| * nbme 7
||Hi..i solved NBME form 7 and I'm putting up all questions that I got wrong for discussion:
Please help out..
1. A 5-year-old girl is brought to the physician by her parents for an initial physical examination. They recently moved to town, and they failed to bring any medical records. They state that the child was "behind" in most of her developmental milestones, and that her teeth erupted "late." During the last 3 years, she has sustained fractures of both upper extremities as well as her left lower extremity. The physician notes a distinct nasal quality to the child's voice. Her height is at the 10th percentile, and her weight is at the 30th percentile. Physical examination shows frontal bossing of the skull. X-rays confirm the healed fractures and show generalized increase in bone density, and widening of the metaphyses and diaphyses of the long bones. Which of the following are most likely to be defective in this patient?
2. A 42-year-old woman has the sudden onset of abdominal pain 1 day after undergoing abdominal hysterectomy because of leiomyomata uteri. Her temperature is 38.3°C (101°F). Abdominal examination shows tenderness over the right lower quadrant. Retrograde pyelography shows contrast in the left renal pelvis and none in the right renal pelvis. A structure that passes inferior to which of the following was most likely severed during the operation?
A. Ovarian artery
B. Ovarian ligament
D. Round ligament of the uterus
E. Uterine artery
(not A)...I think its E
3. The binding of a ligand to a membrane-bound receptor can result in a conformational change in the receptor leading to activation of an enzyme such as adenylyl cyclase. This conformational change is initiated by a series of events that requires the binding of which of the following nucleotides?
(not C).. I think its E
4. A 60-year-old man is brought to the emergency department because of a severe headache and weakness on the left 3 hours after falling from a ladder and hitting his head on the sidewalk. He briefly lost consciousness but is awake on arrival at the emergency department. He is alert and oriented. His temperature is 36.1°C (97°F), pulse is 65/min, respirations are 12/min, and blood pressure is 160/100 mm Hg. Neurologic examination shows a dilated pupil on the right and a normal pupil on the left. He has mild weakness of his left upper and lower extremities. Which of the following findings is most likely on a CT scan of the head?
A. Brain stem hemorrhage
B. Herniation of the cerebellar tonsils
C. Herniation of the cingulate gyrus
D. Herniation of the uncus
E. Subarachnoid hemorrhage
5. A 2-month-old girl has asymmetric gluteal folds. If untreated, the underlying pelvic condition will most likely progress to an erosive arthropathy. Which of the following is the most likely diagnosis?
D. Myositis ossificans
6. A 16-year-old boy is brought to the emergency department because of intermittent testicular pain during the past 2 hours. Physical examination shows a swollen, red scrotum. Testicular torsion is suspected in this patient. The most appropriate diagnostic test is Doppler ultrasound to show the blood flow to the testicle from which of the following arteries?
A. Artery of the ductus deferens
B. Cremasteric artery
C. Direct branch from the aorta
D. External pudendal artery
E. Internal pudendal artery
(not B) C??
7. A 27-year-old woman comes to the physician because of three episodes of right-sided abdominal pain during the past 2 weeks. She says that the pain is steady, radiates to the right shoulder, and lasts 60 to 90 minutes. She has had an intentional 18-kg (40-lb) weight loss during the past 10 weeks. She has not had fever or chills. Current medications include gemfibrozil for hypertriglyceridemia. She is 168 cm (5 ft 6 in) tall and weighs 93 kg (205 lb); BMI is 33 kg/m2. Abdominal examination shows mild right upper quadrant tenderness. Serum studies show an alkaline phosphatase activity of 85 U/L and amylase activity of 60 U/L. Which of the following is the most likely diagnosis?
A. Acute pancreatitis
C. Chronic pancreatitis
D. Crohn disease
E. Drug-induced hepatitis
F. Peptic ulcer
(not A) I think the answer is B
8. A 25-year-old woman comes to the physician because of increasingly severe pain of the right hip during the past week. She runs 5 miles daily and recently changed her route because of construction. She now runs on uneven ground rather than pavement. Range of motion of the hip is full. The pain is exacerbated by flexion and internal rotation of the hip and by direct palpation over the lateral aspect of the hip. Which of the following structures is most likely involved in her condition?
A. Anserine bursa
B. Ischial bursa
C. Psoas bursa
D. Sacroiliac joint
E. Sciatic nerve
F. Trochanteric bursa
9. A 75-year-old man comes to the physician because of a 2-week history of moderate low back pain. Physical examination shows tenderness of the back and down each lower extremity on bending forward; there are no neuromuscular abnormalities. Rectal examination shows an enlarged prostate. Serum studies show a markedly increased prostate-specific antigen concentration. An x-ray of the spine shows vertebral collapse at L1 and patchy areas of increased density, consistent with osteoblastic metastases. Vertebroplasty is done to relieve the patient's pain, and a biopsy specimen of the damaged vertebra is obtained. Histologic examination of the biopsy specimen is most likely to show which of the following findings?
A. Aggregates of proliferating plasma cells and plasmablasts
B. Nests of epithelial cells joined by intercellular bridges and containing keratin pearls
C. Pleomorphic epithelial cells forming duct-like structures
D. Sheets of small oval- to spindle-shaped basophilic cells
E. Sheets of uniform cells divided into lobules by fine fibrous septa containing lymphocytes
(not D) I think the answer is C
10. When a patient is asked to look to the right, the right eye moves appropriately, but the left eye does not cross the midline of its optic axis. When the patient is asked to look upward, both eyes move appropriately. Which of the following neuroanatomic sites is most likely involved?
A. Oculomotor nerve
B. Abducens nerve
C. Vestibular nerve
D. Medial longitudinal fasciculus
E. Vertical gaze center
11. A 6-month-old boy is brought to the physician by his mother because of a 3-day history of fever and cough. His mother says that he has been sickly since birth. He was admitted to the hospital on two previous occasions because of severe diarrhea and pneumonia. He is below the 5th percentile for length and weight. His temperature is 39°C (102.2°F). Physical examination shows diffuse erythroderma with pustules in the diaper area. Coarse bilateral breath sounds are heard on auscultation of the chest. A chest x-ray shows diffuse bilateral pulmonary infiltrates. Despite appropriate treatment with antibiotics, the patient dies 3 days later. At autopsy, Pneumocystis jiroveci (formerly P. carinii) pneumonia is identified as the cause of death. His thymus is markedly decreased in size. Karyotype is normal. He has decreased circulating serum immunoglobulin concentrations. A photomicrograph of a biopsy specimen of the thymus is shown. Which of the following is the most likely cause of this patient's condition?
A. Congenital HIV infection
B. Cystic fibrosis
C. DiGeorge syndrome
D. Severe combined immunodeficiency
E. Wiskott-Aldrich syndrome
E?? (eczematous rash + immune deficiency) (had marked C)
12. A previously healthy 32-year-old man is unconscious after an overdose of a sedative drug. His pulse is 90/min, respirations are 6/min, and blood pressure is 80/40 mm Hg. Arterial blood gas analysis on room air shows:
Pco2 80 mm Hg
Po2 40 mm Hg
HCO3- 12 mEq/L
Which of the following best describes this patient's acid-base status?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis and metabolic acidosis
C. Respiratory acidosis with metabolic compensation
D. Uncompensated metabolic acidosis
E. Uncompensated respiratory acidosis
Is it B? (Had marked C)
13. A 26-year-old woman comes to the physician to be fitted for a new diaphragm. She had an elective abortion for an unplanned and unwanted pregnancy 2 months ago. She and her husband have been using a diaphragm and contraceptive jelly as their only means of contraception. They have a pattern of drinking heavily on weekends and having unprotected intercourse. Which of the following is the most appropriate next step?
A. Evaluate her for a sexually transmitted disease
B. Fit her with a diaphragm as requested
C. Help her to deal with her feelings about the abortion
D. Refer her to Alcoholics Anonymous
E. Talk to her about a nonbarrier method of contraception
(not B)- This should be E
14. A 69-year-old man with Parkinson disease has a progression of his tremor that is unresponsive to medications. A stereotactic operation is scheduled. To alleviate the tremor, the needle should be placed in which of the following locations?
A. Cerebellar hemisphere
B. Frontal lobe of the cortex
C. Globus pallidus
D. Inferior olivary nucleus
E. Substantia nigra
(not E) C??
15. A 55-year-old woman comes to the physician because of a 2-week history of intermittent heartburn. She has a 20-year history of significant sensitivity to cold weather. She states that her hands turn white when they are exposed to the cold. She also states that the skin on her fingers has become tighter over the past year. Physical examination shows tight, shiny, hyperpigmented skin of the face and hands. Several subcutaneous calcifications are present in the upper extremities. Joint mobility is normal. Renal and pulmonary function studies show no abnormalities. An autoimmune disorder is suspected. Autoantibodies directed against which of the following antigens demonstrate a high degree of specificity for this patient's condition and suggest a benign course?
C. Double-stranded DNA
G. SS-A (Ro)
H. SS-B (La)
(not E) B??
16. 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 and tenderness over the lower extremities. His hemoglobin concentration is 7 g/dL. A peripheral blood smear shows target cells, poikilocytes, and many sickled erythrocytes. Which of the following best describes the molecular basis for sickling in this patient?
A. Gain of stabilizing hydrophobic interactions in the deoxygenated form of hemoglobin S
B. Gain of stabilizing hydrophobic interactions in the oxygenated form of hemoglobin S
C. Loss of stabilizing hydrogen bonds between water and the surface of hemoglobin S in the oxygenated state
D. Loss of stabilizing salt bridges in the deoxygenated form of hemoglobin S
E. Loss of stabilizing salt bridges in the oxygenated form of hemoglobin S
(not D) A??
17. A 19-year-old primigravid woman delivers 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?
(not A) E??
18. A 45-year-old man who works at a nuclear power plant is brought to the emergency 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 and fearful, but he currently has no symptoms. This patient is most likely to initially show which of the following types of symptoms?
(not A: thought radiation would affect thyroid so effect on--> CVS)
is it B??
19. During an experiment, the following data are obtained from an anesthetized dog:
Mean glomerular capillary hydrostatic pressure (HPGC) 45 mm Hg
Mean Bowman space hydrostatic pressure (HPBS) 12 mm Hg
Mean glomerular capillary oncotic pressure (πGC) 23 mm Hg
Mean Bowman space oncotic pressure (πBS) 0 mm Hg
Coefficient of filtration (Kf) 3.0 (mL/min)/mm Hg
Renal blood flow 200 mL/min
Filtration fraction 25%
An intravenous infusion of angiotensin II is administered for 60 minutes. Which of the following is most likely in this animal after the infusion?
A. Increased filtration fraction
B. Increased HPBS
C. Increased Kf
D. Decreased mean πGC
E. Decreased renal blood flow
(not E) A??
20. A 67-year-old man with small cell carcinoma of the lung develops antibodies directed against the P/Q-type calcium channel. He is at increased risk for developing a neurologic syndrome that most closely resembles that produced by which of the following toxins?
21. During a study of intravenous urinary catheters, an investigator sterilizes a plastic catheter by incubation in alcohol. This compound acts by disrupting which of the following structures?
A. Cell wall
(not A) C??
22. A 25-year-old woman is evaluated for infertility. She has a history of pelvic inflammatory disease due to Neisseria gonorrhoeae infections. Based on history alone, the most likely cause of this patient's infertility is the effect of her infection on which of the following structures?
A. Cervical glands
C. Fallopian tube
(not E) C??
23. A healthy 40-year-old woman inhales to total lung capacity and then exhales forcefully. The rate of expiratory airflow is highest at total lung capacity and decreases linearly as exhalation continues. Which of the following is the most likely cause of the observed decrease in expiratory airflow?
A. Airway compression
B. Decreased expiratory effort
C. Decreased intrapleural pressure
D. Doming of the diaphragm
E. Increased elastic recoil