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* nbme 13
 #663942  
  mdhouse1282 - 03/17/12 19:19
 
  Q1 A 16year old boy has a 6 month history of type 1 diabetes mellitus and requires daily insulin injections. his blood glucose control has been poor recently, which the physician suspects may be related to the pt's rluctance to self administer insulin. which of the following questions is most appropriate to broach this issue with the pt?

A> givin yourself insulin injections can be difficult. what's it like for you?
B> i get the feeling you have not been taking your insulin regularly. would you like me to arrange some training for you by our nurses?
C> its been my experience that most poorly controlled diabetics have trouble giving themselves insulin. do you have this problem?
D> you are clearly having difficulty with insulin injections. would you like to arrange for a family member to give you your shots?
E> you seem to have missed your shots. how often has this happend?

Q2 an investigator breeds a transgenic strain of mice that develops severe fasting hypoglycemia. administration of glucagon does not correct the hypoglycemia, but administration of epinephrine results in an inc in the serum glucose conc. which of the following proteins is most likely defective in this mouse strain?

A> adenylyl cyclase
B> glucagon recepter
C> glycogen phosphorylase (wrong)
D> heterotrimeric G protein
E> phosphorylase kinase
F> protein kinase A

A 25 year old woman comes to the physician because of a 2-day history of dec urine output despite ample fluid intake. she underwent operative removal of a perforated appendix 3 weeks ago. she received intravenous gentamicin for 2 wks. physical examination shows no abnormalities. lab studies show.

Serum:
urea nitroge: 35mg/dl
creatinine: 2.9md/dl

urine:
specific gravity 1.010
protein 2+
Na+ 25mEq/L
casts brown granula
Histologic examination of this pts kidneys would most likely show necrotic cells in which of the following components of the nephron?

a. bowman capsule
b.collecting tubule
c. glomerular basement membrance
d.mesangium
e. proximal tubule








































 
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* Re:nbme 13
#2619989
  trickemcy - 03/17/12 19:21
 
  1. A? not sure
2. B
3. E
 
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* Re:nbme 13
#2619996
  aicilef - 03/17/12 19:24
 
  1. A
2. B
3. A
 
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* Re:nbme 13
#2620023
  mr821 - 03/17/12 19:51
 
  Q1 A 16year old boy has a 6 month history of type 1 diabetes mellitus and requires daily insulin injections. his blood glucose control has been poor recently, which the physician suspects may be related to the pt's rluctance to self administer insulin. which of the following questions is most appropriate to broach this issue with the pt?

A> givin yourself insulin injections can be difficult. what's it like for you?
B> i get the feeling you have not been taking your insulin regularly. would you like me to arrange some training for you by our nurses?
C> its been my experience that most poorly controlled diabetics have trouble giving themselves insulin. do you have this problem?
D> you are clearly having difficulty with insulin injections. would you like to arrange for a family member to give you your shots?
E> you seem to have missed your shots. how often has this happend?


A --- open end question to know whts going on

Q2 an investigator breeds a transgenic strain of mice that develops severe fasting hypoglycemia. administration of glucagon does not correct the hypoglycemia, but administration of epinephrine results in an inc in the serum glucose conc. which of the following proteins is most likely defective in this mouse strain?

A> adenylyl cyclase
B> glucagon recepter
C> glycogen phosphorylase (wrong)
D> heterotrimeric G protein
E> phosphorylase kinase
F> protein kinase A
B----- Glucagon and epinephrine both work on adenylyl cyclase since it increases with epi tht means adenyl cyclase is fine so receptor is the best answer


A 25 year old woman comes to the physician because of a 2-day history of dec urine output despite ample fluid intake. she underwent operative removal of a perforated appendix 3 weeks ago. she received intravenous gentamicin for 2 wks. physical examination shows no abnormalities. lab studies show.

Serum:
urea nitroge: 35mg/dl
creatinine: 2.9md/dl

urine:
specific gravity 1.010
protein 2+
Na+ 25mEq/L
casts brown granula
Histologic examination of this pts kidneys would most likely show necrotic cells in which of the following components of the nephron?

a. bowman capsule
b.collecting tubule
c. glomerular basement membrance
d.mesangium
e. proximal tubule

E--- ATN u ll c it PT
 
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* Re:nbme 13
#2620026
  dehunknown786 - 03/17/12 19:53
 
  1. This is a pretty interesting Ethics question has me stumped, I am between A and E and if I had to pick one it would be A.

2. B. Glucagon Receptor, because upon glucagon administration the glucose doesnt increase (Glucagon works via cAMP pathway), BUT upon administration of Epinephrine (B1 B2 A1 receptors) more specfically B2 which increases glycogenolysis, also works via the cAMP pathway thus affirming that the cAMP pathway is intact and any of the intermediaries cannot be the answer, hence the receptor is messed up.

3. Muddy Brown casts, = Tubular Necrosis (more spefically proximal tubule necrosis) therefore answer being E.
 
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* Re:nbme 13
#2620035
  yakareem - 03/17/12 20:05
 
  Q1 EE
Q2 BB not sure
Q3 EE ( Toxic ATN is characterized by proximal tubular epithelium necrosis)
 
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