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* Nbme 15... QUestions.. Help!!
  sukar - 04/21/13 21:50
  Can someone tell me the answer for this question...

4. A 72 year old man with poorly controlled hypertension is brought to the emergency department because of severe abdominal pain for 2 hours. He appears pale and lethargic. His pulse is 124/min, respirations are 16/min, and blood pressure is 95/60 mmHg. The lungs are clear to auscultation. An S4 is present. Abdominal examination shows guarding, rigidity, and a pulsatile periumblical mass. Which of the following additional findings is most likely in this patient?
a. Ankle brachial indices that are within normal limits
b. Aortic regurgitation
c. Asymmetric radial pusles
d. Blood pressure readings that are higher in the left upper extremeity than in the right
e. Decreased femoral pulses
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* Re:Nbme 15... QUestions.. Help!!
  sukar - 04/23/13 11:20
  Thanks buddy!!

19. A 56 year old woman is brought to the emergency department by her husband because of fever and shortness of breath for 2 hours. Her husband says that she also has had urinary frequency and pain with urination for 2 days. She is in respiratory distress. Her temperature is 38.7C (101.7F), pulse is 120/min, respirations are 30/min, and blood pressure is 80/50 mmHg. Which of the following components of the causal organism is the most likely cause of the hypotension?
a. Flagella H antigen
b. Lipopolysaccharide
c. P pilus
d. Polysaccharide capsules
e. Shiga-like cytotoxin

26. A 65 year old man with hypertension volunteers to participate in a clinical trial of a newly developed loop diuretic. As part of the study, his acid-base/volume status is monitored. After 3 days of treatment, which of the following sets of findings is most likely in this patient?
Acid-base volume contraction
a. Metabolic acidosis yes
b. Metabolic acidosis no
c. Metabolic alkalosis yes
d. Metabolic alkalosis no

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* Re:Nbme 15... QUestions.. Help!!
  sukar - 04/23/13 16:00
  31. A 69 year old woman is brought to the physician by her son because of a 2 month history of memory problems, difficulty walking and urinary incontinence. He says, “She’s always been very sharp, but recently she’s had a lot of trouble functioning.” She has forgotten on several occasions to turn off the stove when cooking, and she once forgot she had turned on the bathtub until she noticed water coming down the walls from the upstairs bathroom. She also is unsteady on her feet and has fallen down at home on several occasions. She reports that her mood is fine. Physical examination shows mild nystagmus. She has a broad-based gait and is unable to walk in a straight line without assistance. Neurologic examination shows no other focal findings. Mini-mental state examination score is 20/30. Which of the following is the most likely diagnosis?
a. Cerebral neoplasm
b. Dementia, Alzheimer type
c. Normal-pressure hydrocephalus
d. Parkinson disease
e. Pick disease

33. A 3 year old girl is brought to the physician because of fever and rapid breathing for 1 day. She has had episodes of otitis media and sinusitis since the age of 1 year. Her temperature is 39C (102F), and respirations are 24/min. she is at the 10th percentile for height and weight. Physical examination shows tachypnea. Crackles and rhonchi are heard in all lung fields. Heart tones are heard best on the right side of the chest. A chest x-ray shows bilateral infiltrates, dextrocardia and stomach bubble on the right. A deficiency of which of the following is the most likely cause of this patient’s disorder?
a. Adenosine deaminase activity
b. Bruton tyrosine kinase activity
c. Cystic fibrosis transmembrane regulator
d. Dynein
e. Fibrillin-1

35. A 42 year old woman with multiple sclerosis is brought to the physician because of double vision that began yesterday morning when she awoke. The double images are horizontal on lateral glaze. Her only medication is interferon beta. On ophthalmologic examination, the eyes converge normally, but there is decreased adduction in both eyes during lateral conjugate gaze. Which of the following is the most likely location of a demyelinating plaque causing this patient’s diplopia?
a. Lateral lemniscus
b. Medial longitudinal fasciculus
c. Oculomotor nerve nucleus
d. Rubrospinal tract
e. Superior colliculus

37. An 18 year old man comes to the physician because of a 1 year history of progressive headaches. An x-ray of the head shows a cystic tumor above the sella turcica. The serum concentration of which of the following hormones is most likely to be increased in this patient?
a. ADH (vasopressin)
b. Adrenocorticotropic
c. Follicle-stimulating
d. Growth
e. Luteinizing
f. Prolactin
g. Thyroid stimulating

39. A previously healthy 25-year-old woman comes to the physician for a routine pelvic examination. Physical examination shows an enlarged right ovary. The ovary is surgically removed. Examination of the excised ovary shows a cystic lesion filled with hair and a thick, oily, yellow-tan substance. Microscopic examination of the lesion shows hair follicles, cartilage, smooth muscle, and brain tissue. Which of the following cell types is the most likely source of the neoplasm in this patient?
a. Germ cells
b. Granulosa cells
c. Sex cord cells
d. Stromal cells
e. Surface epithelial cells

48. A 30 year old woman has had Hodgkin disease that was diagnosed 10 years ago and was treated with radiation and chemotherapy for 6 month period. She has remained in remission for 10 years. She now feels weak and has petechiae and ecchymoses. A diagnosis of acute myelogenous leukemia is made. Which of the following best explains this course of events?
a. Hodgkin disease was not cured by the treatment, and surving neoplastic cells changed to acute leukemia
b. The patient had both Hodgkin disease and acute leukemia at the time of initial diagnosis, but the leukemia remained dormant for several years.
c. The patient has a genetic defect in the ability to repair DNA damage
d. The patient has inherited a predisposition to develop malignancies caused by Epstein-Barr virus
e. Therapy for Hodgkin disease causes mutations in hematopoietic stem cells, and one mutant cell progresses to leukemia.

49. A 50 year old man comes to the physician for a routine health maintenance examination. Physical examination shows a firm thyroid nodule. The neoplasm is resected; histologic sections show sheets of granular cells embedded in a hyaline stroma. Immunohistochemical stains show the presence of cytoplasmic calcitonin. Which of the following is the most likely type of carcinoma?
a. Anaplastic
b. Follicular
c. Giant cell
d. Medullary
e. Papillary

50. A 71 year old woman is brought to the emergency department 1 hour after the sudden onset of double vision. She has a 4-day history of progressive fever, fatigue, headache, left-sided facial pain, and periodic episodes of blurred vision. Her temperature is 38.3C (101F). Physical examination shows mild swelling and tenderness on the left side of the face. Laboratory studies show a mild normochromic anemia and an erythrocyte sedimentation rate of 60 mm/h. which of the following is the most likely diagnosis?
a. Amyotrophic lateral sclerosis
b. Cerebral infarction
c. Multiple sclerosis
d. Temporal arteritis
e. Trigeminal neuralgia
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* Re:Nbme 15... QUestions.. Help!!
  nayapakistan - 04/24/13 00:30
  19. C - p pilus -- UTI caused by e. Coli
26. C - contraction alkalosis caused by loop/thiazide diuretics
31. C - wet, wobbly wacky - normal pressure hydrocephalus
33. D - kartagener's - also known as immotile ciliary syndrome - caused by defect of dynein
35. B - Multiple sclerosis assoc/ with MLF
37. not sure, got it wrong
39. A - teratomas involve all 3 germ cells layers
48. E - hodgkin treatment can lead to AML (i got this wrong too, didn't know that)
49. D - calctonin assoc with medullary thyroid ca. calcitonin secreted from parafollicular cells
50. D - increased ESR, vision issues
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* Re:Nbme 15... QUestions.. Help!!
  sukar - 04/24/13 05:30
  2. A previously healthy 48-year-old man is brought to the emergency department because of a 1 hour history of nausea and crushing chest pain that radiates to his left arm. An ECG and evaluation of serum cardiac enzyme activity confirm a diagnosis of a myocardial infarction of the anterior wall. Fourteen hours after arrival, he has a cardiac arrest. Resuscitation efforts are successful after approximately 30 minutes. He then immediately develops severe oliguria. Serum studies show increased urea nitrogen and creatinine concentrations. Microscopic examination of this patient’s urine is most likely to show which of the following?
a. Degenerating epithelial cells and dirty brown granular casts
b. Degenerating WBCs and colorless hyaline casts
c. Dysmorphic RBCs and yellow granular casts
d. Lymphocytes and RBC casts
e. Numerous eosinophils and red hyaline casts
f. WBCs RBC casts

3. A 24 year old woman with Marfan syndrome comes to the physician 1 week after a home pregnancy test result was positive. Previous evaluations showed mild dilation of the ascending aorta, and mild aortic regurgitation, but no significant heart failure. If her pregnancy were to proceed, which of the following mechanisms would most likely increase the amount of aortic regurgitation in this patient?
a. Decreased vascular resistance
b. Hypervolemia
c. Increased cutaneous blood flow
d. Increased metabolic rate
e. Weight gain

6. A study was begun in the 1950s to determine the causes of lung cancer. In the study, 40,000 physicians in the United Kingdom were asked whether they smoked cigarettes. The frequency of lung cancer in the study participants was then assessed 10 years later, and the group of smokers and the group of nonsmokers were compared. Which of the following best describes this study design?
a. Case series
b. Case-control study
c. Cohort study
d. Randomized controlled trial
e. Systemic review

7. A 3 year old girl is brought to the physician because of a 1 year history of short stature. She has no history of major medical illness. She is below the 3rd percentile for height and at the 10th percentile fo weight. Physical examination shows coarse facial features and contractures of the large joints. X-ray show dysostosis multiplex. Plasma lysosomal enzyme analysis shows increased B-hexosaminidase, B-glucuronidase, B-galactosidase, and a-fucosidase activities. Which of the following mechanisms is the most likely cause of the lysosomal enzyme findings in this patient?
a. Abnormal targeting of these enzymes to lysosomes
b. Deficiency of the other lysosomal enzymes in the cytoplasm
c. Degradation of these enzymes within the cytoplasm
d. Degradation of these enzymes within the lysosomes
e. Storage of these enzymes within the cytoplasm

8. A 25-year-old primigravid woman at 25 weeks’ gestation comes to the physician for a routine prenatal examination. She uses cocaine one to two times weekly. Vital signs are within normal limits. Physical examination shows a uterus consistent in size with a 25-week gestation. Ultrasonography shows no abnormalities. This patient’s fetus is at increased risk for which of the following because of her cocaine use?
a. Down syndrome
b. Heart defect
c. Hypothyroidism
d. Neural tube defect
e. prematurity

9. A 30-year-old woman with seasonal rhinitis has been treated with therapeutic doses of chlorpheniramine for 4 weeks. Which of the following adverse effects is most likely?
a. Atrioventricular block
b. Biliary colic
c. Chronic cough
d. Decreased myocardial contractility
e. Drowsiness
f. Increased blood glucose concentration
g. Intermittent claudication
h. Miosis
i. Seizures
j. Tinnitus

11. A 32 year old woman comes to the physician for a follow-up examination after atypical cells were noted on a recent Pap smear. Physical examination shows a 1*1-cm area of leukoplakia on the cervix. A biopsy specimen of the lesion shows invasive squamous cell carcinoma. Malignant cells from this site will most likely drain first to which of the following lymph nodes in this patient?
a. Femoral
b. Inferior mesenteric
c. Internal iliac
d. Lumbar
e. Superficial inguinal

13. A 42 year old woman comes to the physician for an examination prior to employment. She has no history of major medical illness. Her vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies show:
Hemoglobin 10.2 g/dL
Hematocrit 31%
Mean corpuscular volume 65 um3
Leukocyte count 5900/mm3
Platelet count 350,000/mm3
Which of the following is the most likely diagnosis?
a. Aplastic anemia
b. Folic acid deficiency
c. Sickle cell disease
d. B-thalassemia minor
e. Vitamin B12 (cobalamin) deficiency

14. A 22-year-old woman is found to be HIV positive after sexual contact with a partner with HIV infection. Combination therapy with lamivudine (3TC), ritonavir/lopinavir, and zidovudine (AZT) is initiated. Three months later, genomic typing shows that her HIV strain has become resistant to ritonavir/lopinavir. The cause of this resistance is most likely the acquisition of a mutation in a gene that is critical for which of the following viral processes?
a. Adsorption and penetration
b. Early protein synthesis
c. Genome integration
d. Late protein synthesis
e. Nucleic acid synthesis
f. Packaging and assembly
g. Protein processing
h. Release
i. Uncoating

16. A 50-year-old woman comes to the physician because of progressive shortness of breath during the past 2 years. Her respirations are 20/min. physical examination shows cyanosis and ankle edema. Her pulmonary artery pressure, pulmonary vascular resistance, and right atrial pressure are increased, her pulmonary capillary wedge pressure is 9.3 mmHg (N=8-16). Her ventilation improves when inhaled nitric oxide is administered. Treatment with oral bosentan is begun for long-term therapy. Which of the following mediators of pulmonary resistance in this patient will most likely be antagonized by this drug?
a. Adenosine
b. Calcitonin gene-related peptide
c. C-reactive protein
d. Endothelin
e. Prostacyclin (PGI2)

22. A 28-year-old woman is brought to the hospital by her boyfriend because of severe lethargy for 2 hours. Her temperature is 37.1C (98.7F), pulse is 110/min, respirations are 24/min, and blood pressure is 126/78 mmHg. Physical examination shows obtundation. Her serum glucose concentration is 25 mg/dL. She revives immediately upon intravenous administration of 50% dextrose in water. She does not have type 1 or type 2 diabetes mellitus, and she takes no mediations. Multiple nonfasting glucose concentration measurements are within the reference range, and results of a 75-g, 2-hour glucose tolerance test show no abnormalities. Corresponding serum insulin concentrations are within the reference range. Six hours later, she is unresponsive. Her serum glucose concentration is 32 mg/dL. She is again resuscitated with range. Six hours later, she is unresponsive. Her serum glucose concentration is 32 mg/dL. She is again resuscitated with 50% dextrose in water. The physician suspects use of insulin. Which of the following is the most appropriate next step?
a. Confront the patient about the physician’s suspicion
b. Search the patient’s personal belongings for insulin and syringes
c. Obtain a psychiatric consultation
d. Determine the C-peptide concentration in the latest blood specimen drawn
e. Measure haemoglobin A1c
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* Re:Nbme 15... QUestions.. Help!!
  b4 - 04/24/13 08:18
  19 BB-Lipopolysaccharide
20 CC-Met alkalo yes
31 CC-Normal press hydro
33 DD-Dynein
37 FF-Prolactin
39 AA-Germ cell
48 EE-Treatment induce AML
49 DD-Medullary
50 DD-Temporal arter
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* Re:Nbme 15... QUestions.. Help!!
  b4 - 04/24/13 09:56
  2 AA-ATN
3 BB-Hypervolume
6 CC-Cohort
7 AA-I cell
8 EE-Premature
9 EE-Sleepy
11 CC-Int iliac
13 DD-Beta thal
14 DD-Late protein syn
16 DD-Endothelin
22 AA-Confront
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* Re:Nbme 15... QUestions.. Help!!
  sukar - 04/24/13 13:05
  b4.. U sure about 19?
16 I chose D (endothelin) and got it wrong.
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* Re:Nbme 15... QUestions.. Help!!
  nayapakistan - 04/24/13 13:18
  I think b4 is right about 19.. hypotension should be due to LPS endotoxin causing septic shock. my mistake.

14 is G.. protease inhibitors stop cleavage of protein precursors thus halting HIV replication

22 I think is D

Are you sure you got 16 wrong? I'm pretty sure I bet endothelin and I just went thru my wrong answers and don't see it there...
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* Re:Nbme 15... QUestions.. Help!!
  sukar - 04/24/13 21:39
  Ok thanks!
I am sorry I got 16 right.. It is endothelin! I don't know why I thought I got that wrong! sorry about that!
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* Re:Nbme 15... QUestions.. Help!!
  sukar - 04/24/13 22:10
  1. A 4-year-old boy is brought to the physician by his father because of a 2-month history of progressive weakness and loss of muscle function. He has had difficulty running, climbing stairs, and rising from a sitting position. Physical examination shows hypertrophy of the calf muscles. Serum studies show a markedly increased creatine kinase activity. The most likely cause of these findings is a defective or absent protein in which of the following areas of muscle?
a. Cytoskeleton
b. Endoplasmic reticulum
c. Golgi apparatus
d. Mitochondria
e. Nucleolus

2. A 4-year-old boy with asthma is brought to the emergency department because of a 4-hour history of difficulty breathing. His symptoms do not improve with the use of an inhaled beta-adrenergic agonist. Physical examination shows tachypnea an d intercoastal and subcostal retractions. Expiratory wheezing is heard bilaterally on auscultation. Following the administration of intravenous methylprednisolone, there is marked clinical improvement. Which of the following molecular pathways of methylprednisolone best explains this improvement?
a. Binding to its cell-surface receptor and induction of phosphorylation of JAK2 and the STAT family
b. Binding to its cytoplasmic receptor, translocation to the nucleus, and activation of transcription of target genes
c. Binding to its G protein-coupled membrane receptor and stimulation of adenylyl cyclase
d. Binding to its serine kinase receptor on the cell membrane that signals through SMADs
e. Binding to its tyrosine kinase receptor on the cell membrane that undergoes autophosphorylation and activation of multiple kinases

4. A 7-year-old is brought to the physician because of a 1-day history of fever, headache, nonproductive cough, and muscle aches. His temperature is 39.4C (102.9F). Physical examination shows a mildly erythematous pharynx. A rapid antigen test of nasal secretions is positive for influenza A virus. Treatment with zanamivir is initiated. Which of the following viral activities will most likely be directly inhibited by this pharmacotherapy?
a. Fusion of viral envelope and cell membrane
b. Protein synthesis
c. RNA packaging
d. Transcription of viral genes
e. Virion release
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