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NBME 19 questions and answers

Discussion in 'USMLE Step 1' started by conan, Mar 20, 2017.

  1. conan

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    #1 conan, Mar 20, 2017
    Last edited: Mar 27, 2017
    BLOCK 1

    1) 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?
    Coronary vasospasm due to alpha 1 stimulation?

    2) 40yo G0 women delivered newborn. CVS at 15 wks results male chromosome fetus. Physical exam show female external genitals and absent internal genitals. Mutation prevent reponse to what?
    Testosterone

    3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?
    Hormones derived from 7-dehyrocholesterol

    4) 56 yo man lethargy. No meds, no postural hypotention, no edema. Na: 125. Others normal. Dx?
    Small Cell Carcinoma of lungs

    5) 15 yo girl received BMT 1 year ago due to AML. Now karyotype 46, XY. Dx?
    Nonautologous donor

    6) 23yo women strenuous exercise. X-sectional area of pulmonary microcirculation?
    increased, as a result of distention and recruitment of microvessels.

    7) 33yo woman had weakness of right lower 2/3 of face. Where is brain lesion?
    C (precentral gyrus, lower motor cortex)

    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?
    1:600?

    9) Chemical disrupts tight junction between cells in the testes. Autoimmune response to products of germ cells entered circulation. What cells disrupted?
    Sertoli

    10) Case control study

    11) 25 yo woman w/ AIDS in ICU treated for sepsis by Cryptococcus neoformans. Drug?
    Amphotericin B

    12) 27yo man 4 days of cough producing blood-tinged sputum. BP160/100. Creatine: 4.8, erthyrocyte casts in urine. IgG deposites in IF microscopy. What glomerulus histologic abnormalities?
    Crescent formation.

    13) 48yo man. 3 yrs ago removed right kidney and adrenal gland of encapsulated renal cell carcinoma. 2 annual exams normal. No EtOH and no smoking. P75, BP130/88. Physical exam normal. Serum mild increased bilirubin, ALT, AST and ALP. CT abdomen shows widening hepatic venules. Radiographic fluorography pressure: R Atria: 5, Hepatic vein: 25, Hepatic wedge: 30. Dx?
    Budd-Chiari syndrome

    14) Picture represent eukaryotic translation. Only mRNA and rRNA shown. Whats next step?
    binding of aminoacyl-tRNA to the A site.

    15) 48 yo man in hospital for idiopathic pulmonary hypertension. 6 months progressive dyspnea. Cadiac catheterization show decreased in cardiac function. Whats increased?
    Right ventricular afterload.

    16) 65 yo man low back pain. Multiple osteoblastic lesions in vertebrae on x ray. Whats increased in serum?
    Prostate-specific antigen

    17) 43 yo man severe hip pain after fall. 15y h/o RA. Fracture and marked osteopenia of hip on xray. What drug responsible?
    Prednisone

    18) 35 yo man w/ HIV. 2 yrs of HAART. Physical exam thin extremeties, wide abdominal girth, and buffalo hump on upper back. Labs: CD4: 43, viral load: 1190, glucose: 110, cholesterol: 225, Triglycerides: 260. Glucose tolerance test is abnormal. Cause?
    Protease inhibitor

    19) 80 yo woman SOB and fatigue. Dx severe aortic stenosis. Undergoes AV replacement. After operation, dicumarol is given, result in prolonged PT. Cause?
    induces a vitamin K deficiency like state.

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

    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?
    Histamine.

    22) 19 yo man stabbed in abdomen. Denies starting fight and intends to “get even”. Incarcerated for past 3 yrs for armed robbery but says he was “set up”. Dx?
    Antisocial personality disorder

    23) 45 yo man major depressive disorder. Taking Fluoxetine. Increased risk of serotonin syndrome w/ what in food?
    Tryptophan.

    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?
    Hepatocytes.

    25) 52 yo man severe headache, anxiety, sweating and palpitations. Well controlled HTN w/ clonidine and HCTZ, but ran out of Rx 3 days ago. P120, BP170/110, Physical exam diaphoresis. What happens after injection of propranolol?
    Increase total peripheral resistance and decrease cardiac output
     
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  2. conan

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    #2 conan, Mar 20, 2017
    Last edited: Mar 27, 2017
    Block 1 part 2
    26) ABG values in a resting patient.
    PO2: 96, PCO2: 40, A O2 content: 12% (N=20), Mixed V PO2: 36 (N=40), Mixed V O2 content: 8% (N=15). Dx?
    Anemia

    27) Neck irradiation risk factor for thyroid cancer study. Identified a group of patients with thyroid and similar group of patients without thyroid. History of prior neck irridation is obstained from each group. Study type?
    Case-control

    28) Investigator experient prevented 3rd pharyngeal pouches from forming in mouse embryo. Which organs failed to develop?
    Thymus

    29) Microtubule-associated (MAP-1C) ATPase (dynein) production blocked in neuronal cell body. What neuronal process is reduced?
    retrograde axonal transport

    30) Graph shows rate of breakdown by phosphorylase in the presence and absence of AMP. Based on data, the action of AMP?
    Allosteric activator.

    31) 39yo police man w/ 6m headache, muscle aches and fatigue. 1m crampy epigastric pain, which he think its stress. Become increasingly irritable and distractible while instructing people at firing range. Wife reports irritable and forgetful at home. Vitals normal. Neuro exam shows b/l distal motor weakness of extremities and impaired concentration. Memory function intact. Hemoglobin: 11, Hematocrit: 36%, MCHC: 31%, MCV: 78. Blood smear?
    Basophilic stippling.

    32) 20m girl T101 and upper respirator infection. Condition worsens and develops dyspnea and cyanosis. Crackles heard on chest auscultation. CXR show cardiac enlargement. Hemoglobin, hematocrit and WBC count is WNL. Cardiac arrest day after admission and dies. Autopsy finding is diffused lymphocytic infiltrate in the myocardium w/o evidence of inclusion bodies or microorganisms. Dx?
    Coxsackievirus

    33) 44 yo man with following pulmonary functions. Dx?
    COPD only

    34) Skin from male mouse grafted on back of female. Within 2 wks graft becomes necrotic and must be removed. What cells responsible?
    Netrophils

    35) 41 yo woman at 34wk gestation has amniocentesis due to uncontrolled HTN. Amnionic fluid shows decreased lecithin:sphingomyelin of 1.5:1 (N=3:1). What condition to newborn born at this time?
    Decreased FRC

    36) 49yo woman ask risk of osteoporosis. Mother had osteoporosis and bone fractures after menopause. Pt work as landscaper and plays tennis 3/wk. no smoking, drinks 1 glass wine/wk, no meds. Wt: 121lbs. what more info needed for evaluation of osteoporosis?
    Diet history

    37) 25 yo woman request prenatal diagnosis at 12 wk b/c sister has infant w/ Down. Woman karyotype is 45,XX,t(14q21q). what test needed?
    Chorionic Villi sampling.

    38) Study conducted to determine effects of drug X on Airflow, Phrenic nerve activity and Abdominal. Tracing shown. Whats drug X?
    Tubocurarine

    39) 25 yo man severe pain on left side chest after falling off ladder. Pain sharp, stabbing and more intense when pt is coughing or takes deep breath. CXR shows 4 rib fracture on left. No pneumothorax. Whats pattern of respirator change?
    RR: increase, TV: decreased, Airway resistance: no change.

    40) 45 yo w/ chronic alcohol dependence w/ 3 days of foul smelling brownish sputum. Pt has severe episodes of LOC and binging past month. Which CRX is his?
    D

    41) 74 yo man for f/u. 5 yrs ago MI and taking thyroid replacement meds for 25ys for hypothyroidism. Past BP normal. Today BP200/115. Physical exam continuous systolic/diastolic bruit over right posterior flank. Labs normal. Dx?
    Renal artery stenosis.

    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?
    Synovial pannus formation.

    43) 45 yo man lost in Rockty mountains for 10days. 11lb lost. Glucose concentration 92. Serum glucose constant because glucose synthesized in liver and?
    Kidney

    44) 43 yo woman 3 day black tarry stools. Taking ASA for 1 wk for sprained ankles. Which steps is inhibited.
    Arachidonic acid –Xà Prostaglandin G2

    45) 24yo woman severe vomiting, flushing and headache after wine. Taking med for Trichomonas vaginalis. Whats drug?
    Metronidazole

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

    47) 24 yo man sharp left chest pain and dyspnea 4 hrs ago. CXR shown. Whats cause of CXR finding?
    Loss of negative intrapleural pressure

    48) 65 yo man w/ prostate cancer has severe fatigue and bone pain. Suspect metastasis to bone. Androgen ablation therapy recommended for relief using IM monthly leuprolide and daily PO flutamide. Why?
    Flutamide blocks the initial androgen action of leuprolide.

    49) 30yo woman visual difficulty. 3 yo h/o MS. Vitals normal. When lights off, both pupils 6mm, ambient light pupils 4mm. Light at left eye, both pupils 2mm. light on right eye, both pupils 4mm. where is lesion?
    right optic nerve.

    50) 19yo woman 1st prenatal visit, feels well w/ some spotting. 10wk gestation by dates. Uterus is englarged to level of umbilicus. Beta HCG = 350,000. Dx?
    Hydatidiform mole
     
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  3. orthopod

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    Block 2 part 1
     
  4. orthopod

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    Block 2 Part 2
     
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    Block 3 part 1
     
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    Block 3 part 2
     
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    Block 4 part 1
     
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    Block 4 part 2
     
  9. conan

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    #9 conan, Mar 20, 2017
    Last edited: Mar 24, 2017
    BLOCK 2

    1) 31 yo man 4 hr severe right flank cramping pain radiating to groin. Pain 10/10. T99, P90, R20, BP130/88. R flank tender to percussion. Tx is given and pt stabilized. Whats dietary change decrease risk?
    increased fluids.

    2) 69 yo woman tremor in hands. Muscle tone increased, difficulty stopping abruptly when moving forward. Short shuffling gait. Affect is blank. Neurotranmitter system most likely result these symptoms at where in brain?
    D

    3) 22 yo man lost during hiking. He survives by eating plants. One plant causes nausea and vomiting. Which structure cause his vomiting?
    Area postrema

    4) 46yo man suffers DCS while SCUBA. Small gas bubble form in spinal vessels supplying dorsal white matter of supper thoracic spinal cord. What neuro Sx?
    Discriminative sensation of lower extremities

    5) 24 yo woman studied for renal function. Her renal O2 consumption is 20ml/min. Which function uses most O2?
    Tubular reabsorption

    6) 22 yo man involve in MVC. BP not detectable on arrival. BP returns to normal with IV fluids and PRBC. X lap shos lacerated spleen and liver. Splenectomy and liver repaired. 24 hr later, urine output is 350cc. Dx?
    Acute tubular Necrosis.

    7) 23 yo woman w/ vagina sore. Sexually active, inconsistent condom use. Pelvic exam nontender ulcer on vulva. Spirochetes positive on dark field. Whats biopsy histology?
    Obliterative endarteritis w/ lymphocytes and plasma cells.

    8) 6m male infant h/o severe viral and bacterial infections. Dx as SCID. Which enzyme deficient?
    Adenosine deaminase

    9) Rifampin MOA.
    RNA

    10) 17yo boy collapsed while working as traffic controller on hot summer day. At 4yo had numerous skin grafts due to full thickness burns on 30% of body. Examine shows hyperthermia. Dx?
    Burn scars and skin grafts lack eccrine glands, limit sweating

    11) 30yo woman pap smear w/ high intraepithelial lesion undergoes cervical biopsy. What location of tumor cell is consistant as in situ?
    Superficial of basement membrane

    12) 18yo women with sever, painful blistering after day at beach. Which antibiotic cause photosensitivity?
    Tetracycline

    13) 52yo woman with non-small cell carcinoma treated w/ cisplatin. What other drug needed?
    Ondansetron

    14) Man w/ light complexion develops ulcerated nodule on face under the sun. biopsy shows invasive squamous cell carcinoma. What is DNA damage?
    Pyrimidine dimers

    15) 47yo man w/ rheumatic valve disease w/ chest pain and difficulty breathing. ECG shows acute MI. Examination shows systolic murmur. Pressure tracing shown. Dx?
    Ruptured of chordae tendineae.

    16) 8yo girl lost of consciousness. Family travel in truck overnight and girl slept in truck bed. She was difficult to arouse, with severe headache and nausea. Vomit during transit to hospital. P150. Perioral Cherry red skin. Tx?
    Oxygen

    17) 2 yo boy 2 days fever, cough. h/o Strep. Pneumoiae and multiple ear and sinus infection since birth. T101. No tonsillar tissue. Crackels heard in lower right lung. Dx?
    bruton agammaglobulinemia

    18) 45yo woman fever, cough, runny nose, sore throat, muscle aches. Moderately ill. T101. Cardiopulmonary exam normal. Influenza virus antigen positive. Tx?
    Neuraminidase inhibitor

    19) Immunocompromised patients, positive PPD skin test changed from 10mm of induration to 5mm. whats effect on incidence and prevalence?
    Both increase.

    20) 52 yo woman with CAD with right dominant coronary circulation. After angioplasty of circumflex artery. Which structure receive blood flow?
    Left Ventricle

    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?
    increased number of circulating plasma cells?

    22) 35yo woman 3 months fatigue. Vegan for 12 yrs. Loss of vibratory sensation of lower distal extremities. Labs. Hemoglobin 9.1, MCV:114. Dx?
    Vitamin B12

    23) 40yo man with cardiac phonogram shown. Dx?
    Mitral regurg.

    24) 6 wk boy with projectile vomiting. Nothing change symptoms. No bile in vomit. Dehydrated, stools decreased. Metabolic alkalosis. Dx?
    Pyloric Stenosis

    25) 65 yo woman stage 4 breast cancer need meds for severe pain. Drugs A-E graph shown, Log Dose vs Response(pain relief). Which med best?
    Drug C
     
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  10. conan

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    #10 conan, Mar 20, 2017
    Last edited: Mar 27, 2017
    26) 52 yo man w/ hypercholesterolemia tx w/ lovastatin. Gemifibrozil added. 2 wks later develop renal failure. Dx?
    Myoglobinuria

    27) 54yo man for exam. P80, R14, BP140/95. Physical exam normal. ACE inhibitor given. Where is MOA in kidney?
    F

    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?
    Meningioma

    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?
    1:4

    30) 60 yo man 20y h/o HTN with SOB and fatigue. P80, BP100/70. Physical exam shows peripheral cyanosis. Crackels heard bilateral lungs. Cardiac exam shows S3. 2+ pitting ankle adema. Whats CO and CVP findings?
    CO: decreased, CVP: decreased?

    31) 11 yo boy pain in right mid-thigh. Warm and tenderness around mass. Femur XR shows solitary mid-diaphyseal osteolytic lesion w/ permeative margins. Lesion surrounded with layers of reactive bone. Biospy composed of poorly differentiated sheets of small, uniform, hyperchromatic cells w/ highly nuclear:cytoplasmic ratio, scant stroma and no visible matrix. Dx?
    Ewing Sarcoma

    32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated?
    C (Na/Glucose port)

    33) 16 yo girl 2 day h/o thick, yellow vaginal discharge and burning urination. Pt does not want parents to know she’s sexually active. T98, P80, BP 110/70. Exam shows mucopurulent discharge at the cervical os and friability. Uterus is small, firm and nontender. No adnexal mass or external vaginal lesion. Stain Gram negative diplococci in pairs with greater than 30WBC. Urine WNL. Test for gonorrhea and chlamydia ordered. Action?
    Prescribe antibiotic w/o notifying parents.

    34) 59 yo woman yellow skin and dark urine. Return from Asia 3 wks ago. Physical exam shows jaundice. IgM anti hepatitis E antibodies. Whats different between HAV and HEV?
    Mortality among pregnant women

    35) 53 yo man w/ angina pectoris tx w/ nitroglycerin. MOA?
    increased concentration of cGMP in smooth muscles.

    36) 32 yo woman absent tactile fremitus, hyperresonance on percussion and absent breath sounds at left lung base. Dx?
    Pneumothorax on the left.

    37) 36 yo woman w/ T2DM. taking sulfonylurea. BMI: 32. Physical exam shows Acanthosis nigricans. Tx with metformin. MOA?
    inhibit hepatic gluconeogenesis

    38) Autopsy of 20yo women died of MVC 8hrs ago. Greats amount of alveolar endothelial surface covered by what cells in lungs?
    Type 1 pneumocytes.

    39) 26yo woman losts 290 lb after jejunoileal bypass . Fecal fat excretion excessive. Deficiency?
    Vitamin A

    40) Members of same family have progressive dementia, major depressive disorder and movement disorder. Autosomal dominant trait with great variability of symptom severity and age at onset. Dx?
    Number of triplet repeat sequences.

    41) 27yo woman treated pneumococcal pneumonia with penicillin become afebrile and improved pulmonary function. Then she became jaundiced and anemia with increased reticulocyte count and increased unconjugated bilirubin. Test?
    Direct Coombs Test

    42) Induction of galactorrhea by metoclopramide? Dx?
    Stimulation of release of prolactin from adenohypophysis.

    43) 67yo man dx of primary lung carcinoma metastasis to adrenal glands, liver and bone. 8Kg wt loss, cachexia and muscles wasting. Conjugation of what protein cause breakdown of muscle proteins?
    Ubiquitin

    44) 20yo man in MVC. Contusion to chest and abdomen. Unsteady gait and slurred speech. Admitted for damage to spleen. 3rd night became restless and having generalized tonic-clonic seizures. Dx what substance withdraw and treatment?
    Ethanol, diazepam

    45) 30yo woman with Marfan with tearing chest pain. 1 yr ago echocardiogram show aortic root to be 5.5cm. Stopped taking propranolol 1 yr ago. P120, BP80/40. Physical exam show JVD 6cm above sternal angle. Maximum impulse is not palpable and heart sound cannot be distinguished. What’s cardiac catheterization findings?
    C

    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?
    Pelvic nerves.

    47) 3 day newborn female with unusual sweet order in diaper. Not feeding well. Lab shows hypoglycemia, metabolic acidosis, ketonemia and hyperammonemia. Isoleucine increased in urine. What metabolic pathway defective?
    Branched-chain amino acid degradation.

    48) 25 yo man fever, swelling of left calf since injury while mountain biking. Awake but confused. Exquisitely tender, edematous left calf, swollen with crepitus. Foul smelling, watery discharge from wound. Gram stain shown. Bug?
    Clostridium perfringens

    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?
    The mother is infected; the status of newborn is uncertain.

    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?
    Budd-Chiari syndrome
     
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  11. e90m123

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    Thanks for this. Would you be willing to post the last 2 sections?
     
  12. conan

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    in the process.
     
  13. conan

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    #13 conan, Mar 26, 2017
    Last edited: Apr 16, 2017
    BLOCK 3

    1) 38yo woman depressed mood, joint pain, muscle weakness, memory problems, insomnia, palpitations, blurred vision, varied duration and severity. h/o erythema migrans. Dx?
    Lyme disease

    2) 32 yo woman’s sister recently died of melanoma. Other 1st degree family members have similar illnesses, with large pigmented skin lesions. Which lesion most likely on sun/no sun exposed areas of skin?
    Dysplastic nevi

    3) 25 yo man stress exercise test. What changes to exercising skeletal muscles?
    Art diameter, Tissue adenosine conc, vascular conductance. All increase

    4) 29 yo man left testicular mass. Frozen section during orchiectomy shows seminoma. Whats greatest predisposing risk?
    Cryptoochidism.

    5) 62 yo woman abdominal cramping, pain and constipation. Tx w/ simethicone provided some relief. 20lb weight loss, increasing fatigue, and need more sleep. Endoscopy, colonoscopy, Abdomen CT normal. Pt believes insomnia due to worries about her son who’s been using drugs. She worry cancer will never get better. Vitals stable. Not anemic, all labs WNL. Next?
    evaluate for Major Depressive Disorder

    6) Study found malformations of embryos exposed to retinoic acid involved changes in homeobox (HOX) gene expression. Retinoic acid and HOX gene products recognize and bind to specific DNA sequences at various chromosome sites. Function?
    Transcription factors

    7) 42 yo man progressive weakness of hands. Physical exam shows hand muscle atrophy and tongue, and trapezius muscle fasciculations. Electromyography confirms Amyotrophic lateral sclerosis. Physician statement?
    You have Lou Gehrig disease. Have you ever heard anything about this disease?

    8) 45 yo man gradually worsening heartburn. Physical exam unremarkable. Endoscopy shows stomach with thickened nodular mucosa w/ no discrete ulcerations. Steiner silver stained gastric biopsy shown. Abnormality commonly associated w/ what disease?
    Peptic ulcer Disease

    9) 48 yo woman fatigue, weakness, loss of appetite, and weight loss. Serum PTH increased. Xray of skeletal system shows generalized osteopenia with subperiosteal resorption of bone within the phalanges. MOA?
    Paracrine stimulation of osteoclasts by osteoblasts

    10) New humanized monoclonal antibody investigated for treatment. This antibody is monomeric, crosses placenta, serum ½ life of 21 days. Which antibody?
    IgG

    11) 29yo woman inability to conceive. 10 menstrual periods in past year, but very erratic and unpredictable. May not be ovulating. 4 days Right pelvic pain. Pt suspects pain indicating ovulation. What hormone changes indicate ovulation occurred?
    Increased in progesterone

    12) 73 yo man localized back pain. HTN and T2DM. mild discomfort but able to walk. Pain with percussion over lower thoracic spine. Neuro exam normal. Xray show vertebral cortical thickening of the end-plates, creating “picture frame” vertebrae. Serum study?
    Calcium, Phosphorus, PTH: no change, ALP: increased

    13) Diagram of proximal renal tubular epithelium. Which is pathway for transepithelial transport of water?
    C?

    14) 61 yo man erectile dysfunction due to L-2 spinal injury. Sildenafil corrects ED by acting on which structure?
    D (Cavernosum)

    15) Sexually active 20 yo woman painful, erythematous vesicular lesion on vulva. Examination by speculum shows lesion in vaginal vault and on cervix. Photo of scraping of base of unroofed vesicle shown. Dx?
    Genital herpes

    16) 25 yo man upper respiratory infection w/ features of common cold. What viral/host features most critical for infection?
    Presense of viral receptor molecules on epithelial cells

    17) Action potential cause current to flow deep within the skeletal muscle fiber by what?
    Transmission along T tubules

    18) 3 month old girl congenital HIV, diaper rash spread to abdomen and highs. Physical exam shows clusters of erythematous papules and pustules distributed over the abdomen, groin and thighs. Photo of scraping shown. Dx?
    Normal skin flora

    19) 30 yo woman nausea and vomiting. T1DM. confused and sleepy. P130, R30. BP 80/60. Urine output is scant and dark. Given IV insulin and isotonic saline. What changes 4 hrs after treatment?
    K: decrease, HCO3: increase, BUN: decrease, pH: increase, PCO2: increase

    20) 10 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration. Photo of tissue biopsy given. Dx?
    Granuloma

    21) A substance produced in the GI tract is isolated and examined. This substance cause activation of pancreatic trypsinogen to trypsin, also activation of other proteolytic zymogens. This substance resembles what?
    Enteropeptidase

    22) 30yo man stung by several wasps. Confused, difficulty breathing. T100, P122, R34, BP80/40. Physical exam shows dry skin and decreased capillary refill. Multiple erythematous inflamed marks on back and ankle pitting edema. Other than IV normal saline, whats next?
    Sympathomimetic agent

    23) 7yo boy emigrated from Africa, headache, recurrent fever with back pain. Mother reports a child in village had similar condition. T102. Physical exam shows weakness of left lower extremity. Knee relax weaker on left. Neuro exam shows fasciculations of lower extremeties. Dx?
    Poliomyelitis

    24) Case control study. 100men with bladder cancer compared to 100 controls. Case and control asked about EtOH consumption. Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder cancer to EtOH consumption. Interpretation?
    The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6.

    25) 18yo man with pain in multiple joints and fatigue. 2 months ago, rash and flu-like illness while working as a counselor at a camp on the New England Coast. Dx?
    Lyme disease
     
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  14. conan

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    #14 conan, Mar 26, 2017
    Last edited: Apr 16, 2017
    26) 12 yo boy asthma and wheezing. Tx w/ inhaled bronchodilator did not resolve symptoms. What part of airway most susceptible to flow limitation due to smooth muscle contraction?
    Bronchiole

    27) 75 yo man Alzheimer dementia in hospital because of cough, difficulty breathing and agitation after breakfast. Resident of skilled nursing care. Wife and children visit often. Wife mention coughing during meals and longer to finish meals. Imaging consistent with aspiration pneumonia with developing compromised swallowing functions. No advance directive. Speaking to family regarding feeding tube?
    follow only the wishes of the wife

    28) Instillation of lipid into duodenum leads to release of hormonal substance from endocrine cells in duodenal mucosa. Action?
    Gallbladder contraction

    29) Histone acetyltransferase cataylze acetylation of lysine residues on histones. Whats effect?
    Decreases affinity of histones for DNA.

    30) 24 yo man generalized tonic-clonic seizure. Somnolent. Na: 118, K: 4. Urine gravity: 1.005. Na slowly return to normal over 36 hrs. 3rd hospital day, serum osmolality: 280, uring osmolality: 260, 272. Pt becomes more alert and active. He drinks more than 6L/day water. Serum Na begin to decrease. Dx?
    Psychogenic polydipsia

    31) 45 yo woman cancer treated w/ vinblastine. What changed end of treatment?
    Decreased number of neutrophils.

    32) 32 yo woman with fecal incontinence after child birth. Dx?
    Damage to anal sphincter.

    33) 2 people return from 5 day hike in Arizona admitted for infection. Sudden onset fever, chills, weakness and headache, followed by unilateral, intensely tender lymphadenopathy in the groin. Gram stain of lymph show gram negative coccobacilli. Dx?
    Yersinia pestis

    34) 25 yo man significant blood loss after fracture of right tibia. Prior to emergency treatment, how compensate decreased blood volume?
    Reabsorption of fluid into systemic capillaries.

    35) 60 yo woman increasingly severe joint pain and swelling. Physical exam shows irregular, asymmetric enlargments of multiple joint of fingers, toes, left elbow, right knee. Focal ulceration of overlying skin. Photo shown. Uric acid : 9.1. Dx?
    Gout

    36) 48 yo woman urinary frequency and urgency. Physical exam normal. MOA of medication prescribed?
    Blockade of parasympathetic innervation of detrusor muscle.

    37) Pulmonary artery pressure study, subjects with hypertension experience decrease in this pressure after receiving phosphodiesterase inhibitor. This decrease in pressure is mediated by increase in intracellular concentration of what?
    cGMP

    38) 24 yo woman painful menstrual periods. No pain during midpoint of menstrual cycle. Also rectal bleeding associated w/ menses. Dx?
    Endometriosis

    39) 10 yo girl pain and swelling of right index finger. T99, right hand shows tender erythematous, edematous index finger with intact wooden splinter. White exudate during removal of splinter. Whats in pus?
    Neutrophils

    40) Cholesterol measured on community. Mean and SD given. Assume Gaussian distribution. Whats probability woman between ages 50-54 year has cholesterol greater than 296?
    16%

    41) 3 day old male abdominal distention and increasing distress. Sibling has cystic fibrosis. No bowel movements since birth. Abdomen XR shows small bowel obstruction. Dx?
    Meconium ileus

    42) 3month old infant immunization with tetanus toxoid results in IgM anti-tetanous antibody then anti-tetanous IgG antibody response. What B-T cell interaction?
    CD40-CD40L

    43) 25 yo woman nervousness and emotional lability. P110, BP 135/70. Wide eyed, staring gaze, skin warm and moist and fingers show fine tremor when extended. Thyroid gland diffusely inlarged. Cause?
    Thyrotropin receptor autoantibodies.

    44) Decrease activity of what causes scurvy?
    Prolyl hydroxylase

    45) 2 day old newborn jaundice. Jaundice caused by reduction of what?
    Conjugation of bilirubin to glucuronic acid

    46) 25 yo man eczematous dermatitis. Biopsy shows Langerhans cells infiltrating dermis. What characteristic?
    Birbeck granules.

    47) 40yo woman chorionic villus sampling. Chromosome analysis shows 46XY in 14 cells and 47, XY+15 in 25 cells. Chromosome analysis of amniotic fluid shows 46XY in 50 cells. Dx?
    confined placental mosaicism

    48) 24 yo man MVC. Lost 2L blood from left femoral fracture. BP70/40. Post surgery, multiple ecchymoses over medial aspect of upper arms. Bleeding from IV sites. What coagulation abnormal?
    Consumption coagulopathy

    49) 70 yo man progressive disinhibition syndrome characterized by emotional outbursts, inappropriate use of language, socially inappropriate behavior. Whats damaged?
    B (frontal)

    50) 42 yo woman hearing loss while treated for pyelonephritis. What drug class?
    Aminoglycosides
     
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  15. Mika

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    What was your answer to this? Thank you so much. I anxiously await your block 4. =D
     
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  16. conan

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    #16 conan, Mar 26, 2017
    Last edited: Apr 16, 2017
    BLOCK 4

    1) 60yo man congestive heart failure, bacterial bronchopneumonia in ICU. Responds to antibiotics. But 3 days after develops maculopapular rash over extremities with central vesicles and bullae having a targetoid appearance. Biopsy shows subepidermal blisters and degeneration of basal cell layer, keratinocyte necrosis and lymphocytic infiltration at dermal/epidermal junction. Dx?
    Erythema multiforme

    2) 64 yo man fever, cough and purulent sputum. 60 pack year. T103. Physical exam shows erythematous tympanic membranes. Rhonchi on auscultation of chest. CXR shows consolidation in right middle lobe. MOA of drug inhibit protein synthesis by binding to 50s subunit of bacterial ribosomes. Drug?
    Azithromycin

    3) Niemann-Pick diease pathophysiologic process?
    decreased lysosomal hydrolase

    4) Biopsy of neoplasm on scalp of 45 yo man shows early invasive squamous cell carcinoma. Site of incision is not sutured. One week later, mass is widely excised. Biopsy site most likely show what?
    Granulation tissue?

    5) 29 yo man untreated HIV, with fever, severe diarrhea, and fatigue. T101. Physical exam shows oral thrush and enlargement of cervical and axillary lymph nodes. CD4: 190 (N>500). CD8: 200 (N>200). Which mechanism cause decreased CD4?
    CD8 T lymphocyte mediated killing

    6) 35 yo man nephrotic syndrome. Renal biopsy shows uniformly thickened glomerular capillary basement membrane. Immunofluorescent shos granular deposits of IgG and C3. Dx?
    Membranous nephropathy.

    7) Adhesion of platelets to subendothelial surface requires interaction of platelet membrane glycoprotein and?
    von Willebrand factor

    8) 62 yo woman weakness of left leg. Smoked 1 ½ pack for 40 yrs. BMI 27. P85, BP140/100. 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?
    Right anterior cerebral

    9) What distinguishes tumor-suppressor gene from proto-oncogenes?
    inhibition of cell-cycle regulation

    10) 73 yo man changed in behavior, decreased appetite and intermittent constipation. 10lb weight gain. Wife claims pt takes forever to get out of bed and talks slowly, and forgetful”. Pt claims no memory problem but feel apathetic all the time. Physical exam shows enlarged tongue. Slowed speech and difficulty following complex commands. Recalls only 1 of 3 objects after 5 mins. Next?
    Measure thyroid-stimulating hormone concentration.

    11) Determine ACE inhibitors superior to CCB in preventing renal disease progression in pt with T1DM. whats advantage of randomized controlled trial versus prospective cohort study?
    Better control for confounding variables

    12) Healthy 36 yo woman think she had a heart attack during grocery shopping. Palpitations, shortness of breath, dizziness, numbness and tingling of hands and feet and shaking. Symptoms 30 mins and resolved spontaneously. 2 similar episodes before. Once at home, another at work. Physical exam, EKG, and labs normal. Dx?
    Panic disorder

    13) 40yo man buttock pain extends down to posterior left lower extremity to heel. Pain on passive flexion of hip beyond 30 degrees with straight knee. Decreased power on plantar flexion. Left Achilles tendon reflex is absent. All other reflexes are 2+. Decreased pinprick over lateral left foot and fourth and fifth toes. Which nerve root?
    S1

    14) 22 yo woman frequent headaches and fatigue. Overeats when she’s anxious and induce vomit and using laxatives. BMI 21. Exam shows what?
    Dental caries

    15) 2 yo girl exposed to sun has progressive development of dry skin and excessive freckling and keratosis. Skin fibroblasts cultured most likely defective in what?
    Nuclear excision repair of pyrimidine dimers

    16) Pt early stages of hemorrhagic shock ?
    A weak pulse due to decreased stroke volume

    17) 32 yo man, international health worker given primaquine as prophylaxis against malaria. Becomes jaundiced. Lab shows hemolytic anemia. MOA?
    Enzyme deficiency in the erythrocytes.

    18) 60 yo man flank pain and blood in urine. Weakness and 10 lb weight loss. Lab shows hypercalcemia and polycythemia. Chest CT shows multiple nodules in both lungs. Abdomen CT shows 8cm mass in upper pole of right kidney. Biopsy of lung nodule shows?
    Metastatic renal cell carcinoma.

    19) 53 yo man malaise and increased fatigue and 20lb weight loss. Physical exm shows splenomegaly. Leukocyte count is 75,000. Bone marrow biopsy shows hypercellularity with maturing granulocytes, increased megakaryocytes, and normal erythroid elements. Blood smear shown. Pt treated w/ imatinib mesylate. This drug block what?
    Tyrosine kinase

    20) 40 yo woman had Strep pneumonia pneumonia comes for follow up exam. CXR normal. Which produced by cell type responsible for restitution of normal lung structure?
    Surfactant

    21) 18 yo woman screen for colon cancer. Father and grandfather died of colon cancer at ages 36, 45. Physical exam normal. Colonoscopy shows 200 lesions. Colectomy done and shown. What chance pt offspring will develop same condition?
    50%

    22) 13 yo girl check up. Girl and mother healthy. Girl doing well in school and participate in soccer and lacrosse. How physician ask regarding sexual activity?
    Ask the mother to leave the room before asking the pt any questions.

    23) 50 yo man chronic abdominal pain. Intermittent mild knee pain 30 years. Pain more constant recently. Physical exam shows mild epigastric tenderness and decreased range of motion of both knees. Endoscopy shows antral ulcer. What med best for knee pain?
    Acetaminophen

    24) New drug developed designed to stimulate epithelial cell turnover in small intestine. Drug target?
    Crypt cells

    25) 48 yo man left leg injury. Physical exam shows obvious lateral swing of the left lower extremity when walking. NO fracture on Xray. Injury to left obturator nerve which passes through the obturator foramen. Which movement to strengthen?
    Adduction
     
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  17. conan

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    #17 conan, Mar 26, 2017
    Last edited: Apr 16, 2017
    26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal is developed. Whats effected?
    Decreases the amplitude of the action potential

    27) cDNA clone of ovalbumin contains 1872 bp. Genomic clone contains 7700 bp. why?
    Introns

    28) 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 3 followed by test 1 if test 3 positive.

    29) 11 yo boy repeated staph pneumonia. When incubated w/ Staph. Aureus, his neutrophils fail to make respiratory burst and do not kill staph. Even through EM the neutrophils shows bacterial cells in phagosomes. Def?
    NADPH oxidase

    30) newborn is cyanosis, tachypnea, and retractions of muscles of chest wall during inspiration. Weighs 2500g. ABG given. Describe acid-base balance.
    Respiratory acidosis, Metabolic Acidosis.

    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?
    Retinal cells

    32) 12 yo girl unable to walk. Parents very anxious but pt unconcerned. T98, P70, BP115/70. Deep tendon reflex of legs equal bilaterally. Pain/light touch variable. Dx?
    Conversion disorder

    33) 2 yo boy cerebral palsy. Surgical correction of early adduction contracture and subluxation of right hip. Difficulty sitting up and learn to crawl by dragging his legs. Which nerve relieve adduction contracture?
    Obturator

    34) 65 yo man radical prostatectomy and lymph node dissection for adenocarcinoma of prostate. Grading?
    Tumor cell appearance and arrangment

    35) 66 yo man inability to maintain erection. Fatigue and difficulty sleeping and concentrating. Cerebral infract 3 months ago with right hemiparesis that gradually improved. Physical exam normal. What other findings?
    Lidido, Nocturnal erections: normal

    36) 28 yo man urinary frequency and discomfort. Uro exam normal. Urinalysis shows pyruia. Clean catch urine culture yields no growth. Dx?
    Chlamydia trachomatis

    37) Efficacy of autoclave sterilization. Autoclave generates pressure 15-20 psi and temperacture of 121-126C. What can be retained?
    Prions

    38) 3 month boy difficulty breast feeding and gasp for breath. 50% for length and 5% for weight. Lungs clear. Grade 3/6 holosystolic murmur. Cardiac test show normal O2 tension in right atrium, increased O2 tension in right ventricle and normal systemic O2 tension. Dx?
    VSD

    39) 48 yo woman fever and frequent slimy stools. Emigrated from Uganda. T101. Abdominal exam mild tenderness of RUQ. Stool shows mucus. Colonscopy shows multiple ulcers that have undermined and destroyed large areas of intestinal epithelium. Dx?
    Entamoeba histolytica

    40) 4 yo boy fever and acute renal failure. Stool specimen grows E coli O157:H7. Blood smear?
    Schistocytes and thrombocytopenia

    41) 6 yo girl difficulty hearing bilaterally. Multiple fractures. Teeth has yellowish brown discoloration. Photo of eyes shown. Whats gene coding defect?
    Procollagen type 1

    42) 50 yo woman decreased energy. Does not trust doctors. Lots of health problems. Physician primary focus?
    Establishing a therapeutic alliance with patient

    43) 14 yo boy extremity tremors and greenish rings at the margin of cornea near limbus. Lab shows ceruloplasmin below 95% and 12 fold increase of serum ALT. Tx?
    Periodic IM injections of Penicillamine

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

    45) 22 yo woman polydipsia and polyuria. Wakes up at night with urge to urinate. Taking Lithium for bipolar. Dose increased 6 months ago. Vitals/physical normal. 24 hr urine output 6.5L. after tx of desmopressin, uring output and osmolality does not change. Which part of nephron defective?
    collecting duct

    46) 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?
    Thyroglossal cyst.

    47) 62 yo woman with 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?
    Cholesterol emboli

    48) MRI of brain of 54 yo man. Lesion indicated w/ arrows. Lab shows decreased gonadotropin concentration. Transbronchial biopsy shows granulomas indicative of sarcoidosis. Where?
    Hypothalamus

    49) 2070g stillborn male delivered by cesarean at 36 wks. Autopsy shows cyclopia and cleft lip and palate. Chromosomal analysis shows 47, XY+13 karyotype. What congenital central nervous system malformation?
    Holoprosencephally

    50) 62 yo right handed man cerebral infarction. Decreased fluency of spontaneous speech, phrases less than 4-5 words. Comprehension normal. Neuro exam shows weakness of lower 2/3rd of face on right. Where is lesion?
    A (Broca’s)
     
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  18. conan

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    i think its coronary vasospasm due to alpha 1 stimulation.
     
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  19. e90m123

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  20. A-Cor

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    34) 65 yo man radical prostatectomy and lymph node dissection for adenocarcinoma of prostate. Grading?
    Metastatic spread

    Grading deals with differentiation of cells. Think it should be D.
    Staging deals with TNM criteria so, tumor size would be the T part.
     

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