il D F) Uncharged tRNA
C) Releasing factor 1 UAA UAG UGA - STOP codons
21) A 65-year-old woman comes to the office after finding blood in her stool. She is physically active and exercises regularly. She does not use tobacco or alcohol. She has no history of peptic ulcer disease. Her physical examination is unremarkable.
Colonoscopy reveals several large adenomatous polyps with severe dysplasia in the sigmoid colon. She undergoes resection of the sigmoid colon, and her carcinoembryonic antigen level is normal.
Aminoacyl-tRNA synthetase function is to proofread things. But if a misplaced amino acid gets pass the *Aminoacyl-tRNA* synthetase then that is *Irreversible* and the mischarged codons will not rectify.
Cysteine on the t-RNA is modified to alanine. But now this alanine will go and incorporate into a site requiring Cysteine.
The agent used to treat this patient's infection affects which of the following bacterial processes? A) DNA winding-unwinding B) Folic acid utilization C) Glycopeptide polymerization D) Maintenance of membrane potential E) Ribosome assembly
D) Maintenance of membrane potential - Daptomycin
A) Cortical follicles B) Medullary sinuses C) Medullary cords D) Paracortex region E) Subcapsular sinuses
D) Paracortex region **Digeorge = T cell deficiency**
A) Arteriovenous difference in oxygen content B) Oxygen-binding capacity of hemoglobin C) Percentage of hemoglobin saturation D) Rate of oxygen consumption E) Respiratory quotient
D) Rate of oxygen consumption
Arteriolar vasodilators -Minoxidile/Hydralazine - Blood vessels -Dipyridamole - Heart Arterial vasodilator -Cilostazole
Dipyridamole is a arteriolar *vasodilator*. In Non-ischemic areas, *Dipyridamole*, will increase arteriolar vasodilation. Blood supply will get reduced in ischemic areas. Therefore this will aggravate the hypo perfusion and ischemia.
**Daptomycin** Mechanism of action ?
Disrupts *Membrane potential*
If a patient has TB, is treated and then develops joint pains and has anti-histone antibodies in the serum, think of ?
Drug-induced SLE = Isoniazid = Acetylation
Which of the following medications, if initiated early, could have most effectively prevented this patient's current problem? A) Bicalutamide B) Danazol C) Finasteride D) Spironolactone E) Tamoxifen
E) Tamoxifen Treatment for: Gynaecomastia - prevents effects of estrogen on breast: Breast antagonist
A) Empirical oral antibiotics B) Erythrocyte sedimentation rate and anti-neutrophil antibodies C) Ibuprofen and oral hydration D) TSH and T4/T3 levels E) White blood cell count with differential
E) White blood cell count with differential Propylthiouracil & Methimazole cause *Agranulocytosis*
A) Ambiguity B) No punctuation C) Transition D) Universality E) Wobble
E) Wobble - multiple codons producing the *same amino acid*
10) A 54-year-old man is being evaluated for exertional dyspnea that started 6 months ago. The patient has no associated cough or wheezing. There is no known history of heart disease in his family.
ECG, chest x-ray, exercise stress test, and echocardiogram are obtained to evaluate his symptoms. He subsequently undergoes right and left cardiac catheterization. What additional information is necessary to calculate cardiac output in this patient?
6) An infant is born with facial dysmorphia and a cleft palate. Further evaluation reveals a heart condition with a right-to-left shunt and the absence of a thymic shadow on x-ray. The infant experiences frequent and recurrent sinopulmonary infections.
Examination of this patient's lymph nodes will most likely show poor development of which of the following structures?
B) Elevated serum indirect bilirubin
FAT -Fever -Anemia -Thrombocytopenia = Hemolytic uremic syndrome
A) Acute stress disorder B) Adjustment disorder C) Brief psychotic disorder D) Depersonalization/derealization disorder E) Major depressive disorder F) Nightmare disorder G) Post-traumatic stress disorder
G) Post-traumatic stress disorder
COX-2 is involved in Adenoma-carcinoma conversion.
Hence inhibiting COX-2 with *Aspirin* prevents the conversion of the adenoma into the carcinoma
8) A 55-year-old nurse was started on multidrug therapy 3 weeks ago to treat pulmonary tuberculosis contracted from a former patient. He comes to his primary care provider due to fatigue and low-grade fever for several days.
He also has had muscle aches and severe joint pain in his elbows, wrists, and knees. The patient says, "I don't think it's the flu; I had the vaccine months ago." He has no current respiratory symptoms apart from pleuritic chest pain.
26) A 45-year-old woman comes to the office due to several months of episodic right upper quadrant abdominal pain associated with nausea. The pain is often brought on by fatty meals and subsides in 1-2 hours. She has no fever, vomiting, diarrhea, melena, or bright red blood per rectum.
Her BMI is 31.2 kg/m2. Physical examination is unremarkable. A cholecystokinin stimulation test is performed and shows slow and incomplete gallbladder emptying. This patient is most likely to have which of the following pathologic findings?
16) A 62-year-old woman comes to the physician with decreased vision. Over the last 6 weeks, she has had progressive difficulty with visualizing objects on her right side. She also has intermittent headaches that are worse in the morning.
Her past medical history is significant for non-small cell lung carcinoma that was diagnosed 2 years ago and treated surgically. Physical examination shows right homonymous hemianopia. When light is shone in the left eye, both pupils constrict.
1) A 25-year-old woman comes to the emergency department due to 2 days of abdominal pain and bloody diarrhea. A few days ago, she attended a church barbeque party. She does not know if anyone else at the party developed similar symptoms.
Her temperature is 37.1 C (98.8 F), blood pressure is 119/76 mm Hg, pulse is 92/min, and respirations are 16/min. There is abdominal tenderness with no rebound or guarding. Guaiac-positive bloody stools are detected on rectal examination.
34) Electric stimulation of the musculocutaneous nerve causes a rapid twitch of the biceps muscle. Electron microscopy shows numerous vesicles within the musculocutaneous nerve terminals.
In order for these vesicles to release their contents into the synaptic cleft, which of the following substances is required?
Cardiac output = Rate of oxygen consumption/ arteriovenous oxygen content difference
In this question, they have already given the *Arterial oxygen content* and *Venous oxygen content* separately, so thats why option A) is not the answer, because its already given in the question and we do not need to calculate it.
19) A 55-year-old woman comes to the physician because of a persistent cough and recent, unintentional weight loss. She has never smoked and has no history of exposure to industrial pollutants. There is decreased breath sounds and dullness to percussion at the left lung base.
Imaging studies show an irregular mass in the lower lobe of her left lung and a left-side pleural effusion. A diagnostic thoracocentesis is performed and the aspirated fluid is sent for cytological evaluation. If a malignancy is diagnosed it is most likely to be which of the following types?
This guy has *Left-sided* heart failure and is being treated with a drug. What will this drug mostly do?
Increase *Stroke volume*
20) A pharmaceutical researcher develops a new drug that affects bacterial protein synthesis. In an experiment, Escherichia coli is exposed to the drug and serially cultured in media containing tagged nucleotides and amino acids.
It is found that the drug inhibits molecules that recognize the highlighted codon in the bacterial mRNA fragment shown in the image below. Which of the following molecules is the most likely target of this drug?
D) Serum creatinine
Metformin
what is the difference between *Arteriolar vasodilators*?
Minoxidil/ Hydralazine- Blood vessels Dipyridamole- Coronary
How do you know that this person has an increase in *Stroke volume* ?
Name the graph as COCO MAAM. Now trace the graph from Aortic opening to Aortic closing because that is when the *Stroke volume* happens. When the graph goes from AV opening to AV closing, and this space widens, think of *Stroke volume*
18) A 22-year-old man is brought to the emergency department by ambulance after a fight in a bar during which he suffered a knife wound to his neck. The patient is in moderate distress, but vital signs are stable and he is alert and can follow commands.
Neurologic examination shows right-sided hemiparesis. There is a loss of proprioception and vibratory sensation below the C8 dermatome on the right side. On the left side, there is loss of pain and temperature sensation below the T2 dermatome.
23) A 14-year-old girl comes to the emergency department due to rapidly progressive exertional dyspnea and generalized weakness, which were preceded by a mild febrile illness several days ago. She has a history of sickle cell disease and takes a daily folic acid supplement.
On examination, the patient has conjunctival pallor but no icterus. A cardiac flow murmur is present. The abdomen is soft and nontender with no organomegaly. Laboratory studies show a hematocrit of 16% with reticulocyte count of 0.1% (normal range; Leukocyte and platelet counts are normal.
37) A 3-year-old boy is brought to the emergency department for refusal to move his right upper extremity. His mother states that the child was fine this morning. She recalls that he fell while holding hands and walking with his older sister 2 hours earlier.
On physical examination, he holds his right upper extremity at his side with his elbow extended and forearm pronated. Any motion of the right elbow produces pain. There are no visible bruises or edema. Which of the following structures is most likely injured in this patient?
2) A 38-year-old woman is brought to the hospital after a motor vehicle accident. She says she sustained no injuries in the collision, but is adamant that she did not see the car that hit her along the front side of her vehicle.
On review of systems, she admits to having headaches almost daily and says that she has not menstruated in 4 months. Physical examination reveals bitemporal hemianopsia. A magnetic resonance imaging scan of her head is shown below.
Right homonymous hemianopia =
Optic tract
**Nuclear grooves**=
Papillary carcinoma
A) Ca2+
Phospholipase *C*
24) A 22-year-old woman comes to the physician with a fever and sore throat. Her medical history is significant for Graves' disease, for which she takes an antithyroid medication. She works as a teacher at an elementary school
Physical examination shows an erythematous pharynx but is otherwise insignificant. Which of the following is the best next step in management of this patient?
but what is the actual formula for calculating the cardiac output?
Rate of oxygen consumption / Arteriovenous oxygen content difference
again how to calculate the *Cardiac output* ?
Rate of oxygen consumption/ Arteriovenous oxygen content difference
what is the formula for *Cardiac output* ?
Rate of oxygen consumption/ Arteriovenous oxygen content difference
B) It will be incorporated into the polypeptide chain at a site requiring cysteine
Reshmi= Cysteine Ramya= Alanine Watchman= t-RNA synthetase
E) Optic tract
Right homonymous hemianopia.
**Drug-induced SLE** =
SHIPE Sulfonamides Hydralazine *Isoniazid* Procainamide Etanercept
30) A 21 -year-old woman, gravida 1 para 0, comes to the office for a prenatal visit. She is at 16 weeks gestation. The patient, who has lost 2.3 kg (5 1b) since her latest prenatal visit 4 weeks ago, has occasional nausea with vomiting once a week.
She has no constipation or diarrhea and no dysuria, chills, or fever. The patient has little appetite, and her food consumption has decreased. However, she craves ice and consumes it throughout the day. Her medications include daily prenatal vitamins. T
14) A 51 -year-old woman comes to the physician for a routine follow-up appointment She appears in good health and has no complaints. Physical examination shows a nodule in the left lobe of the thyroid.
She has no family history of thyroid cancer and has had no prior radiation exposure. Thyrotropin-stimulating hormone level is normal. Thyroid ultrasound shows a hypoechoic nodule in the left lobe of the thyroid with increased central blood flow.
39) A 21 -year-old woman comes to the office at her mother's urging due to significant sleep disturbance. Three months ago, the patient was sexually assaulted in the parking lot of her workplace.
Since then, she has had recurrent nightmares about "being chased by someone who wants to hurt me" and dreads falling asleep at night. During the day, the patient sometimes "spaces out" and feels like she is "back in the parking lot."
**Prolactinoma** =
Surface ectoderm
4) A 34-year-old woman comes to the office due to 3 days of discomfort and swelling in the right axilla. The patient has no known medical problems. She is the local community veterinarian and volunteers as a swim coach at her children's school. She owns a parrot and a hamster.
Temperature is 36.9 C (984 F). On physical examination, there is an enlarged, tender axillary lymph node on the right, measuring about 3 cm and with slight surrounding erythema but no skin breakdown. There is no other area of lymphadenopathy present.
5) Atherosclerotic lesions involving the coronary arteries limit blood flow to portions of the myocardium supplied by the affected vessels.
The administration of certain medications can cause a redistribution of blood flow away from ischemic areas, exacerbating existing myocardial ischemia. A drug that causes which of the following effects is most likely to be associated with this phenomenon?
31) In an experiment, erythrocyte precursor cells are incubated in a medium containing radiolabeled cysteine. These radiolabeled cysteine residues are attached to their appropriate tRNAs by the enzyme aminoacyl-tRNA synthetase.
The bound cysteine residues are then chemically modified to form alanine. The end product of this reaction is a tRNA molecule that contains the cysteine anticodon but is mischarged with alanine.
25) A 5-year-old boy is brought to the emergency department due to 2 days of dark, low-volume urine and decreased energy. The parents say that the boy had abdominal pain, fever, and bloody diarrhea for 4 days, which resolved about 3 days ago without treatment.
The day before the onset of symptoms, the patient swam in a lake and ate hamburgers at a family picnic. His vital signs are within normal limits. Physical examination shows pallor but is otherwise normal. He has no peripheral edema or rashes.
27) A 35-year-old woman comes to the emergency department due to 4 days of persistent fever and malaise. She was recently diagnosed with depression and takes citalopram.
The patient also has a history of intravenous heroin use, which she had stopped 10 years ago following an episode of infective endocarditis; however, she recently relapsed and started using intravenous drugs again.
36) A 32-year-old woman comes to the office due to a small amount of malodorous vaginal discharge. She is sexually active with her male partner and uses condoms sporadically.
The patient also requests testing for all sexually transmitted diseases as she is unsure if her partner is monogamous. She smokes 2 packs of cigarettes daily and had an abnormal Papanicolaou test in the past. Speculum examination reveals thin gray discharge.
33) A 46-year-old man comes to the emergency department with flank pain and hematuria. The pain is similar to several previous episodes when he was diagnosed with kidney stones. Abdominal imaging shows a radiopacity in the right ureter.
The patient is admitted to the hospital and started on intravenous hydration and analgesics. He subsequently passes the stone and becomes asymptomatic. Chemical analysis of the stone reveals calcium oxalate composition.
She is allergic to vancomycin. Cardiovascular examination reveals an early systolic murmur at the left lower sternal border. The extremities have several needle marks. Chest x- ray is unremarkable. Blood cultures grow methicillin-resistant Staphylococcus aureus.
The patient is started on a once-daily intravenous antibiotic. A week later, she develops muscle pains and is found to have an elevated creatine phosphokinase level. The symptoms improve within days of stopping the antibiotic.
38) A 72-year-old man comes to the emergency department due to severe chest tightness and dyspnea, which started several hours ago at a family dinner. He has never experienced similar symptoms.
The patient's medical problems include hypertension, hyperlipidemia, type 2 diabetes mellitus, and prostate cancer. He has smoked a pack of cigarettes daily for 30 years and stopped smoking 10 years ago. Chest CT scan.
17) A 60-year-old woman comes to the office to discuss newly diagnosed type 2 diabetes mellitus. She was recently seen at an urgent care center, where her nonfasting capillary blood glucose level was 190 mg/dL. A subsequent hemoglobin A1C measurement was 85%.
The patients past medical history is insignificant, though she had not seen a health care provider for several years prior to this episode. Her BMI is 31.5 kg/m2. She does not use tobacco or alcohol.
12) A 4-year-old boy is brought to the emergency department for difficulty breathing and a productive cough. He has a past medical history of recurrent episodes of sinusitis and otitis media.
The respiratory infections typically have a protracted course but respond to high-doseantibiotic therapy. Pulmonary auscultation shows crackles and wheezing. Cardiovascular examination shows a cardiac point of maximal impulse that is palpated at the right 5th intercostal space.
At other times, she feels a sense of unreality as if she is outside her body and the assault happened to someone else. The patient has become withdrawn and avoids her friends. She has lost interest in her hobbies of writing poetry and exercising and has not returned to her job.
There is a family history of depression in the patient's mother. Which of the following is the most likely diagnosis?
How to treat MRSA?
Vancomycin Daptomycin - In this patient we cannot use Vancomycin because our patient has Vancomycin allergy. - So here use Daptomycin
b) B Inferior Vena cava
Usually you put a filter in the *IVC* for preventing pulmonary embolism. so you basically need to identify where the IVC is in the picture.
11) A 45-year-old woman comes to the office for an initial visit after recently moving to the community Her medical history includes obesity and type 2 diabetes mellitus. Her current glycated hemoglobin level is 10%. Patient has been using oral hypoglycemic drug for past few years.
When the physician asks how she is doing with her medication, she replies, "I use it most of the time but its easy to forget when I am feeling good." Which of the following statements is most appropriate to begin a discussion about the patient's non-adherence to her medication?
Fine-needle aspiration of the nodule is performed, and cytology shows clusters of overlapping cells with large nuclei containing sparse, finely dispersed chromatin. Numerous intranuclear inclusion bodies and grooves are also seen.
Which of the following is the most likely diagnosis? A) Anaplastic carcinoma B) Colloid nodule C) Follicular adenoma D) Follicular carcinoma E) Medullary carcinoma F) Papillary carcinoma
13) Electrophysiologists conduct a study in which they record the membrane potential changes of cardiac cells while exposing them to various agents. A tracing from one of the experiments is shown below.
Which of the following substances was most likely applied to the cells at the point indicated by the arrow?
29) A 65-year-old man comes to the office to follow up for advanced prostate cancer with bone metastases. He has been treated with a gonadotropin-releasing hormone agonist for the last 4 months.
With treatment, the patients bone pains have subsided significantly, but he now reports discomfort at the anterior chest wall. Physical examination shows bilateral, mildly tender enlargement of the breast tissue behind the nipple-areolar complex.
A cut of this patient's abdominal CT at the level of L2 is shown in the image below. The filter will most likely be placed in which of the following structures?
a) A b) B c) C d) D e) E
A) Squamous cell carcinoma b) Adenocarcinoma c) Mesothelioma E) Small cell carcinoma F) Large cell carcinoma
b) Adenocarcinoma
which of the following factors contributed to this patient's current condition? a) atherosclerosis b) Fluid overload c) Hypercoagulability d) Infectious vasculitis e) Intimal tear f) Noninfectious vasculitis g) Pulmonary bleb rupture h) Pulmonary metastasis
c) Hypercoagulability Diagnosis: Pulmonary embolism is due to *Hypercoagulability*
which of the following parameters is most likely to increase as a result of this change? a) End-diastolic pressure b) End-systolic volume c) Stroke volume d) Ventricular afterload e) Ventricular preload
c) Stroke volume
which of the embryologic layers does this woman's lesion most likely originate? a) Endoderm b) Mesoderm c) Neural crest d) Neural tube e) Notochord f) Surface ectoderm
f) Surface ectoderm **Prolactinoma**
*e) Alveolar fluid rick in neutrophils* is WRONG because here we do NOT have an infection so *NO neutrophils* will be involved.
here we have *Heart failure*. Neutrophils means exudate. in Heart failure we do NOT have *exudate* because there is NO infection. we ONLY have *Transudate* in heart failure.
Whenever there is an occlusion, *Dipyridamole* will cause *Coronary steel phenomenon*. Dipyridamole is a arteriolar *vasodilator*.
in Non-ischemic areas, *Dipyridamole*, will increase arteriolar vasodilation. Blood supply will get reduced in ischemic areas. Therefore this will aggravate the hypo perfusion and ischemia.
28) A 63-year-old man comes to the emergency department due to sudden-onset shortness of breath. He has a history of recurrent gastrointestinal hemorrhage and was discharged from the hospital 4 days ago following a prolonged admission for diverticular bleeding requiring
multiple blood transfusions. The patient's pulse oximetry shows 94% on room air. Evaluation shows deep venous thrombosis and pulmonary embolism. A filter placement is planned to prevent further embolization.
