Nbme 161) A 42 yr old woman undergoes biopsy of suspicious calcifications seen on routine mammograms. Light microscopy shows a poorly demarcated region consisting of poorly cohesive cells growing in sheets. The nucleus to cytoplasmic ratio approaches 1:1 and a prominent nucleolus is observed. There is microscopic evidence of stromal invasion. She has no adenopathy. CT scan shows no evidence of hepatic, pulmonary or bone metastases. These findings are most consistent with which of the following? A)High grade, High stage neoplasm B)High grade, low stage neoplasm C)Low grade, high stage neoplasm D)LOw grade, low stage neoplasm 2)A new anti-platelet agent is developed for the prevention of recurrence of stroke. In a large randomized clinical trial with equal numbers of men and women, the rates of stroke are lower in pts rceiving the new agent than in pts receiving the std treatment. Results are shown: Recurrent stroke rates per 1000 person years Std treatment New antiplatelet drug Women 0.12 0.04 Men 0.24 0.08 Overall 0.18 0.06 Based on the following which of the following is the absolute risk reduction in women? A) 8% B)12% C)16% D) 33% E)62% F)67% G)75% 3)A case control study is conducted to explore a possible association between exposure to a herbicide and non-hodgkin's lymphoma. Controls are matched to cases by age, gender and race. Exposure status is determined by interviewing the subjects. On matched-pair analysis, the odds ratio is 3.2 (95% CI: 1.4-5.4) Which of the following is most likely to affect the validity of the study? A) Biased measurement of the condition B) Biased measurement of the exposure C) Confounding by age D) Type 1 error E) Type 2 error 4) A 32 yr old woman, gravida 4, para 0, aborta 3, delivers a female new born at term with dysmorphic features and numerous organ anamolies. She had multiple spontaneous abortions, and this is her first live born child. Which of the following is the most likely explanation for the abnormalities seen in this newborn? A) AD inheritance B) AR inheritance C) gonadal mosaicism D) Submicroscopic deletion E) Unbalanced chromosome reaarangement 5) A 60 yr old man with no h/o bleeding problems has coagulation testing prior to CABG. His prothrombin time is 11.5 sec (INR-1.0) and APTT is 160 sec. Which of the following is most likely to be abnormal in this patient? A)C5a generation B)Histamine release C)Kallikrein formation D)Phagocytosis E)Platelet aggregation 6) To determine whether children of workers in a lead foundry sustain neurological damage from exposure to dust on their parent's clothing, a test for motor skills was given to 30 first graders whose parents has worked at the foundry for 5 years or longer and to 30 controls. Which of the following groups of children would be the proper control group for this study? A) First graders living with guardians or relatives who worked at the foundry for 5 years or longer. B)First graders whose parents had never worked at the foundry C)First graders with motor impairment whose parents had worked at the foundry D) First graders without motor impairment whose parents had worked at the foundry for 5 years or longer E) Random sample of school children from the same community 7)A 65 yr old woman with HTN comes to the ED becoz of a 3 hr h/o of headache, chest pain & SOB. Current medications are Aspirin,Furosemide and Lisinopril.Her resp are 20/min & BP-230/110 mm Hg. The physician plans to initiate treatment with a non-selective antagonist that blocks alpha-1 & beta receptors. Which of the following drug is most appropriate? A)Hydralazine B)Labetalol C)Phenoxybenzamine D)Phentolamine E)Trimethaphan 8)A yr old boy is brought to the physician for developmental delay. There is a h/o hearing loss in her mother and delayed speech in his older sister. His maternal uncle had stroke like episodes at 25 yrs of age. PE shows opthalmoplegia and hypotonia. His serum LA conc is increased. Which of the following best explains the findings in this family? A) AD inheritance B)Decreased penetrance C)Heteroplasmy D)Imprinting E)X-linked recessive inheritance 9. a study is conducted to assess 32 pts in a community of 1000 who have devel drug resistant tb during a 1 yr period. these pts are community for treatment assuming that the risk for infection and susceptibility to the desease is constant, which of the following best represents the number of individuals devel subsequent drug resistant tb during the next yr? a.27 b.29 c.31 d.32 e.33 10. A 9 YO M is brought to the physician by his mother because of a 1 yr hx of cough productive of mucoid sputum, wheezing, and sob with exertion hx of recurrent upper respiratory tract and sinus infections since birth. he is at the 25th percentile for height ans weight. the mother says that his younger sibling is being develop similar problems. physical examination shows mild clubbing of the fingers. laboratory studies show markedly increased sweat chloride and sodium concentration. which of the following in this pt's bronchial epithelium is most likely causing these symptoms? a. adrenoreceptors b. membrane receptors c. nuclear receptors d. protein regulation e. protein structure 11: Lesh nyhan syndrome, an x-linked recessive dz is seen in aproximatly 1/100,000 males. which of the following is expected prevalence of heterozygous female? a. 1/1000 b. 1/10,000 c. 1/50,000 d. 1/200,000 e. 1/10,000,000 12. a 24 yo f was stung on her right thumb by a bee 30 minutes ago. she develops an urticarial lesion at the site of the sting 6 hrs later, the area has become indurated and firm. which of the following explains the induration at the site of the sting? a. decrease in the expression of the adhesion molecules on vascular endothelial cells b. decrease in derum c reactive protein concentration c. infulx of macrophages producing interleukin 1(IL1), IL6, and tumor necrosis factor alpha d. lysis of endothelial cells by the alternative complement pathway e. vasoconstriction 13. A 54-yo man has an aneurysm in the distal portion of his abdominal aorta. The estimated cross-sectional area of the aneurysm is 2 cm2 and the mean velocity of blood flow through the aneurysm is 20 cm/sec. Which of the following best represents the flow rate ( in L/min) through the aneurysm? She is 5 ft 2 inches (157 cm) tall weighs 52 kg(115 lb). Examination of right calf shows erythema and induration. CT Angiography of the chest shows a large embolism occluding blood flow to the right lobe.54. pO2-61mmHg. 2. pCO2-29mm Hg.6 E. Her gastric pH is 2. Her pulse is 100/min and RR -24/min.78/min. PE shows multipe superficial lipomata and mild epigastric tenderness.0 B. Which of the following best describes the current ventilation perfusion relationship in the right lower lobe of this patient? A)Dead space B)Diffusion Abnormality C)Hypoventilation D)Low FiO2 E))Shunt 16)A 38 yr old woman comes to the physician because of a 10 week h/o epigastric pain and frequent stools.2 D. Lab studies show Anemia.21. Which is the mechanism? A) activation of aspartate-spcific caspase B) Binding of Fas ligand to receptor C) Decreased function of Na/K ATPase . ABG shows pH-7. She appears anxious. Rx with recombinant erythropoietin is started. – MEN type 1 17. BP140/100 mm Hg. 3. A pleural friction rub is heard in the right lung base. Measurement of which of the following is most appropriate to monitor the effectiveness of this pharmacotherapy? A)Arterial blood Ph B)Arterial pressure of CO2 C)Oxygen saturation of the blood D)Plasma Hb conc E)Serum urea nitrogen conc 15) 2 days after undergoing a right hip replacement operation. She has had 2 episodes of renal calculi during the past 2 yrs. Upper endoscopy shows two large non bleeding duodenal ulcers. Liver showing centrilobular pallor and swelling of hepatocytes and kidneys showing proximal convoluted epithelial cells. serum gastrin conc obtained immediately after the procedure is 2000pg/ml.3 . 4. pulse .A. 1. Immediate treatment with oxygen. BMI. 4L/min via nasal cannula is initiated.0 14)A 62 yr old woman with chronic renal disease comes to the physician for follow up examination.4 C 3. a 67 yr old woman has SOB and pain on the right side of her back with deep breathing. 3. Terminal ileum is normal(so we know its not chrons!) biopsy shows micro abscesses within the crypts and depletion of mucus from goblet cells? diagnosis? Is this ulcerative colitis? Sounds like it. which of the following best represents the flow rate in L/min thru the aneurysm? Can someone please help me out with this? 1.2. +murmur. diastolic decrescendo murmur heard best at Y") I searched this up and someone said that the best answer is 4/6 . collagenous colitis.0.6. Apppearance of intestine from rectum to mid ascending colon shown in pic. 2. Hypertension has been poorly controlled during the past six months despite availability of appropriate pharmacotherapy. but 2 days later. BP 160/98. amebic sysentery. Which murmur is most likely? (then they basically gave a descriptor for each murmur type "grade x/6. Estimated cross-sectional area of the aneurysm is 2 cm^2 and the mean velocity of blood flow thru the aneurysm is 20cm/sec.nerve biopsy shows abnormal myelin sheaths absence of shwann cells lymphycytic infiltrate abnormal astrocytes abnormal oligodendrocytes 21) 54 yr old man w/ aneurysm in distal portion of his abdominal aorta.4. 4. 3. Which one is the better answer? antagonizes VLDL cholesterol secretion or inhibits cholesterol uptake 22) 54y F admitted with acute MI. you must be more responsible” “you realize that your high blood pressure could have been avoided” 20) 12 year old with walking abnormality for 6 months.0 21) It was about the niacin cholesterol mechanism. ulcerative colitis 19)60 yr old woman has 2 history of hypertension comes to doc for follow up examination. HR 100. crohn disease. which of the following statements by the physician is most appropriate to begin a discussion about this patients possible noncompliance w her medication regimen? Is it “it is hard to take pills every day for a condition that has no symptoms” “i will arrange for nurse to visit to make sure you’re taking meds properly” “I’m sorry but i must say missing your meds can kill you” “you clearly have not been taking your meds. ischemic bowel disease. she has acute SOB and sweating. at which point there were no murmurs or signs of heart failure. RR 24.D) Ribosomal degradation E) Stimulation of PFKase 18) 26 yr old dude has tenesmus and bloody diarrhea. mild atrophy and hammer toes. Crackles bilaterally. Whats the appropriate therapy? I need help w this one amphotericin B. Neuro exam . Photo of pas-stain of pleural fluid shown in the pic of the question. Vaginal ultrasonography shows an 8 cm mass in the left ovary. His absolute neutrophil count has been less than 500/mm for the past month. or light-headedness. Rituximab 25) a previously healthy 27-year-old woman comes to physician because of a 3 week history of episodes of left sided chest pain and tenderness. Serum studies show an increased CA 125 concentration. internal iliac artery. round ligament of the uterus. Chest X-ray shows a left lower lobe infiltrate and a moderate pleural effusion on the left. she has not had shortness of breath.holosystolic murmur heard best over lower left sternal border and cardiac apex. Her mensrual flow has been unusually heavy during her last three menstrual periods.1 pulse is 92/min. and vincristine. Infliximab. daunorubicin. rates pain 3 on 10 point scale. ureter 24) 18 yr old dude w acute lymphblastic leukemia has 3 day history of intermittent fever and left sided chest pain. examination shows tenderness to palpation 2 cm lateral to the midline and 10 cm below the clavicle on the left. Which of the following is most likely diagnosis? A) Achalasia B) Acute pericarditis C) Costochondritis D) Dissecting aortic aneurysm E) Gastroesophageal reflux disease F) pleurisy G) pneumothorax H) Stable angina pectoris 26) 23 yr old diagnosed w sjoren syndrome has burning pain in her toes for past month. which of the following structures passing inferior to the ovary must be protected? external iliac artery. During surgical removal of the ovary. an x-ray of the chest and ECG show no abnormalities. prednisone. and blood pressure is 130/86 mm Hg. Phys exam shows a palpable mass in the left adnexa. He’s in 5th week of induction chemotherapy consisting of asparaginase. respirations are 14/min. she uses capsaicin cream for pain which produces partial relief. sweating. ovarian ligament. Menses have occurred at 24-28 day intervals since menarche at the age of 12 years. her temperature is 37. Cardiopulmonary examination shows no abnormalities. the pain radiates to the back and is exacerbated when she reaches over her head or behind her back. Temp is 102 F and he has dullness to percussion and decreased breath sounds on the left side. Ganciclovir. Ertapenem. What do you think about this one? 23) 28 yr old lady w/ 1 month history of pelvic pain that has become increasingly severe during the past week. pulse is 85/min and bounding/ bp is 110/40. reflexes. grade 3/6 decrescendo diastolic murmur heard at aortic area. Her vital signs are with in normal limits. muscle tone. A high resolution CT scan of the head shows stenosis of the internal aoustic meatus on left. dislocation of right lens. proteoglycan 28)A 23 yr old man comes to the physician because of difficulty maintaining an erection. proprioception. The pt has most likely had a developmental anamoly involving which of the following cranial nerves? A)Occulomotor B)Trigeminal C)Trochlear D)Abducens E)Facial 30)A 43 yr old man comes to the physician becoz of a 6 week h/o sharp. PE show left sided facial weakness and decreased hearing in the left ear. The best explanation for this type of erection is an intact spinal reflex arc between the sacral parasympathetic nerves and which of the following? A)Genitofemoral B)Ilio-inguinal C)Lumbo sacral trunks D)Obturator nerves E)Pudendal nerves 29) A 6 month old girl is brought to the physician by her mother 3 days after she noticed that her daughter's smile seemed lopsided. affecting motor sensory functions of the lower trunk and extremities. serotonin. He first noticed the pain when shaving. Pectus excavatum. He is only able to obtain an erection through physical contact with his penis by his wife. She is at the 50th percentile for length and weight. hyaluronate. elastin. muscle strength. dopamine. The nerve supplying this area of the face exits the skull through which foramina? A)Lacerum B)Magnum . 6’3 and weights 165 lb. stabbing pain on the left side of his face that occurs when he touches it. BMI 21 kg. Touching the face just lateral to the left nasal ala reproduces the pain. fibrillin. Genetic defect in what? collagen type 2. substance P 27) 15 yr old boy. Which neurotransmitter mediating pain? gamma minobutyric acid. Wide mediastinum. Sensation to vibration. and the erection doesnot last a long time. He was involved in an automobile collision that damaged his thoracic spinal cord.shows decreased perception of temperature over feet bilaterally. and bulk are normal. enkephalin. normal male rats are exposed to levels of cigarette smoke comparable to those encounterd by humans who smoke cigarettes. A 25-year-old man comes to the physician 8 hours after the onset of severe pain of his low back that radiates down his left leg.C)Ovale D)Rotundum E)Spinosum 31)An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. the surgical approach to repair of the aneurysm in this patient is most likely to be further complicated by the presence of which of the following? A) Abnormal origin of the superior mesenteric artery B) Anomalous origins of multiple renal arteries to each kidney C) Friability of vascular tissue as a result of collagen synthesis abnormalities D) Multiple ureters with abnormal courses E) Tumors with malignant degeneration 33. He underwent a left femoral-popliteal bypass 3 months ago for peripheral vascular disease. A 76-year-old man with a 1-month history of a pulsatile abdominal mass is diagnosed with an abdominal aortic aneurysm. The most likely cause of his condition is an embolus in which of the following arteries? A) Abdominal aorta B) Left common carotid C) Right anterior cerebral D) Right middle cerebral E) Right ophthalmic 34. The pain began almost immediately after this attempt. In this setting. Which of the following sets of changes is most likely to bee observed? Mucus production&secretion activity of airway cilia Alveolarmacrophage function Increase Increase Increase Increase Increase Decrease Increase Decrease Decrease Decrease Increase Increase Decrease Decrease Increase Decrease Decrease Decrease 32. Which of the following is the most likely cause of this patient's pain? A) A fracture of a lumbar vertebra B) Rupture of the deltoid tendon . Results of pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. He started a weight-lifting regimen earlier in the day during which he tried to lift a bar loaded with 91 kg (200 lb) from the ground to over his head. His vital signs are normal. For 1 week. Funduscopic examination shows cholesterol emboli. A 68-year-old man comes to the physician because of a 2-hour episode of loss of vision in his right eye 2 days ago. CT scans of the abdomen with contrast also showed an incidental finding of a horseshoe kidney. Which of the following mechanisms is the most likely cause of these symptoms? A)Donor macrophages secreting cytokines and affecting host cells B)Donor plasma cells elaborating antibodies against host cells C)Donor T-lymphocytes reacting against host cells D)Host macrophages secreting cytokines and affecting donor cells E)Host plasma cells elaborating antibodies against donor cells F)Host T-lymphocytes reacting against donor cells 38)A 31 yr old woman is diagnosed with invasive Squamous cell carcinoma of the cervix....C) Rupture of an intervertebral disc D) A tear in the sciatic nerve E)A torn muscle in the low back 35.. Two weeks ago..Two weeks after the transplant he develops a generalized erythematous. A biopsy specimen of the cervix shows that the tumor cells express HPV. diarrhoea and elevated conc of liver enzymes and bilirubin. The normal fx of which of the following cells and tissues in this pte is most likely to be resistant to this agent? A.. type 16 antigens.keratinocytes in the stratum basale E. he was discharged from the hosp after sustaining MI. He does not exercise." Which of the following best describes this patient's stage of behavioural change? A) Precontemplation B) Contemplation C) Preparration D) Action E) Maintenance 37)A 27 yr old man who is being treated for Hodgkin's lymphoma receives a bone marrow transplant from his first cousin.erythroblasts in the bone marrow D.enterocytes in duodenal crypts C...cortical thymocytes B. The pt. No evidence of infection or drug reaction was found. He smokes 2 packs of cigarettes and drinks 4 12 oz beer daily.. maculopapular rash. His diet mostly consists of cured meats and fast food. "I know that I need to make some changes in how I live so that my heart can be healthier.ventricular cardiac muscle fibers 36) A 62 yr old man comes to the physician for a follow up examination. tells the physician. I just don't have the willpower to quit smoking and drinking and all that stuff right now. Which of the following cell types most likely plays a role in recognizing and killing these virus infected tumor cells? . The chemox regimen prescribed for a 55 y/o woman with non.Hodking includes vin blasting.. and temperature in the lower extremities are normal. pain.. Colonoscopy shows a mass in the sigmoid colon. Which of the following is the most likely causal organism? A)Adeno virus B)Chlamydia trachomatis C)E..DCT C.dysuria and tender. Sensations of joint position. Digital rectal examination shows no papable lesion.. A 43-year-old woman comes to the physician because of progressive difficulty walking during the past 3 months.. chills...Glomeruli E. enlarged prostate.coli D)Pseudomonas aeruginosa E)Ureapalsma urealyticum 40.Bowman capsule B. A 57 year old man comes to the physician because of a 6 month history of progressive constipation and a feeling of rectal fullness. Cells from which of the following areas of the kidney are most likely to show the first signs of anoxic injury? A..Prox tub 41.Efferent art D.A)Dendritic cells B)Macrophages C)Myeloid precursors D)T-cells E)plama cells 39)A 45 yr old man has fever. Metastases from this mass will most likely spread via which of the following lymph nodes? A) Inferior mesenteric B) Internal iliac C) Left colic D) Pararectal E) Superficial inguinal 42. Patellar and Achilles tendon reflexes are diminished. A biopsy specimen of the mass shows adenocarcinoma. Test of the stool for occult blood is positive.. Neurologic examination shows weakness and decreased muscle bulk of the lower extremities... Which of the following is the most likely cause of the findings in this patient? A) Acute peripheral neuropathy B) Degeneration of motoneurons of the lumbar cord C) Demyelination of the corticospinal pathways D) Loss of afferent la axons innervating muscle spindles E) Myotonic muscular dystrophy . or an injection of both angiotensin II and drug X. Physical examination shows the presence of a central venous catheter that was placed on the day of the operation. 56 y o male with palpable hard nodule on prostate has an increased pSA. elliptical. purple. budding organisms. Blood Pressure Before Drug Blood Pressure After Drug Drug Administered Injection (mm Hg) Injection (mm Hg) Angiotensin II 110/70 150/105 Drug X 108/68 122/84 Angiotensin II + drug X 112/66 126/86 2-On three separate occasions. Which of the following best describes drug X? A ) Aldosterone receptor antagonist B ) Angiotensin II-converting enzyme inhibitor C ) Angiotensinogen inhibitor D ) Partial agonist at angiotensin II receptors E ) Renin inhibitor 46.Staphylococcus aureus 45..Sporothrix schenckii E. 1-A 70-year-old woman is found to have persistent fever despite intravenous broad-spectrum antibiotic therapy 3 days after undergoing operative excision of the anterior pelvic organs for recurrent cervical carcinoma.5°C (101. an injection of drug X.3°F). If the spinal needle is inserted posteriorly between the L-3 and L-4 vertebral arches.A 56-year-old man is scheduled for repair of an inguinal hernia under spinal anesthesia. A Gram stain of one of the colonies shows 4-μm. a 25-year-old man is given an injection of angiotensin II. Fine needle biopsy : adenocarcinoma during radical prostatectomy which of the structures is at greatest risk for injury? 1) dome of bladder 2) obturator nerve 3)pelvic parasympathetic nerves 4) penile urethra 5) ureterovesical junction 44.43. which of the following ligaments must be traversed to reach the spinal canal? . Blood cultures and cultures of the tip of the central catheter on a sheep blood agar plate grow the organism shown in the photograph. Her temperature is 38.Escherichia coli D. Which of the following is the most likely causal organism? A-Candida albicans B-Cryptococcus neoformans C. There is also a well-healing abdominal wound without erythema and with two drains in place. The table shows his blood pressure (in mm Hg) after each injection. and nausea. Stool culture shows a 1. Which of the following best explains these findings? A ) Colon neoplasm B ) Diverticulitis C ) Epididymitis D ) Renal infarction E ) Torsion of the testis F ) Ureteral calculus 48. She has generalized anxiety disorder treated with diazepam. respirations are 18/min.Costotransverse C-Denticulate D-Ligamentum flavum E-Posterior longitudinal 47.A-Anterior longitudinal B. wheezing. She is obtunded and responds only to painful stimuli. Physical examination shows no other abnormalities. An interaction with which of the following drugs is the most likely cause of her condition? A-Calcium carbonate B-Cimetidine C-Famotidine D-Magnesium trisilicate E. A 25-year-old man is brought to the emergency department because of severe abdominal pain.6-cm roundworm larva. and vomiting for 1 hour. nausea.A 70-year-old woman is brought to the emergency department by her husband 45 minutes after he found her unresponsive on the living room floor. A chest x-ray shows bilateral infiltrates. This disease was most likely caused by ingestion of which of the following? A ) Feces-contaminated soil B ) Improperly canned beans C ) Pork products D ) Raw shrimp E ) Undercooked meat . Test of the stool for occult blood is negative. Her husband said she recently began taking an over-the-counter medication for heartburn. Coarse bilateral crackles are heard on auscultation of the chest. Physical examination shows tenderness of the left flank and the left lower quadrant of the abdomen. His pulse is 100/min. and blood pressure is 150/100 mm Hg. Ranitidine 49. The pain originates in the left flank and radiates to his groin.3-year-old boy is brought to the physician by his parents because of a 1-week history of nonproductive cough. Bowel sounds are mildly hypoactive.. the rates of stroke are lower in patients receiving the new agent than in patients receiving the standard treatment. Analysis of cerebrospinal fluid obtained from a lumbar puncture shows increased mononuclear cells and oligoclonal banding. Her family history includes osteosarcoma. Cytokines released by T-lymphocytes infiltrating this patient's central nervous system are most likely causing inflammation and destruction of which of the following? A-Astrocytes B -Ependymal cells C-Microglia D-Neurons E-Oligodendrocytes F-Schwann cells 52. A 30 year old woman with Li-Fraumeni syndrome is found to have adenocarcinoma of the breast. Physical examination shows spasticity and hyperreflexia of the involved extremities. Ophthalmologic examination shows swelling of the optic disc on the left. 30-year-old woman comes to the physician because of a 1-week history of left eye pain and blurred vision and a 2-month history of progressive weakness of her right arm and both legs. A new antiplatelet agent is developed for the prevention of recurrence of stroke. This treatment will most likely decrease this patient's risk for infection with which of the following organisms? A ) Escherichia coli B ) Haemophilus influenzae C ) Neisseria meningitidis D ) Salmonella species E ) Streptococcus pneumoniae 51. Daily treatment with penicillin is recommended. An MRI of the brain shows multiple T2-weighted bright signal abnormalities in white matter. Results are shown: Recurrent Stroke Rates per 1000 Person-Years Standard Treatment New Antiplatelet Drug . In a large randomized clinical trial with equal numbers of men and women. A 6-week-old boy is brought to the physician for a follow-up examination after newborn hemoglobin electrophoresis showed homozygosity for hemoglobin S.50. Which of the following mechanisms most likely underlies this condition? A) Activated proto-oncogenes B) Defective detoxification enzymes C) Defective DNA repair enzymes D) Impaired regulation of apoptosis E) Impaired signal transduction 53. Her gastrin level is 2000 (normal is less than 100). Endoscopy shows 2 large. flank pain.24 . A 20 y man is brought to the physician b/o a 4 hours Hx of abd pin.Women . risk for liver injury b/o which of the following actions of ethanol? A. nonbleeding duodenal ulcers. Extranodular CNS lymphoma C. 65 yr old woman w/3 month history of headache.. Pulmonary Small cell carcinoma with metastasis to Brain 54.. and synaptophysisn.. nausea and vomiting. acetaminophen clearance via glucuronidation C.. chrmagrin. and he took 3 doses of acetaminophen within 2 h after the onset of sevre headache Monday morning. He says that he ad been drinking ethanol heavily all weekend. NADH/NAD ratio 55. This pte is an inc.anaplastic ependymoma B. which of the following is the absolute risk reduction in women? A) 8% B) 12% C) 16% D) 33% E) 50% F) 62% G) 67% h 75% 53. specimen of lesion shows malignant small blue cell neoplasm that has cytokeratin.08 Overall . 2 episode of renal caliculi in past 2 years.. and weakness of arm w/31 lb weight loss. measurement of which of the following is most appropriate as next step? a) serum [Ca2+] b) serum [cortisol] c) serum tissue transglutaminase activity . augmentation of strength with repetitive testing of deltoid muscles.06 Based on the results. PPI is initiated.Met.. Physical exam shows multiple superficial lipomata and mild epigastric tenderness. 38 yr old woman with 10 week history of epigastric pain and frequent stools.. dec. inc. MRi shows well demarcated mass with surrounding edema in frontal lobe. bioavailability of acetaminophen D Induction of P450 ez that activate acetaminophen to a hepatic metabolite E.18 .12 .Activation ef IgE mediated mast cell degranulation B.Glioblasta Multriforma D. acid due to an inc. P/e weakness of proximal and upper and lower extremity muscles.. Primary cerebral neuroblastoma E. A.04 Men . Pelvic examination demonstrates no vaginal discharge. which of the following is the most appropriate next step? A) Determine serum estrogen concentration B) Order antibody studies for syphilis and HIV C) Prescribe an oral anti-trichomonal medication and antifungal cream D) Question the patient regarding the circumstances surrounding her recent break-up E) Tell the patient you will wait for the Pap smear results before prescribing anything for the discharge 57. The cast is removed. He is at 25th percentile for ht & wt. Results of her last Pap smear 1 year ago were normal. PE shows mild clubbing of the fingers. She works as a respiratory therapist at a local community hospital and recently broke up with a boyfriend of several months. Uterus is normal-sized and nontender. which required cast immobilization. In addition to obtaining cultures for gonorrhea and chlamydia. A)Adrenoceptors B)Membrane receptors C)Nuclear receptors D)Protein regulation E)Protein structure 59)A 12 year old girl is brought to the physician for a follow up. Examination of left calf shows that it is smaller than right calf. Adnexa are palpable and there are no masses. H ehas a h/o recurrent upper resp tract and sinus infection since birth. Physical examination shows no abnormalities. or mucosal lesions. A defect of which of the following in this pt's bronchial epithelium is most likely causing these symptoms. The mother says that his younger sibling is beginning to develop similar problems. wheezing and SOB with exertion. Lab studies show markedly increased sweat chloride and sodium conc.d) stool alpha1 antitrypsin concentration e) urine 5-hydroxyindoleacetic acid concentration 56. bleeding. She has had no other medical problems. 3 months ago she sustained a complex fracture to left tibia. She states that despite bathing frequently. A 27-year-old woman comes to the office because she recently noted a copious vaginal discharge requiring showering or bathing two or three times daily. Which of the following processes in this pt's myocytes is resp for the observed findings? . She has never been pregnant. She is not sexually active at this time and is taking no medications. she never feels clean. Which of the following is decreased in anemic patient? A) Alveolar PO2 B) Arterial O2 carrying capacity C) Arterial oxyhemoglobin saturation D) Arterial P50 ( partial pressure) E) Arterial PO2 58 ) A 9 year old boy brought to the physician by hiss mother because of a 1 year h/o cough productive of mucoid sputum. A)Anerobis glycolysis B)Fatty acid degradation C)Glycogenolysis D)Oxidative phosphorylation E)Polyubiquitination 60) A 35 yr old man comes to the physician becoz of a 3yr h/o enlarging nose. 35 year old woman is given 500 mg of drug X iv . 3 days later. PE shows prognathism and large fleshy nose. coarseninf of his facial features. An MRI of the brain shows a pitutary adenoma.two hours later the serum concentration is 10mg/L. Which of the following mechanisms most likely underlies this condition? A)Activated protooncogenes. PE show pinpoint pupils. The tumor cells in this pt. her resp are 6/min. Her serum conc is 1. Serum studies show increased IGF-1 conc. Morphologic analysis of the biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. C)Morphine downregulates mu opioid receptors with chronic dosing. Which of the following best explains this pt's clinical deterioration after the initiation of morphine therapy? A)Chronic dosing of morphine decreases its bioavailability B)Morphine bioavailability increses with chronic dosing. most likely have an increased activity of which of the following enzymes? A)Adenyly cyclase B)Guanylyl cyclase C)Janus kinase D)Phoapho lipase c E)Tyrosine kinase 61)An 85 yr old woman is diagnosed with a fracture of the right femur and begins treatment morphine by patient controlled analgesic pump.several minutes later the serum concentration X is 12. Her family h/o includes osteosarcoma. D)Morphine inhibits its own metabolism E)Morphine is metabolized to active metabolites that accumulate 62) A 30 yr old woman with Li-Fraumeni syndrome is found to have adenocarcinoma of the breast. B)Defective detoxification enzymes C)Defective DNA repair enzymes D)Impaired regulation of apoptosis E)Impaired signal transduction 63. Further studies show that the G-Alpha S subunit of G proteins in the tumor cells lack GTPase activity.5.8mg/dl. asuming the drug X has first order elimination which of the following will be serum concentration of drug X in mg/L in another two hours . muscle weakness and increased hand and foot size. His blood pressure is 105/70 mm/hg while sitting Physical examination shows epigastrIc tendemess A CT scan of the abdomen shows 1 cm mass in the pancreas. Her immunizations are up to date. An 8-year-old girl is brought to the physician for a well-child examination. She is at the 50th percentile for height and 60th percentile for weight.5 c7 d7. febrile." E) “Your daughter's development is normal. Pneumocystis E. Physical examination shows breast bud development and a few pubic hairs. Strep bovis 66." 65. Her mother says that she has been well except for an occasional cold. 26 month old boy with SOB & cough who had cutaneous abscesses caused by S. Which of the following is the most appropriate initial response by the physician? A) "I am concerned that your daughter may have precocious puberty. A 35-year-old man comes to the physician because of a 6-month history of burning abdominal pain that occurs 1 to 2 hours After he eats. Use of over the counter antacids and Histamine 2 (h2)-receptor blocking agents has not been effective in relieving his symptoms He is sweatlng profusely and has light-headedness when stands.a6 b6. aureus." D) “Your daughter's breast development is somewhat less than might be expected for her age. Answer choices are A." C) "I would like to order laboratory studies to ensure that your daughter's development is normal." B) "I think that your daughter is likely to begin menstruating in the next few months. The mother asks whether her daughter's development is normal. he also has had black stools for 2 days. Immunohistochemical labeling of neoplastic CellS in a biopsy specimen is most likely to involve the use on antibodies directed to which which of the following substances ? A) Amylase B) Gastrin C)Glucagon D) Human pancreatic polypeptide E) Insulin F) Lipase G) Serotonin . Candida C. Bacillus anthracis B. Culture grows filamentous gram + rods.5 e8 64. x-ray shows cavitary infiltrate of left lingula. Nocardia D. and an asymmetric neck mass. A female newborn is delivered at term to a 35-year-old primigravid woman. Which of the following is the most likely cause of the newborn's stridor? A) Cystic hygroma B) Enlarged thyroid gland C)Thymglossal duct cyst D) Tracheomalacia E) Vascular ling 68. She develops an urticarial lesion at the site of the sting.H) Somatostatin I) vasoactive Intestinal polypeptide 67.10 F) Transsforming growth factor-beta 69. intercostal retractions. Three days later. Which of the following explains the induration at the site of the sting? A) Decrease in the expression of adhesion molecules on vascular endothelial cells B) Decrease in serum C-reactive protein concentration C) Influx of macrophages producing interleukin-1. IL-6. Measurement of which of the following cytokine concentrations is most likely to indicate a positive result? A) Granulocyte-macrophage colony-stimulating factor B) Interferon alpha C) Interferon gamma D) Interlukein-4 E) IL . A sample of her whole blood is incubated with a mixture of synthetic peptides representing two proteins of the suspected pathogen. An otherwise healthy 60-year-old man comes to the physician for a follow-up examination 2 weeks after he was found to have a serum prostate-specific antigen concentration of 5.. A 54-year-old woman who works as a nurse comes to the physician for routine tuberculosis screening. supernatant is collected for evaluation. the area has become indurated and firm. a study is designed to evaluate the relationship b/w ambient noise and hearing loss in an automoblile plant .3 ng/mL (N. Pregnancy was complicated by untreated maternal Graves disease. Six hours later. nasal flaring. A CT scan of the .each employe is given a test for hearing acuity and the the noise level is measured at his or her workstation which of the following describe this study design a) case series b )cohort c )crossover d )cross sectional e )randomized c trial 71.different location in the manufacturing plant have different levels of ambient noise . Her respirations are 66/min Physical examination shows stridor. A 24-year-old woman was slung on her right thumb by a bee 30 minutes ago. and tumor necrosis factor-a D) Lysis of endothelial cells by the alternative complement pathway E) Vasoconstriction 70.4) A biopsy specimen of the prostate shows evidence of adenocarcinoma.. A) Corpora amylacea B) Edema C) Hypertrophied cells D) Necrosis of the blood vessel walls E) Scattered shrunken cells F) Widespread necrosis 72. 70 yr old african american women come to physician after 1 day onset of back pain. her father underwent spleenectomy as a youth and recently underwent cholystectomy. Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular ribosomes. X-ray shows vertebral compression fracture of L3 and she has decreased bone mineral density. her blood ct shows hb-decreased MCV-90 leukocyte-6000 N-58% E-2% L-35% M-5% platelet 188.Ethnicity B.spine shows osteoblastic lesions at LI. and smoked 1/2 a pack for 50 years and drinks 3 caffeinated beverages a day.Smoking E.Abnormal Hb structure B. a 10 yr old girl had fatigue and appears pale. Answer Choices A. She's a part time cashier. Five months later. Socioeconomic status 74. The patient undergoes bilateral orchiectomy. low income. Which of the following additional structural features of poliovirus mRNA is the most likely cause of its ability to be translated in the absence of a cap? A) Absence of a 3' untranslated region (UTR) B)Absence of a 5' UTR C) Absence of a poly(A) tail D) Presence of an internal ribosome entry site E) Very short open reading frame 73.Abnormal Iron absorption . Occupation D.Gender C. At autopsy. he dies suddenly of a massive myocardial infarction.000 Retic-9%(Increased) A. which of the following microscopic changes in the prostate resulting from the orchiectomy is most likely present. Def. Decreased Excretion of Ca from GIT B.Slipped Strand mispairing 77. endomyocardial tissue will show excess of . 15 yr old female ingested Vit D in a suicide attempt. of erythrocyte Spectrin D.pneumo with lyste from heat killed s. A. Pneumo to monitor effect of conjugate polysaccharide on dif. mutation in plasmid gene E.C.4 (slightly elevated) What is the mechanism of increased Ca.Increased absorption of ca in GIT D. 75. inhibits cholesterol uptake (i think this is the answer) d inhibit HMG COA e. antagonizes VLDL cholesterol secretion b. capsule types.Increased 1 Hydroxylase activity in kidney E. investigator studying s. On which of the following days in this patient`s menstrual cycle were these hormones most likely measured? A) Day 1 B) Day 6 c) Day 12 D) Day 18 E) Day 26 79. laboratory studies show an increased concentration of estradiol and decreased concentration of progesterone. Follow up 1 month later show Ca [C] 10. Inadequate erytrhopotein production. pneumo are isolated after the addition of dnase to the lysate. A.Bacteriophage transduction B. Pt. It was about the niacin cholesterol mechanism a. strains express capsular type expressed in s.Natural transformation C. after incubation of non encapsulated s.mittis colonies from s pneumo expressing new capsular type are identified but no capsule of s. Pt with CHF with 2 relatives dying from dilated cardiomyopathy and cirrhosis. Plasmid Transfer D. increase catabolism of LDL c.Impaired Oxidatiive enzyme function E. Menses occur at regular 28 day intervals and she has been shown to ovulate on day 14 when her saliva is tested on a particular day of the cycle.Decreased osteoclast activity in bone C. mitts are identified. stimulates PPARa 78)A 35 year old woman participate in a study of a new diagnostic test of steroid hormones in saliva. P/E of pt shows cardiac enlargement and hyperpigmentation and glucose is 320.Increased Ostoblast activity in bone 76. Lysosomal Glcogen H. Mucopolysaccharide 80-During an experiment endothelial cells are incubated wit 30Mn of glucose compared w 5Mm of glucose. nothing seems abnormal about him.6BP 220%. Eosinophils F. puruvate kinase 81. a 42-year-old woman is brought to the emergency department 30 minutes after the sudden onset of severe headache.3 BPGLYCERATE 75%. Glyceraldehyde 3PDH c. the right pupil is 6 mm and nonreactive to light. he demands a prescription for an opioid drug.Copper E. adduction of the right eye is impaired. 23 year old man comes to emergency department bc of 2-week history of back pain refractory to treatment with over-the-counter medications. Cerebroside D.alpha 1 antitrypsin C. what should you do? A) Determine which drugs have been prescribed for the patient in the past B)Obtain serum toxicology screening on the patient C) order an MRI of the spine D) prescribe only a 2-week course of an narcotic medication for the patient E) refer the patient to a drug addiction program . Nuchal rigidity is noted. Cerebral aniography is most likely to show an Aneurysm in which of the following arteries? A) Anterior Cerebral B) Internal Carotid C) Middle Cerebral D) posterior communiating E) Vertebral 82. PFK e. PGlyceraldehyde mutase f. she has no history of major medical illness and takes no medicatons. Hexokinase d. the results are: G6P 180%. PYRUVATE 70% Wich of the following enzymes is most likely inhibited indirectly by increase of glucose concentration a. her blood pressure is 163/90 mm Hg.Amyloid B. FRUCTO1. on arrival. GLYCERALDEHYDE 3P 210% 1. A CT scan of the head shows Blood in the subarachnoid space. Iron G.A. Aldolase b. a 24 year old african american man comes to the physician because of a 3 month history of red bumps on his face and chin. Inactivated polio v e.9% saline for 5 minutes F) Intravenous infusion of 20% albumin solution (20g/100mL saline) for 5 minutes 84. 65 y/o lady with T38.3% to 3% E) Intravenous infusion of 0. MMR f. The lymph flow question. physical examination shows hyper pigmented papules over the cheeks. varicella 87. jawline. Typhoid g. shortness of breath and nonproductive cough.5°c. he says that the bumps are itchy and painful. How do you increase lymph flow through lungs? A) Administration of endothelia-1 into the pulmonary artery B)Administration of phenylephrine into the pulmonary artery C)Decreasing the inspired oxygen conctration from 21% to 10% * I put this WRONG D)Increasing the inspired carbon dioxide concentration from 0. and neck. 4 month y/o boy with skeletal dysplasia involving abnormal endochondral bone formation. Hep B D. 23. which of the following is the most likely diagnosis? A) acne vulgaris B) cutaneous lupus Erythematosus C) Keloids D) pseudofolliculitis barbae E) Rosacea 86. What enzyme is inhibited indirectly by increase glucose concentrations A)aldolase B)Glyceraldehyde-3phosphate dehydrogenase C) hexokinase D) phosphofructokinase E) phosphoglycerate mutase F) pyruvate kinase 85.83. Electron microscopy of patient will most likely show which? a) decreased RER b) decreased SER . DPaP b. Hib c. Which vaccine might have prevented this findings? a.valent pneumo (wrong) h. 4 pulse is 84/min. respirations are 14/min. respirations are 18/min. he appears cachectic. sputum cultures will most likely grow which of the following organisms? A) chlamydophila Pneumoniae B) Haemophilus influenzae C) Mycoplasma Pneumoniae D) Streptococcus Pyogenes (Group A) E) Normal Oral Flora . and blood pressure is 110/70.a 53 year old homeless man with alcoholism is brought to the emergency department by police shortly after he was found collapsed and coughing on a park bench. a lumbar is performed. and an occasional bowel sound over the left hemithroax. a previously healthy 59 year old man comes to the emergency department because of a 2 day history of fever and headache. his temperature is 39. physical examination shows cyanosis. a chest X-ray shows cavitation in the right lower lung lobe with a surrounding infiltrate. he is oriented to person and place but not to time. gram positive cocci in chains. markedly decreased breath sounds bilaterally. and gram negative bacilli. Examination of a sputum sample shows gross purulence.c) dilated RER d) increased SER e) large lysosomes f) small lysosomes 88. A full term female newborn develops respiratory distress shrtly after delivery. his temperature is 39. physical examination shows no other abnormalities. it is most appropriate to adminster a drug that inhibits which of the following viral enzymes? A) DNA polymerase B) Neuraminidase C) protease D) Reverse Transcriptase E) RNase A 90. and the results of polymerase chain reaction testing of cerebrospinal fluid show herpes simplex virus. a chest x-ray taken while the patient is supine shows multiple cystic appearing areas on the left and decreased aeration on the right. pulse is 90/min.400/mm^3. and blood pressure is 112/78 mm Hg. his leukocyte count is 11. physical examination shows clubbing of the digits breath sounds over the right lower lung field. which of the following is the most likely diagnosis? A) Bacterial pneumonia B) Bullae related pneumothorax C) congenital cystic adenomatoid malformation D) congenital diaphragmatic hernia E) laryngeal atresia F) lobar sequestration G) Tracheal stenosis 89. pregnant 16 year old came because of a tonic clonic seizure. ldh. and pulse are elevated. elevated uric acid. in vsd and truncus arteriosus. unable to urina. Shunt 92.91. what causes all this? high protein diet over supp of vit d polycystic kidney renovasc disease normal aging 94. hypoventilation d. dead space b. but the serum levels stay the same if the patient is 75 years old now. over the course of 10 years. respirations. low FiO2 e. creatinine. 52 yo comes in with 3 week history of polydipsia. urine creatinine excretion and clearance increases. For killing of gram positive diploccoi. he's on metoprolol and simvastatin for hyperlipidemia and htn. her bp. polyuria and weight loss. ast. and takes supplemental calcium and vitamin d. which of the following enzymes is going to initiate intracellular killing? 1) NADPH OXIDASE 2) CATLASE 3)SUPEROXIDE DISMUTASE 4) COX 1 93. what is the diagnosis? drug od eclampsia epilepsy renal disease sepsis 95. what is increased? choices: (a) fasting glucose concentration (b) glycogen synthesis (c) insulin-mediated glucose disposal rate (d) serum calcium concentration (e) serum HDL-cholesterol concentration (f) urine sodium concentration . Pulmonary embolus results in what type of V/Q relationship? a. alt. is the extraembryonic mesoderm absent or is it the splanchopleuric mesoderm?Neuroectoderm 96. diffusion abnormality c. chest xray shows left lower lobe infiltrate and pleural effusion on the left. prednisone. daunorubicin. elevated ptt. normal pt – Hemophilia. in mcad. vincristine). 23 y/o woman with sjogrens has burning pain in her toes for past month. what treatment should be given? amphotericin b ertapenem ganciclovier infliximab rituximab 99. she is started on a proton pump inhibitor. She also has multiple lipomas and two large non bleeding ulcers. long chain suffice 102. the pathogenesis of asthma is involved with elastase hydrogen peroxide ifn gamma il-10 lactoferrin leukotriene c4 100. which neurotransmitter is mediating the pain gaba dopamine enkephalin serotonin substance p 98. 18 y/o with ALL has 3 day h/o fever and left side chest pain. temp is 102. 38 y/o woman seems to have a gastrinoma (serum gastrin concentration is 2000 (normal <100). sensation is all normal. vWB 101. there is a pas thoracocentesis pic shown. pmn is below 500.97. i know that the deficiency is in medium chain acyl coa dehydrogenase. what measurement should you follow? serum ca serum cortisol serum tissue transglutaminase stool alpha 1 antitrypsin urine 5hiaa . neuro exam shows decreased perception of temp over feet bilat..6. he is on chemo (asparaginase. p/e shows soft. a newborn female is diagnosed with hypothyroidism 2 days after birth. 105. vivax and P. ovale a dormant stage (hypnozoites) can persist in the liver and cause relapses by invading the bloodstream weeks. pedal pulses diminished. Which of the following best describes the position of his vocal cords throughout this sequence? Immediately After While Swallowing Laryngeal Irritation While Coughing A) Closed closed open B) Closed open closed C) Closed open open D) Open closed closed E) Open closed open F) Open open closed 108. After the forearm muscles are exercised. which artery is stenosed? greater pancreatic hepatic right gastric superior mesenteric supraduodenal 106. pain is relieved when she decreases the amount of food she eats. A 32-year-old man begins to laugh while eating dinner with his friends.104. p/e and reflexes are normal. Serum creatine kinase concentration is increased. (Don't remember too well but I think the right answer was A) 107. Hantavirus with the big chart asking about which segment is associated with temperature sensitive phenotype associated of Hantavirus A? I think whenever the A strain had the L segment it was temperature sensitive and that was the answer. or even years later. venous blood obtained from the antecubital vein shows that lactate concentrations do not increase compared with preexercise values. maternal to fetal transfer of which of the following explains the normal development in the newborn? iodine thyroglobulin tsh thyrotropin releasing hormone t4 105. Physical examination shows no abnormalities. nontender abdomen and abdominal bruit. This patient most likely . 68 y/o woman has 1 year history of severe ab pain after meals.. A 33-year-old man comes to the physician because of a 3-month history of muscle weakness and cramping. also has an unintentional 20lb weight los. ultrasonography of the neck shows no gland tissue. chloroquine spares which two plasmodium species? P. He says that the symptoms appear shortly after he begins exercising. A small particle of food irritates his larynx and provokes him to cough. does knitting gardening reading. HC03. a chest x ray density in hilar region.Long walk outside daily . It does not change the amount of ferritin gene products detected by Northem blotting or by the polymerase chain reaction. one alcoholic beverage per day. what are the Amino Acids.has a deficiency in the activity of which of the following enzymes in muscle? A) Carnitine palmitoyltransferase-1 B) Fumarase C) Glucose-6-Phosphatase D) Glycogen phosphorylase E) Succinate Dehydrogenase 109.lung biopsy shows round cells with little cytoplasm that are twice the size of lymphocye infiltrating sheets that are neither glandular nor squamous in origin.Swimming pool based exercises 3 times .Discontinue alcohol . 75 year old lady. When you prescribe appropriate pain medications to a patient who wanted to kill herself through pain medications which core ethical principal are you using? Justice Beneficence Non maleficence Dignity Autonomy 112. A 64 year old man is evaluated for cough dyspnea and chest pain. . An increase in the amount of iron inside cultured hepatocytes leads to an increase in the amount of ferritin gene products detected by Westem blotting. goes to swimming pool occasionally. These results suggest that iron increases the frequency of which of the following events? .Lose weight 110) Fanconics syndrome.serum abnormalities? 1 hyperkalemia 2hyperlipidemia 3 hypmagesemia 4hypoalbuminemia 5 hypogylcemia 6hyponatremia 113. Phosphate and Glucose levels ? Everything decreased 111. BMI 21 Which of the followning would decrease patients risk for additional hip fractures? .Discontinue gardening .afebrile. pulses in the lower extremities are weak. A 62-year-old woman with chronic renal disease comes to the physician for a follow-up examination. he appears pale and has a cold sweat. Measurement of which of the following is most appropriate to monitor the effectiveness of this pharmacotherapy? A) Arterial blood pH B) Arterial pressure of carbon dioxide C) Oxygen saturation of the blood D) Plasma hemoglobin concentration E) Serum urea nitrogen concentration 117. nausea. 70 year old man comes to the emergency department 30 minutes after the onset of weakness. test for occult blood for colon cancer has? low sensitivity low specificity uncertain PPV uncertain NPV potential for False positive 116. Her pulse is 78/min. Which of the following is the most likely diagnosis? A) Acute compression fracture of the L3 vertebral body B) Herniated L3 to L4 intervertbral disc C) Leaking aortic aneurysm .A) Maturation of the ferritin gene transcript B) Transcription of the ferritin gene C) Translation of ferritin mRNA D) Transport of ferritin mRNA out of the nucleus 114. BMI is 21 kg/m2.biopsy will show? cental vacuolization with gycogen central vacuolization with lipid mitochondia increase mucopolysaccharide PAS + myofibrillar vacuolization segmental ishemic necrosis 115. a 51 yr old man with 3 month history of HBV negative PAN presents with myalgia . a Faint bruit is heard in the lower abdomen. Laboratory studies show anemia. pulse is 110/min and blood pressure is 90/60mm Hg. and blood pressure is 140/100 mm Hg. She is 157 cm (5 ft 2 in) tall and weighs 52 kg (115 lb). and lower abdominal and back pain that radiates to the lower extremities. Treatment with intravenous recombinant erythropoietin is started. muscle stretch reflexes are normal in both lower extremities. Male with a h/o abd pain and diarrhea. VENOUS VASOCONSTRICTION 120. Old man with fever chills fatigue SOB and weight loss. peritonitis. Which is most likely dx? Bacterial endocarditis. Clear lungs. prostatitis. PE. High temp/pulse/BP. Karyotyping and fluorescent in situ hybridization studies do not show deletion in the usual site on chromosome 15. Labs show gastrin of 500 and gastric acid secretion of 80. what about the woman that thinks she has sleep apnea and came to get checked for this?? Reassurance 121. A 5-year-old boy with mental retardation is grossly obese and has facial features of PraderWilli syndrome (PWS). Viral pneumonia . 2/6 early diastolic murmur and accentuated when pt leans forward with held expiration. which one of these doesn't have microtubules? corticol thymocytes enterocytes in duodenal crypts erythroblasts in the bone marrow keratinocytes in stratum basale ventricular cardiac muscle fibers 122. pain relieved by eating and antacids. Underwent urinary catheterization for prostatic obstruction. ARTERIOLAR VASOCONSTRICTION PERIP. Soft s1 and normal S2. what is the most definitive treatment? low protein diet/abx therapy/antihistamine therapy/sectioning of the vagus nerve/surgical removal of the suspected tumor 119. they ask how does the temp return to normal?? EVAPORATION OF SWEAT INCREASED MINUTE VENTILATION INCREASED MUSCLE TONE PERIP. Which of the following findings is most likely to confirm PWS in this child? ~ A) Deletion in the short arm of chromosome 15 B) Duplication within chromosome 15 C) Large trinucleotide repeat expansion in the PWS area of chromosome 15 D) Maternal origin of both chromosomes 15 E) Translocation in the short arm of chromosome 15 123.D) Leaking left renal artery aneurysm E) Perforated rectum F) perforated sigmoid colon 118. 25 year old man that after running his temp is 38. so he is diseased and thus cannot have the same trinucleotide repeats as the woman which is a carrier. coli. ilioinguinal. Supraduodenal 125. pudendal nerve 128. hx of atherosclerosis and underwent CABG 2 yrs ago. exam shows soft nontender abdomen and abdominal bruit. 127. Neisseria mening. Strep pneumo. obdurator nerve. flu. asking for an intact spinal reflex arc between the sacral parasympathetic nerves and which of the following? Genitofemoral. Right Gastric.124. A 43-year-old woman comes to the physician because of progressive difficulty walking during the past 3 months. He has not had any changes in his appetite or sleep pattern. A 35-year-old man is referred for psychiatric evaluation by a work-sponsored depression screening program. H. Which of the following is the most likely cause of the findings in this patient? A) Acute peripheral neuropathy B) Degeneration of motoneurons of the lumbar cord C) Demyelination of the corticospinal pathways . Which of the following is the most likely diagnosis‘? A) Adjustment disorder with depressed mood B) Avoidant personality disorder C) Bipolar disorder D) Dysthymic disorder E) Major depressive disorder F) Schizoafiective disorder 129. He wonders if he is just getting old. Diminished pedal pulses Greater pancreatic. pain relieved with less food. SMA. he has not had suicidal thinking or planning. Cause of patient's sx of stenosis in which artery? She had 1 year hx of severe abdominal pain after meals and weight loss. pain. He has no history of serious illness. and temperature in the lower extremities are normal. Boy homozygous for HbS. and his last routine examination was 12 years ago. Salmonella. The pedigree with Fragile x syndrome that asks the probability that III-5 will have similar expansion? Would love an explanation of the answer. He is generally unmotivated and pessimistic about the future and has little energy for relationships or work. With regards to the erection. Sensations of joint position. lumbosacral trunks. Although he has had occasional thoughts that life is not worth living. Hepatic. and his symptoms have not afiected his ability to work. daily tx w/ penicillin to decrease risk of infection with what? E. Patellar and Achilles tendon reflexes are diminished. 0% recall that the male only needs one allele to manifest the dz. I put salmonella but incorrect 126. He says that for the past 2 years he has felt down and has not fully enjoyed life. Neurologic examination shows weakness and decreased muscle bulk of the lower extremities. clonidine. inactivated polio. magnesium trisilicate. tricuspid stenosis(diastolico) 134) 51 yr old woman w/ pheochromocytoma.pulse 90 min bp 150/90 cardiac exam s4. increased cGmp. shortness of breath. purple budding organism that grows on sheep agar. hepatitis b. which vaccine coulda prevented this stuff? diphteheria tetanus acellular pertussis. typhoid.. tricus regurgitation(tricuspida). phenoxybenzaminem sildenafil? 135) 70 yr old lady brought to er by husband 45 min after he found her unresponsive. will undergo an operation to improve her condition. mitral valve regurgitation (apex y axila). stabilizing depolarization of the vascular smooth muscle cell membranee 137) previously healthy 67 yr old lady w 3 day history of fever. 23 valent pneumococ. who has immune thrombocytopenic purport resistant to corticosteroid treatment. She has anxiety disorder trted w/ diazepam. just to confirm the elliptical. lungs clear to auscultation. which drug should be admins. inhibits cholesterol uptake (i think this is the answer) d inhibit HMG COA e. preoperative treatment w propranolol prescribed to decrease tachycardia.. famotidine. Systolic murmur is loudest at the point marked by X. antagonizes VLDL cholesterol secretion b.. Exanm shows no abnormalities. she only responds to painful stimuli. ranitidine 136) 66 yr old man brought to er sudden substernal chest pain. increasing camp. nifedipine. mmr. removing which organ in the ct scan will help? Splenectomy 133. aortic valve stenosis (base irradiado a carotidas). mitral valve stenosis(diastolico).jogging when pain began. before starting propranol? atenolol. She recently started taking over the counter med for heart burn. It was about the niacin cholesterol mechanism a. Which cardiac abnormality is causing the murmur? aortic valve regurgitation (diastolico). treatment w sublingual med fixed pain in 2 min…mech of action of which drug let to relaxation of vascular smooth muscle in this patient? Obv nitroglycerin so is the answer increased cGMP? decreasing intracellular calcium. nonproductive cough.candida 132.hypertension trted w indapamide. inhibiting the sodium pump. headache. cimitidine. pulmonic stenosis. varicella . h. Temp is 102 F. and muscle pain. interaction with which drug causing this prob? i know its a cytp450 inhibitor so is it cimetidine or ranitidine? calcium carbonate.D) Loss of afferent la axons innervating muscle spindles E) Myotonic muscular dystrophy 130. pulmonic regurgitation (diastolico). influenza virus. 43 yr old woman. stimulates PPARa 131. influ type b. increase catabolism of LDL c. mcv 112. Repetitive nerve stimulation shows a 25% decrease in muscle action potentials in several muscles. no abnormal motor movements are observed during this reg activity. group a step pyogenes 140) 4 month boy w recurrent sinopulmonary infections since birth. carbamazepine. leukocyte adhesion deficency. Micro shows numerous gram negative rods. muscle strength shows fatigable weakness of the neck. hct of 27%.138) 35 yr old man w long history of atrophic gastritis has increased lethargy and fizziness during past 2 weeks. Needle core biopsy of femur shows metastatic carcinoma.5 cm destructive osteoblastic lesion w an associated fracture in proximal femur and 2 separate similar smaller lesions in the bony pelvis. and platelet count 200. ataxia telangiectasia. urine culture brain heart infusion medium grows more than 100. hands. undifferentiated crypt 139) 80 yr old woman fever cloudy urine after knee replacement. absence of sufficient numbers of which cell types explains these findings? chief. reg shows 1-3 second hurts of 3 sec spike and wave activity. Blood smear shows giant granules in neurtophils and eosinophils. paneth. hair. decreased release of acetylcholine from the receptor. and slurred speech. X-ray of ship shows 4. sezary syndrome 141) 62 yr old man has pain in the left hip for 3 wks.000 bacterial colonies predominantly one thats oxidase positive and produces diffusible green pigment. doesn’t respond to questions during these episodes. arms. lung. kleb. pancreas. ethosuximide. pays exam shows ptosis of the eyelids and waddling gait.aueroginosa? ecoli. prostate 142) previously healthy 52 yr old lady has 2 mo history of progressive difficulty swallowing.4 F.aureoginosa. Whats the most likely primary site of the cancer? prostate right cuz of the clues? if its not this then lung(most common metastasis site) colon. phenytoin . chediak higashi syndrome. goblet. phenobarbital. proteus mirabilis. deceased acetylcholine production. binding of antibody to the acetylcholine receptor. decreased reuptake of acetylcholine 143 )5 yr old stares blankly into space for several seconds.000. mucous. Temp is 100. enteroendocrine. gabapentin. I know this is chediak higashi lol but still wanna double check acute myeloblastic leukemia. pale skin and mucous membranes. no palpabl adenopathy. and fingers. p. eyes. columnar absorptive. Which of the following mechanisms is the most likely cause of this patients disease? binding of acetylcholine by an antibody.pneumoniae. Bandaged left knee and indwelling foley cath. ecchymoses over trunk and extremities. kidney. double vision. parietal. decreased vibratory sensation. whig organism? Is this p. liver edge palpable. pays exam shows no abnormalities. Phys exam shows hypo pigmentation of skin. Proton pump inhibitor therapy is begun.patient too young and more likely in females) lymphycytic infiltrate abnormal astrocytes (brain) abnormal oligodendrocytes (oligodendrocytes are in the brain) .3. her gastric pH is 2. She had two episodes of renal calculi during the past 2 yrs.so check Parathyroids---> they make PTH-> increased CA2+ 148) 12 year old with walking abnormality for 6 months. Serum studies show increased ammonia. you must be more responsible” “you realize that your high blood pressure could have been avoided” 147) 38 yr old lady w/ 10 wk history of epigatric pain and frequent stool. which of the following statements by the physician is most appropriate to begin a discussion about this patients possible noncompliance w her medication regimen? Is it “it is hard to take pills every day for a condition that has no symptoms” “i will arrange for nurse to visit to make sure you’re taking meds properly” “I’m sorry but i must say missing your meds can kill you” “you clearly have not been taking your meds. lactate. and serum gastrin concentration obtained immediately after the procedure is 2000 pg/ml(N<100). measurement of which of the following is the most appropriate next step in management? MEN syndrom. Physical exam shows multiple superficial lipomata and mild epigastric tenderness.144) 5 year old boy brought to the ER.. mild atrophy and hammer toes. he had a flu like illness 5 days ago that she treated with aspirin. Liver showing centrilobular pallor and swelling of hepatocytes and kidneys showing proximal convoluted epithelial cells. with vomiting and sleepiness. and transaminase levels. Hypertension has been poorly controlled during the past six months despite availability of appropriate pharmacotherapy.nerve biopsy shows abnormal myelin sheaths absence of shwann cells (would be MS. Upper endoscopy show two large non bleeding duodenal ulcers. what's the most likely cause of the patient's coma? a) cerebral edema b) metabolic alkalosis c) subarachnoid hemorrhage d) venous sinus thrombosis e) viral encephalitis 145).. Which is the mechanism? A) activation of aspartate-spcific caspase B) Binding of Fas ligand to receptor C) Decreased function of Na/K ATPase D) Ribosomal degradation E) Stimulation of PFKase 146)60 yr old woman has 2 history of hypertension comes to doc for follow up examination. 6. Crackles bilaterally. 2. HR 100. which ingredient in this med most likely cause of this patients new symptom? dextromethorphan right? acetaminophen. 3.4. loratidine phenylephrine 151) 54y F admitted with acute MI. which of the following best represents the flow rate in L/min thru the aneurysm? Can someone please help me out with this? 1. BP 160/98. The onset of anesthesia is found Abe significantly faster in GmupY than in Group X. she has acute SOB and sweating. but 2 days later. Estimated cross-sectional area of the aneurysm is 2 cm^2 and the mean velocity of blood flow thru the aneurysm is 20cm/sec. Her mensrual flow has been unusually heavy during her last three menstrual periods. 4. In Group X. anesthesia is induced by administering isofiurane at a concentration 1. RR 24. guafenesin. The different response rates between the two groups is best explained . each at 0. Two sets of patients (Groups X and V) of similar age.0 150)55 yr old dude w contipationsine taking meds for chronic persistent cough n sinus congestion. 3. Vaginal ultrasonography shows an 8 cm mass in the left ovary.75 times the MAC for that drug. therefore left sided heart failure -> the concept is that ischemia of the papillary muscles lead to Mitral insuff.. Most likely cause of movement deficits in this patient is damage to which region of the spinal cord? Is it G. by the ventral cord of the spinal cord? Don't have the picture but it is upper motoneuron so right side middle cause anterior is spinathalamic tract 154. and health status are given general anesthesia by inhalation.. gender. Which murmur is most likely? So SOB and Crackles must be fluid backing up into the lung. -> murmur is holosystolic high pitched loudest at apex 152) 28 yr old lady w/ 1 month history of pelvic pain that has become increasingly severe during the past week.2. at which point there were no murmurs or signs of heart failure. which of the following structures passing inferior to the ovary must be protected? Ureter 153) 16 yr old boy dove into pool.5 times the minimal alveolar concentration (MAC) for this drug. Menses have occurred at 24-28 day intervals since menarche at the age of 12 years. anesthesia is induced by administering a combination of isofiurane and nitrous oxide. In Group V. During surgical removal of the ovary. weight. Serum studies show an increased CA 125 concentration. dextromethorphan. +murmur. Phys exam shows a palpable mass in the left adnexa. unable to move right upper and lower extremities.149) 54 yr old man w/ aneurysm in distal portion of his abdominal aorta.0. and the standard deviation is 8 mm Hg.by differences in which of the following properties of isoflurane and nitrous oxide? A) Blood:gas partition coefficient B) Brain blood partition coefficient C) Brain'gas partition coefficient D) Hepatic metabolism E) Lipid solubility F) Minimal alveolar concentration G) Molecular weight 155. but the direction cannot be predicted B) Decrease in width C) Increase in width D) Remain the same 156. Gram stain is performed on a sputum specimen. If four rather than ten measurements of the mean blood pressure are made. the patients average diastolic blood pressure is 113 mm Hg. which of the following is the expected impact on the size of the 95% confidence interval about the mean blood pressure? A) Change. Which of the following features is characteristic only of the pink rods? A Endoplasmic reticulum B Growth inhibition by ciprofloxacin C Outer membrane D Peptidoglycan cell wall E Polysaccharide capsule . A 48-year old man is referred for evaluation of possible hypertension On the basis of ten measurements. Pink rods and blue cocci are observed.