ALL ANSWERS ARE CONFIRMED FROM ONLINE NBME
1- a
this woman most likely has urge incontinence
regardless the diagnosis, it is mentioned in the question stem that the drug prescribed affects the normal stimulation of bladder contraction
the bladder contraction (mediated by detrusor muscle) is stimulated by parasympathetic system and inhibited by sympathetic system
internal urethral sphincter is stimulated by autonomic system (sympathetic) while external urethral sphincter (as well as external anal sphincter) have somatic nerve supply (pudendal nerve)
---------------------------------------------------------------------------------------
2- a
the most important principle in ethics is autonomy
even if the patient has no capacity to decide, his family has to come to a consensus based on their perception of patient's wishes not their own wishes
---------------------------------------------------------------------------------------
3- c
1- a
this woman most likely has urge incontinence
regardless the diagnosis, it is mentioned in the question stem that the drug prescribed affects the normal stimulation of bladder contraction
the bladder contraction (mediated by detrusor muscle) is stimulated by parasympathetic system and inhibited by sympathetic system
internal urethral sphincter is stimulated by autonomic system (sympathetic) while external urethral sphincter (as well as external anal sphincter) have somatic nerve supply (pudendal nerve)
---------------------------------------------------------------------------------------
2- a
the most important principle in ethics is autonomy
even if the patient has no capacity to decide, his family has to come to a consensus based on their perception of patient's wishes not their own wishes
---------------------------------------------------------------------------------------
3- c
Bronchioles are the least resistance due to parallel arrangement but in case of bronchoconstriction, it is the most to be affected due thick muscular layer
---------------------------------------------------------------------------------------
4- c
flu like illness and rash (erythema migrans) followed by arthralgia in new England coast makes lyme disease a reasonable choice
if it was rheumatic fever ,it would be more specific as sore throat and fever and won't mention a specific location as a camp in new England
the most important key in this question is NEW ENGLAND as lyme disease is common there
---------------------------------------------------------------------------------------
5- a
There is no organic disease here (as evidenced by no anemia, normal scans and endoscopy). The reason to evaluate for major depressive disprder is because she has definite red flags for that(weight loss , increasing fatigability ,need for more sleep), even if not fulfilling all criteria
---------------------------------------------------------------------------------------
6- e
this picture is so bad
diaper rash is most commonly caused by candida,which is normal skin flora
---------------------------------------------------------------------------------------
7- b
an easy question doesn't need explanation as everyone knows that cryptorchidism is a great risk factor for testicular malignancy
---------------------------------------------------------------------------------------
8- b
because the fetus while delivery causes enormous enlargement in the vagina that could damage nearby structures like the anal sphincter
the pressure at a sphincter refers to the inner pressure caused by feces etc...
the pressure at a sphincter refers to the inner pressure caused by feces etc...
---------------------------------------------------------------------------------------
9- c
Most likely foreign body reaction(sutures) and granuloma formation
Granulation tissue is formed on ulcers and open wounds by proliferation of capillaries and fibroblasts.
Granulomas are chronic inflammatory lesions seen as a reaction towards any foreign body or fungi or mycobacterium etc.
The granulomas are composed of giant cells, epithelioid cells and may have central necrosis (caseation)
---------------------------------------------------------------------------------------
10- a
a case of DIC
following trauma associated with femoral fracture,fat droplets from bone marrow circulate in blood as emboli causeing disseminated intravascular coagulation indicated by multiple ecchymosies ad bleeding from venopuncture sites
although it is called coagulation but this dissemination causes consumption and dilution of clotting factors and platelets so lead to bleeding
---------------------------------------------------------------------------------------
11- f
this man has manifestations of anaphylaxis due to sting.
the toxin released increases capillary permeability leading to edema and severe hypotension
treatment for this case is epinephrine which is a sympathomimetic agent to increase blood pressure
---------------------------------------------------------------------------------------
12- e
The flaccid paralysis especially of lower limbs is most common presenting sign of poliomyelitis and they have mentioned about transmission from another child that also point towards polio because it transmitts via feco oral route whereas west nile virus involves birds as hosts and culex mosquito as vector
Moreover,emigrated from Africa and does not have vaccination history make polio virus most likely
---------------------------------------------------------------------------------------
11- f
this man has manifestations of anaphylaxis due to sting.
the toxin released increases capillary permeability leading to edema and severe hypotension
treatment for this case is epinephrine which is a sympathomimetic agent to increase blood pressure
---------------------------------------------------------------------------------------
12- e
The flaccid paralysis especially of lower limbs is most common presenting sign of poliomyelitis and they have mentioned about transmission from another child that also point towards polio because it transmitts via feco oral route whereas west nile virus involves birds as hosts and culex mosquito as vector
Moreover,emigrated from Africa and does not have vaccination history make polio virus most likely
---------------------------------------------------------------------------------------
13- e
picture frame vertebrae=cement lines seen in paget’s disease
you should know that all lab values are normal in paget’s disease except alkaline phosphatase increases
you should know that all lab values are normal in paget’s disease except alkaline phosphatase increases
---------------------------------------------------------------------------------------
14- a
adverse effects of aminoglycosides include nephrotoxicity and ototoxicity
---------------------------------------------------------------------------------------
15- d
It increases cGMP in the corpus cavernosa vascular smooth muscle
corpus carvenosum is spongy like structure which will filled by blood from central vessel during erection.
A is dorsal superficial vein & C is urethra
---------------------------------------------------------------------------------------
16- e
the photo shows silver stain. H Pylori.
H.pylori is associated with development of peptic ulcer disease
---------------------------------------------------------------------------------------
17- d
Excessive thirst is a physiological response initiated from the hypothalamus with increased osmolality of the blood. What we see here is a guy who is drinking water regardless of that physiological response. Most of the patients with psychogenic polydypsia drink water to feel well hydrated and not because they are thirsty.
---------------------------------------------------------------------------------------
18- c
sildenafil ,which is a phosphodiestrase inhibitor,is used in pulmonary hypertension as it increases amount of intracellular cGMP causing smooth muscle relaxation
---------------------------------------------------------------------------------------
19- b
frontal lobe is responsible of concentration as well as behavior so lesion in it will lead to inappropriate behavior.
another important clue is (inappropriate use of language) ..remember expressive aphasia (broca's area,which is located in inferior frontal gyrus of frontal lobe)
J is temporal lobe which contains amygdala but it is not the answer as lesion in Amygdala will cause Kluver Bucy = hyperphagia, hyperorality and hypersexuality
--------------------------------------------------------------------------------------
20- d
IgG is the only immunoglobulin that crosses placenta
--------------------------------------------------------------------------------------
21- c
CI=95% is a value set by a researcher that states: i am 95% confident that this OR/RR that i got from my study will between these 2 numbers (interval).
so basically the researcher would accept only 5% mistake that the value is out of this interval.
CI=95% is a value set by a researcher that states: i am 95% confident that this OR/RR that i got from my study will between these 2 numbers (interval).
so basically the researcher would accept only 5% mistake that the value is out of this interval.
--------------------------------------------------------------------------------------
22- b
Hyperparathyroidism , PTH increases osteoclasts activity indirectly . first activates osteoblasts which activates osteoclasts (paracrine)
because only the osteoblasts have PTH receptors on them.
because only the osteoblasts have PTH receptors on them.
--------------------------------------------------------------------------------------
23- b
it is neonatal physiologic jaundice,which occurs because neonatal conjugation enzymes are not fully mature or ready and spleen is removing excess red blood cells that carry Hgb F. so decreased conjugation of bilirubin to glucuronic acid
please keep in mind that it NEVER occurs in first 24 hours. so if you find a neonate with jaundice in first 24 hours,it is always PATHOLOGICAL NOT PHYSIOLOGICAL
--------------------------------------------------------------------------------------
24- b
the best way to answer arrows questions in the exam in short time is not looking at all values in the same time,but the more important first then the less important.
this is a case of diabetic ketoacidosis (metabolic acidosis condition)
the most important values in diabetic ketoacidosis are :
arterial pH decreases (HCO3 decreases)
serum K+ increases (but total body K+ decreases)
ketone bodies increases
so when this condition is treated ,you will find that :
arterial pH increases as insulin decreases ketones production (this excludes choices a&e)
insulin will shift K+ inside the cell so serum K+ decreases (this excludes choices c,d,e&f)
now you know the answer, IT IS B !
other lab values :
serum HCO3 increases as blood pH increases
blood Pco2 increases as part of compensation
BUN will decrease as renal failure will resolve
------------------------------------------------------------------------------------
25- c
painful menstrual periods and no pain during the midpoint of menstrual cycle + rectal bleeding episodes associated with menses (due to ectopic endometrial tissues) >>> endometriosis
uterine leiomyoma is usually asymptomatic or may presents with abnormal uterine bleeding
------------------------------------------------------------------------------------
26- e
T-tubules are extensions of plasma membrane juxtaposed with terminal cisternae of the sarcoplasmic reticulum,allowing for coordinated contraction of muscles.
------------------------------------------------------------------------------------
27- d
loss of fluid/blood will cause decrease capillary hydrostatic pressure
this will cause less fluid leakage from the systemic capillaries and more fluid reabsorption
this will cause less fluid leakage from the systemic capillaries and more fluid reabsorption
------------------------------------------------------------------------------------
28- c
Water goes through with just simple diffusion from tubular lumen to peritubular capillaries, so it must not have transporters/carriers ---> the ONLY line that goes from one side to other and does NOT have carrier is C.
------------------------------------------------------------------------------------
29- d
Graves disease,in which anti TSH antibodies are present and thyrotropin is another name of TSH
So thyrotropin receptor anibodies
So thyrotropin receptor anibodies
------------------------------------------------------------------------------------
30- a
you should know that langerhans cell has Birbeck granules which are tennis rackets or rod shaped on EM
------------------------------------------------------------------------------------
31- i
fat soluble vitamins like vitamin A uses intracellular receptor as they penetrate cell membrane without carrier,after that they activate a cascade -or act themselves- that bind DNA increasing or decreasing transcription process (acting as transcription factor).
HOX gene is important in embryo development and vitamin A is very teratogenic due to its effect on developmental genes as HOX gene.
------------------------------------------------------------------------------------
32- d
patients with scurvy has vitamin c deficiency ,which is very important in collagen synthesis.
vitamin c is important in the step of hydroxylation of aminoacids proline and lysine .
if this process is defective, collagen will be defective leading to easy bruising,poor wound healing,subperiosteal hemorrhage and corkscrew hair.
------------------------------------------------------------------------------------
33- e
Stage 1: erythema migrans. Fever, headache, fatigue...
Stage 2: myocarditis, meningitis and neuropathies.
Stage 3: Encephalopathy and arthritis
fat soluble vitamins like vitamin A uses intracellular receptor as they penetrate cell membrane without carrier,after that they activate a cascade -or act themselves- that bind DNA increasing or decreasing transcription process (acting as transcription factor).
HOX gene is important in embryo development and vitamin A is very teratogenic due to its effect on developmental genes as HOX gene.
------------------------------------------------------------------------------------
32- d
patients with scurvy has vitamin c deficiency ,which is very important in collagen synthesis.
vitamin c is important in the step of hydroxylation of aminoacids proline and lysine .
if this process is defective, collagen will be defective leading to easy bruising,poor wound healing,subperiosteal hemorrhage and corkscrew hair.
------------------------------------------------------------------------------------
33- e
Stage 1: erythema migrans. Fever, headache, fatigue...
Stage 2: myocarditis, meningitis and neuropathies.
Stage 3: Encephalopathy and arthritis
------------------------------------------------------------------------------------
34- d
dysplastic nevi, which can occur on both sun exposed and no sun exposed areas, can be pre neoplastic lesions that lead to melanoma and they can have genetics mutation inherited in a familiar fashion pattern.
------------------------------------------------------------------------------------
35- c
it is the most suitable answer as you should start conversation with open ended question
------------------------------------------------------------------------------------
36- c
trypsinogen is activated to trypsin by enteropeptidase (enterokinase) in small intestine.
------------------------------------------------------------------------------------
37- d
It is an easy question if you know the normal distribution curve
with a standard deviation of 50 and a mean of 246, concentration greater than 296 means greater than one standard deviation .
one standard deviation = 34%, so above it would be 16%
------------------------------------------------------------------------------------
38- a
instillation of lipids in the duodenum leads to secretion of cck which causes contraction of gall bladder and relaxation of sphincter of oddi
------------------------------------------------------------------------------------
39- a
histone acetylation decreases positivity of histone,hence, decreases the affinity of histones for DNA , release supercoils and this will lead to increase transcription
-----------------------------------------------------------------------------------
40- f
after ovulation, corpus luteum secretes progesterone, so it can be used as indicator for ovulation.
progesterone increases body temperature,so some females feel ovulation without measuring hormones concentrations.
estrogen is secreted before and after ovulation
-----------------------------------------------------------------------------------
41- a
B cell activation and class switching depends on interaction between Th cell and B cell,
CD 40 receptor on B cell binds CD 40 ligand (CD40L) on Th cell.
-----------------------------------------------------------------------------------
42- a
vinblastine binds tubulin and inhibits its polymerization into microtubules and prevent mitotic spindle formation >>> decreasing multiplication of cells >>> decreasing number of neutrophils
-----------------------------------------------------------------------------------
43- a
Amniotic fluid analysis is normal but only chorionic Villi sampling shows mosaicism ..chorion is nothing but placenta ..so it’s confined placental mosaicism ..if amniotic cells to have involved it would have been fetal mosaicism
it is the most suitable answer as you should start conversation with open ended question
------------------------------------------------------------------------------------
36- c
trypsinogen is activated to trypsin by enteropeptidase (enterokinase) in small intestine.
------------------------------------------------------------------------------------
37- d
It is an easy question if you know the normal distribution curve
with a standard deviation of 50 and a mean of 246, concentration greater than 296 means greater than one standard deviation .
one standard deviation = 34%, so above it would be 16%
------------------------------------------------------------------------------------
38- a
instillation of lipids in the duodenum leads to secretion of cck which causes contraction of gall bladder and relaxation of sphincter of oddi
------------------------------------------------------------------------------------
39- a
histone acetylation decreases positivity of histone,hence, decreases the affinity of histones for DNA , release supercoils and this will lead to increase transcription
-----------------------------------------------------------------------------------
40- f
after ovulation, corpus luteum secretes progesterone, so it can be used as indicator for ovulation.
progesterone increases body temperature,so some females feel ovulation without measuring hormones concentrations.
estrogen is secreted before and after ovulation
-----------------------------------------------------------------------------------
41- a
B cell activation and class switching depends on interaction between Th cell and B cell,
CD 40 receptor on B cell binds CD 40 ligand (CD40L) on Th cell.
-----------------------------------------------------------------------------------
42- a
vinblastine binds tubulin and inhibits its polymerization into microtubules and prevent mitotic spindle formation >>> decreasing multiplication of cells >>> decreasing number of neutrophils
-----------------------------------------------------------------------------------
43- a
Amniotic fluid analysis is normal but only chorionic Villi sampling shows mosaicism ..chorion is nothing but placenta ..so it’s confined placental mosaicism ..if amniotic cells to have involved it would have been fetal mosaicism
-----------------------------------------------------------------------------------
44- e
the first step in establishment of viral infection is attachment of viral surface protein to its receptor on host cell.
if this receptor is absent or defective , no infection will occur
-----------------------------------------------------------------------------------
45- c
This is herpes and the image is a tzanck smear. You can clearly see the eosinophilic Cowdry type A bodies within the cell nucleus.
even if you do not know the image,you can answer,
the question says it is a painful vesicle so Herpes
candida -- not usually painful
condyloma -- a wart not vesicle
syphilis --- it causes non painful chancre
trichomonas --- causes inflammation and pain but with discharge no ulceration or vesicles
-----------------------------------------------------------------------------------
46- e
history of cystic fibrosis in one sibling is the most important key,
in cystic fibrosis: pancreatic secretions are have low water and electrolytes making making them more viscid >> meconium more hard >> small bowel obstruction
tip:
if in the question the baby fail to pass meconium or has small bowel obstruction in first 2 days of life ,you should think of:
- meconium ileas
- Hirschsprung disease
- duodenal atresia
-----------------------------------------------------------------------------------
47- e
the only gram negative coccobacilli in choices is yersinia pestis
yersinia pestis causes plague which may take three forms : pneumonic,septicemic and bubonic (as described in the stem)
-----------------------------------------------------------------------------------
48- a
during exercise , sympathetic system shifts blood from periphery to skeletal muscle to provide them with fuel and to wash waste products,so,arteriolar diameter is increased,vascular conductance (flow of blood or blood velocity) is also increased.
ATP is metabolized to AMP , so more adenosine is present (this also causes vasodilation)
-----------------------------------------------------------------------------------
49- a
increased level of uric acid in addition to manifestations in the stem >> gout
important note:
we say gout when there are hyperuricemia as well as joint manifestations,but if there is hyperurecemia only with no joint manifestations, it is not called gout, it is called only hyperuricemia !
-----------------------------------------------------------------------------------
50- e
this white exudate is pus.
pus is formed primarily of dead neutrophils
No comments:
Post a Comment