N.B.M.E challenge! - pepsi00

[ArchivalUser]

thank u for ur input efi

[ArchivalUser]

so we will agree on Estrogen or steroids??

[ArchivalUser]

From all the posts of vitf/rsvr-thank you for ur contribution

1. A 4336 dm newborn is delivered at term. The cephalic vaginal delivery was difficult and complicated with severe depression of the right shoulder. Ab MRI shows avulsion of single root of brachial plexus. The ventral ramus of which of the following spinal nerves has most likely been injured?
(1) C5****
(2) C6
(3) C7
(4) C8
(5) T1
The most common cause of Erb's palsy is dystocia, an abnormal or difficult childbirth or labour. For example, it can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal.[2]
The condition can also be caused by excessive pulling on the shoulders during a vertex delivery (head first).[2]A similar injury may be observed in adults or following a traumatic fall on the side of the neck.

2. how do come to know from the q whether it is epidural or subdural??
history points to both??
okt3-An epidural hematoma differs from a subdural hematoma in that it occurs much more rapidly, usually over several hours or less, presentation of a subdural hematoma, usually occurs several days to weeks following a traumatic head injury.young patient , with history of trauma itself is sufficient for epidural .. plus they also say bruise over temple , it gives away

3.ultra" adh is increased in response to increased osmolality in serum in response to water restriction.. so two things mentioned r right there.. osmolality of urine will of course be low coz there s a mutation in v2 receptor , thus adh is not able to act..adh normally reabsorbs water and reduces body osmolality .. but here v2 receptors r mutated , on which adh cant act to reabsorb water.. so adh cant reabsorb water .. and on other hand u r restricting water , serum osmolality is increasing without reabsorption being done by increased adh due to mutated v2 receptors."

4.An 80 yr old woman dies shortly after admission to the hospital bco of a 3 day h/o progressive shortening of breath. She had a h/o heart failure. Examination of lungs during autopsy showed alveolar damage with distended lympathics, congested alveolar capillaries, and pink staining protenaceous hyaline material in alkveoli. Which of the foll is most likely cause of these findings?
1.Amyloidosis.
2.Aspiration pneumonitis.
3.Emphysema
4.Pneumonia
5.Pulmonary oedema
6. Septic shock
pulomnary edema come after the cause-its the effect. Septic Shock can be it,but here it
says Most Likely.
http://www.nhlbi.nih.gov/health/dci/Dise...auses.html
5.
A 17-year-old girl comes to the physician because of a 1-month-history of progressive generalized headaches and episodes of fading vision in either eye for several seconds. Visual acuity is 20/20. The pupils react well to light and accommonadation. Visual fields are full in confrontation testing. Funduscopic findings of the right eye are shown. Which of the following is most likely?

A. Optic atrophy
B. Optic neuritis
C. Papilledema
D. Retinal infarction
E. Retrobulbar neuritis
How do you differentiate optic neuritis from pailledema?okt3"the answer is papilledema because visual acuity(20/20) and pupillary reflexes are normal, in case of optic neuritis, BOTH are decreased."

6.A series of experiments is performed to determine the mechanism by which a pharmacologic agent traverses cell membranes and accumulates within target cells. The rate of transport depends on the concentration of the drug only. When the extracellular
concentration of the agent exceeds 10 mM(OVERSATURATION-B), no further increase in the rate of uptake is observed. Structurally similar compounds pass through the cell membrane, but at a lower rate. Ouabain, an inhibitor of Na*, K* ATPase, fails to inhibit transport. Which of the following is the most likely mechanism by which this agent enters cells?
o A) Antipon
o B) Facilitated diffusion
o C) lon-gated coupling
o D) Simple diffusion
o E)Symport
paprica-"B. facilitated diffusion , as diffuson depends on conc gradient, and facilitated diffusion depends on the number of protein transporters, once they are saturated no more diffusion will occur, and we know tht Na K atpase is involved in active transport, oubain cannot inhibit the transport."

7.A 5-year-old boy is brought to the physician's office because of pharyngitis Culture of a swab from the throat grows a l3-hemolytic gram-positive coccus in chains Which of the following components of the microbe is responsible for this organism's shape?
o A) Glycoprotein
o B) Lipopolysaccharide
o C) Lipoteichoic acid
o D) Peptidoglycan
o E) Polysaccharide -D , peptido glycan present in its cell wall
o F) Teichoic acid

8.Sudden withdrawal from which of the following substances is most likely to produce a life-threatening syndrome in a person dependent on that substance?
o A) Amphatamine
o B) Cocaine
o C) Heroin
o D) Methylphenidate
o E) Secobarbital Paprica" barbiturate withdrawal causes life threatening seizures"

9.Double-stranded DNA can be denatured by heating and renatured by cooling Renaturation under conditions of high stringency has which of the following effects?
o A) Considerable base mismatching is permitted
o B) GC base pairing is inhibited
o C) GT base pairing is promoted
o D) Mismatched DNA hybridization is prevented
rizo-dna renaturation is an imp step in southern blot or pcr. here a well characterized probe dna is added to a target molecule. the mixed sample is denatured and then renatured. when probe dna bind to the target dna sequence of sufficient complimentarity, its hybridization.
ince regeneration occurs under high stringency conditions ssDNA will only pair with exact complementary sequence hence mismatching is prevented.
9.)
A 4-year-old girl is brought to the emergency department because of a 5-day history of fever, diffuse abdominal pain, nausea, vomiting, and diarrhea. Examination shows petechiae, hepatomegaly, and splenomegaly Hemoglobin concentration is 8.7 g/dL and platelet count is 60,000/mm3 A peripheral blood smear shows erythrocyte fragmentation Which of the following renal findings is most likely to be associated with her condition?
o A) Glomerular crescent formation
o B) IgG-associated glomerular basement membrane antibody
o C) Membranoproliferative glomerulonephritis
o D) Narrowing of the capillary wall by fibrin deposition-HUS(FEVER-saying it is some type
of infection,lil girl ate a uncooked burger,shaiga like toxin 0157)- (PAN- would of shown
microaneruysm,I doubt a fever will be seen with PAN)
o E) Peri glomerular granuloma with giant cells
10.)A 45-year-old woman has an acute coronary occlusion Within seconds, the ischemic region shows mitochondrial swelling and depletion of glycogen granules Which of the following metabolic events is the most likely cause of these cellular changes?
o A) Accumulation of free fatty acids
o B) ATP depletion(Well if mito dies, how is ATP being made, PUMP shuts down,leaading
to having alot of Na+ and Water comin in making it SWELL)
o C) Degradation of membrane phospholipid
o D) Efflux of K+
o E) Influx of Na

11.)25-year oldwoman, gravida 1, para 0, who is Rh-negative, delivers a full¢term Rh.positive neonate. The mother is given prophylactic anti.Rho(D) immune globulin immediately post partum. During her second pregnancy 3years later, she is screened each trimester for Rho(D) antibodies, An indirect antiglobulin test done during the third trimester indicates the presence of anti¢ Rho(D) antibodies in her serum. Which of the following is the most likely mechanism for the occurrence of these maternal antibodies?
o A) Anamnestic production of maternal anti. Rho(D) immunoglobulin
o B) Intrauterine transplacental fetal-maternal hemorrhages during the second pregnancy o (1ST pregenancy not 2nd)
C) Residual circulating prophylactic anti¢ Rho(D) immunoglobulin
o D) Transplacental passage of fetal lgG anti- Rho(D) antibodies( I think its this one)
12.74.year old man has a cough. On auscultation of the right posterior chest, the patients spoken "ee" sounds more like "ay". Which of the following conditions on the right is most likely
o A) Bronchopleural fistula
o B) Lower lobe consolidation
o C) Middle lobe atelectasis
o D) Pleural effusion
o E) Pleural plaque
o F) Pneumothorax
o G) Sequestration
Air loss also affects transmission of vocal sounds. So when you think you hear abnormal bronchial sounds, ask the patient to say "ee" several times as you continue to auscultate the area. If there is air loss, you'll hear "ay" instead of "ee." This phenomenon is called egophony. I REALLY THINK,THEY WILL HAVE ON SOMEONE'S EXAM THE ACTUAL MEDIA QUESTION ON THIS. While listening to the lungs with a stethoscope, the patient is asked to say the letter "e." What is heard is a higher pitched sound that sounds like the letter "a." (Some doctors refer to this as "e to a changes.") Most commonly, this indicates pneumonia.
13.A previously healthy 56-year-old man has the sudden onset of severe headaches that become worse in the afternoons. His blood pressure is 180/110 mm Hg Renal arteriography shows 85% occlusion of the rightrenal artery The laboratory finding that best predicts whether an operation that relieves the obstruction will reduce the blood pressure to normal is increased renin activity in the
o A) left renal artery vs right renal artery
o B) left renal vein vs right renal vein
o C) right renal artery vs left renal artery
o D) right renal vein vs left renal vein
shiney"its D, I AGREE
this man has HTN secondary to decrease in renal flow,==>b/c right renal art stenosed==>decreased perfusion pressure in right kidney===>trigger MD(JG cells)--->secrete renin(notice its in rt side vein)----->answer D "
14. A homeless 38-year-old man has a 3-month history of decreased appetite, generalized wasting, a low-grade fever, and worsening cough productive of bloody, mucopurulent sputum He has a 3-year history of alcohol abuse. X-ray films of the chest show consolidation and cavitary lesions(CAN BE STAP AUREUS CAN IT?) in the apices of the lungs. Which of the following is the most likely inflammatory and/or immune response in the lung?
o A) Endothelial cell proliferation, vascular budding, fibroblasts
o B) Epithelioid cells, multinucleated giant cells, caseation necrosis
o C) Fibroblasts, collagen deposition, replacement of intrinsic tissue
o D) Macrophages, lymphocytes, hypergammaglobulinemia
o E) Neutrophils, vascular congestion, exudate
condtion is
Pulmonary tuberculosis in whchic the microscopic findings are epthelial cells, multinucleated giant cell and caseation type of necrosis
Answer is B
15.
∆GO'
V↔W -4.0
W↔X +0.4
X↔Y -3.4
Y↔Z +5.7
From the values of ∆GO' given in the table, which compound in the overall metabolic pathway V ↔ W ↔ X ↔ Y ↔ Z will accumulate in the largest amount at equilibrium?
A)V
B)W{wouldn't it be this,the more negative, the more spontaenous energy it can generate,
someone please correct me}
C)X
D)Y
E) Z
16.A female neonate has profound hypotonia The only known complication of pregnancy was polyhydramnios The mother has a lack of facial expression and weak muscles: she says she did not have any problems as an infant or child. Which of the following best explains the difference in presentations in the mother and child?
o A) Anticipation-
Myotonic Dystrophy-In DM1, there is a triplet repeat of Cytosine - Thymine - Guanine (CTG) in the DMPK gene.
The repeat expansion for DM2 is much larger than for DM1
o B) Delayed onset
o C) Genetic heterogeneity
o D) Incomplete penetrance
o E) Pleiotropy
17.A 25-year-old woman has had generalized bone pain for 9 years She has frequent episodes of loose bulky stools. Examination shows muscle weakness and a distended abdomen. X-ray films show generalized demineralization of bones, absence of the lamina dura, and fracture-like lines in the bones of the feet. Which of the following sets offindings in serum is most likely in this patient?
Vitamin D deficiency- LOW CA,LOW PHOSPHATE,HIGH PTH,HIGH ALKALINE PHOSPHASTE
CORRECT ME IF I AM WRONG-THANKS
Calcium
PO4 Alk P Parathyroid hormone
A ↓ ↓ ↑ ↑
B ↓ ↑ ↑ ↓
C ↓ ↑ ↑ ↑
D ↑ ↓ ↓ ↓
E ↑ ↓ ↓ ↑

[ArchivalUser]

PMLE-anabolic steroids is the right answer

[ArchivalUser]

Hi pepsi,
for question #15, for delta G.. it's spontaneous and the more negative the more the reaction will go.
If you look closely, the arrows are reversible and so the reaction can go either way.
V--W is -4 and w--> V would be +4.. so if Y-->Z is +5.7 then z--->Y would be -5.7.. making Y the largest amount.

I think ur doing a great job. Keep it up. Let's do all the NBME question..

Good Luck,

DW

[ArchivalUser]

nice dandy! i did not catch dat,makes sense

[ArchivalUser]

Q9,,,q asking mismatching is PERMITTED,,,and in explanation it said mismatching is PREVENTED

[ArchivalUser]

so for Q 4....we will go for Pulm.edema or Sepsis,,,,as findings are of Pulmonary edema and cause is Sepsis,,,so ?

[ArchivalUser]

PMLE

An 80 yr old woman dies shortly after admission to the hospital bco of a 3 day h/o progressive shortening of breath. She had a h/o heart failure. Examination of lungs during autopsy showed alveolar damage with distended lympathics, congested alveolar capillaries, and pink staining protenaceous hyaline material in alkveoli. Which of the foll is most likely cause of these findings?
1.Amyloidosis.
2.Aspiration pneumonitis.
3.Emphysema
4.Pneumonia
5.Pulmonary oedema
6. Septic shock

I think pnemonia is most common cause and septic shock is second. Plus where in this
it saying there is a infection? Check the site I showed you, but someone please
further explain it if I am wrong

Double-stranded DNA can be denatured by heating and renatured by cooling Renaturation under conditions of high stringency has which of the following effects?
o A) Considerable base mismatching is permitted
o B) GC base pairing is inhibited
o C) GT base pairing is promoted
o D) Mismatched DNA hybridization is prevented
It's prevented,bc no mismatching is occuring and plus we have a probe thats complementary.
Which means it MATCHES so mismatching prevented.

[ArchivalUser]

thanks pepsi00,,,but most common cause of ARDS is SEPSIS,,,