NBME 13 Questions and Answers

I will post the questions (in my own words) and answers here in case anyone has a question regarding one. It will take time, so feel free to post any questions here and we can answer them for you. Eventually, we will have a nice list here of all of the questions and answers that you can refer to.

 

Block 1 part 1

 

Block 1 part 2

 

Block 2 part 1

 

Block 2 part 2

 

Block 3 part 1

 

Block 3 part 2

 

Block 4 part 1

 

Block 4 part 2

 

Hi can you please post the answers soon?

 

@InterFeron we will be posting all the answers soon! NBME 13 is a bit outdated, so it will come after the others. In the meantime, post any specific questions you have, and someone will answer them correctly!

 

I don't see any answer or questions

 

Really appreciate orthopod. This is hard work. So i'll help. Any correction welcome please. Thank you.

 

Block 1:

1) 72yo man ER 1 wk severe abdominal pain. T101F, HR 106, Abdominal distention and rebound tenderness localized to LLQ. Leukocyte count 18K (80% segmented neutrophils, 10% bands, 10% lymphocytes). Abdominal CT scan w/ contract shows 7mm, thickend colonic wall, and pericolic fat inflammation; there is collection of contrast in this region. Dx?
Diverticulitis?

2) A prospective study exam between gastric cancer and exposure to Selenium. RR of gastric cancer 0.3 in individuals with high-Selenium diet (95% CI 0.1-0.8), Interpretation?
Selenium is associated w/ lower risk of gastric cancer

3) 10yo boy T1DM 1 yr receiving insulin. 1 hr after morning does, becomes tremulous and diaphoretic and tachycardia. Hours later, symptoms resolve. Blood glucose now increased. Cause of hyperglycemia
Inhibition of hepatic protein kinase A

4) 39yo man stabbing pain behind L eye 5 nights. headache begin 1 hr after bed and last 1 hr. During pain, L side nasal stuffiness and tearing from left eye. Similar series of nightly headaches 6 wks several yrs ago. Dx?
Cluster Headache

5)Couple unable to conceive for 2 yrs. Woman regular cycles no contraceptive. Semen:
Quality: Normal; Quantity: Normal
Color: white; Fructose: 5% of normal
Infertility?
Seminal Vesicles

6) 55 yo man ER 45min after collapsed. HR 120, R: 16, BP: 80/45. Px no other abnormalities. Hemoglobin 8g/dL, hematocrit 24%, platelet 240K. Endoscopy bleeding duodenal ulcer, surgically repaired. Received 4 units PRBC. 2 days later lab:
BUN: 70
Creatinine: 3 mg/dL
Sediments: Granular casts
2 wk later, urine sediments clear and renal function is normal. Histo?
Regenerating Tubular epithelial cells.

7) 3 cases of nosocomial pneumonia Klepsiella pneumo in 13 bed ICU. Each pt private, enclosed room. Infection control?
Promote thorough hand cleaning before and after medical personnel visit each patient.

8)29mo boy 2 wk h/o green nasal d/c and cough. Past h/o frequent respiratory tract illness and pneumonia. 6m h/o large foul smelling stools, salty taste when she kisses him. No Fx similar conditions. 5th % for ht 3rd % wt. T100.9F. Abdominal distention. Cystic fibrosis transmembrane conductance regular gene. Which modification destruction of misfolded proteins?

Ubiquitination

9) 32yo woman. 5 yrs no conceive. Husband fertility normal. 28d menses. BP 110/70. Exam, hysterosalpingography, hormone normal. Tx?
Clomiphene

10) 15yo boy 1m behavior changes. Failing class, late night. Family moved. P110, R24, BP140/85. Pupillary dilation, diaphoresis. Affect agitated, thoughts confused. Dx?
Amphetamine

11) 72yo woman bloody diarrhea 12h diffused abdominal pain 4d. Hx cerebral infarction 3y ago, recovered completely. Watery stool w/ red blood. Colposcopy patch ulceration area near splenic flexure. Dx?
Ischemic Colitis

12) 4yo girl 3d puffy eyes. URT infection 1 wk. urine 3+ protein. Urinalysis no RBC/WBC, no casts. Dx?
Loss of negative glomerular charge

13) 23yo woman 2m no menses. Start 14yo, 28d cycle. Blue tinged vaginal mucosa. Uterus lower segment, size of orange. Adnexa nontender w/ normal size ovaries. Next?
Measure beta HCG.

14) 70yo man 7d rash. 4-6cm tense bullae filled w/ clear fluid over forearm, lower abd, groin and thighs. Skin biopsy non-acantholytic blister w/ separation of epidermis from basement membrane. Autobodies against?
Hemidesmosomal proteins

15) 23yo woman 45mins injury to R shoulder. Hold her R arm external rotation. Tenderness and absent sensation over lateral aspect of forearm. After reduction, no flex elbow against gravity. Dx?
Musculocutaneous nerve

16) 78 yo man. 3m h/o increasing back pain. 12lb wt loss. Pain at night by movement. ASA no relieve. No trauma. Chronically ill. P100, BP160/100. Tenderness to L4-5. No skin lesion, Urine 4+ protein. Bone marrow aspiration pic. Dx?
Multiple Myeloma

17) 26yo P0 women deliver 6lb male. 6m ago received GBS vaccine. Screening indicate antibody to vaccine. Antibody detected in serum during labor. Newborn appears lethargic. CSF and blood grew GBS. Which isotype mom has?
IgM

18) 16yo boy T1DM need daily insulin. Poor BG control still. Dr. response?
“Giving youself insulin injection can be difficult. What’s it like for you?”

19) 25yo man advanced testicular cancer. Cisplatin included, MOA?
DNA

20) Drug X treat trematode and cestode infection. X increase cell membrane permeability to Ca, causing paralysis, dislodgement, and death. Whats X?
Praziquantel

21) Tracing contractile reponse of skeletal muscle to electric simulation at 5 different frequencies. Ca in SR highest ?
A?

22) 40yo man MVC. DOA. h/o fever, HA, chills, pain in URQ of abd 5d ago. Liver histo disruption of normal hepatic lobule. Small shrunken hepatocytes w/ intease eosinophilic cytoplasm. Fragmented nuclear chromatin. Cytoplasmic bleb formations. Process?
Apoptosis.

23) 20yo man 3m hemoptysis, hematuria, 22lb wt loss. Hypochromic microcytic anemia. Microscopic?
Light: Glomerular Crecents; GBM: IgG/C3, electron: no deposits

24) 42yo Asian woman n/v/lethargy. 25pack year. 4g wine daily. High dose APAP for headaches. No illicit drugs. BMI 21. Responsive to painful stimuli. Increased ALT/AST. EtOH effect?
Induction of cytochrome P450

25) Homologous pairing of chromosomes in prophase 1?
Crossing over

 

26) 70yo man weakness, nausea, lower abd and back pain radiates to lower extremities. Pale, cold sweat. HR110, BP90/60. Lower extremities weak pulse. Lower abd bruit. Dx?
Leaking aortic aneurysm

27) 6yo boy almond shaped eyes, temp instable, MR, hyperphagia, obesity. Balanced tranlocation involving chromosome 15q11-q13. Father and paternal aunt with identical balanced translocation. Aunts 5yo daughter h/o inappropriate laughter, abnormal gait, MR. why?
Imprinting

28) 25yo woman radical mastectomy w/ removal of axillary lymph nodes on L side. Develop painful edema of left upper ext. what therapy?
Compression sleeve

29) 33yo woman R handed 3d h/o progressive weakness, numbness of arms/legs. Proximal/distal weakness of extremities. Areflexia. Vibration/joint position decreased in fingers/toes. Slow nerve conduction in median, ulnar, peroneal and tibial nerves. What channels impaired?
Voltage gated Na channels

30) 2yo girl PO cephalexin for impetigo by GAS. MOA?
Interference with bacterial cell wall synthesis.

31) 31yo woman 10mins difficulty breathing, severe muscle weakness. 3y h/o Myasthenia gravis tx c neostigmine. Double dose 2 days ago. Weakness increased, why?
Densensitization of nicotinic receptors.

32) 50yo man 2m h/o wrist pain, skin color change, fatigue. Brother T2DM/cirrhosis. Bronze color skin, MCP join pain, and hepatosplenomegaly
AST 100, ALT 110, Ferritin 1200, Transferrin sat: 80%.
Liver biopsy increased Fe conc. Why?
Increased intestinal iron absorption.

33) 50yo man T2DM several fainting episodes and fatigue. Chronically ill. Vitals normal. Hemoglobin 8, hematocrit 24%, BUN 60, creatinine 6. Other heme lab normal. Tx?
Erythropoietin

34) male newborn delivered at 34 wks gestation uncomplicated spontaneous vaginal delivery develops RDS 30mins later. RR40. Cyanosis and lower rib retraction with respirations. CXR fine densities with reticulogranular appearance b/l. Dx?
Pulmonary surfactant deficiency

35) 25yo man w/ CF 3d fever, cough, SOB. T100, RR 32. B/L crackels and rhonchi. Grows aerobic, oxidase +, G – rod form slimy colonies and produce pyocyanin. Abx no eradication of organism. Why?
Biofilm formation in the lower respiratory tract.

36) 20 subjects participate study cardiopulmonary physiology. Pulomary circulation compared to bronchial circulation?
Larger % of cardiac output.

37) autopy of 46yo women died of colon adenocarcinoma. 5cm round neck mass next to bifurcation of carotid art. Slide positive for synaptophysin, chromogranin, and neuron-specific enolase. EM shows numerous electron-dense, membrane bound neurosecretory granules. Adrenal gland no mass. Dx?
Paraganglioma

38) 40yo man with ED. ½ L bourbon per day for 15y. P:88, BP 130/80. Scleral icterus and spider angiomata. Liver span 5-6cm midclavicular line. Spleen tip 5-6 cm below L costal margin. what decreased?
Testosterone

39) Study molecular events in cause of autoimmune disease developes monoclonal antibodies to ribosomal proteins. A monoclonal antibodies inhibit ribosomal peptidyl transferase. What effected?
Establishment of covalent bonding between amino acids.

40) 24yo man 25yo woman unable to conceive 3y. wife normal. Man’s semen immotile but normal numbers of sperm. What other problems?
Sinusitis

41) 60yo man 2wk fatigue and exercise intolerance. Dx w/ stage 1 HTN and began tx with propranolol. Today P56, before P72. Switched to Pindolol. Symptoms resolved in 1 month. P68. Why
Partial agonism.

42) 9yo boy 2 days of fever, chest pain, migratory joint pain of shoulders, hips and knees. 4 wk ago, febrile pharyngitis resolved 2wk later w/o tx. T102, lungs clears to auscultation. Pericardial friction rub and quiet heart sounds heard. Throat culture no pathogens. Increased antibody titers to streptolysin O. Death?
Myocarditis

43) 57yo man dies of MI. Autopsy lung tissue shows alveoli containing epithelial cells cuboidal in shape w/ electron dense lamellar bodies. Produce?
Surfactant

44) 52yo man epigatric abd pain. 15lb weight loss. Osteoarthritis tx w/ naproxen PRN. Immigrated from japan to USA 6 months ago. 60 pack yr. 3-4g wine daily. BMI 28. Exam epigastric tenderness. Endoscopy show 4cm ulcer. Biopsy adenocarcinoma. What risk factor?
Naproxen

45) 63yo man R chest pain and SOB after 10h truck drive. Pain severe on inspiration. No smoking. P110, R32, lungs clear to auscultation. V/Q scan?
Absence of perfusion in some areas that are ventilated

46) 40yo man severe pain L leg while playing tennis. Ruptured L Achilles tendon. Surgical repair and cast immobilization. After 6 months, 2cm decrease in circumference compare to R calf. Dx?
Increased protein degradation.

47) 45yo man severe headache. Worst headache ever. Lethargic. BP 130/80. Nuchal rigidity, CT scan w/o contract shown. Dx?
Subarachnoid hemorrhage

48) Study on cardiovascular disease in AA men/women in USA. Series of factor defined. Census tracts representative of national census data sampled. Technique?
Population based.

49) 23yo woman T1DM f/u. Recurrent yeast infections. Deficiency of myeloperoxidase. Dx?
Inability to produce hydroxy halide radicals.

50) 48yo woman R breast ductal carcinoma has modified radical mastectomy. Results in wing scapula when pressed arm against wall. Nerve?
Long thoracic.

 

Block 2:


1) 40yo woman dies after MVC. Controlled seizures for 25yrs. Gross coronal section of brain photographed. Dx?
Vascular Malformation

2) 48yo man difficulty open mouth, neck and back stiffness. Puncture wound to arm 1 wk ago. Received no medical care for 30yr. Exam trismus and opisthotonos. Why?
Blockade of inhibitory neurotransmitter release.

3) 38yo woman 32 wk pregnant h/o fever, nausea, vomiting and muscle aches. T102, R20. Gram stain given (looks like G+rod). Dx?
Listera Monocytogenes.

4) 30yo woman, G2P2, vaginal bleeding after vaginal delivery. Uncontrolled hemorrhage, hysterectomy to control. Uterus shows fragments of placenta adherent to uterine wall. Absence of decidua basalis. Dx?
Placenta Accreta

5) 22 yo G0 woman cannot conceive for 18m. irregular menses since 13yo. BMI32. T98, P88, BP140/90. Moderate hirsutism and mild acne over face/back. Pelvic/genitalia normal. Bimanual exam limited by obesity. Dx?
PCOS

6) 22yo man study of heat rate regulation. Sitting on bicyle and start to pedal in 5 mins. 1 min before heart rate increases. Why?
Transmitter: Norepi, Receptor: beta1

7) 55yo man 2 episode of painless, blood tinged urine. Last time was 2 days ago. 35pack yr. vitals/physical exam normal. Urine microscopic blood. Dx?
bladder cancer

8) 7yo girl 3yr history of temper tantrums when separated from parents. Refuse sleep alone and attend friends parties. Mom angry with daughters behavior. Father recalls same behavior when young. Dx?
Separation anxiety disorder

9) 76yo woman 3hr h/o headache, slurred speech, confusion. 2 yo h/o A fib. Difficulty understanding and answer questions. But cooperative. Optho exam hemianopia and gaze to right. PERRL. Neuro exam shows left side numbness and paralysis more severe in face and upper exterimity and lower. Which artery?
Middle Cerebral

10)28yo woman with marital problems. She wants to go out, husband likes to be alone, prefer hiking, indifferent to sexual intimacy and shows no emotion nor understand her feelings at all. Dx?
Schizoid

11)76yo man admitted 2wk h/o UTI. BMI 20. IV abx to obtain serum concentration of 8mg/L. Volume of distribution is 0.35L/Kg. 24hr creatinine clearance normal. Loading dose?
150

12)27yo woman 2y h/o sporadic diplopia and arm numbness and tingling. Symptoms more severe when in-laws visit. 4 episodes of urinary incontinence. Exam mild dysarthria. Mild worried mood and reactive affect. Brain MRI few, scattered nonspecific white matter plaques. Dx?
Multiple Sclerosis

13)55yo manhepatic encephalopathy w/ confusion and increased lethargy. Cirrhosis due to hep C. T98. Physical exam scleral icterus, asterixis, protuberant abd, ascites. Stool occult blood negative. Med?
Lactulose

14)60yo man weakness and light headedness for 3 months. Healthy balanced diet of fruits, vegetables, whole grain, lean chicken and fish. 10yr h/o chronic autoimmune (Hashimoto) thyroiditis tx w/ thyroxine. Physical exam shows pallor. Serum increased concentration of methylmalonic acid and total homocysteine. Blood smear shows megaloblastic anemia. Dx?
Failure of intrinsic factor production

15)55yo woman scheduled for transvaginal hysterectomy and oophorectomy for uterine bleeding. Uterus separated from all surrounding structures. Incision of what structure that attaches to cervical region and extend posteriorly ?
Uterosacral ligament

16)24yo woman pain in left leg while walking. T98, P84, BP135/78. Exam: Left lower extremity decreased pulse. Faint diastolic heart murmur at apex. Angiograph of lower extremity show complete obstruction of distal L femoral artery by thrombus. Occlusion removed and specimen shows scattered mesenchymal cells with abundant extracellular matrix. Echo confirm cardiac tumor. Dx?
Myxoma

17)3yo boy multiple ecchymoses, bleeding into joint, bloody diarrhea 48h after ingesting lots of warfarin. PT80 (INR=20). Tx?
Fresh Frozen Plasma

18)35yo man 5y h/o recurrent genital herpes tx w/ acyclovir. Pt complain of recurrent lesions. Explain?
Established latent infection of sensory nerve cells

19)49yo man pancreatic cancer undergoes Whipple resect distal stomach, duodenum, head of pancrease. Stomach joined w/ jejunum. Which nerves can be cut to reduce ulcers in jejunum?
Vagal trunks.

20)22yo woman admitted due to polydipsia and polyuria. Urination awakes pt at night. Taking Lithium for bipolar. Dose increased 6 months ago due to recurrent manic. Vitas and physical exam normal. 24hr Urine excretion 6.5L. Serum Na: 75, osmolality 315, urine osmolality 75. Output and osmolality no change after desmopressin. Nephron tubular osmolality compared to serum?
PCT: isotonic, Juxt: hypotonic, Collect Duct: hypotonic.

21)6yo girl severe abd pain, nausea, vomit after attending friend party. Cake and pastries served. Appears acutely ill and mildly dehydrated. T98, P104, R20. BP: 96/60. Normal skin. Bowel hyperactive. Dx?
Enterotoxin ingestion

22)31 yo woman 1yr infertility. Hysterosalpingogram shown. Malformation?
Paramesonephric (mullerian) ducts.

23)40yo woman genetic counseling of family history of muscle weakness. No treatment b/c symptoms not severe. Her children have profound muscle weakness and fatigue. Analysis of mtDNA shows mutation in 50% of mother mtDNA and 100% in all 4 children’s mtDNA. Genetic principle?
anticipation?

24)Male newborn delivered at 38wks uncomplicated pregnancy. 12 hr post, sucking frantically and crying inconsolably. Overreacts to stimuli and marked startle response. Resolved after 2-3 wks. Maternal use?
Heroin

25)21 yo AA man w/ sickle cell disease, severe pain to abdomen and knees. 6 episodes in 4 yrs. 2 episodes of pneumonia and small cerebral infarction in past 2 yrs. Asks for extra pain meds, unbearable to symptoms. Dr tx?
Reevaluate patient after pain has been controlled.

 

26)72 yo woman admitted to ICU after surgical repair of ruptured colonic diverticulm. 2 wk developed recurrent fevers. Blood grew yeast, micafungin started. MOA?
Cell Wall

27)25yo man admitted to tx viral pneumonia. Mechanically ventilated due to respiratory failure due to hypoxemia. Open lung biopsy shows acute lung injury. What suggest diffuse alveolar damage rather than bronchioloitis obliterans-organizing pneumonia?
Alveolar hyaline membrane

28)54 yo woman severe mid back pain. Point tenderness over T6 vertebra. Serum show Ca: 13.4, urine: Bense Jones proteins. Hypercalcemia?
Local IL-1 and TNF effects.

29)15yo boy intracranial neoplastm, MR, seizure due to tuberous sclerosis. AD. 41yo mother is healthy but has angeofibromas. Which are benign skin lensions of TS. Why?
Variable Expressivity.

30)Study conducted assess effectiveness of vitamin C to prevent common cold in children. Pt randomly assigned to receive either vitamin C or no intervention. Common colds are reported by parents monthly for 1 yr. Results show vitamin C children had fewer colds (p<0.05). whats problem?
Variability in outcome assessment?

31)54yo man burning epigastric pain. Divorced. Fast food diet. Smoke cigars and drinks on weekends. Treated for H. pylori 1 yr ago. Takes OTC IBU600 daily for chronic joint pain. Abdominal exam show tenderness to deep palpation of epigastric area. Peptic ulcer suspected. Risk?
Ibuprofen use

32)2mo boy dies of meningitis despite abx tx. CSF grew mycobacterium Tuberculosis. 2 brothers died of atypical mycobacterial infection. Dx?
Interferon gama receptor deficiency.

33)23yo woman h/o chills, nausea, vomiting, flank pain, urinary frequency and urgency, pain w/ urination. T102, P125, BP96/60. Right CVA tenderness. Urine 25 WBC, pink colonies on Lactose-MacConkey agar. Green sheen on eosinmethylene blue agar, indole positive. What virulence?
Adhesions

34)9yo girl severe pain in right shoulder after fall. Exam pain on movement and tender right clavical. XR shows nondisplaced fracture of right clavical. Which structure produce new bone healing?
Periosteum

35)18yo woman mild MR with decreased ability to see in reduced light. Chronic diarrhea. 2 y ago lack of muscle control of her arms and legs and generalized weakness. 16 yo brother has similar symptoms. Eye exam bilateral retinitis pigmentosa. Ataxia and loss of DTR. Erythrocytes with spiny projections and total cholesterol: 40. Which APO deficient?
APO B

36)39yo woman at end stage renal disease by SLE undergoes allograft kidney transplant. Rejection after 6 months. Biopsy of transplant show numerous infiltrating CD8+ T lymphocytes. Why?
Direct Cytotoxicity

37)23 yo woman tx with acetazolamide to prevent acute altitude sickness 3 days before mountain climbing expedition. MOA?
Proximal tubule

38)retrospective study assess incidence and outcome of subarachnoid hemorrhage. Annual incidence is 15 per 100000 ppl. Fatality rate 40%. What’s annual mortality rate?
0.4 x 15

39)51yo man bloody cough. 6.6lb wt loss. 62 pack yrs. HTN treated w/ metroprolol. Clubbing fingers. Wheezing over right upper lob anteriorly. No crackles. LAB:
Na: 125, Cl: 85, Creatining: 0.4
CT Chest 2.4x1.2cm speculated noncalcified mass in right upper lobe eroding into right bronchus. Which hormone excess?
Brain Natriuretic peptide

40)Experiment cuff oclcuder placed on left renal artery of normal rat inflated to cause 90% decrease in artery cross section. Catherter placed in Left/Right renal veins. What higher in effluent of left than right?
Renin

41)21yo man dies of cardiac arrest after snorting cocaine. Dx?
Norepi reuptake.

42) 18yo man twisted ankle while playing football. Tear of lateral collateral ligament. What limits ligament healing?
blood vessels

43)82yo woman tx for small right pleural effusion. Exam dullness to percussion at level of 7th rib and below on right. Pt sitting up. Whats location for thoracentesis?
above 9th rib in the midscapular line

44)32 yo man intermittent flashing spots, blurred vision, vomiting, confusion and difficulty walking. Painter and claims cleaned up spilled bottle of paint thinner. Eye exam show dilated pupils w/ hyperemia of optic disc and retinal edema. Physical show tachypnea. Serums anion gap metabolic acidosis. Meds inhibit what?
Alcohol Dehydrogenase

45)52 yo man renal failure with abdominal pain for 6 months. treated for renal calculi and HTN. Physical exam shows bilateral palpable masses in upper abdomen. Urinalysis crenated erythrocytes and mild proteinuria. CT abdomen ID cause, Dx?
PCKD

46)22 yo woman f/u exam. Dx w/ PE. 2 yrs ago delivered a female stillborn at 23wk. today normal. Platelet: 250K. PT normal, increased PTT. Dx?
Antiphospholipid antibody syndrome.

47)62yo man progressive difficult breathing and mild left shoulder pain. Symptoms started after ran up stairs. Poorly controlled HTN and mild angina pectoris. 20 pack yr. uncomfortable with labored breathing. Diffused crackles, rhonchi, scattered wheezing on posterior lung fields. PO2 58. Dx?
Pulmonary edema

48)Mouse melanoma, B16, highly metastatic. B16 clone infected into tail vein of mice. Tumor found in lungs, liver and ovaries. When antibody to liver cell surface antigen is injected before B16. Only tumors in lungs and ovaries, No tumor in lungs. In vitro no cytotoxic effect of antibody to B16 or hepatic cells. Why?
Homing

49)64 yo woman heartburn and difficult swallow solid food and liquid. No nausea no vomit. Pain in wrist and hands. No meds. No smoke. No wrinkles on face and neck. Vitals normal. Synovial thickening of wrist bilaterally. Photo of hand provided. Abdominal exam normal. Esophageal manometry?
Esophagus Peristalsis: decreased; esophagus Sphinter tone: decreased

50)33 yo woman 35lb wt gain despite diet. BMI 37. BP 156/96. Round ruddy face with hirsutism, excess wt in shoulders and abdomen and purple striae over the abdomen. MRI mass in pituitary gland. CT abdomen enlarged adrenal glands. Histo changes of adrenal glands?
Cortical hyperplasia.

 

BLOCK 3:

1) 18mo boy facial abnormalities and slow growth. Older brother w/ same abnormalities with MR. Pt below 3rd % for length and 10th % for wt. Exam coarse facial features, hepatosplenomegaly, joint stiffness. Urine dermatan sulfate and heparin sulfate increased. Deficiency?
Iduronate sulfatase

2) 45 yo woman heart murmur and hepatomegaly. Flushing with hypotension and crampy diarrhea. Primary neoplasm?
small intestine.

3) 43 yo man BMI 30. Physical exam no abnormalities. Older brother DM. Pt does not want to be DM. what diet?
low Calorie

4) 35yo man gradual ED. Decreased facial hair. Puberty started at 12. BMI 23. Vitals normal. Physical exam typical male pattern hair, genital normal. Serum TSH: 2, prolactin 120. Total testosterone 25 (N= 10~35). Semen decreased sperm count with impaired motility. MRI brain 1cm lesion in pituitary gland. Tx?
Bromocriptine

5) 60yo man skin blistering. Blisters in mouth easily ruptured. Scattered blisters over upper/lower extremities, trunk intermingled with crusted denuded areas. Biopsy intraepidermal vesicle formation. IgG deposit in keratinocytes. What structure involved in skin?
Desmosomes.

6) 60yo man progressive weakness to hands. Carpenter w/ difficulty handle tools. 45 pack yr. 2 beers daily, 6 beers on weekends. No LAD. Decreased strength (4/5)in upper and lower extremities and atrophy in hand muscles. Diffuse hyperreflexia. Fasciculations noticed on muscles on hands and upper extremities. Next?
Difficulty Swallowing

7) male newborn 34wk delivered vaginally. no abnormalities except 1cm raised red area on anterior section of neck. Dr explain lesion is hemangioma. Origin?
Endothelium

8) 42 yo with numbness to fingers on left hand. Neuro exam shows loss of touch graphesthesia and loss of 2 point discrimination on left hand. Where is lesion?
B?

9) 25 yo woman decreasing urine output despite ample fluid intake. Removed perforated appendix 3 wks ago. IV gentamicin for 2 wks. Physical Exam normal. BUN: 35, Creatinine: 2.9, Urine protein: 2+, Casts: brown granular. Histo where is necrotic cells?
Proximal Tubule

10) Pharm company design new Protease inhibitor what inhibit HIV in T lymphocytes in culture. What finding indicate PI is working?
Lack of mature core

11) 5 yo boy headache, clumsiness and fatigue. Generalized tonic clonic seizure 1 month ago. Often falls during running. Eye exam ptosis of left eye and b/l external ophthalmoplegia. Weakness of left lower extremity. Increased lactate concentration. Calf muscle biopsy shows ragged red fibers. What impaired?
Oxidative phosphorylation.

12) 42 yo man muscle cramping and pain. Treated w/ simvastatin for hypercholesterolemia. Marked improvement after 1 month but triglyceride remain increased. Gemfibrozil added to decrease triglyceride. Physical exam normal. Why myalgia?
Inhibition of cytochrome P450 metabolism.

13) 2 clinical trials. Trial X and Trial Y to assess efficacy between new and current antibiotics for UTI. Studies identical, except statistical power. Trial X = 0.8 and Trial Y = 0.9. Type 2 error?
Greater in Trial X than in Trial Y

14) 43 yo man lower back pain. Complain about PCP to ER dr. What’s response?
Encourage pt to make appointment with physician to communicate his concerns

15) 44 yo man angina pectoris with increasing chest pain. 5 similar episodes needing increased nitroglycerin. T98, P105, R16, BP150/90. S4, ST depression in precordial leads. Given ASA, heparin, nitroglycerin and monoclonal antibody against platelet IIb/IIIa receptor. Prevent what binding to platelets?
Fibrinogen

16) 44 yo woman pain, swelling, stiffness to both hands. Worst in mornings symptoms improve with activity. Painless nodules on extensor surfaces of arms and tenderness and swelling of MCP and PIP joints. What path process?
Pannus formation

17) 4 yo boy headache, nausea, vomiting and dizziness. Physical exam severe lethargy. Venous blood bright red. Carboxyhemoglobin sat 30% (N<5%). Which electron transport pathway effected?
Cyt a/a3à O2

18) 3 yo girl grade 4/6 loud harsh, high pitched holosystic murmur radiates over the precordium and palpable thrill at left sternal border. Defect?
VSD

19) 48 yo woman 3 hr history of nausea and sharp right abdominal pain radiate to back. Physical exam Enlarged right ovary, pregnancy test negative. U/S confirm enlarged right ovary. Dopple U/S decreased adnexal flow. What affected?
Suspensory ligament

20) 65 yo woman diabetic ketoacidosis, fever and proptosis of left eye. Unable to move left eye. Black eschar on nasal mucosa. Dx?
Mucormycosis.

21) 22 yo woman painless, slowly enlarging mass on left side of neck. Physical exam freely mobile, soft, cystic mass with cutaneous surface opening. Dr explain imcomplete fusion during embryonic development. Wheres location of duct?
Anterior to SCM

22) 55 yo man fever and shaking chills. End stage renal disease tx w/ hemodialysis. T 102, P110, BP 156/92. Physical exam tunneled central venous catheter enter right side of chest below clavicle; not tender. Echo 3cm vegetation on tricuspid valve. Dx?
Staph aureus

23) 42 yo man autoimmune disorder proximal muscle weakness of lower extremities. Arrows show indicate membranes that contain high concentrations of channels targeted by disease. Dx?
Myasthenic(Lambert-Eaton) syndrome

24) 18yo G0 woman at 16 wk gestation, nausea, vomiting. No prenatal care. Uterus consistant with 20 wk gestation. B-HCG increased, urine protein 4+. U/S echogenic material within endometrial cavity but no fetus. What proliferated?
Trophoblastic tissue

25) 30 yo woman and 25 yo husband ask having another child w/ Tay-Sachs. 6 month old son Dx w/ Tay-Sachs. Both has Fx of disease. Whats risk?
25%

 

26) 20 yo man cramping periumbilical pain. Pain shifts to RLQ and consistant. T104, WBC 20,000 with 90% neutrophils. What mediator cause fever and leukocytosis
IL-1

27) 47 yo man sharp left flank pain and fever. T100, Abdominal exam exquisite tenderness in Left CVA. Labs normal. Image show hydronephrosis of left kidney and staghorn calculus. Nephrectomy done, calculus composed of Struvite. Bug?
proteus mirabilis

28) 12 yo AA girl fever, severe rib pain. Recurrent, paternal aunt/uncle same. T102. Lungs clear. Abdominal exam tenderness to palpation. Blood smear shown. Cause?
Polymerization of hemoglogin w/ hypoxic conditions due to amino acide substitution to beta chain

29) 43 yo woman metastatic colon cancer remission with bevacizumab. Bevacizumab works because?
the agent being a humanized antibody

30) 32 yo woman progressive SOB and anxiety. Symptoms worse as day progresses. BMI 24. Breath sounds normal, but pt difficult taking long breath.
pH 7.33, PCO2: 70, PO2: 65. Pulmonary function test show decreased vital capacity, tidal volume and expiratory reserve volume. Residual volume normal. Dx?
Myastenia Gravis

31) 15 yo boy painless swelling in left breast for 1 month. 65% ht, 70% wt. P65, BP 118/76. PHyscial exam mild facial acne, thickening mustache hair on face, axillary hair. No adenopathy. Left breast mildly enlarged with palpable breast buds. Right breast normal. Genitalia tanner stage 3. Statement?
this is a common condition for teenage boys and should resolve in time.

32) 3 yo girl consumed 25 metformin tablets. Physical exam normal. Greatest risk?
Increased lactic acid concentration

33) 18yo man T101, sore throat, cervical lymph node enlargement. EBV antibody positive. Atypical cells with abundant lacy cytoplasm in blood smear derived from?
T lymphocytes.

34) Trangenic mice develops severe fasting hypoglycemia. Glucagon does not correct hypoglycemia but epinephrine results increase in serum glucose. What protein defective?
glucagon receptor

35) 3 yo boy unexplained fever, lack perspiration, absence response to noxious stimuli, self mutilating behavior Dx congenital insensitivity to pain with anhidrosis. Gene analysis shows missense mutation of tyrosine kinase domain of TrkA gene. This only single defect. What’s disrupted?
Phosphorylation of downstream molecules in response to nerve growth factor

36) 60yo woman DM with decreased vision over past year. Eye show milky opacity of both lenses. What metabolite responsible?
Sorbitol

37) 6yo boy fever, sore throat, occasional vomit. T102. Physical exam erythema and purulent exudate over posterior pharyngeal wall and tonsils. Anterior cervical glands enlarged and tender. Throat culture grows GAS. Allergy to PCN. Tx w/ erythromycin. MOA?
Interferes with translocation.

38) 60yo man fluctuating weakness. Difficulty lifting books. Drooping of eyelids and double vision. Difficulty climbing stairs and regurgitation of liquids into nose. PHyscial exam weakness increases with repeated exercise. CXR mediastinum mass. Lab positive?
Actylcholine receptor antibody

39) 12 yo woman throbbing headache associated with sensitivity to light and sound. Neuro exam normal. Sumatriptan initiated for migraie. Activate what receptor?
serotonin

40) 5 yo girl listlessness, fatigue, dull pain URQ abdomen. Ht/wt below 25%. Beta globin chain 15%-20% normal. Point mutation from AATAAA to AACAAA. mRNA for beta globin is decreased to 10% normal. Whats AATAAA function in mRNA synthesis and processing?
Cleavage and polyadenylation

41) Investigator study human immune reponse to tumor cell antigens in malignancies. Which set cancer: tumor antigen produces highest antibody titer?
Cancer type: Cervical cancer; tumor Antigen: HPV type 16E6 protein

42) 54 yo man light headedness. Started after skiing at 9000ft. taking carbonic anhydrase inhibitor. BP110/60, sitting BP95/50. Physical exam normal. Why hypotension?
Hypovolemia

43) 23yo man low grade fever, nasal congestion, muscle aches. Eyes yellow, no clay colored stools or dark urine. Taking IBU. No foreign travel, tattoos, or IV drugs or exposure to blood products. BMI 23, physical exam mild scleral icterus but no subungual icterus. Total bilirubin 2.6. Dx?
Gilbert syndrome

44) 55yo man recovered from stroke. Lives alone. Risk?
Major Depressive disorder

45) 42 yo man SOB, night sweats, wt loss, fatigue. CXR enlargement of hilar lymph nodes and nodular infiltrates in both lungs. PDD test negative. Lung biopsy shows multiple noncaseating granulomas with many giant cells. No organisms. Dx?
Sarcoidosis

46) 48yo man concerned about wt. BMI29. Waist circumference 41in. BP140/90. Protuberant abdomen. Serum glucose and insult remain increased after 75g of oral glucose. Serum finding?
Triglycerides: increased, HDL: decreased; FFA: increased.

47) 20yo man cramping abdominal pain and diarrhea. 10lb wt loss. Pain after meals. Camping trip upstate new york, swimming in lakes and hiking in mountains. Vital signs normal. Physical exam normal. Test?
microscopic examination of stool for ova and parasites

48) screening test detect prostate cancer in 100,000 men. Sensitivity 70%, specificity 90%. Test used to screen second population which prevalence of prostate cancer is different. Whats PPV?
increases as prevalence increases

49) healthy person, thyroid gland produce and secretes T4. What describes T4 biding substance in blood and type of cellular receptor?
Binding substance in blood: Globulin; Receptor in peripheral tissue: Nuclear

50) 77yo woman dies, vertebral column shown. Process associated w/ what increase?
Interleukin 1

 

BLOCK 4

1) 32 yo man back pain and joint stiffness. Improve after mild exercise. Fatigue and 7lb wt loss. Physical exam and xray of sacroiliac joint confirm ankylosing spondylitis. Test to evaluate susceptibility of 2 children?
Analysis of class I MHC allele expression

2) epidemiologist investigate diarrhea outbreak among 1000 consumers. 800 ate tomato, 200 ate lettuce. 400 became ill, 80 ate tomatoes, 40 ate lettuce. Whats probability of diarrhea who ate lettuce?
0.2

3) 55 yo man intermittent heartburn. 2 episode weekly develop burning pain between chest and abdomen when lie down for nap after dinner. Bitter taste with pain. Alcohol before and during dinner. BMI 36. Physical exam no other abnormalities. Tx: Wt loss and decrease EtOH. What drug?
Omeprazole

4) 35yo man farmer. Difficulty breathing sweating, excess salivation, diarrhea. Symptoms started when applying insecticide to crops. T96, P50, R22, BP 90/60. Tx?
Atropine

5) 59yo woman metastic renal carcinoma receiving cyclophosphamide, paclitaxel and IL2. Why IL2?
stimulate T lymphocytes.

6) 76 yo man CHF, SOB after walk stairs. Nausea, 2 pillow for sleep. Diffuse moist crackles heard both lungs. Pitting edema above ankles. Function of product secreted by atrial myocytes?
Inhibition of renin release

7) study death from CAD. Persons 30+ studied. BP, cholesterol, smoking assessed along w/ death from CAD. Perons w/ increased BP compared to normal BP to determine greater mortality from CAD. Study type?
Observational cohort study

8) 32 yo man generalized band like headaches and dizziness everyday. Physical exam and CT scan normal. What findings dx hypochondriasis rather than somatoform disorder?
disproportionate fear of serious disease

9) 47 yo woman complain about wrinkles. Tx: tretinoin. MOA?
activation of nuclear gene transcription

10) 35 yo man wt loss, chronic abdominal pain, bloating, frequent voluminous, greasy malodorous stools. Adolescent symptoms resolved spontaneously. Mother similar illness controlled by restricting wheat, barley and rye in diet. Pt chronic pruritic rash on elbow. Dx?
Dermatitis Herpetiforms

11) 25yo man receives Bupivacain block median nerve for carpal tunnel syndrome. MOA?
Decreased permeability to Na+

12) 15 yo boy sneezing, coughing, watery eyes immediately after mows lawn. 15 mins later red rash soft to touch. Physical exam shows boggy, soft, raised pruritic, erythematous lesions with wheal and flare eruptions over the face, trunk, and back. MOA?
type 1 (immediate) hypersensitity

13) 46 yo man SCC of esophagus. Barium swallow shown. Esophagectomy involve ligation of arterial branches of?
Aorta

14) 8 yo boy severe MR, self mutilating behavior, biting fingers. Male cousins similar symptoms. Physical exam shows spasticity, chorea, and mutilation of digits. Labs show?
Hyperuricemia

15) 26 yo woman 30lb wt gain. Irregular periods, constipation, fatigue. Increased difficulty concentration and memory. BP 145/84, dry skin, decreased muscle stretch reflex at ankles. Cholesterol 310, K: 4, what to test next to Dx?
Thyroid stimulating hormone

16) 30yo woman severe abdominal pain and confusion. Brother, father, and paternal grandmother similar problems. Started low calorie diet. P120, BP160/110. Physical exam restlessness, excess sweating and tremors. No abdominal tenderness. Urine studies increased porphobilinogen concentration. What inheritance pattern?
Autosomal dominant

17) 2 yo girl fever, sore throat. Difficulty swallowing and become irritable, listless, and uninterested in eating. Adopted, immunization history unknown. T101, P150, R40. Physical exam dull red throat, gray exudate lifted with tongue blade. Cervical lymphadenopathy. Organism produce toxin cause ADP-ribosylation at what target?
Elongation Factor 2

18) 22 yo man SOB and wheezing. R12, physical exam normal. Symptoms start after taking ASA. Lab shows serum IgE normal and no eosinophilia. Symptoms caused by excessive production of what?
Leukotrienes

19) 5 month boy difficulty feeding. Physical exam macroglossia and enlargement of anterior neck at midline. CT neck 4cm, well defined, cystic structure. Remnant?
Thyroglossal duct

20) 35 yo man chronic cough. 30pack yr. worried have lung cancer like his dad. Physcial exam and xray normal. Dr comment?
Have you considered quit smoking?

21) 22 yo G0 women right flank pain after appendectomy and right ovarian resection due to appendiceal abscess. Menses 28d. vital signs normal. Physical exam mild right flank tenderness. Accidental ligation?
Ureter

22) 23 yo woman persistent cough worse to cold air in apartment. No smoke, no meds, no asthma or COPD. Physical exam normal. Short term cough suppressant tx started w/o constipation and low abuse?
Dextromethorphan

23) 70yo woman burning pain with urination. Physical exam uterine prolapse. Urine mild increase in leukocytes. U/S abdomen shows bilateral dilation of renal collecting system. Greatest risk?
Pyelonephritis

24) 49yo man faint in street. Watery diarrhea, no improvement w/ fasting. No change in diet, no foreign travel. BP 90/60. Physical exam flushed face and dehydration. Serum study K:2, Glucose: 150, admitted to hospital, IV fluid started. Passs stool with volume 3.5L. Dx?
Vasoactive intestinal polypeptide secretion

25) 38yo woman lying on sidewalk. Pt is conscious but too weak to stand. Physical exam red, swollen, tender tongue; angular stomatitis, and spoon shaped nails. Hemoglobin and MCV decreased. Dx?
Iron Deficiency