NBME 19 spoiler questions

[nanitch]

I tried to edit it the most I can to not have it the same as written in the exam. Can someone please give me the answer but with explanations because I want to really understand why its one and not the other. For some reason when people explain it in forums its more easier than in medical terms. lol. Thank you for your time by the way.



42) Diagnosis of cancer, weight loss, cachexia and significant muscle wasting. The breakdown of muscle proteins in the patient was most likely preceded by conjugation of the porteins with?


A) BCl2

D) Cytochrome C

E) Lysozyme

F) Phospholipase A2

G) Ubiquitin


***The reason its not ubiquitin its because ubiquitin has to do with going to proteins that are already damaged like broken? cytochrome c binds to proteins that aren't damaged but want to degrade??I got confused and put ubiquitin


30) 13 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration. Photo of tissue biopsy given. Dx?

a. Granuloma

b. Granulation tissue

e. Neutrophilic infiltrate


**I keep confusing granuloma and granulation tissue. Can someone explain in simple terms the different regarding a question to differentiate them.


24) Case control study. 100men with bladder cancer compared to 100 controls.Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder cancer to EtOH consumption. Interpretation?


a. The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6.

b. There is a 95% chance that the true odds ratio is 3.00

c. At least 5% of consumers of alcohol will develop cancer of the bladder.

d. Men who drink alcohol are 5 times more likely to develop bladder cancer than those who do not drink alcohol


**Im confused regarding this, can someone explain me this on how you would conclude and say what is this like these options in simple words VS. relative risk


32) 32 yo woman with fecal incontinence after child birth. Dx?

a. Damage to anal sphincter

b. Spastic contraction of puborectalis muscle

c. spastic external anal spinchter

d. achalasia of internal anal sphincter


**I assumed puborectalis muscle damaged by levator anti because was pregnant



54) 3 tests evaluate children with diarrhea for rotavirus. Sensitivity and specificity are summarized. If only treat children actually have disease because of toxicity of treatment, which tests should be run?


Test 1 Sensitivity 70 and Specificity 100

Test 2 Sensitivity 90 and Specifiticity 95

Test 3 Sensitivity 95 and Specificity 70


A. Test 1 followed by test 3 if test 1 is positive

B Test 3 followed by test 1 if test 3 is positive

C. Test 2 only

D. Test 2 followed by test 3 if test 2 is negative

E. Test 2 followed by test 3 if test 2 is positive


**This one I have NO IDEA, i hate biostats. not my thing.


47) 62 yo woman, abdominal aortic aneurysm repaird. 48 hr later right distal leg dusky, cool and dark purple to black necrotic lesions on several toes. Biopsy of lesion shows occluded small arteries with needle shaped clefts. Dx?


A. Arterioal narrowing

B. Septic emboli

C. Cholesterol emboli

D. Vasospasm

E. Venous thrombosis


40 yo woman lump in neck became larger recently. 8x10mm mass lateral to midline over thyroid cartilage. Soft, mobile and moves upward when patient protrudes tongue. Whats structure?


A. Hygroma

B. Thyroglossal cyst

B. Dermoid cyst

C. Lymph node


***So because of the protrudes her tongue it moves i thought thyroglossal cyst but should thyroglossal cyst be midline not lateral? I'm confused



44) 53 yo woman w/ GERD. Dietary change and stress reduction no effect symptoms. Physical exam shows mild epigastric tenderness. Tx?


A. Omeprazole

B. Misoprostol


**I dont know why I saw healing esophageal mucosa thought of protection to barrier and put stupidly misoprostol....


8) 62 yo woman weakness of left leg. Left lower extremity shows muscle strength of 1/5 and deep tendon reflexes of 3+. When eyes closed, she cannot tell left great toe is raised or depressed. Embolism of what arteries?


A. Right anterior cerebral

B. Right radicular branches of the posterior spinal


**Yup, I put B. Im so stupid... I put it thinking about propiocpetion Idk lol.


26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal. Whats effected?


A. Decreases amplitude of action potential

B. Decreases maximum frequency of action potential production

C. Increases conduction velocity of axon

D. Increases input resistance of axon

E. Increases rate of depolarization of action potential


***Whats the answer and why


31) 5 yo boy pain in right eye at night. No Fx of neoplasia. Exam shows strabismus and tenderness in eye. Left eye normal. Retina show presence of mass. Physician explain unlikely to develop other neoplasms. Mutation occurs?


A. Retinal cells

B. Somatic cells of parents

C. Somatic cells of child

D. Germ cells


**Why not somatic cells?? whats the answer and why, like how to differentiate



46) 30yo man with urinary incontinence after tx of left pelvis fracture. Physical exam show distended bladder, absence of micturition reflex. After bladder fills to capacity, overflow of urine occurs through urethra by few drops. What other nerve injury?


A. Pelvic nerves

B. Pudendal nerves

C. External urinary sphincter


**Explain which one and why not the others


29) 35yo man want to donate kidney to his sister who is T1DM and chronic renal failure. Healthy, physical exam normal. How likely his HLA type is a match?


A. 1:1

B. 1:2

C. 1:4

D. 1:6


**Which one and why?


21) Mouse thymocyte obtained from normal active bone marry was altered to express bcl-2 and combined with normal marrow cells was injected into mice w/ destroyed active marrow. Control mouse with destroyed marrow was injected w/ normal marrow only. After recovery, whats different between mouse?


A. Decrease cell death in thymic cortex

B. Increase number circulating plasma cells

C. Decrease number of circulating lymphocytes

D. Decrease overall risk of autoimmunity

E. Increase formation of lymphoid nodules in thymic cortex

F. Decrease naive B lymphocytes production by reconstituted marrow


**I put increase number of circulating plasma cells, why its wrong??



49) 1 day old newborn tested for anti-HIV antibodies. Western blot confirm presense of IgG antibodies which react with virus envelope and core glycoproteins. Dx?


A. Both newborn and mother infected

B. The mother is infected, status newborn uncertain

C. Newborn is infected; infection occurred at birth

D. Newborn infected; infection occurred in utero

E. Newborn infected; status of mother is uncertain


**What is the answer and why?


32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated?

So apparently its Na and Glucose cotransport :/ I got it wrong. Im confused...... can someone explain.


50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small bile ducts and increased portal fibrosis. If not treated, what develops?

A. Budd Chiari syndrome

B. End stage cirrhosis

C. Hepatocellular carcinoma

D. Recurrent episodes of hepatitis


**I didn't even mark this one.. i put hepatocellular carcinoma because in FA and DIT it mentioned it so I just put it fast seeing that it was antitrypsin deficiency. What is the answer and why


28) 60yo woman 1 yr involuntary rhythmic jerking of right leg and foot. Increased right ankle jerk reflex. Babinski sign + on right. MRI shows 2cm round lesion at interhemispheric fissure at the central sulcus. Dx?


Why not lymphoma?

Other options

A. Metastatic carcinoma

B. Meningioma

C. Oligodendroglioma


24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive. Further observation shows CD8 T cells bind to antigens resulting in liver injury. Where’s antigen from?

A. Hepatocytes

B. Ito cells

C. Stellate cells

D. Kupffer cells

E. Bile duct epithelium


3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?

A. Hormones derived from 7-dehyrocholesterol

B. Cyclic AMP generated in the enterocytes in response to PTH

C. Calcium binding proteins in goblet cells


20) 23 yo woman DVT at 6 months pregnant. IV heparin started. 7 days later platelet count: 44,000. Dx?

A. Antimegakaryocyte antibodies

B. Antiplatelet antibodies

C. Heparin induced hemodilution


***Which is the answer and why???


42) 26yo woman 3m pain and stiffness of both hands. Physical exam shows swelling and redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP joints spared. Biopsy show?


A. Necrotizing granulomas

B. Neutrophilic infiltrates

C. Pigmented villonodular synovitis

D. Synovial pannus formation

E. Urate crystals


**So since it doesn't include DIP i assumed its not rheumatoid arthritis?? so not pannus??? so which one is it??? and why??



76) yo man 30mins severe substernal chest pain while arguing with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG ST elevation at leads I, aVl, and V4-V9. What happened during argument with brother?

A. Coronary vasospasm due to a1

B. Coronary vasospasm due to B1 adrenergic

C. Increase after load for left ventricle due to B1

D. Negative chronotropc effect of a1


**I have no idea, i assumed increase sympathetic stimulation and for some reason was in between coronary vasospasm due to B1 and after load of B1 but now thinking about it sympathetic stimulates NE release which causes a1 stimulation so I'm an idiot, its that one right?? or which one and why




8) 30 yo man and 24 yo woman genetic counseling. Man’s brother has type 1 oculocutaneous albinism (AR). Single gene disorder 1/40,000 in population. Pedigree shown. What are the odds?
A. 1:600
B. 1:100
c. 1:200
d. 1: 40,000
e. 1:4

**Which is the answer and how u got to it??



21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What substance cause new symptoms?

A. NO
B. Serotonin
C. Histamine

**NO Vs. Histamine???



46) Isolated skeletal muscle is isolated w/ glucose bath. Muscle is contracted w/ electrical stimulation. What intracellular increase indicates fatigue?

A. ADP
B. Inorganic phosphate
C. Inosine monophosphate
D. Lactate
E. pH

**WHYY

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[Episome]

Did anyone get the transport of water in the PCT question correct? I put E, but that was wrong.

 

[GI Guy]

The Correct answer is Histamine (I got this question right). I found this article on-line:
Histamine release during morphine and fentanyl anesthesia. - PubMed - NCBI

From the article:"Patients in the morphine group had an average 750 per cent peak increase in plasma histamine accompanied by a significant decrease in mean arterial pressure"

thats correct. Just so everyone knows, ALL opioids can cause histamine release. Morphine is just the one with the greatest chance of causing overt symptoms

 

[Brorthopedic]

Can anyone explain to my why the question about colon cancer (assuming FAP) is 50% chance the offspring will develop carcinoma?

I put 75% because I thought there's no way of knowing whether he's homo or hetero for the disease (i.e. AA or Aa or Aa = 3/4)

 

[Brorthopedic]

Did anyone get the transport of water in the PCT question correct? I put E, but that was wrong.

There were two of them, I got them both right and I chose the ones that followed Na/Glucose

 

[PIDS]

Quick question:
How was nbme 19 in terms of difficulty compared to other NBMEs?
TIA

 

[karling]

Can anyone explain to my why the question about colon cancer (assuming FAP) is 50% chance the offspring will develop carcinoma?

I put 75% because I thought there's no way of knowing whether he's homo or hetero for the disease (i.e. AA or Aa or Aa = 3/4)

With AD diseases, we generally assume that the parent with symptoms is heterozygous. That parent, then, has a 50% chance of passing on the dominant/disease gene.

 

[karling]

Did anyone get the transport of water in the PCT question correct? I put E, but that was wrong.

I chose the option where the arrow went from tubular lumen to blood and didn't utilize any transporters.

 

[Notetoself1609]

So in lead poisoning I get there is Baso Stippling but Lead inhibits ALA dehydrog and Ferrochel preventing Fe from binding to the porphyrin causing accumulation in the mitochondria = ringed sideroblasts. So which will be seen on blood smear, baso stippling or sideroblasts??

 

[Brorthopedic]

So in lead poisoning I get there is Baso Stippling but Lead inhibits ALA dehydrog and Ferrochel preventing Fe from binding to the porphyrin causing accumulation in the mitochondria = ringed sideroblasts. So which will be seen on blood smear, baso stippling or sideroblasts??

Ringed sideroblast is seen in the bone marrow, while basophilic stippling is seen in the peripheral smear (FA2017, pg 395)

 

[Notetoself1609]

Ringed sideroblast is seen in the bone marrow, while basophilic stippling is seen in the peripheral smear (FA2017, pg 395)

So in the question about the police officer asking what is most likely to be seen, it's stippling because blood smear would be the next step?

 

[Brorthopedic]

So in the question about the police officer asking what is most likely to be seen, it's stippling because blood smear would be the next step?

Bingo

 

[natemerg]

42) are you sure that ubiquitin is not the correct answer. It's what I chose and it was correct
30) granuloma--->try to contain an infection by creating a big "wall" around it, granulation tissue--> wound repair, in very simple words
24) A---> a condifence interval is the probability that a value lies between the two extremes. If you know the mean and the standard deviation you will have 95% confidence that a value will lie between Mean+- 2SD. (ex: average weight in a population is 70 kg, standard deviation is 10kg. If you go out the street and you talk to first person you meet you will be 95% confident that his weight will lie between 50Kg (70-2SD) and 90Kg (70+2SD)
32) I put damage to the anal sphincter. Didn't come up.
54) Test 3 followed by test 1 if test 3 is positive. with test 3 you find 95% of the people with the disease, but since you are gonna have a lot of false positives you use test 1 which is always negative in false positive
47) cholesterol emboli
40) i think thyroglossal cyst
44) also put misoprostol... this question was very tricky, don't know the answer
26) decreased action potential amplitude
31) it seems like a local problem. I put retinal cells--> it's not retinoblastoma, that was the trick I think
46) A. Just guessed I suck at anatomy lol. But seriously I think that's a typical case of atonic bladder. on Uworld is explained much better than how I would explain it
29) 1:4. I guess that you inherit one allele from each parent, 4 different combinations
21) decrease cell death. Bcl2 has to do with apoptosis, mutated in follicular lymphoma
49) B I think
32) I got it wrong
50) I think you read it wrong, antitrypsin has been ruled out and the patient is just few weeks old. I unfortunately got it wrong because I put budd-chiari syndrome
28) Meningioma... I just read central sulcus and 60 year old woman
24) got it wrong, let me know if you find the solution
3) got it wrong... I think A
20) B. Written in first aid
42) Pannus. RA-->PIP, osteoarthritis-->DIP
76) A--> B1 is not present in vessels
8) 1/600. Her brother is diseased and she is clearly not. We can assume that she has 2/3 probability to be a carrier. Disease prevalence 1/40000, then just use Handy weinberg and you'll come up to the results. The other options were very unlikely, I didn't do any calculation
21) I put NO and I got it wrong, i think it's histamine
46) pH decreases during exercise as a lot of lactic acid is formed

Hope that I was helpful. When I have time I'll post the questions that I got wrong

Dude! re: 44

I put Misoprostol, too, but I think the answer is omeprazole. Seems obvious; misoprostol is good for gastric ulcers. Omeprazole is food for acid production in general.

 

[Episome]

Hey does anyone know the right answer (and the reasoning behind it) for the question about the kid with the decreased lecithin-to-sphingomyelin ratio? I chose decreased airway resistance but that was wrong.

 

[natemerg]

Hey does anyone know the right answer (and the reasoning behind it) for the question about the kid with the decreased lecithin-to-sphingomyelin ratio? I chose decreased airway resistance but that was wrong.

Mature surfactant production (achieved around 37 weeks) is confirmed by a lecithin to sphingomyelin ratio of 2. If it is less than this, then surfactant production is immature. Remember what the purpose of surfactant is? To prevent collapse of alveoli at low volumes, decreasing the work required to breathe and keeping airways open longer (what would more open airways do to resistance?). When you're blowing up a balloon, which breath is the hardest (the first breath). I forget the answer options, but does this help you figure out he right answer?


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[Episome]

Mature surfactant production (achieved around 37 weeks) is confirmed by a lecithin to sphingomyelin ratio of 2. If it is less than this, then surfactant production is immature. Remember what the purpose of surfactant is? To prevent collapse of alveoli at low volumes, decreasing the work required to breathe and keeping airways open longer (what would more open airways do to resistance?). When you're blowing up a balloon, which breath is the hardest (the first breath). I forget the answer options, but does this help you figure out he right answer?


Sent from my iPhone using Tapatalk

Yeah, that definitely makes sense. I think the problem for me was the answer choices were really strange. There was:
a) Decreased airway resistance
b) Decreased functional residual capacity
c) Decreased respiratory rate
d) Increased static lung compliance
e) Increased total lung capacity

I thought that I could eliminate d and e pretty quickly. I ended up choosing a) because that's what happens at birth normally (even though I knew that wasn't what they were going for). Oh shoot I just realized the connection right now while typing. The answer is decreased functional residual capacity, because having less surfactant decreases compliance, which is sorta like a restrictive lung disease, and restrictive lung diseases have decreased functional residual capacity. I hadn't even considered that choice before because I assumed less surfactant would make the lung have more residual capacity. Thanks!

 

[natemerg]

Nice connection with RSD!


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[amazonprime]

Hey guys, thanks for the super helpful answers so far! Does anyone have an an answer for the question below?

Renal oxygen consumption is 20 ml/min. which of following process uses most oxygen consumption?
a. acid-base homeostasis
b. glomerular filtration
c. metabolism of tubular toxins
d. production of renal hormones
e. tubular reabsorption

is this just a memorize the fact kind of question or is there a reason behind this?

 

[kenjixshadow]

@amazonprime E. tubular reabsorption. Think of how many ATP you need throughout the whole PCT and DCT. That's why you get ATN during ischemia, see FA page 572.

 

[amazonprime]

@amazonprime E. tubular reabsorption. Think of how many ATP you need throughout the whole PCT and DCT. That's why you get ATN during ischemia, see FA page 572.

Awww that does make a lot of sense! I knew about ATN and ischemia but didn't connect the concept to the question. Thanks!

 

[John4321]

Can anyone explain the question about the woman, with T1DM, in DKA, given some insulin and iso saline. If someone has low bicarb, pCo2, and pH and elevated K, BUN; wouldn't you expect everything to reverse in a few hours? I put decrease K and BUN, and increase pH, HCO3, and Blood pCO2, but got it wrong.

 

[Socaroleen]

Regarding the question of the 38 yo depressed mood, memory problem, palpitations, blurred vision and isomnia plus symptoms pointing to lyme dz like joint pain and Hx erythema migrans.

Maybe I just haven't reviewed this recently but what's the deal with the Cns involvement? I supposed she had been dealing with this for 6 months but that seemed like a lot of neuro involvement for it to just be Lyme. After narrowing it down the the two I went with herpes encephalitis and convinced myself they were avoiding part of her history. Lol.

Anyways, can someone delineate the pathogenesis of cns involvement in Lyme dz?

 

[Socaroleen]

7 yr old boy who emigrated from africa, 2d of HA, fever and back pain. Child in village has similar illness. Weak left LE, diminished reflex, and faciculations in LE. Dx?

I was btw poliomyelitis and west nile encephalitis and chose the latter due to the likely prevalence. I recognized the unilateral paralysis and the LMN signs but then changed my mind on it because -- who gets polio??? Apparently Africans who immigrate and see you in the clinic, but can someone please explain a little on why it wouldn't be West Nile? Just trying to be able to distinguish btw the two better. Thanks!

 

[Socaroleen]

Regarding the patient with dementia and Alzheimer's. They mentioned the wife visits him daily and the adult kids visit several times per week. I absolutely HATE missing these question, but I thought the decision making would be left entirely to the wife. I suppose it would be nicer to ask for the family to come to an agreement, but it even says in FA and also, legally, the wife is the patient's first of kin with the responsibility to make those decision. Seems like offering for everyone to some to a consensus would just open up the possibility for disagreement. Sorry, I guess I'm just ranting. I understand the best way to know the patient's true wishes are to hear it from multiple sources or during multiple instances but it's just hard to tell what exactly they are testing because for sure the decision making is solely the wife's responsibility slash right.

 

[Socaroleen]

Need help with this one as well: brother wants to donate his kidney to his sister with type 1 DM. What is the likelihood his HLA type will match?

I understood there were 6 types of HLA alleles, several of which have subtypes but besides that point I was generally thrown off by this one since the ratios were very small. Anyone have a good grap on the

 

[TheBoneDoctah]

Regarding the question of the 38 yo depressed mood, memory problem, palpitations, blurred vision and isomnia plus symptoms pointing to lyme dz like joint pain and Hx erythema migrans.

Maybe I just haven't reviewed this recently but what's the deal with the Cns involvement? I supposed she had been dealing with this for 6 months but that seemed like a lot of neuro involvement for it to just be Lyme. After narrowing it down the the two I went with herpes encephalitis and convinced myself they were avoiding part of her history. Lol.

Anyways, can someone delineate the pathogenesis of cns involvement in Lyme dz?

The stem said erythema migrans. You see erythema multiforme in HSV1.


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[Nucleus Accumbens]

Can someone explain the question on "gaussian" distribution?
ages 50-54 were 246+/- 50 and it wants to know the probability that the age group in question had a serum concentrations of 296+

 

[Pseudotumor cerebri]

Can someone explain the question on "gaussian" distribution?
ages 50-54 were 246+/- 50 and it wants to know the probability that the age group in question had a serum concentrations of 296+

If I recall, the SD was 50, and the mean 246 for that age group.
So, they were asking for how much percentage would fall beyond +1 SD, when they asked for 246+50 (they didn't ask for 246-50, IIRC)
68% Fall within 1 SD, 95% within 2 SD, and 99.7% within 3 SD. (FA 2017, pg 251)
So 100-68 = 32 would give the percentage that falls outside the range of -1SD to +1SD

Since they only asked for the percentage that falls outside +1 SD, and with a symmetrical curve, just divide 32/2 and you get 16% on either side.

 

[T@k∂šhî]

7 yr old boy who emigrated from africa, 2d of HA, fever and back pain. Child in village has similar illness. Weak left LE, diminished reflex, and faciculations in LE. Dx?

I was btw poliomyelitis and west nile encephalitis and chose the latter due to the likely prevalence. I recognized the unilateral paralysis and the LMN signs but then changed my mind on it because -- who gets polio??? Apparently Africans who immigrate and see you in the clinic, but can someone please explain a little on why it wouldn't be West Nile? Just trying to be able to distinguish btw the two better. Thanks!

Q of Polio vs WNV
I think the key word they used to trigger polio as an answer over WNV is fasciculations of Lower EXT + all the other LMN signs mentioned.

Q about family consensus over decision making
One should always Encourage Consensus for families that are united & to make decisions Based on Perception of Pt Wishes. These is most truly of families from eastern world countries (China, Japan, India).

Choice C. Seems plausible but the answer states (follow ONLY wishes of next of kin) & Not wishes of Pt. The next of kin (in these case the wife) is responsible for making decision based on what the Pt would have wanted, not on what the next of kin wants (Her Wishes).

Choice E. Is a Recommendation & decision of whether accepting or not has to be made by next of kin. since no advance directive was left, these implicates guessing if Pt would have wanted or not the recommendation & Not based on Pt wishes.

if you have answers for HLA question please share. i have been searching but no luck.

 

[W19]

A 32 year old woman comes to the physician because her sister recently died of melanoma. Other first degree family members have been similarly affected and other family members also have large pigmented skin lesions. Which of the following lesions is most likely on both sun-exposed and non-sun exposed ares of the patients skin?

Acanthosis nigircan
Basal Cell carcinoma
Blue Nevi
Dysplastic nevi
Pigmented seborrheic keratosis
I literally have no idea. I'm assuming it's not BCC and from there I just guessed acanthosis nigricans since that's not associated with sunlight.

They give the family hx which is HUGE clue in this question... My guess is it's dysplastic nevi--a precursor of melanoma.

Can someone confirm?

 

[codebluewinniethepooh]

I tried to edit it the most I can to not have it the same as written in the exam. Can someone please give me the answer but with explanations because I want to really understand why its one and not the other. For some reason when people explain it in forums its more easier than in medical terms. lol. Thank you for your time by the way.



42) Diagnosis of cancer, weight loss, cachexia and significant muscle wasting. The breakdown of muscle proteins in the patient was most likely preceded by conjugation of the porteins with?


A) BCl2

D) Cytochrome C

E) Lysozyme

F) Phospholipase A2

G) Ubiquitin


***The reason its not ubiquitin its because ubiquitin has to do with going to proteins that are already damaged like broken? cytochrome c binds to proteins that aren't damaged but want to degrade??I got confused and put ubiquitin


30) 13 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration. Photo of tissue biopsy given. Dx?

a. Granuloma

b. Granulation tissue

e. Neutrophilic infiltrate


**I keep confusing granuloma and granulation tissue. Can someone explain in simple terms the different regarding a question to differentiate them.


24) Case control study. 100men with bladder cancer compared to 100 controls.Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder cancer to EtOH consumption. Interpretation?


a. The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6.

b. There is a 95% chance that the true odds ratio is 3.00

c. At least 5% of consumers of alcohol will develop cancer of the bladder.

d. Men who drink alcohol are 5 times more likely to develop bladder cancer than those who do not drink alcohol


**Im confused regarding this, can someone explain me this on how you would conclude and say what is this like these options in simple words VS. relative risk


32) 32 yo woman with fecal incontinence after child birth. Dx?

a. Damage to anal sphincter

b. Spastic contraction of puborectalis muscle

c. spastic external anal spinchter

d. achalasia of internal anal sphincter


**I assumed puborectalis muscle damaged by levator anti because was pregnant



54) 3 tests evaluate children with diarrhea for rotavirus. Sensitivity and specificity are summarized. If only treat children actually have disease because of toxicity of treatment, which tests should be run?


Test 1 Sensitivity 70 and Specificity 100

Test 2 Sensitivity 90 and Specifiticity 95

Test 3 Sensitivity 95 and Specificity 70


A. Test 1 followed by test 3 if test 1 is positive

B Test 3 followed by test 1 if test 3 is positive

C. Test 2 only

D. Test 2 followed by test 3 if test 2 is negative

E. Test 2 followed by test 3 if test 2 is positive


**This one I have NO IDEA, i hate biostats. not my thing.


47) 62 yo woman, abdominal aortic aneurysm repaird. 48 hr later right distal leg dusky, cool and dark purple to black necrotic lesions on several toes. Biopsy of lesion shows occluded small arteries with needle shaped clefts. Dx?


A. Arterioal narrowing

B. Septic emboli

C. Cholesterol emboli

D. Vasospasm

E. Venous thrombosis


40 yo woman lump in neck became larger recently. 8x10mm mass lateral to midline over thyroid cartilage. Soft, mobile and moves upward when patient protrudes tongue. Whats structure?


A. Hygroma

B. Thyroglossal cyst

B. Dermoid cyst

C. Lymph node


***So because of the protrudes her tongue it moves i thought thyroglossal cyst but should thyroglossal cyst be midline not lateral? I'm confused



44) 53 yo woman w/ GERD. Dietary change and stress reduction no effect symptoms. Physical exam shows mild epigastric tenderness. Tx?


A. Omeprazole

B. Misoprostol


**I dont know why I saw healing esophageal mucosa thought of protection to barrier and put stupidly misoprostol....


8) 62 yo woman weakness of left leg. Left lower extremity shows muscle strength of 1/5 and deep tendon reflexes of 3+. When eyes closed, she cannot tell left great toe is raised or depressed. Embolism of what arteries?


A. Right anterior cerebral

B. Right radicular branches of the posterior spinal


**Yup, I put B. Im so stupid... I put it thinking about propiocpetion Idk lol.


26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal. Whats effected?


A. Decreases amplitude of action potential

B. Decreases maximum frequency of action potential production

C. Increases conduction velocity of axon

D. Increases input resistance of axon

E. Increases rate of depolarization of action potential


***Whats the answer and why


31) 5 yo boy pain in right eye at night. No Fx of neoplasia. Exam shows strabismus and tenderness in eye. Left eye normal. Retina show presence of mass. Physician explain unlikely to develop other neoplasms. Mutation occurs?


A. Retinal cells

B. Somatic cells of parents

C. Somatic cells of child

D. Germ cells


**Why not somatic cells?? whats the answer and why, like how to differentiate



46) 30yo man with urinary incontinence after tx of left pelvis fracture. Physical exam show distended bladder, absence of micturition reflex. After bladder fills to capacity, overflow of urine occurs through urethra by few drops. What other nerve injury?


A. Pelvic nerves

B. Pudendal nerves

C. External urinary sphincter


**Explain which one and why not the others


29) 35yo man want to donate kidney to his sister who is T1DM and chronic renal failure. Healthy, physical exam normal. How likely his HLA type is a match?


A. 1:1

B. 1:2

C. 1:4

D. 1:6


**Which one and why?


21) Mouse thymocyte obtained from normal active bone marry was altered to express bcl-2 and combined with normal marrow cells was injected into mice w/ destroyed active marrow. Control mouse with destroyed marrow was injected w/ normal marrow only. After recovery, whats different between mouse?


A. Decrease cell death in thymic cortex

B. Increase number circulating plasma cells

C. Decrease number of circulating lymphocytes

D. Decrease overall risk of autoimmunity

E. Increase formation of lymphoid nodules in thymic cortex

F. Decrease naive B lymphocytes production by reconstituted marrow


**I put increase number of circulating plasma cells, why its wrong??



49) 1 day old newborn tested for anti-HIV antibodies. Western blot confirm presense of IgG antibodies which react with virus envelope and core glycoproteins. Dx?


A. Both newborn and mother infected

B. The mother is infected, status newborn uncertain

C. Newborn is infected; infection occurred at birth

D. Newborn infected; infection occurred in utero

E. Newborn infected; status of mother is uncertain


**What is the answer and why?


32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated?

So apparently its Na and Glucose cotransport :/ I got it wrong. Im confused...... can someone explain.


50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small bile ducts and increased portal fibrosis. If not treated, what develops?

A. Budd Chiari syndrome

B. End stage cirrhosis

C. Hepatocellular carcinoma

D. Recurrent episodes of hepatitis


**I didn't even mark this one.. i put hepatocellular carcinoma because in FA and DIT it mentioned it so I just put it fast seeing that it was antitrypsin deficiency. What is the answer and why


28) 60yo woman 1 yr involuntary rhythmic jerking of right leg and foot. Increased right ankle jerk reflex. Babinski sign + on right. MRI shows 2cm round lesion at interhemispheric fissure at the central sulcus. Dx?


Why not lymphoma?

Other options

A. Metastatic carcinoma

B. Meningioma

C. Oligodendroglioma


24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive. Further observation shows CD8 T cells bind to antigens resulting in liver injury. Where’s antigen from?

A. Hepatocytes

B. Ito cells

C. Stellate cells

D. Kupffer cells

E. Bile duct epithelium


3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?

A. Hormones derived from 7-dehyrocholesterol

B. Cyclic AMP generated in the enterocytes in response to PTH

C. Calcium binding proteins in goblet cells


20) 23 yo woman DVT at 6 months pregnant. IV heparin started. 7 days later platelet count: 44,000. Dx?

A. Antimegakaryocyte antibodies

B. Antiplatelet antibodies

C. Heparin induced hemodilution


***Which is the answer and why???


42) 26yo woman 3m pain and stiffness of both hands. Physical exam shows swelling and redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP joints spared. Biopsy show?


A. Necrotizing granulomas

B. Neutrophilic infiltrates

C. Pigmented villonodular synovitis

D. Synovial pannus formation

E. Urate crystals


**So since it doesn't include DIP i assumed its not rheumatoid arthritis?? so not pannus??? so which one is it??? and why??



76) yo man 30mins severe substernal chest pain while arguing with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG ST elevation at leads I, aVl, and V4-V9. What happened during argument with brother?

A. Coronary vasospasm due to a1

B. Coronary vasospasm due to B1 adrenergic

C. Increase after load for left ventricle due to B1

D. Negative chronotropc effect of a1


**I have no idea, i assumed increase sympathetic stimulation and for some reason was in between coronary vasospasm due to B1 and after load of B1 but now thinking about it sympathetic stimulates NE release which causes a1 stimulation so I'm an idiot, its that one right?? or which one and why




8) 30 yo man and 24 yo woman genetic counseling. Man’s brother has type 1 oculocutaneous albinism (AR). Single gene disorder 1/40,000 in population. Pedigree shown. What are the odds?
A. 1:600
B. 1:100
c. 1:200
d. 1: 40,000
e. 1:4

**Which is the answer and how u got to it??



21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What substance cause new symptoms?

A. NO
B. Serotonin
C. Histamine

**NO Vs. Histamine???



46) Isolated skeletal muscle is isolated w/ glucose bath. Muscle is contracted w/ electrical stimulation. What intracellular increase indicates fatigue?

A. ADP
B. Inorganic phosphate
C. Inosine monophosphate
D. Lactate
E. pH

**WHYY

Hi

Nice connection with RSD!


Sent from my iPhone using Tapatalk

I hope that you guys are still there... I was having problem with this question earlier, but I now I get it that there is decrease the FRC. what I do not get is why "decreased airway resistance is not correct? because in restrictive lung diseases, NRDS are one of them, there is decreased airway resistance..
I sincerely appreciate your response

 

[codebluewinniethepooh]

Yeah, that definitely makes sense. I think the problem for me was the answer choices were really strange. There was:
a) Decreased airway resistance
b) Decreased functional residual capacity
c) Decreased respiratory rate
d) Increased static lung compliance
e) Increased total lung capacity

I thought that I could eliminate d and e pretty quickly. I ended up choosing a) because that's what happens at birth normally (even though I knew that wasn't what they were going for). Oh shoot I just realized the connection right now while typing. The answer is decreased functional residual capacity, because having less surfactant decreases compliance, which is sorta like a restrictive lung disease, and restrictive lung diseases have decreased functional residual capacity. I hadn't even considered that choice before because I assumed less surfactant would make the lung have more residual capacity. Thanks!

I hope that you guys are still there... I was having problem with this question earlier, but I now I get it that there is decrease the FRC. what I do not get is why "decreased airway resistance is not correct? because in restrictive lung diseases, NRDS are one of them, there is decreased airway resistance..
I sincerely appreciate your response

 

[Progeria7]

Anyone get the spirochete question right? Not sure why it is Obliterative endarteritis w/ lymphocytes and plasma cells?

Also for the propranolol question, why does TPR go up? TIA!

Propranolol is a non-selective beta blocker... so it increases TPR due to inhibition of the normal vasodilation in beta 2 receptor

 

[Med_2016]

I tried to edit it the most I can to not have it the same as written in the exam. Can someone please give me the answer but with explanations because I want to really understand why its one and not the other. For some reason when people explain it in forums its more easier than in medical terms. lol. Thank you for your time by the way.



42) Diagnosis of cancer, weight loss, cachexia and significant muscle wasting. The breakdown of muscle proteins in the patient was most likely preceded by conjugation of the porteins with?


A) BCl2

D) Cytochrome C

E) Lysozyme

F) Phospholipase A2

G) Ubiquitin


***The reason its not ubiquitin its because ubiquitin has to do with going to proteins that are already damaged like broken? cytochrome c binds to proteins that aren't damaged but want to degrade??I got confused and put ubiquitin


30) 13 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration. Photo of tissue biopsy given. Dx?

a. Granuloma

b. Granulation tissue

e. Neutrophilic infiltrate


**I keep confusing granuloma and granulation tissue. Can someone explain in simple terms the different regarding a question to differentiate them.


24) Case control study. 100men with bladder cancer compared to 100 controls.Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder cancer to EtOH consumption. Interpretation?


a. The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6.

b. There is a 95% chance that the true odds ratio is 3.00

c. At least 5% of consumers of alcohol will develop cancer of the bladder.

d. Men who drink alcohol are 5 times more likely to develop bladder cancer than those who do not drink alcohol


**Im confused regarding this, can someone explain me this on how you would conclude and say what is this like these options in simple words VS. relative risk


32) 32 yo woman with fecal incontinence after child birth. Dx?

a. Damage to anal sphincter

b. Spastic contraction of puborectalis muscle

c. spastic external anal spinchter

d. achalasia of internal anal sphincter


**I assumed puborectalis muscle damaged by levator anti because was pregnant



54) 3 tests evaluate children with diarrhea for rotavirus. Sensitivity and specificity are summarized. If only treat children actually have disease because of toxicity of treatment, which tests should be run?


Test 1 Sensitivity 70 and Specificity 100

Test 2 Sensitivity 90 and Specifiticity 95

Test 3 Sensitivity 95 and Specificity 70


A. Test 1 followed by test 3 if test 1 is positive

B Test 3 followed by test 1 if test 3 is positive

C. Test 2 only

D. Test 2 followed by test 3 if test 2 is negative

E. Test 2 followed by test 3 if test 2 is positive


**This one I have NO IDEA, i hate biostats. not my thing.


47) 62 yo woman, abdominal aortic aneurysm repaird. 48 hr later right distal leg dusky, cool and dark purple to black necrotic lesions on several toes. Biopsy of lesion shows occluded small arteries with needle shaped clefts. Dx?


A. Arterioal narrowing

B. Septic emboli

C. Cholesterol emboli

D. Vasospasm

E. Venous thrombosis


40 yo woman lump in neck became larger recently. 8x10mm mass lateral to midline over thyroid cartilage. Soft, mobile and moves upward when patient protrudes tongue. Whats structure?


A. Hygroma

B. Thyroglossal cyst

B. Dermoid cyst

C. Lymph node


***So because of the protrudes her tongue it moves i thought thyroglossal cyst but should thyroglossal cyst be midline not lateral? I'm confused



44) 53 yo woman w/ GERD. Dietary change and stress reduction no effect symptoms. Physical exam shows mild epigastric tenderness. Tx?


A. Omeprazole

B. Misoprostol


**I dont know why I saw healing esophageal mucosa thought of protection to barrier and put stupidly misoprostol....


8) 62 yo woman weakness of left leg. Left lower extremity shows muscle strength of 1/5 and deep tendon reflexes of 3+. When eyes closed, she cannot tell left great toe is raised or depressed. Embolism of what arteries?


A. Right anterior cerebral

B. Right radicular branches of the posterior spinal


**Yup, I put B. Im so stupid... I put it thinking about propiocpetion Idk lol.


26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal. Whats effected?


A. Decreases amplitude of action potential

B. Decreases maximum frequency of action potential production

C. Increases conduction velocity of axon

D. Increases input resistance of axon

E. Increases rate of depolarization of action potential


***Whats the answer and why


31) 5 yo boy pain in right eye at night. No Fx of neoplasia. Exam shows strabismus and tenderness in eye. Left eye normal. Retina show presence of mass. Physician explain unlikely to develop other neoplasms. Mutation occurs?


A. Retinal cells

B. Somatic cells of parents

C. Somatic cells of child

D. Germ cells


**Why not somatic cells?? whats the answer and why, like how to differentiate



46) 30yo man with urinary incontinence after tx of left pelvis fracture. Physical exam show distended bladder, absence of micturition reflex. After bladder fills to capacity, overflow of urine occurs through urethra by few drops. What other nerve injury?


A. Pelvic nerves

B. Pudendal nerves

C. External urinary sphincter


**Explain which one and why not the others


29) 35yo man want to donate kidney to his sister who is T1DM and chronic renal failure. Healthy, physical exam normal. How likely his HLA type is a match?


A. 1:1

B. 1:2

C. 1:4

D. 1:6


**Which one and why?


21) Mouse thymocyte obtained from normal active bone marry was altered to express bcl-2 and combined with normal marrow cells was injected into mice w/ destroyed active marrow. Control mouse with destroyed marrow was injected w/ normal marrow only. After recovery, whats different between mouse?


A. Decrease cell death in thymic cortex

B. Increase number circulating plasma cells

C. Decrease number of circulating lymphocytes

D. Decrease overall risk of autoimmunity

E. Increase formation of lymphoid nodules in thymic cortex

F. Decrease naive B lymphocytes production by reconstituted marrow


**I put increase number of circulating plasma cells, why its wrong??



49) 1 day old newborn tested for anti-HIV antibodies. Western blot confirm presense of IgG antibodies which react with virus envelope and core glycoproteins. Dx?


A. Both newborn and mother infected

B. The mother is infected, status newborn uncertain

C. Newborn is infected; infection occurred at birth

D. Newborn infected; infection occurred in utero

E. Newborn infected; status of mother is uncertain


**What is the answer and why?


32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated?

So apparently its Na and Glucose cotransport :/ I got it wrong. Im confused...... can someone explain.


50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small bile ducts and increased portal fibrosis. If not treated, what develops?

A. Budd Chiari syndrome

B. End stage cirrhosis

C. Hepatocellular carcinoma

D. Recurrent episodes of hepatitis


**I didn't even mark this one.. i put hepatocellular carcinoma because in FA and DIT it mentioned it so I just put it fast seeing that it was antitrypsin deficiency. What is the answer and why


28) 60yo woman 1 yr involuntary rhythmic jerking of right leg and foot. Increased right ankle jerk reflex. Babinski sign + on right. MRI shows 2cm round lesion at interhemispheric fissure at the central sulcus. Dx?


Why not lymphoma?

Other options

A. Metastatic carcinoma

B. Meningioma

C. Oligodendroglioma


24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive. Further observation shows CD8 T cells bind to antigens resulting in liver injury. Where’s antigen from?

A. Hepatocytes

B. Ito cells

C. Stellate cells

D. Kupffer cells

E. Bile duct epithelium


3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?

A. Hormones derived from 7-dehyrocholesterol

B. Cyclic AMP generated in the enterocytes in response to PTH

C. Calcium binding proteins in goblet cells


20) 23 yo woman DVT at 6 months pregnant. IV heparin started. 7 days later platelet count: 44,000. Dx?

A. Antimegakaryocyte antibodies

B. Antiplatelet antibodies

C. Heparin induced hemodilution


***Which is the answer and why???


42) 26yo woman 3m pain and stiffness of both hands. Physical exam shows swelling and redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP joints spared. Biopsy show?


A. Necrotizing granulomas

B. Neutrophilic infiltrates

C. Pigmented villonodular synovitis

D. Synovial pannus formation

E. Urate crystals


**So since it doesn't include DIP i assumed its not rheumatoid arthritis?? so not pannus??? so which one is it??? and why??



76) yo man 30mins severe substernal chest pain while arguing with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG ST elevation at leads I, aVl, and V4-V9. What happened during argument with brother?

A. Coronary vasospasm due to a1

B. Coronary vasospasm due to B1 adrenergic

C. Increase after load for left ventricle due to B1

D. Negative chronotropc effect of a1


**I have no idea, i assumed increase sympathetic stimulation and for some reason was in between coronary vasospasm due to B1 and after load of B1 but now thinking about it sympathetic stimulates NE release which causes a1 stimulation so I'm an idiot, its that one right?? or which one and why




8) 30 yo man and 24 yo woman genetic counseling. Man’s brother has type 1 oculocutaneous albinism (AR). Single gene disorder 1/40,000 in population. Pedigree shown. What are the odds?
A. 1:600
B. 1:100
c. 1:200
d. 1: 40,000
e. 1:4

**Which is the answer and how u got to it??



21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What substance cause new symptoms?

A. NO
B. Serotonin
C. Histamine

**NO Vs. Histamine???



46) Isolated skeletal muscle is isolated w/ glucose bath. Muscle is contracted w/ electrical stimulation. What intracellular increase indicates fatigue?

A. ADP
B. Inorganic phosphate
C. Inosine monophosphate
D. Lactate
E. pH

**WHYY

Sorry, a little late to the thread but I didn't see the answer in the replies.
#50 is end stage cirrhosis because the child has biliary atresia, it's in Pathoma/UWorld but not First Aid. The histologic description in the question stem is a classic presentation.
#31 IS retinoblastoma, unlike what was said above, but it was sporadic (unilateral eye) and not inherited (bilateral eyes), which is why there is no risk of other Rb related cancers.
#24 the antigen is from the hepatocytes. I picked that one because a key feature of any hepatitis is apoptotic hepatocytes and since its a viral illness, the apoptosis is induced by CD8 T cells
#3 the question asked what increased Calcium absorption from the intestinal tract. Vitamin D does that, which is described in A
#21 he had an allergic reaction to the drug so it was histamine. NO also causes vasodilation, but not in allergies

 

[Med_2016]

Would also like an explanation for this, I got it wrong, do you remember what you put down?

30 yo woman with marfan syndrome with tearing chest pain. ECG one year ago showed arotic root to be 5.5 cm (N< 4.0). Stopped taking her perscribed propranolol 1 yr ago because of fatigue. pulse 120 BP 80/40. JVD 6cm above the sternal angle does not decrease with inspiration. The point of maximum impulse is not palpable, heart sounds cannot be distinguished. Asks about which represents the cardiac catheterization?

Cardiac Index (N= 2.5-4.2), Right atrial pressure (N=0-8), Pulmonary Capillary wedge pressure (5-16) Pulmoary diastolic arterial pressure (N= 12-30), Systemic vascular Resistance (N=770-1500)
Answers in order of CI, RAP, PCWP, PDAP, SVR
A) 2,2,5,6,600
B) 2,5,15,15,1200
C) 2,18,18,20,2000
D) 4,2,5,6,600
E) 4,5,15,15,1200
F) 4, 18,18,20, 2000

Thank you!!

She has cardiac tamponade due to an aortic aneurysm rupture.
The method someone wrote about how they figured it out works because they gave the JVD, but if they don't give any values: tamponade causes all four heart chambers to equalize in pressure (specifically DIASTOLIC pressure). Also, tamponade is an obstructive-type shock, which causes a decrease in CO. So CI (which is CO in terms of BSA I think?) would be 2 rather than 4 and then RAP, LAP (PCWP) and the Diastolic pressure should be roughly the same (C).

 

[ch0mpr]

I tried to edit it the most I can to not have it the same as written in the exam. Can someone please give me the answer but with explanations because I want to really understand why its one and not the other. For some reason when people explain it in forums its more easier than in medical terms. lol. Thank you for your time by the way.



42) Diagnosis of cancer, weight loss, cachexia and significant muscle wasting. The breakdown of muscle proteins in the patient was most likely preceded by conjugation of the porteins with?


A) BCl2

D) Cytochrome C

E) Lysozyme

F) Phospholipase A2

G) Ubiquitin


***The reason its not ubiquitin its because ubiquitin has to do with going to proteins that are already damaged like broken? cytochrome c binds to proteins that aren't damaged but want to degrade??I got confused and put ubiquitin
- I put Ubiquitin and it didn't show up on my feedback

30) 13 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration. Photo of tissue biopsy given. Dx?

a. Granuloma

b. Granulation tissue

e. Neutrophilic infiltrate


**I keep confusing granuloma and granulation tissue. Can someone explain in simple terms the different regarding a question to differentiate them.
- Granuloma is an T-cell mediated immune reaction and Granulation tissue is what you find during healing.

24) Case control study. 100men with bladder cancer compared to 100 controls.Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder cancer to EtOH consumption. Interpretation?


a. The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6.

b. There is a 95% chance that the true odds ratio is 3.00

c. At least 5% of consumers of alcohol will develop cancer of the bladder.

d. Men who drink alcohol are 5 times more likely to develop bladder cancer than those who do not drink alcohol


**Im confused regarding this, can someone explain me this on how you would conclude and say what is this like these options in simple words VS. relative risk
- 95% Confidence Interval is a term that describes that if the test was repeated, 95% of the values would lie between those numbers. Thats what i think so. Please correct me if I'm wrong

32) 32 yo woman with fecal incontinence after child birth. Dx?

a. Damage to anal sphincter

b. Spastic contraction of puborectalis muscle

c. spastic external anal spinchter

d. achalasia of internal anal sphincter


**I assumed puborectalis muscle damaged by levator anti because was pregnant
- Anal sphincter can be damaged during childbirth. I believe the correlation is with the damage of the pudendal nerve.


54) 3 tests evaluate children with diarrhea for rotavirus. Sensitivity and specificity are summarized. If only treat children actually have disease because of toxicity of treatment, which tests should be run?


Test 1 Sensitivity 70 and Specificity 100

Test 2 Sensitivity 90 and Specifiticity 95

Test 3 Sensitivity 95 and Specificity 70


A. Test 1 followed by test 3 if test 1 is positive

B Test 3 followed by test 1 if test 3 is positive

C. Test 2 only

D. Test 2 followed by test 3 if test 2 is negative

E. Test 2 followed by test 3 if test 2 is positive


**This one I have NO IDEA, i hate biostats. not my thing.
- High sensitivity test --> Then highly specific test to confirm

47) 62 yo woman, abdominal aortic aneurysm repaird. 48 hr later right distal leg dusky, cool and dark purple to black necrotic lesions on several toes. Biopsy of lesion shows occluded small arteries with needle shaped clefts. Dx?


A. Arterioal narrowing

B. Septic emboli

C. Cholesterol emboli

D. Vasospasm

E. Venous thrombosis
- H/O Vascular repair + Livedo reticularis --> Cholesterol Emboli

40 yo woman lump in neck became larger recently. 8x10mm mass lateral to midline over thyroid cartilage. Soft, mobile and moves upward when patient protrudes tongue. Whats structure?


A. Hygroma

B. Thyroglossal cyst

B. Dermoid cyst

C. Lymph node


***So because of the protrudes her tongue it moves i thought thyroglossal cyst but should thyroglossal cyst be midline not lateral? I'm confused
- It's just probably really big?


44) 53 yo woman w/ GERD. Dietary change and stress reduction no effect symptoms. Physical exam shows mild epigastric tenderness. Tx?


A. Omeprazole

B. Misoprostol


**I dont know why I saw healing esophageal mucosa thought of protection to barrier and put stupidly misoprostol....
- GERD = Pick Omeprazole, NBME loves this for some reason xD

8) 62 yo woman weakness of left leg. Left lower extremity shows muscle strength of 1/5 and deep tendon reflexes of 3+. When eyes closed, she cannot tell left great toe is raised or depressed. Embolism of what arteries?


A. Right anterior cerebral

B. Right radicular branches of the posterior spinal


**Yup, I put B. Im so stupid... I put it thinking about propiocpetion Idk lol.
- Right ACA

26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal. Whats effected?


A. Decreases amplitude of action potential

B. Decreases maximum frequency of action potential production

C. Increases conduction velocity of axon

D. Increases input resistance of axon

E. Increases rate of depolarization of action potential


***Whats the answer and why
- So here's what I did, I eliminated the resistance because it could depend on the diameter
Eleminated Conduction Velocity --> Myelin dependent and the resistance?
Option E is super-contradictory so eliminated that one.

Left me with A and B.
*I didnt know for sure but A felt like a more complete answer, so i picked it anyway.

31) 5 yo boy pain in right eye at night. No Fx of neoplasia. Exam shows strabismus and tenderness in eye. Left eye normal. Retina show presence of mass. Physician explain unlikely to develop other neoplasms. Mutation occurs?


A. Retinal cells

B. Somatic cells of parents

C. Somatic cells of child

D. Germ cells


**Why not somatic cells?? whats the answer and why, like how to differentiate



46) 30yo man with urinary incontinence after tx of left pelvis fracture. Physical exam show distended bladder, absence of micturition reflex. After bladder fills to capacity, overflow of urine occurs through urethra by few drops. What other nerve injury?


A. Pelvic nerves

B. Pudendal nerves

C. External urinary sphincter


**Explain which one and why not the others
- The parasympathetic afferent of the micturition relex is the Pelvic Nerve?

29) 35yo man want to donate kidney to his sister who is T1DM and chronic renal failure. Healthy, physical exam normal. How likely his HLA type is a match?


A. 1:1

B. 1:2

C. 1:4

D. 1:6


**Which one and why?
- 1 HLA allele from each parent, so a 1/4 chance to match perfectly..

21) Mouse thymocyte obtained from normal active bone marry was altered to express bcl-2 and combined with normal marrow cells was injected into mice w/ destroyed active marrow. Control mouse with destroyed marrow was injected w/ normal marrow only. After recovery, whats different between mouse?


A. Decrease cell death in thymic cortex

B. Increase number circulating plasma cells

C. Decrease number of circulating lymphocytes

D. Decrease overall risk of autoimmunity

E. Increase formation of lymphoid nodules in thymic cortex

F. Decrease naive B lymphocytes production by reconstituted marrow


**I put increase number of circulating plasma cells, why its wrong??

- Plasma cells are from B-cells. Here, more BCL-2 is anti-apoptotic, hence option A. This is just my reasoning

49) 1 day old newborn tested for anti-HIV antibodies. Western blot confirm presense of IgG antibodies which react with virus envelope and core glycoproteins. Dx?


A. Both newborn and mother infected

B. The mother is infected, status newborn uncertain

C. Newborn is infected; infection occurred at birth

D. Newborn infected; infection occurred in utero

E. Newborn infected; status of mother is uncertain


**What is the answer and why?
- RT-PCR to confirm in the baby..

32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated?

So apparently its Na and Glucose cotransport :/ I got it wrong. Im confused...... can someone explain.
- SGLT2; also heard this on Goljan audio

50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small bile ducts and increased portal fibrosis. If not treated, what develops?

A. Budd Chiari syndrome

B. End stage cirrhosis

C. Hepatocellular carcinoma

D. Recurrent episodes of hepatitis


**I didn't even mark this one.. i put hepatocellular carcinoma because in FA and DIT it mentioned it so I just put it fast seeing that it was antitrypsin deficiency. What is the answer and why


28) 60yo woman 1 yr involuntary rhythmic jerking of right leg and foot. Increased right ankle jerk reflex. Babinski sign + on right. MRI shows 2cm round lesion at interhemispheric fissure at the central sulcus. Dx?


Why not lymphoma?

Other options

A. Metastatic carcinoma

B. Meningioma

C. Oligodendroglioma
- Just read the interhemispheric sulcus and picked Meningioma

24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive. Further observation shows CD8 T cells bind to antigens resulting in liver injury. Where’s antigen from?

A. Hepatocytes

B. Ito cells

C. Stellate cells

D. Kupffer cells

E. Bile duct epithelium
- Hepatocytes

3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?

A. Hormones derived from 7-dehyrocholesterol

B. Cyclic AMP generated in the enterocytes in response to PTH

C. Calcium binding proteins in goblet cells

-Vitamin D is a derived from 7-dehydrocholesterol

20) 23 yo woman DVT at 6 months pregnant. IV heparin started. 7 days later platelet count: 44,000. Dx?

A. Antimegakaryocyte antibodies

B. Antiplatelet antibodies

C. Heparin induced hemodilution


***Which is the answer and why???
- Anti-platelet anti-bodies

42) 26yo woman 3m pain and stiffness of both hands. Physical exam shows swelling and redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP joints spared. Biopsy show?


A. Necrotizing granulomas

B. Neutrophilic infiltrates

C. Pigmented villonodular synovitis

D. Synovial pannus formation

E. Urate crystals


**So since it doesn't include DIP i assumed its not rheumatoid arthritis?? so not pannus??? so which one is it??? and why??
- DIP is spared in RA --> Answer is Pannus

76) yo man 30mins severe substernal chest pain while arguing with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG ST elevation at leads I, aVl, and V4-V9. What happened during argument with brother?

A. Coronary vasospasm due to a1

B. Coronary vasospasm due to B1 adrenergic

C. Increase after load for left ventricle due to B1

D. Negative chronotropc effect of a1


**I have no idea, i assumed increase sympathetic stimulation and for some reason was in between coronary vasospasm due to B1 and after load of B1 but now thinking about it sympathetic stimulates NE release which causes a1 stimulation so I'm an idiot, its that one right?? or which one and why
- A1 is located in the vessel and and will cause vasoconstriction



8) 30 yo man and 24 yo woman genetic counseling. Man’s brother has type 1 oculocutaneous albinism (AR). Single gene disorder 1/40,000 in population. Pedigree shown. What are the odds?
A. 1:600
B. 1:100
c. 1:200
d. 1: 40,000
e. 1:4

**Which is the answer and how u got to it??



21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What substance cause new symptoms?

A. NO
B. Serotonin
C. Histamine

**NO Vs. Histamine???

- Morphine degranulates mast cells and releases Histamine.

46) Isolated skeletal muscle is isolated w/ glucose bath. Muscle is contracted w/ electrical stimulation. What intracellular increase indicates fatigue?

A. ADP
B. Inorganic phosphate
C. Inosine monophosphate
D. Lactate
E. pH
**WHYY