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NBME 30 questions and answers with rated solutions
56 y/o F comes to physician 3 wk hx increasing weakness of arms and legs. - Smoking - Weakness of hip girdle muscles, lesser weakness of shoulder girdle ... [Show More] muscles. - Weakness improves with repetitive testing. - Hilar lung mass What's impaired: - Acetylocholinesterase - Binding of ACh on postsynaptic membrane - Direct depolarization of muscle by Ca - Postsynaptic membrane potential - Presynaptic release of ACh Presynaptic release of ACh - Lambert Eaton myasthenic syndrome (ab to voltage-gated calcium channels on presynaptic LMNs, which decreased calcium influx and ACh release to postsynaptic SkM cells 23 y/o F 1 wk history of intermittent fever, chills, rash - Hx 4 operations (1) scoliosis, (2) tonsillectomy, (3) appendectomy, (4) lipoma. - Hx admission for N/V - Dermabrasion to correct acne scarring - PE: 12 evenly spaced punctate marks in linear patten on abdomen and UE, LE Diagnosis? - AML - Factitious d/o - ITP - Lyme disease - Syphilis Factitious disorder - patients produced symptoms for primary gain. Primary gain is motivation to be cared for, which constitutes unconscious motivator in patients production of symptoms. "Care seeking" tx - regular f/u with one physician who oversees management & psychotherapy 00:37 01:25 An investigator is studying the adverse effects of a proteasome inhibitor, bortezomib, on immune responses. Administered to group of pts with relapsed MM and immune response observed. Which immunologic processes affected by drug? - Activation of complement cascade - Activation of perforin - Presentation of antigens to CD8+ T lymphocytes - Secretion of histamine by mast cells - Secretion of IL-1 by macrophages Presentation of antigens to CD8+ T lymphocytes - Proteasomes ar elarge proteases with numerous domains that ar epresent in cytoplasm adn nuceli. Made of alpha nd beta subunits and have extensive role in cell cycle regulations and immune function. Caspase, chymotrypsin, and trypsin-like protease capabilities of this enzyme complex are critical to their role as APC; intracellular peptides are processed in teh proteasomme for presentation on Class I MHC. Which are regogized by CD8 T lympocytes. 12 y/o girl sliced her left palm with a knife. Would is cleaned and suture. One week later, sutures are removed. At this time, which of the following factors is most instrumental in migration fo fibroblasts into area of would healing? - collagen - fibronectin - heparin - IG - plasminogen Fibronectin. Collagen is then synthesized by the fibroblasts. What is the most common brain tumor in adults? Meningiomas - most common primary brain tumor. Patients may be asymptomatic or experience seisures or focal neurologic deficits related to tumor locaiton. Malignant ones may grow rapidly - leading to symptoms of ICP Glioblastoma highly malignant brain tumor in intraaxial mass in cerebral hemispheres, which typically demonstrate areas of necrosis and can spread to opposite hemisphere across corpus callosum. infant understanding of death zero 4 year old understanding of death temporary and reversible 20 y/o man with 4hr history abd pain, N/V. Binge drinking all weekend. Three doses of tylenol for HA. Increased risk for liver injury why? Induction of CYP450 that activate acetaminophen to a hepatotoxic metabolite. Ethanol lead sto induction of P450 enzymes that result in increased production of NAPQI when high doses of tylenol taken. depletin of glutathione. give NAC. translocations balanced - no significant consequence unless the break point affects a regulatory sequence or section of an exam that results in reduced or absent translation of encoded protein. regulatory sequences: promoters, enhancers, silencers Frank Starling mechanism relationship between cardiac output and LVEDV - preload. CHF - line falls down AVM - increased CO per this relationship Tamponade - decreased ventricular filling but no change on this curve Cor pulmonale - RVF from chronic pulm HTN no change on this curve Restrictive cardiomyopathy - decreased compliance of ventricular wall disatolic dysfunction and preserved LV systolic function (CO would be preserved) renal autoregulation relatively constantly GFR despite change sin glomerular perfusion and is mediated by delivery of filtered sodium to macula densea in ealry DCT. in Renal a. stenosis, there is a decreased glomerular perfusion --> decreased filtration and decreased sodium delivery to macula densa. COmpensates by promoting activatoin of RAASD system --> constriction of efferent arteriolar. Induces increased intraglomerular pressure to maintain GFR. 00:11 01:25 Round ligament fibromusclar band of tissue that extends from superolateral part of uterus where fallopian tubes insert, passes through the inguinal canal, ends in labia majora. remnant of gubernaculum. this is stretched in preganancy --> pain an investigator is conducting a study of the effetcs of a newly discovered spider venom on NM transmission. Isolated nerve muscle prepartion is bathed in a solution containing the venom; there is a decreased in teh end-plate potential amplitude following stimulation of the nerve. Presence of venom does not change the amplitude of the nerve AP or the repsosne to exogenous acetylcholine. BLockage of which fo the following is the MOA? - Chloride conductance - Function of acetylocholinesterase - Inactiavte of voltage-gated Na channels in muscle - Insertion of AChR into muscle membrane - Presynaptic, voltage-gated calcium channels Presynaptic, voltage-gated calcium channels decreased end-plate potential amplitude. normallY: AP --> depolarization of terminal bouton of axon --> presynaptic voltage-gated Ca channels consequently open and allow calcium influx which tiggers exocytosis of ACh filled vesicle sinto synaptic cleft. brief psychotic disorder characterized by acute onset of one or more psychotic symptoms (delusions, hallucinations disorganized speech, d/o behavior) lasting less that one month. schizoaffective = 6 m/o vasopressin is made in the paraventricular and supraoptic nuclei transformation required ____ DNA naked (not a/w proteins/lipids/molecules) Waardenburg syndrome syndrome of pathy depigmentation of skin, ahir, irises, cochlear dyscuntion AD neural crest cells do not properly differentiare into melanoblasts - white forelock, eyelashes, depigmented skin patches, iridic heterochromia, sensorineural deafness, eyes may be laterally displaced Glucose-dependent insulinotropic peptide (GIP) secreted by duodenum & jejunum (K cells), paracrine and classical signaling to pancreas. Stimulates insulin secretion, triggered by glucose in the duodenum. to decreased gastric acid production and stimulate insulin release from pancrease RR = x per 10,000 / y per 10,000 RR = x/y obese vs. non obese same drug administered greater volume of distribution os takes longer ot get to therapeutic dose pores of Kohn connections between alveoli and are present in normla lung tissue. type II alveolar cell sand llow for the passage of air, gluid, phagocytes, and in the setting of pneumonia, bacteria between adjacent alveoli PKU patient supplement with what for catecholamine production tyrosine (can't convert phenylalanine to tyrosine) PO2 in the renal vein is high compared with venous PO2 from other organs. What explains this finding? blood flow per gram of tissue is greater in kidneys than in other organs it is in excess of what is needed to meet its metabolic demands Gerstmann syndrome Angular gyrus lesion finger tap agnosia, alexia (inability to read), acalculia (inability to use arithmetic operations), agraphia (inability to copy), and left-right confusion. Dejerine-Roussy syndrome dorsolateral thalamus stroke connects wiht the limbic system adn may mediate emotional aspects of pain. post-stroke intractable pain known as thalamic pain syndrome Wallenberg syndrome lower medulla (lesions may affects nuceli of multiple CNs, spinal trigeminal nucleus, solitary nucleus, vestibular nuclei, nucleus ambiguus, the sympathetic, spinothalamic, and spinocerebellar tracts. ipsilateral facial numbness, impaired taste sensation, vertigo with nystagmus, dysphonia, dysgia, Horner syndrome, pain and temperatiev sensation deficits in the contralateral arms and legs and/or ipslateral ataxia. constellation of symptoms is wallenberg syndrome Weber syndrome lower midbrain paramedian branchs of PCA affect the cerebral peduncle contianing the corticospinal tract and neighboring oculomotor nerve. Diplopia, ptosis, primary gaze palsy, popully constriction deficits) and contralalteral hemiparesis with UMN patter of dysfuntion. Horner syndrome upper spinal cord sympathetic nerve supply to ipsilateral face and eye - ipsilateral ptosis, miosis, anhidrosis. malignant mesothelioma chronic cough, SOB, pleural effusion + calcified pleural plague a/w asbestosis (working in shipyard, roofing, plumbing) exudative pleural effusion caused by the malignant pleural disease leuprolide for prostate cancer decreased LH and testosterone GnRH analon - contuned non-pulsatile fasino GnRH R antagonist androgen insensitivity syndrome caused by defect in androgen receptor complex resulting genotypic XY male to develop external demale or ambiguous genitalia and femal esecondary sex characterisitics. testes are present. increased concentrations of testosterone, estrogen, and LH (no uterus or ovaries) chronic hypertension on kidneys hyperplastic arteriolitis marasmus acute protein energy malcutrition = decrease din mid-upper arm circumderence, weight for length, BMI. maintain linear growth because weight is more quickly ipacted than height. - deficient caloric intade but no specfic vitamins or minerals are missing. wasing of mucle mass and consumption of body fat stores NO EDEMA what produces progesterone in pregnancy corpus luteum to maintian the endometrial lining slowly, the placenta that begins to secrete HCG which then maintains the corpus letum and its secretion of progesterone. as the placenta develops it becomes primarily repsonisble for progesterone production around seven to ten weeks of gestation. HIV encephalopathy most likely in AIDS patient wiht progressive memory loss and motor deficits who does does not adhere to antiretroviral therpay. diagnosis of exclusion in patients with HIV movement disorders psychomotor impairment memory deficits poorly demarcated T2 hyperintense lesion scattered in subcortical white amtter. brain biopsey: microglial nodules iwth multinuclearted giant cells acromegaly glucose regulation decreased muscle glucose uptake increaed adipose lipolysis increased hepatic gluconeogenesis ** increase dperipherla insulin resistnace impairing muscle and adipose uptake of glucose, increasing adipose lipolysis, increasing hepatic gluconeogenesis white vs. black skin pigmentation difference in number of melanosomes not the number of melanocytes themselvs URI infection clearance is most dependent on what class I MHC viral peptide complex presentation and subsequent activation of CD8+ T lymphocytes 40 year old man evaluated because skin etremely sensitivy to sunlight. -->> vesciles and blisters on skin which take weeks to heal which biochemical pathwya is most defective in patient heme synthesis porphyria cutanea tarda - severre cutaneous photosentivity wiht blistering and hyperpigmentation after exposure to sunlight and is most common of the porphyrias. decreaed acitvity of uroporphyringogen decarboxylase. which is also used in the production of heme. no OCPs in people who smoke PEEP is for preventing absorption atelectasis - keeps alveoli stented open to prevent impaired gas exchange (further) Muir-Torre syndrome hereditary nonpolyposis CC affected individuals are prone to developing colon, genitourinary, skinc ancer, keratoacanthomas and sebaceous glad tumors Peutz-Jeghers syndrome AD hamartomatous polyps in colon/GI tract and pigmented macules i hte mouth/lips/hands/genitalia cowden disease AD polyposis a/e hamartomatous polyps in GI tract. a/w mucocutaneous neuromas, oral papillomas, and cutaneous trichilemmomas. clamp coronary artery first hting that's going to happen swelling of endoplasmic reticulum (swelling fo the cell and its organelles is the first cellular change that occurs after cessation fo blood flow from shut down fo NA/K ATPase which results intracellular accumulation of sodium which shifts the osmotic graident and leads to cellular swelling Zellweger syndrome genetic mutations that leads to absense of peroxisomes - increased VLACFA, seizures, ID< hypotonia, hepatomegaly, jaundice, kidney diease, cataracts, hearing loss,a dn craniofacial abormalities allosteric activator if the concentration of substrate at one-half of V-max decreases in presence of a substance than that substance must icnreased the affnity of the enzyme for its substrante - results froma conformational change in the active site of the enzyme where the substrate binds. catabolite acitvator/respressor transciption of genes is affected. 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NBME 26c questions and answers with verified content
Paresthesias abnormal sensation (e.g., tingling, prickling, "pins and needles") false positives and false negatives placenta accreta A rare... [Show More] disorder in which the placenta is directly adherent to the myometrium (without penetrating) instead of the decidua basalis. Results in delayed separation and/or placental retention as well as postpartum hemorrhage. The most important risk factors for placenta accreta are a previous C-section and placenta previa. -risk factors include: prior uterine instrumentation (including ceserean delivery), increased maternal age, placenta previa, and pultiparity. given the high risk of morbidity and mortality, elective surgical delivery at 34 to 36 weeks is recommended. leiomyomata uteri (uterine fibroids) benign tumors of the uterus, which can present with abnormal uterine bleeding and pelvic pain. however, they are more common in older women and are associated w an irregular shaped uterus on physical exam. Monobactams inhibit transpeptidation by inhibiting penicillin-binding protein 3 antimycin A inhibits complex III of the electron transport chain cyanide, monoxide, azides -- electron transport chain inhibitors inhibit complex IV normal alveolar-arterial gradient (a/A gradient) 5-10 mmHg Baclofen a GABAb receptor agonist, which hyperpolarized muscle cells and relieves muscle spasticity Bacteroides fragilis an anaerobic, gram-negative bacillus and a normal component of the gastrointestinal microbiota. it only results in infections when displaced from the colon, such as following surgery, rupture, or trauma, where is has the potential to cause bacteremia, intra-abdominal infections, peritonitis, and subcutaneous abscesses. Bacterial vaginosis is caused by the vaginal overgrowth of Gardnerella vaginialis, a gram-variable, facultative anaerobe. It presents with gray, thin, malodorous vaginal discharge, a vaginal pH greater than 4.5, a fishy odor upon KOH testing, and clue cells on microscopy Glucagonoma a rare functional malignancy that secretes glucagon, which raises blood glucose. Glucagon acts on hepatocytes via a cAMP pathway activating protein kinase A that ends in the activation of glycogen phosphorylase, with release of glucose monomers in the serum. When glycogen stores are exhausted, the body relies on the breakdown of fat through beta oxidation of fatty acids to provide energy. -- occurs in mitochondria of the cell Carnitine acetyltransferase a transmembrane protein found on the surface of mitochondria in liver, muscle, and brain, and catalyzes the bond between acyl-CoA and carnitine, which permits the long-chain fatty acid to translocate into the mitochondria matrix where beta-oxidation (breakdown of fatty acid) can occur. Renal tubular acidosis A normal anion gap (hyperchloremic) metabolic acidosis in the presence of normal or almost normal renal function. The various types of RTA include proximal tubular bicarbonate wasting (type II), distal tubular acid secretion (type I), very rarely carbonic anhydrase deficiency (type III), and aldosterone deficiency/resistance (type IV). Renal tubular acidosis arises as a result of defects in the tubular transport of HCO3- and/or H+. Most forms of RTA are asymptomatic although, rarely, life-threatening electrolyte imbalances can occur. Salicylate poisoning initially results in a respiratory alkalosis from the stimulation of respiratory centers causing hyperventilation. Subsequently, it results in the development of a delayed anion gap metabolic acidosis secondary to its decoupling effects on the electron transport chain, resulting in increased anaerobic metabolism and the production of lactate and ketoacids. ansa cervicalis a loop of nerves in the anterior neck that originate from the spinal nerve roots C1-C3. the inferior root is formed by the fibers of C2 and C3 and provides branches to the inferior portion of the omohyoid, stenothyroid, and sternohyoid muscles. the phrenic nerve arises from the cervical roots C3-C5 and provides motor innervation to the diaphragm. it also provides sensory innervation to the mediastinal pleura and the pericardium phrenic nerve injury can occur during cardiothoracic surgery or thoracic or cervical trauma and can lead to diaphragmatic paralysis. developing 20-month old child can typically walk up stairs (and may be able to run), stack several blocks, and use 100 or more vocabulary words, and play pretend. aggressive, impulsive behavior is not uncommon, and cooperative play does not typically develop until the age of 4 years. Osteoarthritis the most common disease of joints in humans. It affects 60% to 80% of adults over the age of 65. it is characterized by global degeneration of a joint with fraying, fibrillation, and degradation of cartilage, thickening of the subchondral plate w sclerotic bone, and SUBCHONDRAL CYSTS due to inflammation of synovial fluid into the bone. Arthrocentesis typically demonstrates few leukocytes, normal appearance, and normal glucose. jejunum possesses several characteristic features, including prominent plicae circularis, which lends the jejunum an increased mucosal surface area and feathered appearance w oral contrast material -also demonstrates a large caliber, thicker muscular walls, longer vasa rectae, and fever arcades congenital adrenal hyperplasia results from a defect in adrenal steroid biosynthesis. its most common form, 21-hydroxylase deficiency, presents with salt-wasting in infants or precocious puberty in children. it also causes the virilization of XX fetuses, elevated levels of 17-hydroxyprogesterone, hypotension, and hyperkalemia. tx: exogenous administration of mineralcorticoids and glucocorticoids Sex determining region of Y A region of the Y chromosome gene that encodes for the SRY protein (also known as testis-determining factor, or TDF), which is a transcription factor that suppresses ovarian development and regulates male sex determination at around 6 weeks of gestation. the intracranial compartment is a fixed, rigid space, and any lesion that occupy space in it may displace normal brain parenchyma, causing midline shift and mass effect. THERAPEUTIC HYPERVENTILATION and resulting hypocapnia cause cerebral vasoconstriction, which results in decreased cerebral blood flow and intracranial pressure. Interleukin-12 (IL-12) and interferon-gamma activate the two primary cells responsible for granuloma formation in patients with mycobacterium tuberculosis infection. Tension pneumothorax occurs when air is able to enter the pleural space but is prevented from exiting. leading to an increasing amount of air trapped in the pleural space w subsequent collapse of the lung parenchyma and mass effect on the mediastinum. it is characterized by respiratory distress, tracheal deviation, hypotension, decreased breath sounds, and hyperresonant percussion on physical exam Muscle necrosis leads to rhabdomyolysis, myoglobinuria, and acute renal failure. Evaluation for Rhabdo reveals red or brown urine and urinalysis is positive for blood due to the presence of myoglobinuria without microscopic evidence of red blood cells. pressure tracing -- mitral regurg could be due to rupture of the chordae tendineae medially, the precentral gyrus contains neurons that control the lower extremity. laterally, the precentral gyrus controls the contralateral face. ??? look up after a cerebral infarction, neurons undergo liquefactive necrosis and are replaced by a glial scar consisting of proliferated astrocytes. the glial scar forms approximately 2 weeks after the initial ischemic event Bartonella bacilliformis a gram-negative coccobacillus found in Peru, Ecuador, Colombia, and some parts of southern Florida that cause bartonellosis (Carrion disease) or Oroya fever in the acute phase of infection and verruga perunana in the chronic phase. It is transmitted by sandflies Babesiosis tx Atovaquone plus Acithromycin recall Atovaquone = Atovaquone-proguanil --> An antimalarial drug used for the treatment of chloroquine-resistant P. falciparum infection and for malaria prophylaxis. Can cause gastrointestinal discomfort. the hemidesmosome an intricate complex of proteins whose ultimate function is to anchor the basal keratinocytes of the epidermis to the dermis at the derma-epidermal junction epidermolysis bullosa A rare, heterogeneous group of congenital and/or genetic blistering skin disorders that occur during infancy and childhood. The severity of the lesions, extent of mucosal involvement, and site of cleavage (intraepidermal/subepidermal) differ depending on the specific subtype. A common feature in all forms of epidermolysis bullosa is the induction of blisters by minor trauma and exacerbation in warm weather. Behcet disease An immune-mediated vasculitis that can involve blood vessels of all sizes (i.e., small, medium, and large) and may affect both the arterial and venous vessels. It commonly presents as oral and genital ulceration and uveitis. Hypogammaglobulinemia A decrease in the serum concentration of immunoglobulins. Etiologies include nephrotic syndrome, drug-induced reactions, acquired humoral immunodeficiencies, and congenital immunodeficiencies. Craniosynostosis results from the premature fusion of cranial bone sutures, leading to asymmetric growth in the area of remaining, unfused sutures, skull shape deformity results, which is both cosmetic and physiologically problematic due to constriction of the CNS bregma suture Lambdoid Suture CRP (C-reactive protein) an acute phase reactant protein that is synthesized in the liver. CRP functions as an opsonin & aids in the targeting of cells for phagocytosis and in the fixation of complement. Serum CRP serves as a non-specific inflammatory marker and can be useful in the diagnosis and monitoring of a variety of inflammatory diseases. Zollinger-Ellison Syndrome stems from a gastric-secreting tumor located typically within the pancreas or duodenum that results in excessive production of acid by the gastric parietal cells. patients develop recurrent, chronic duodenal or jejunal ulcers, which can present with abdominal pain, diarrhea secondary to malabsorption, and possible hematemesis, melena, or hemotochezia. Immunohistochemical labeling of neoplastic cells will reveal positive staining for gastrin VIPoma vasoactive intestinal polypeptide rare tumors often associated with MEN1 (3 Ps) that presents with profound watery diarrhea, electrolyte disturbances (eg: hypokalemia, hypercalemia), acholorhydria, alkalosis, flushing, and vasodilation Treatment: Tumor resection Octreotide (inhibits VIP secretion) Pelvic parasympathetic nerves in the pelvic nerve plexus...... function to excite and contract the bladder via muscarinic acetylcholine receptors where sympathic nerves mediate relaxation of the internal urethral sphincter via alpha1-adrenergic receptors, leading to normal urination. damage to the pelvic nerve plexus can affect both bladder contraction and internal urethral sphincter relaxation, leading to overflow incontinence the external urinary sphincter is innervated by......... the pudendal nerve. the pudendal nerve supplies sensory neurons to the external genitalia along w somatic skeletal motor fibers to pelvic muscles [Show Less]
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Nbme 10 questions with verified content
11-year-old girl presents With tanner stage one of the pubic hair, she has a flat left breast and the right breast is tender and a small mass What is the ... [Show More] best next step? Reassurance This is normal thelarche and can be asymmetric Order of maturation in female Thelarche, pubarcge, growth spurt, menarche 27-year-old man presents with thrombocytopenia, eczema and recurrent infections Wiskott-Aldrich, WAS gene, Patient comes in with ulcerative colitis Treated with prednisone mesalamine and much more and the doctor decides to add a regimen, due to the addition of the regimen what should be tested next Tuberculosis screening, due to initiation of TNF alpha inhibitor Patient with sickle cell disease comes in with vaso-occlusive crisis it is given pain control what else should be given with the pain control? Intravenous fluids Patient with a MI 10 years ago Comes to the hospital due to vomiting. The patient ends up getting a transfusion and 30 minutes later starts developing shortness of breath, what is the most likely cause? Transfusion associated circulatory overload Remember: patience with ABO incompatibility present with flank pain and hypotension Treatment of transfusion associate circulatory overload Oxygen and positive pressure ventilation And possible directions Can lead to psychosis, bizarre behavior, agitation, aggression, nystagmus and ataxia treatment PCP intoxication Treatment: IM lorazepam or Midazolam 38-year-old woman comes in due to seizures, MRI demonstrates unilateral or bilateral temporal lobe abnormalities, what is the next best step? Lumbar puncture: HSV encephalitis If a patient has stroke like symptoms occurring less than 4 1/2 half hours Without signs of hemorrhage what is administered? Alteplase If the patient comes in with a stroke in the amount of time is unknown, with no evidence of hemorrhage what is administered? Aspirin instead of alteplase Bell's palsy Presents with facial nerve palsy causing facial paralysis that doesn't spread the forehead, what is the next best step? Treatment: It's diagnose clinically, no further testing indicated Treatment: glucocorticoids and occasionally antiviral therapy Patient after gastric bypass presents with ataxia, altered mental status and opthalmoplegia including nystagmus, most likely cause? Vit B1 def Immunocompetent child with cervical lymphadenitis presents with a purpleish hue, And presence of multiple granulomas on excisional biopsy Purpleish hue: mycobacterium infection Patient presents with a 2 cm ulcer on the foot and new mid back pain, what is the most likely cause and what is the next best step to confirm the diagnosis? Vertebral osteomyelitis, MRI of the lumbar spine. Can occur through hematogenous spread Patient with a history of inflammatory joint disease are at increased risk for Septic arthritis An x-ray showing periosteal elevation is diagnostics for osteomyelitis, what is the next best step? MRI before bone biopsy Patient presents with generalized weakness due to a strict diet and taking laxatives in diuretics to lose weight. What is the cause of her generalized muscle weakness? Loss of potassium EKG demonstrating ST elevations in lead to I III and a VF is significant for right sided heart infarction, administration of what is contraindicated in patients? Nitroglycerin Patient with long-standing diabetes that initially was poorly controlled presents with urinalysis showing 4+ proteins, asks for what is the mechanism of the patients increase blood pressure Renal parenchymal disease What is the proper age for screening individuals for lipid studies Asymptomatic males over 35 or women over the age of 40 to 45 unless they have a family history of hypercholesteremia or cardiovascular disease in the first degree relative seen early If you see A ulcer on the medial aspect of the leg, woody induration and dark pigmentation, Even if the ankle brachial index is less than one Venous insufficiency, the reason ankle brachial index is less than one is because the patient has both peripheral artery disease and Venus insufficiency Any patient with HIV regardless of CD4 count with a TB screening over 5 mm what is the next best step Treatment of latent tuberculosis right away Untreated obstructive sleep apnea can cause both Systemic and pulmonary artery hypertension Lead to local inflammatory response and classically presents with fever in lower left quadrant abdominal pain and bloody diarrhea is less frequent Diverticulitis Acute abdominal pain in the setting of a recent MI that shows the fuse tenderness most prominent in the left lower quadrant Ischemic colitis Beta three agonist used to treat overactive bladder Mirabegron Female with a recent fetal demise With a new pregnancy should undergo Non-stress testing in the third trimester for the next pregnancy What most likely determines a patient's risk for diabetic nephropathy Measurement of urine microalbumin concentration Men 1 tumors Pituitary, parathyroid, pancreatic MEN 2A tumors Medullary carcinoma of the thyroid, pheochromocytoma, parathyroid Men 2B tumors Medullary carcinoma of the thyroid, pheochromocytoma, neuroma's Commonly causes diseases in immunocompromise patients in the setting of severe ulcerative colitis, solid organ or allergenic bone marrow transplant Tatian or HIV/aids. Intracellular inclusion bodies are classically observed Treatment CMV colitis treat with ganciclovir or valganciclovir Attributable risk AR = [a/a + b] − [c/c + d] Patient comes in with a severe head injury after a motorcycle collision presents with fixed and dilated pupils unresponsive to all physical and verbal stimuli, no cranial reflexes EEG with no electrical activity. Asks what is the most accurate regarding continuation of mechanical ventilation? Mechanical ventilation can be withdrawn without patient's families permission due to patient being brain dead Any patient with new onset of A.fib should undergo TSH measurement Crohn's disease can lead to small bowel obstruction due to Forming small bowel structures Patient presents with abdominal aneurysm measuring 7 cm and pancreatic Adenocarcinoma, what do you do? Do you fix the aneurysm No because of the patients poor prognosis Patient with bacteremia and disseminated intravascular coagulation With hypotension, has an increase in creatinine from 1.5 to 3 ATN Mainly caused by medication's Such as antibiotics, NSIADs, PPIs, infections or autoimmune disorders AIN After dilation and curettage the beta hCG should drop if it drops and goes back up into the thousands what is your diagnosis? Gestational trophoblastic neoplasia Pregnant females with SLE or Sjogren are increased risk for what Kind of cardiac issue in the infant AV block Patient with anaphylactic shock is treated with epinephrine and Normal saline Pentad of patients with TTP pay close attention, what is treatment? Fever Altered mental status (confusion) Thrombocytopenia Acute kidney injury Microangiopathic hemolytic anemia Tx: Plasmapheresis Treatment of OCD SSRI Patient with weakness in shoulders and pelvic girdle with a reflexia and elevated CK Spinal muscular atrophy Benign growth of conjunctival tissue that looks like a web/wing over part of the eye or the entire eye what do you recommend to these patients? Pterygia Tx: recommend wearing sunglasses So tinea capitis is a result of fungal infection of the hair that is seen as scaly patches, however it can lead to significant inflammatory response inform what is known as a kerion (boggy texture and swollen appearance) - trychophyton, epidermophyton, microsporum all cause tunes capitis Any patient that comes in with mono reticular arthritis severe pain with passive flexion and fever suspect Septic arthritis Caused by hematogenous infection First line treatment for osteoarthritis according to NBME Acetaminophen Two main effective ways of decreasing blood pressure DASH diet and weight loss Aortic dissection/coronary perfusion can lead to petechiae, livedo reticularis blue toe syndrome Cholesterol emboli [Show Less]
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Emergency Med NBME Form 1 questions and answers 100% correct
52 yo man - 6 hrs after onset of severe, epigastric abd pain > began at cocktail party > was there for 4 hrs - 3 martinis, lot of food PMHx: HLD (statin... [Show More] ) 100.4F 104/min 150/92 mmHg PE: diffuse tenderness over upper quadrants BL - esp epigastrium; no guarding/rebound labs: WBC WNL, BR 3 (direct 2.4), alk phos 210, AST 325, ALT 360, amylase 1200, lipase 600 most likely cause of symptoms? common bile duct obstruction choledocholithiasis = stone in CBD lipase high so think pancreatitis 2 MC causes: alcohol and gallstones if alcoholic cause - the AST should be higher than ALT (A Scotch and Tonic) abd pain that started right after eating a lot of food > think gallstones he also has PMHx of HLD - another RF for pancreatitis 42 yo man - 30 min after onset of gen weakness, SOB, severe abd cramps, sweating > began while gardening 99.2F 52/min RR: 24/min 98/60 mmHg POx: 98% RA PE: diaphoresis, excessive lacrimation, 2 mm pupils reactive to light; diffuse wheezes; abd - no tenderness; muscle strength 4/5 in ext - muscle fasciculations; DTRs 2+; no Babinski; intact sens after decontamination - most app tx to immediately relieve current symptoms? administration of atropine homeboy was gardening - exposure to spray insecticides (aka organophosphates - AChE inhibitors) > these can cause acute cholinergic toxicity = DUMBBELLS (diarrhea, urination, miosis/muscle weakness, bradycardia/bronchorrhea, emesis, lacrimation, sweating/salivation) pralidoxime regenerates AChE at musc/nic receptors - only peripheral > useless once aging of bonded complex has occurred atropine reverse peripheral and central musc toxicity 54 yo - 2 hrs of chest pain, SOB, nausea > began while sitting/working at desk > 1 episode of vomiting > pain 7/10, radiates to shoulders, "pressure" 3 similar episodes during past 3 months > occurred on exertion, resolved after 15 min of rest PMHx: HTN, T2DM meds: ASA, metformin, enalapril SHx: smokes 1 pack qd 30 yrs 98.6F 90/min 20/min 154/85 mmHg POx: 99% PE: gucci labs: WNL (including trop) ECG, CXR: gucci ED course: ASA, NTG, morphine administered > 15 min later, pain is now 2/10; pt being observed; repeat trop 4 hrs later WNL; symptoms have resolved most app next step in mgnt? myocardial perfusion testing within 3 days trops aren't elevated and pt is stable - okay to d/c him and f/u really soon he has RFs for CAD and has had similar episodes of chest pain in the past this episode is diff bc occurred w/o exertion - suggesting the etiology has gotten worse 2014 AHA guidelines: 1. for patients with possible ACS who have normal serial ECGs and cardiac troponin levels: it is reasonable to obtain a treadmill ECG (level of evidence: A), stress myocardial perfusion imaging, or stress echocardiography before discharge or within 72 hours after discharge (level of evidence: B). > our guy falls under this category due to his prior episodes 2. in patients with possible ACS and a normal ECG, normal cardiac troponin levels, and no history of coronary artery disease (CAD): it is reasonable to initially perform (without serial ECGs and troponin levels) coronary computed tomography angiography to assess coronary artery anatomy (level of evidence: A) or rest myocardial perfusion imaging with a technetium-99m radiopharmaceutical to exclude myocardial ischemia (level of evidence: B) 47 yo - 1 hr after can of gas exploded 5 ft from him > pain/loss of hearing in R.ear ED: mild distress 98.8F 90/min 14/min 120/80 mmHg PE: abrasions over R.face/neck/upper chest; blood in ext auditory canal; swelling/ecchymosis of R.pinna; can't hear whispered voices; L.ear - gucci most likely explanation of symptoms? rupture of the tympanic membrane blast injuries - potential cause of barotrauma barotrauma = results from the air pressure wave generated by an explosion > rapid pressure change allows no time to equalize the pressure > potential injuries: bruising of the eardrum, bleeding into the drum and middle ear, eardrum rupture, ossicular disruption, and inner ear injury resulting in dizziness and tinnitus 13 yo - 30 min after fell off sailboat into freshwater lake > underwater for about 2 min > rescued - cyanotic and unresponsive > began coughing/breathing again after mouth2mouth ED: awake/alert; mild SOB and cough 98.6F 108/min 20/min 93/45 mmhg POx: 94% RA PE: mild wheezes; no signs of ext trauma CXR: mild diffuse int markings most app next step in mgnt? admission to the hospital for observation I guess you don't give assisted ventilation until O2 really drops - UTD suggests maintaining SpO2 > 94% > if needs oxygen - give noninvasive positive-pressure ventilation via BLPAP or CPAP def needs hospital admission bc CXR looks junky and currently has SOB/cough > make sure she doesn't develop ARDS ~ can develop insidiously over next 72 hrs ~ monitor closely for dyspnea, cough, crackles, and cyanosis 26 yo female - 2 hrs of SOB and mod R.chest pain > SOB when walking up flight of stairs this morning and walking w/ friends at mall earlier > 2 days of nonproductive cough PMHx: sickle cell dz meds: hydroxyurea, acetaminophen w/ codeine prn 1 yr ago: hospitalized for vaso-occlusive crisis ED: mild resp distress BMI: 21 101.1F, 38.4 C 104/min 20/min 128/82 mmHg POx: 91% RA > 95% on 2L O2 NC PE: fine crackles at R.lung base labs: Hgb 8.9, Hct 25.2, WBC 12,600, plt 457,000 CXR: consolidation and infiltrates in R.lung base most likely underlying cause of pt's current condition? infection homegirl has acute chest syndrome 2/2 sickle cell dz > due to infection and occlusion of pulm microvasculature ACS defined as radiographic evidence of consolidation + at least one of the following: temp > 38.5C, >2% dec in SpO2, PaO2 < 60 mmHg, tachypnea, intercostal retractions/nasal flaring/use of accessory muscles, chest pain, cough, wheezing, rales > HOWEVER: presence of PNA meets the criteria since they can't be distinguished from one another due to the hits that the spleen has been taking over the yrs > autosplenectomy (it shrinks up) > pt more prone to encapsulated organisms make sure to r/o PE w/ VQ scan or CT angio tx: monitor oxygenation; Abx; hydration; exchange transfusion if severe 62 yo man - 2 days of feeling light-headed > no chest pain/palp > usually constipated - BMs qd for past 5 days ~ stools dark reddish brown PMHx: chronic low back pain 98.6F 140/min, reg 24/min 80/50 mmHg PE: too LH to check orthostatics; lungs clear; abd - soft, nontender, not distended; rectal exam - soft, dark red stool; pos for occult blood fingerstick bG: 92 labs: H/H 8.0/22%; WBC 8000; plt 240; LDH 6; coags WNL ECG: sinus tachy ED course: blood sample sent for typing/crossmatch; subclavian cath inserted/confirmed by CXR after 0.9% NS 2L administered: > 120/min, reg > 100/70 mmHg > LDH 4.5 > CVP: 11 (inc) (N3-8) most app next step in mgnt? packed red blood cell transfusion give whole blood for volume replenishment in blood loss when CVP is high > doesn't inc volume RBC transfusion thresholds: > <7: gen indicated > 7-8: cardiac surgery, HF, oncology pts in tx > 8-10: ongoing bleeding, symptomatic anemia, ACS, noncardiac surgery > >10: not gen indicated don't give hypovolemic shock pt any vasopressors - already max vasoconstricted !! The "effective blood volume," or that volume which restored arterial blood pressure, urine output, and tissue perfusion, exceeds the "normal blood volume" or the apparent improvement in BP. > which is why most pts in hypovolemic shock get transfused until CVP 10-15 Dr. Pestana: volume replacement starting w/ 2L > follow w/ packed red cells, FFP, plt packs in 1-1-1 ratio 60 yo Hispanic female - 1 wk of cough and low-grade fever > understands some English; doesn't speak fluently > son speaks fluent English/Spanish > physician not fluent in Spanish - can communicate limitedly w/ pt 100F 80/min 16/min 140/70 mmHg POx: 98% RA PE: breath sounds dec at lung bases w/ occ rhonchi that clear w/ cough CXR: no PNA; 1 cm mass that requires f/u in LLL ECG: NSR pt anxious to leave but hospital interpreter w/ another pt most app way to communication the need for further eval of a potential malignancy? wait for the interpreter before issuing the discharge instructions so many things can get lost in translation - make sure you have a professional to help you relay the info > save your ass, don't get sued 77 yo female - fell at home PMHx: T2DM meds: metformin, insulin ED: somnolent 99.9F 130/min 16/min 78/40 mmHg POx: 98% PE: basilar crackles at L.lung base labs: Hgb 13.2; CMP WNL; HCO3 15; glucose 90 blood cx and CXR ordered most app next step in mgnt? administration of 0.9% saline remember your ABCs mofo - esp since homegirl is unstable (tachy and HoTN) Dr. Pestana: even though fast CT scanners are available in Level I trauma centers - pt needs to be hemodynamically stable so pics can be taken w/o all the commotion of continuing resuscitation efforts 60 yo female - 12 hrs of mod, diffuse abd pain/vomiting > 2 wks ago: sigmoidectomy for perforated diverticulitis > no fever/diarrhea/dysuria > last BM yest - normal > no flatus today meds: cipro, metro, oxy-acet ED: mod distress; awake/alert 100.2F 100/min 20/min 140/65 mmHg POx: 98% RA PE: heart/lungs gucci; abd - mod distended and diffusely tender in all quadrants; surg incision clean/dry/intact; bowel sounds dec abd x-ray: mult loops of distended small bowel w/ air-fluid levels; no air in rectum most app next step in mgnt? insertion of a nasogastric tube homegirl clearly has SBO 2/2 adhesions from her prior surgery > classic BOARDs question > MC cause of SBO UTD: pts w/ SBO associated with significant distension, nausea, and/or vomiting > recommend NG tube decompression Dr. Pestana: colicky abd pain, protracted vomiting, prog abd distention, no passage of gas/feces x-rays: distended loops of small bowel w/ air fluid levels > "step-ladder" appearance tx: NPO, NG suction, IVF > if unsuccessful - surgery ~ 24 hrs for complete obstruction ~ few days for partial 52 yo - 2 hrs of fever, severe malaise, joint stiffness > wrists, hands, knees PMHx: RA, HTN, hyperchol meds: pred, etanercept, enalapril, HCTZ, ibuprofen ED: sleepy, easily aroused 101.2F 120/min 26/min 90/50 mmHg POx: 92% RA PE: ext cool to touch; mottling over lower ext; no JVD; crackles over L.lung base; cardiac - hyperdynamic precordium; 2/6 sys ejection murmur at base; no S3/S4 labs: Hgb 9.5; WBC 20,500; plt 90,000; PT 16 sec; CMP WNL; BUN 35; albumin 2.1 ECG: sinus tachy but unchanged from prior ECG most likely dx? sepsis wtf is mottling = veins swell > lacy bluish discoloration on the extremities the other choices just didn't make sense for this case (cardiac tamponade, GIB, NSTEMI, PE) I believe this pt is heading to DIC > inc PT, dec plt [Show Less]
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Step 2 CK NBME Form 12 pt 2 questions and answers updated 2023
any possible exposure to blood that may be infected with HIV requires.... Antiretroviral therapy regardless of HIV results repaired cleft lip and p... [Show More] alate can increased the risk velopharyngeal insufficiency, inability to properly close the velopharyngeal port separating the nasopharynx and the oropharynx during production of speech (whistling sound) closed cervix and a pool of clear fluid in the vagina, complication? preterm delivery pts with SCD that present with pneumonia/ACS, next best step? Blood culture then treat empirically pt treated empirically and after results are in you must narrow down the abx for the correct tx ... old man with hematuria with no pain or any sxs, dx: bladder cancer dx: cystoscopy recall bias similar to differential bias common in pts with smoking and may present as hoarseness, vocal changes, persistent cough, stridor or dysphagia dx: staging: laryngeal carcinoma dx: indirect laryngoscopy staging: CT scan the pt or the pts decision maker should be given the opportunity to update the pts code status during each hospitalization ... development of colovesical fistula can be caused by diverticular disease pts with positive straight leg test no need to test further lumbar disc herniation PCOS dx LH:FSH >2:1 pts presenting with RA should undergo ________ before surgery XR of the cervical spine to reduce catastrophic neurologic damage in the setting of atlantoaxial instability pt presenting with galactorrhea due to increased prolactin initial workup rule out Hypothyroidism (increase TRH increases prolactin) and renal insufficiency as these causes can increase prolactin level pt with recent MI with HTN should control the BP to reduce risk of cardiovascular disease HCTZ seborrheic keratosis does not indicate a diagnostic study ... pt undergoing surgery, trauma or illness on glucocorticoids with hypotension, with hypotension refractory to fluid resuscitation tx: adrenal crisis tx: hydrocortisone pt with COPD with pulse ox <88% or <89% with Right HF or erythrocytosis long term oxygen therapy pts with cardiogenic shock require ........ Echo - indicated to determine underlying cause VSD can cause growth restriction due to inadequate feeding first step in management of asxs mild hyponatremia in the setting of excess free water intake fluid restriction [Show Less]
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NBME 30 questions with rated solutions
difference b/w Kwashiorkor & Marasmus - kwashiorkor (edematous malnutrition): marasmus PLUS EDEMA - marasmus (WASTING SYNDROME): skin lesions, fatty li... [Show More] ver, acute protein-energy malnutrition with decreased arm circumference, weight per length or BMI deformation disruption in organ morphogenesis occurring AFTER embryonic period; extrinsic force limits normal organ development vascular changes in chronic HTN - hyaline arteriolosclerosis: protein deposition in vessel walls - hyperplastic arteriosclerosis (arteriolitis): concentric thickening of vessel wall w/ laminar appearance caused by proliferation of smooth muscle cells - commonly affects renal arterioles Nodular glomerulosclerosis assoc w/ diabetic nephropathy & amyloidosis supraoptic nucleus responsible for ADH secretion from pituitary & urine concentration anterior hypothalamic nucleus thermoregulation (cooling) arcuate hypothalamic nucleus appetite stimulation dorsomedial hypothalamic nucleus regulation of feeding & circadian rhythm lateral hypothalamic nucleus promotes appetite (GHRELIN) posterior hypothalamic nucleus thermoregulating (heating) ventromedial hypothalamic nucleus satiety (LEPTIN) osteopetrosis excessive mineralization of bone & failure of osteoclastic resorption - mutation in macrophage colony stimulating factor achondroplasia human dwarfism - AD mutation in fibroblast growth factor receptor 3 (FGFR3) gene porphyria cutanea tarda severe cutaneous photosensitivity with blistering & hyperpigmentation after exposure to sunlight - decreased activity of uroporphyringoen decarboxylase enzyme in the production of HEME CD8+ T lymphocytes responsible for CLEARING a virus - class I MHC receptors present a virus to CD8+ T cell on an APC - CD8+ T cell has a specific TCR for the virus; responds by secreting inflammatory mediators (to attract other cells) perforin/granzyme or interacting with Fas/FasL to trigger apoptosis Class II MHC are on the surface of antigen-presenting cells (APCs), including B cells - trigger CD4+ T cells, which recruit CD8+ cytotoxic T cells PKU deficiency of phenylalanine hydroxylase - supplementation of TYROSINE is required for synthesis of catecholamines (norepinephrine, epinephrine & dopamine) leuprolide GnRH agonist used for the treatment of prostate cancer - decreased LH & testosterone release production of progesterone during pregnancy - first 7-10 weeks: CORPUS LUTEUM (stimulating by hCG from placenta) >10 weeks: placenta Chronic granulomatous disease X-linked mutation affecting NADPH oxidase causing dysfunctioning neutrophils and oxidative burst - recurrent infections with catalase (+) organisms: S. aureus, Aspergillus & Nocardia MPO deficiency Recurrent candida infections Wiskott-Aldrich syndrome mutation in WAS gene; abnormal cytoskeleton of B & T cells - Eczema, recurrent respiratory infections, thrombocytopenia Chediak-Higashi syndrome Mutation in LYST (lysosomal trafficking gene regulator) which causes accumulation of large cytoplasmic granules that cannot fuse with lysosomes - increase of bacterial, viral, and fungal infections - Albinism, photophobia, silver hair Coccidioidomycosis fungal infection endemic to Southwest US & California - respiratory illness, fever, fatigue, cough, arthralgia Lambert-Eaton Myasthenic Syndrome (LEMS) Auto-Immune; antibodies formed against voltage gated Ca2+ channels at NMJ; IMPAIRED PRESYNAPTIC ACH RELEASE - Sx: skeletal muscle weakness in limbs (improves w/ activity) - paraneoplastic syndrome assoc w/ small cell lung carcinoma round ligament binds uterus to labia majora - commonly leads to pain during pregnancy mesothelioma pleural effusion & scalloped pleural density; thick, firm, white pleural tumor - interstitial fibrosis - ASBESTOSIS: working in a shipyard, roofing & plumbing biggest risk factor for complications w/ use of OCPs tobacco smoking in patients >35 years - contraindications: history of DVT, PE, stroke, MI, HTN, migraine w/ aura, cirrhosis & current breast cancer Pores of Kohn small openings in the alveolar walls that allow gases, fluid, macrophages & BACTERIA to travel between the alveoli Osgood-Schlatter disease inflammation or irritation of the tibia at its point of attachment with the PATELLAR TENDON - common in YOUNG ATHLETES - focal pain & tenderness w/ application of tension to tibial tubercle increased risk of liver injury from acetaminophen + alcohol alcohol leads to induction of P450 enzymes that convert acetaminophen to NAPQI - NAPQI can cause hepatotoxicity childhood perception of death - <3 years: no understanding of death - age 3-5: death is temporary & reversible - >5 years: all living things die (irreversible & inevitable) Weber syndrome (lower midbrain stroke) stroke of paramedic branches of PCA - ipsilateral CN III palsy (diplopia, ptosis, primary gaze palsy, pupillary constriction defects) - contralateral hemiparesis with UMN pattern dysfunction gerstmann syndrome stroke of angular gyrus - agraphia, acalculia, finger agnosia & left sided disorientation Horner syndrome lesion of upper spinal cord interrupting sympathetic supply to ipsilateral face - ptosis, mitosis, anhidrosis Waardenburg Syndrome autosomal dominant disorder of abnormal neural crest development → abnormal melanoblasts - white forelock, PATCHY depigmentation iridic heterochromia & deafness - eyes may be laterally displaced failure of internalization of melanin granules by keratinocytes NONPATCHY albinism, no hearing loss (vs. Waardenburg) maintenance of constant GFR in the setting of renal artery constriction increased EFFERENT arteriole resistance → activation of RAAS rapid plasma reagent (RPR) false positive SLE → antiphospholipid antibodies will yield false (+) RPR/VDRL are used to detect antibodies against syphilis cold agglutinins Mycoplasma pneumoniae, EBV - marker of HEMOLYSIS heterophiles antibodies Infectious mononucleosis (EBV) p24 antigen HIV1/2 glucose-independent insulinotrophic peptide (GIP) secreted by K cells in the duodenum & jejunum - decrease gastric acid production & stimulate insulin release from pancreas - secreted in response to glucose/fatty acids to lower blood sugar ureteral constriction hydronephrosis - vesicoureteral junction, crossing point over COMMON ILIAC ARTERY or ureteropelvic junction ^ renal calculi tend to lodge at these 3 locations most common artery to obstruct the ureter COMMON ILIAC 21-hydroxylase deficiency excessive androgens, low aldosterone & cortisol - female: hypoaldosteronism & virilization during infancy (develops male characteristics) - male: precocious puberty in childhood [Show Less]
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nbme 16 questions and answers graded A+
20 yo woman with 8 yr hx of intermittent HA's, flashing lights in right visual field, f/by unilateral THROBBING headache with NAUSEA, vomiting, with menses... [Show More] MIGRAINE HA-rmbr "POUND"--Pulsatile, One-day duration, Unilateral, Nausea, Disabling. pulsating pain with N/photophobia/phonophobia/aura. Avoid TYRAMINE-containing products intense periorbital pain, tears, rhinorrhea, smoker, for 15 mins-3 hours Repetitive brief HA',s Excruciating periorbital pain with lacrimation and rhinorrhia. may induce Horner syndrome, mc in males/smoker, band around head. Tx" inhaled Oxygen, sumatriptan 80 yo old woman fracture of femur given morphine, soon her resp's are 6/min, has PINPOINT pupils, serum Cr is 1.8mg/dL, best explan of intoxication in pt? morphine is metabolized to active metabolites that accumulate, she is having renal failure possibly, PINPOINt suggests intoxication. child, with infection that has sickle cell anemia, given prophylaxis with PCN, what is the mcc? streptococcus pneumoniae is the mcc of sepsis in sickle cell patients and splenectomy! bulimia nervosa patient treatment? cognitive behavioral therapy + FLUOXETINE (ssri) stabbing pain noticed after shaving, pain is reproduced upon touching lateral nasal ala, nerve supplying this region exits where in the skull? FORAMEN ROTUNDUM--V2--trigeminal neuralgia chemotherapy regimen for 55 yr old w non hodgkin lymphoma is vinblastine. normal function of which cells and tissues resistant to this agent? VENTRICULAR CARDIAC MUSCLE CELLS---vinblastine attacks rapidly dividing cells so since heart cells don't divide, and is a PERMANENT CELL 9neurons, skeletal, cardiac m, Rbc's). all other cells divide. child with 6 month history of difficulty walking and leg pain, has mild atrophy of LE''s, hammer toes, high stepping gait, cause? absence of MYELIN SHEATHS, this is charcot-marie tooth dx. hereditary MOTOR & SENSORY neuropathy, also see foot drop/scoliosis/high or flat arches. defective prodcution of proteins involved in stx/fxn of periph nerves or myelin sheath HCM, spinocerebellar degeneration specifically DC's (spinal ataxia), kyphoscoliosis, DM, hammer toes Friedreich ataxia--initial loss of sensory (DRG), with accompanying gait ataxia, hammer toes, AR, HCM(mc of death and bulbar dyxfunction, unable to protect airway), impairment of mit functioning loss of DTR's, vibratory sense, proprioception, staggering gait, freq falling, nystagmus, dysarthria, pes cavus, HCM, Friedreich ataxia dec frataxin, GAA repeats, similar to VIT E deficiency,child 5-15 yo friederich ataxia 16 yo boy dives into shallow pool that is 3 feet deep, unable to move RIGHT upper and lower extremities, where is the lesion? lesion is at the lateral corticospinal tract (CST), if lesion in the SC--always motor deficit--IPSIlateral. so here, RT sided paresis due to right side lesion. 19 yr old girl withdrawn and isolated, uninterest, very anxious and depressed by listening to radio that only she can hear. thinks about a government scheme to control the psychic pain people feel. she's disheveled and malodorous. normal vital signs no abnormalities. mentally she's distracted. she has sad mood and anxious, sad, blunted affect. best therapy? patient has Schizophrenia--treat with antipsychotic--risperidone previously healthy 52 yo F, 2 mo hx of progressive difficulty swallowing, double vision, and slurred speech., ptosis of the eyelids and waddling gait. muscle strength shows fatigable weakness of the neck, arms, hands, and fingers. Repetitive nerve stimulation shows a 25% decrease in muscle action potentials in several muscles. Which of the following mechanisms is the most likely cause of this patients disease? BINDING OF AUTOAb to ACH receptor BY AN ANTIBODY--myasthenia gravis PREV HEALTHY, young adult male, hears voices in head for 2 men for the past 2 weeks, is afraid of physician when seen BRIEF, PSCYHOTOIC DISORDER, usually lasts <1 month, SUDDEN onset, woman with progressive m. wkness and difficulty walking for 3 months, loss of Patella and achilles tendon reflexes, wkness and DECREASED muscle bulk, sensations of joint/position/pain/temp are normal. cause? DEGENERATION OF MOTORNEURONS OF LUMBAR CORD---either ALS or poliomyelitis, patient is presenting with LMN lesion, desruction of Anterior horn sudden onset severe headache, right pupil is 6mm, nonreactive to light, impaired adduction, nuchal rigidity, aneurysm to what artery? Pcom---posterior communicating artery rupture--The aneurysm pressed on the oculomotor nerve and Trochlear Nerve. The eye is blow bc the right thing to be lost on oculomotor compression is parasympathetics then the motor. The eye can't adduct bc Superior oblique helps with adduction thats why its difficult for people with this paralysis to go down stairs they can't look medial and down. 21 yr old, 2 week hx of refractory back pain from MVA, asks for more opiods to manage pain, phys exam shows no abnormilites, correct response? Determine which drugs have been prescribed for the patient in the past, want to give a nonjudgmental response. 65-yo F, 3mo hx of HA, wknss of her arms, and left flank pain; wt loss, Physical examination shows weakness of the proximal upper and lower extremity muscles. There is augmentation of strength with repetitive testing of the deltoid muscles. An MRI of the brain shows a single well-demarcated mass surrounded by edema in the right frontal lobe. A stereotactic biopsy specimen of the lesion shows a malignant, small blue cell neoplasm that expresses citokeratin, chromogranin, and synaptophysin. Pulmonary small cell carcinoma metastatic to the brain--50% of adult brain cancers are mets, and the augmentation of muscle strength with repeated testing suggests lambert eaton, so small cell lung cancer metastasis female, motor vehicle accident, symptoms of meningitis , spleen removed? Older asplenic person with meningitis --> knee jerk streptococcus pneumoniae breast cancer patient, develops increased numbness and tingling of hands and feet during chemotherapy intervals, which drug caused it? Vincristine--mechanism--microtubules for axonal transport 79 year old sustained hip fracture, gardener, wine with dinner every night, what would help to decrease risk for additional fractures? WALK DAILY 76 year old lives in california, takes beta blocker for HTN, painful swelling of right big toe, drinks homemade distilled liquor, textile factory, what is the most likely cause? drinking from home-distilled liquor.--CHRONIC ALCOHOL ABUSE--is a risk factor for 2nd gout 8 year old with breast bud development and few pubic hairs, mothers asks about this, appropriate response? this is NORMAL development--tanner stage II (pubarche--pubic hair appears), 70 yo man, wife recently died, difficulty sleeping/cries, enjoys grandchildren visits/bowling. No other depressive sx/suicidal ideation. schedule appts to monitor patient; CF patient with weakness, numbness and tingling for 3 wks, and difficulty walking, not adherent to medication for past 6 mo's, bilat wkness and dec tendon reflexes in UE and LE, ataxic gait, which vitamin is the cause? VITAMIN E!!!! poliovirus lacks 5"mCAP, yet is still translated? why? no cap-->still translated because of PRESENCE OF INTERNAL RIBOSOME ENTRY SITE--located in the 5'UTR (untranslated region). G as subunit lacks GTPase activity in the tumor, what is increased? Adenylate cyclase!!! --G alpha s- uses adenyl Cyclase as it's messenger, gtp is hydrolysed and rxn stops,but as it's mutated inc AC table shows intermediates of glycolytic pathways, asks what would be inhibited indirectly if increased glucose concentrations present Glyceraldehyde-3-phosphate dehydrogenase is the right one, because 1,3-bisphosphoglycerate and pyruvate are the only ones <100% and are both downstream the enzyme Glyceraldehyde-3-phosphate dehydrogenase (in glycolysis pathway). clearly drop in glucose conc seen from fructose 1 6 bisphosphate to glyceraldehyde 3 phosphate and so on hypoglycemia, lethargy, diarrhea of 18 month old, Increased DICARBOXYLIC ACIDS, given medium chain TG's for 6 months after he became responsive to IV tx, what is deficient? LONG CHAIN ACYL-CoA DH deficiency---LCAD!!! low blood glucose, hypoketotic, m. biopsy shows intracellular fatty-acyl carnities, mc sx's present are N/V/seizures MCAD deficiency hypoketotic, hypoglycemic + accumulation of 16C's FA (eg. palmitate) LONG chain acyl-coa DH deficienccy hypotonia, hypoketotic, hypoglycemia, myoglobinuria, muscle weakness, Carnitine deficiency--CAT-1 deficiency symptoms/presentation similar to mcardles, except they occur after PROLONGED excercise MCAD deficiency location of Acyl transferase? CAS-II? acyl-transferase in CYTOSOL, CAS-II in MITochondria Type 1 DM, becomes hypoglycemic, loses consciousness without warning, how do you treat? GLUCAGON, stimulates hepatic glucose release 12 Year-old girl is brought to the physician for a follow up examination. Three months ago, she sustained a complex fracture of the left tibia, which required cast immobilization. the Cast is removed. Examination of the left Calf Shows that it is smaller than the right Calf. Which of the following processes in this patient's myocytes is the most likely cause of these findings protein degradation---Polyubiquitination strep pneumoniae capsular type are investigated, after adding Dnase, no colonies of S.pneumonia expressing the capsule are isolated, cause? natural TRANSFORMATION-rmbr ADDITION OF Dnase 62-year-old man with unstable angina pectoris undergoes coronary catheterization. In order to visualize the anterior interventricular (left anterior descending) artery, the tip of the angiographic catheter would need to be placed into the orifice of which of the following arteries LCA. The LAD is a branch of the LCA, so to view the LAD you would need to advance the catheter to its orifice on the LCA. If you advance further, you would be in the L circumflex since the LCA bifurcates into the LAD and L circumflex. woman takes Fish oil AND a SUPPLEMENT to treat her dyslipidemia, mechanism of action? antagonizes VLDL cholesterol secretion--NIACIN 54y F admitted with acute MI, at which point there were no murmurs or signs of heart failure; but 2 days later, she has acute SOB and sweating; HR 100, RR 24, BP 160/98. Crackles bilaterally, +murmur. So SOB and Crackles must be fluid backing up into the lung... therefore left sided heart failure -> the concept is that ischemia of the papillary muscles lead to Mitral insuff. -> murmur is holosystolic high pitched loudest at apex what increases pulmonary lymph IV infusion of 0.9% normal saline--It will increase the hydrostatic pressure and decrease the plasma oncotic pressure, both of which will lead to fluid extravasation and thus lymph flow (to get it back into circulation. 78 y/o man. fever, chills, sob. Urinary catheterization for prostatic obstruction. Soft S1, normal S2. Diastolic mumur in 2nd left intercostal accentuated when leans forward. Bacterial endocarditis with Enterococcus. Recall that Enterococcus faecalis is associated with endocarditis post-GU procedures 9 month old, severe respiratory distress dies, autopsy shows VS and Persistent truncus arteriosus, what cells were absent during development? Neural crest cells form the aorticopulmonary septum and endocardial cushions. [Show Less]
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