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* NBME 7 Block 2_________please help
 #502346  
  iqbalian01 - 04/27/10 10:38
 
  Q14) A 69 year old man is brought to the physician because of a 2 day history of pain in his right knee. During the past 3 years, he also has had recurrent episodes of pain of the left great toe & one episode of pain & swelling of the left elbow. These episodes improved following use of over-the-counter ibuprofen. He has hypertension, gastroesophageal reflux disease, & hypercholesterolemia. Current meds include hydrochlorothiazide, ranitidine, & atrovastatin. Physical examination shows erythema & warmth over the right knee. Nodules are present on the helix of the left ear, chin, right shoulder, middle back, and lower back. Which of the following nodules is most likely a tophus?

a) Chin
b) Ear
c) Lower back
d) Middle back
e) Shoulder

Q15) a 3 year old boy with sickle cell disease is brought to the emergency department because of severe leg pain for 2 hours. Physical examination shows hepatosplenomegaly & tenderness over the lower extremities. His hemoglobin concentration is 7g/dL. A peripheral blood smear shows target cells, poikilocytes, & many sickled erythrocytes. Which of the following best describes the molecular basis for the sickling in this patient?

a) Gain of stabilizing hydrophobic interactions in the deoxygenated form of the hemoglobin S
b) Gain of stabilizing hydrophobic interactions in the oxygenated form of HbS
c) Loss of stabilizing hydrogen bonds between water & the surface of HbS in the oxygenated state
d) Loss of stabilizing salt bridges in the deoxygenated form of HbS
e) Loss of stabilizing salt bridges in the oxygenated form of HbS


Q22) a 45 year old man who works at a nuclear power plan is brought to the ER department 1 hour following an accident in which he was exposed to high levels of radiation. The amount of exposure is not believed to be fatal. He appears agitated & fearful, but he currently has no symptoms. This patient is most likely to initially show which of the following types of symptoms?

a) CVS
b) GIT
c) Renal
d) Reproductive
e) Respiratory


Q24) a study is conducted to estimate the number of procedures performed by general internal medicine physicians. A questionnaire is mailed to 8000 randomly selected physicians. Of these, 5680 (71%) respond. Which of the following measurements most strongly suggests that the respondents represent a heterogenous population with respect to the number of different procedures performed?

Mean number of procedures performed///////standard deviation
a) 4 ...........................................................0.1
b) 7 .........................................................1.8
c) 11 ...................................................0.5
d) 13 ......................................................5.1


Q29) a 50 year old woman dies of a myocardial infarction. A photograph of the brain obtained at autopsy is shown; the arrows indicate an abnormality. Based on the image shown, which of the following findings was most likely present in this patient prior to her death?

a) Decreased visual acuity
b) Difficulty swallowing
c) Double vision
d) Hearing loss
e) Loss of sense of smell


37) a 19 year old primigravid woman delievers a healthy male newborn at term. She asks if breast-feeding would be good for her baby. She is told that breast-feeding would result in passive transfer of her immunity to the baby. This would involve the movement of dimeric IgA molecules through polarized epithelial cells to reach the ductal lumen. Which of the following best describes this process?

a) endocytosis
b) phagocytosis
c) pinocytosis
d) sorting
e) transcytosis

Q41) an unconscious 40 year old woman is brought to the emergency department after taking an overdose of a drug. For which of the following drugs is a method for active removal from the blood available using an immunologic strategy?

a) Chlorambucil
b) Digoxin
c) Parathion
d) Phenoxybenzamine
e) Tranylcypromine

Is the answer digoxin because you use anti-dig Fab fragments. Does this just bind to digoxin and cause is destruction? How does it exactly work?


please provide explanations with your answers. Thanks!!!
 
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* Re:NBME 7 Block 2_________please help
#2090992
  ia - 04/27/10 11:30
 
  Q14) Tophi are most likely to involve the ear helix  
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* Re:NBME 7 Block 2_________please help
#2090997
  ia - 04/27/10 11:34
 
  Q15) Sickling occurs due to hydrophobic interactions that stabilize the deoxygenated form of HbS. There were several questions in UWorld on that, with the whole thing drawn out to explain it well.

Q22) Radiation affects cells that divide very rapidly...so the GIT would show the greatest side effects. Remember this is the basis for using radiation in cancer treatment. Cancer cells divide rapidly and so radiation affects them more than the healthy cells.
 
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* Re:NBME 7 Block 2_________please help
#2091000
  ia - 04/27/10 11:37
 
  Q24) if you are looking for a heterogenous population, then you are looking for the answer that shows the greatest standard deviation. This means that there is the greatest variation here among collected data... So the answer is D  
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* Re:NBME 7 Block 2_________please help
#2091004
  ia - 04/27/10 11:40
 
  Q29) the arrow is pointing at a CPA tumor....therefore the woman would have had hearing loss

Q37) the process is transcytosis. The IgA travels across the cell using this mechanism. A, B, and C would mean that IgA molecule was taken INTO the cell and stayed there...but IgA molecule travels ACROSS the cell...and thats the definition of transcytosis

Q41) You are correct. But I am not sure exactly about the exact mechanism of action though
 
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* Re:NBME 7 Block 2_________please help
#2091019
  iqbalian01 - 04/27/10 11:46
 
  thanks so much ia!!!! great explanations. what is CPA tumor?  
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* Re:NBME 7 Block 2_________please help
#2091020
  ia - 04/27/10 11:47
 
  Cerebellopontine angle tumor....growing between the cerebellum and pons...at this location the tumor commonly involves CN 8 causing sensory neural hearing loss  
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* Re:NBME 7 Block 2_________please help
#2091051
  myusmle99 - 04/27/10 12:11
 
  hello iqbalian01...........please please ....send me the nbmes 6 and 7 ...pleaseeeeeeeeeeeeeeeeeeeeeeeeeeee thanks  
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* Re:NBME 7 Block 2_________please help
#2091253
  yeabiruh - 04/27/10 15:33
 
  Q 14..Tophi are collections of urate crystals in the soft tissues. They develop in more than

halfof patients with untreated gout and may be reported as lumps or nodules. While the

classic location of tophi is along the helix of the ear, they can be found in multiple locations,

including the fingers, toes, in the olecranon bursae, and along the olecranon, where they can

resemble rheumatoid nodules...here is the link

http://emedicine.medscape.com/article/329958-overview

my answer b
 
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* Re:NBME 7 Block 2_________please help
#2091467
  yeabiruh - 04/27/10 22:01
 
  q15...

1-Hemoglobin is an assembly of four globular protein subunits(polypeptide chains)....
2- Each subunit is composed of a protein chain tightly associated with a non-protein heme group.
3-Each protein chain arranges into a set of alpha-helix structural segments connected together in a globin fold arrangement,
4.Adult hemoglobin is made of 2 alpha and 2 beta chains
5-These four polypeptide chains are bound to each other and stabilized by
a- salt bridges...which is a noncovalent bonding...due to interaction between anionic carboxylate (RCOO-) and cationic ammonium (RNH3+) in the amino acids
b-hydrogen bonds,
c- hydrophobic interactions....oil and water donot combine becuase of hydrophobic interaction ...and hydrophobic interaction is a property of nonpolar molecules and this interaction is also used in the case of protein folding where by most folded proteins have a hydrophobic core in which side chain packing stabilizes the folded state, and charged or polar side chains on the solvent-exposed surface where they interact with surrounding water molecules.
6-the hydrophobic effect is important to understand the structure of proteins that have hydrophobic amino acids, such as alanine, valine, leucine, isoleucine, phenylalanine, and methionine grouped together with the protein...and hydrophobic interaction is between individual aminoacids
7-Ordinarily, the hemoglobin molecules exist as single, isolated units in the red cell, whether they have oxygen bound or not...
8-Sickle hemoglobin exists as isolated units in the red cells when they have oxygen bound.
9-When sickle hemoglobin releases oxygen in the peripheral tissues, however, the molecules tend to stick together and form long chains or polymers

Let us see what happens in sickle cell anemia...glutamic acid(hydrophillic ) is replaced by hydrophobic valine (which increases the number of hydrophobic aminoacids ...which inturn increases hydrophobic interactions ) ..and these hydrophobic interactions stabilize the polymerized sickle hemoglobin....

Sorry for the long explanation ....I found this very interesting when I read about it

My answer AAA
 
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* Re:NBME 7 Block 2_________please help
#2091485
  yeabiruh - 04/27/10 22:12
 
  q22....the patient is exposed to high levels of radiation and this causes acute radiation syndrome

Stages of Acute radiation Syndrome
1) prodrome...nausea, vomiting, anorexia, fatigue, diarrhea, abdominal cramping, and dehydration which are GIT Symptom
2) clinical latency,
3) manifest illness, and
4) recovery or death

my answer is GIT

here is the link http://emedicine.medscape.com/article/834015-overview
 
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