NBME 19

Study online at quizlet.com/_3ktyvf

1. A 5 year old girl from Iceland is vegan and Intestinal 9. Acute stress disorder is a condition Post-traumatic stress
her parents don't feed her any diary. She has calcium classified under disorder
a history of 3 bone fractures. Whats the absorption _______________________.
vitamin defect?
10. Autoclave sterilization is ineffective Prions
2. A 24 yo man has progressive numbness of Myelinated against?
both feet that have ascended to his thighs. primary
11. A child with no tonsilliar tissue, had Brutton
He has numbness and tingling in his hands. afferents
two episodes of Hib, sinus infections Agammaglobulinemia
Diminished deep tendon reflexes GBS
and ear infections has what
Ataxic gait.
immunodeficiency syndrome?
Absent vibratory and proprioception in
finger tips and feet bilaterally. A process 12. Chlamydophilia psttaci causes an Aerosol
involving which of the following structures is atypical pneumonia how is it
the most likely explanation? transmitted?

3. A 25 year old man with eczematous Brubeck 13. The collecting system and pelvis of Incomplete
dermatitis skin dips shows Langerhans cells granules the L kidney is dilated and the renal recanalization of the
infiltrating the dermis. What is highly (tennis rackets cortex appears compressed, the left proximal ureter
characteristic of the cells of origin of this or rod and right ureters are not dilated.
condition. snapped on What explains these findings?
EM) 14. A condition that results in increased Pseudocholinesterase
4. A 50 yo woman with gradual back pain Metastatic sensitivity to certain muscle relaxant
(seamed like osteoporosis) 2 lytic lesion on carcinoma of drugs (succinylcholine and
the spine. What is the most likely diagnosis ? the breast mivacurium) used during general
anesthesia is as result of mutation in
5. A 62 year old woman comes up for folllow Major
what enzyme?
up abdominal pain and constipation for the Depressive
past 3 months. She has weight loss , Disorder 15. Continous murmur PDA
increasing fatigue, needs more sleep, works 16. Cystocele anterior prolapse in a
about her son using drugs, has had woman
endoscopy and colonoscopy and CT scan
17. Decreased body hair and decreased Anorexia
and everything is normal, what do you
bone density is associated with? Bulimia
evaluate here for next?
Dental caries and parotitis is
6. a 72 year old man has bruising on the Extensive associated with?
forearms. PE shows winkling, clay solar elastosis
18. The dorsal white matter in the Vibration
erythematous patches on the face and - the effects
thoracic spinal cord innervates: Pressure
irregularly shaped merciless and of sun
Proprioception
ecchymoses in various stages of healing. damage
Light touch
The blood count, coagulation studies are
normal, there is no gingival bleeding. What 19. Efavirenz NNRTI
is the cause of these symptoms? 20. Emtricitabine NRTI
7. A 98 year old woman shoes ecchymoses in Are you safe 21. Erythema migrants Lyme Disease
various stages of healing on the upper at home?
extremities and torso, what do you ask as a 22. Gram - diplococci Niesseria species
physician? 23. Greening reaction on blood agar beta hemolysis seen
8. 100 women were assigned to one of two two groups means: in
groups. The primary purpose of this method with similar S. pyogenes**
of assigning patients to different groups is underlying S. agalctiae
to create: characteristics S. aureus
SMH 24. Group a b-hemolytic strep releases Erythrogenic toxin
WOW _______________________ that causes
Scarlet Fever?
25. Heparin Induced Drug-related antibodies to 35. If you make a test more sensitive, how does It increases
Cytopenia is as a result of: Heparin bout platelet factor 4 this effect the incidence and prevalence of both
(PF4). a disease? incidence and
prevalence
26. Holosystolic murmurs: VSD**
because
mitral regurgitation
you're
tricuspid regurgitation
diagnosing
27. How does PTH induce Paracrine stimulation of more disease
resorption of bone? osteoclasts by osteoblasts
36. If you prescribed a patient a drug and they Contact the
28. How do the baroreceptors Hypotension-Decreased got addicted and got fired from work and patient to
react to hypotension as stretch> decreased afferent the wife class you tripping, what should be discuss the
opposed to carotid firing causes increased efferent your initial action? situation
massage? sympathetic firing and
37. If you're a doctor that doesn't believe in Ill have one of
decreased parasympathetic
prescribing a plan B pill for a 16 year old my
firing > vasoconstriction>
girl, what should you tell her? colleagues
increased BP
call you back
to further
Carotid Massage- increased
discuss you
stretch > increases afferent>
concerns
increased AV node refractory
period> decreased HR 38. If you take less measurements 4 data Larger
points instead of 20, how would this effect because of
29. Hox genes are important Organization of the embryo in
the width of the 95% confidence interval? more
for, what do mutations a craniocaudal direction
variability
indicated? Hox mutations cause
appendages in the wrong 39. Impaired upward gaze! Pineal gland -
location PARINAUD
SYNDROME
30. If a 30 year old woman has Provide follow-up
PCOS, which of the appointments to assess 40. In a Gaussian distribution, how much of the 68%
following should the patient's progress in attaining sample falls within one SD? What would be 16%
doctor that will result in her goals. left of the tail on each side?
patient adherence?
41. In a person who has metabolic alkalosis decreased
31. If a boy comes with breast Reassure the mom that the due to vomiting; what would the pCO2 be? pCO2 to
buds at 12 regardless of if findings are not uncommon for compensate
one is slightly larger and his age for the
the nipple is tender, what metabolic
do you tell the mother? alkalosis
32. If a nodule in the thorught Thyroglossal duct 42. In a person with idiopathic pulmonary An increased
moves with swallowing or hypertension, the cause of decreased RV after load
protruding of the tongue cardiac function is due to
___________________. ___________________________.
33. If a person ruptured their Consumption coagulopathy 43. In a person with Waterhouse Friedricson ACTH
spleen and lost 2 L of DIC syndrome, what would you do to determine stimulation
blood goes into shock and the cause of their hypotension? test
starts bleeding from
44. In a pressure -volume tracing, and increase Mitral
venipunture sites, what is
peak in Left atrial pressure is indicative of regurgitation
the coagulation
what ?
abnormlity?
45. In a randomized placebo-controlled Number of
34. If they're evaluating gout
clinical trial, there is no statistically subjects in the
synovial fluid its likely
significant difference between those study?
_________________.
receiving the antibiotic and standard
treatment. Which of the following aspects is
most likely to result in a Type II error?
46. In Klienfelters, non disjunction occurs In anaphase I- 58. A newborn with ARDs and arterial blood Respiratory
_____________________________. primary values: acidos and
spermatocyte PH 7.04 metabolic
Pco2 65 mmHg acidosis
47. Investigators calculated an odds ratio of The likelihood is
Po2 35 mmHg
3.0; the 95% confidence interval was 1.8 95% that the true
HCO3- 15 mEq/L
to 6.6 for the association of bladder value of the OR
Has what type of acid base balance
cancer and alcohol consumption. What's is between 1.8
the interperetion of this result? and 6.6 59. on light palpation of the carotid artery Aortic
the upstroke is brisk upstroke and and regurgitation
48. An ion channel tharinactivates more Amplitude of the
downstroke falls precipitously, what heat
rapidly than normal has a decreased action potential
murmur would you expect?
_________________?
60. Oral fluid therapy is used to treat Na/Glucose
49. The Jersey finger is as result of injury to Flexor digitorum
diahrrea in those with V. Cholera transporter
what? profundus
stimulates the what transporter?
tendon
61. A patient is started on heparin, then 24 Long half life of
50. Kidney is found to be small and non tubular atrophy
hours later warfarin is added. Why does factor 2
functional due to:
this patient have a normal PT and INR? (prothrombin)
51. Large irregularl assympetric joints with Gout
62. A patient on treatment who has HIV and Continue the
possible necrosis of the overlying skin;
is on 2 NRTI and NNRTI CD4 count drops treatment with
hyperurecemia, high glucose, and uric
to below 200 and viral load quadruples, no changes
acid?
what is the next appropriate step in their
52. Lead poisoing can occur in adults Ammunition and management ?
exposure to__________________________. batteries
63. A patient with CREST syndrome is at Pulmonary HTN
53. A man has nephrotic syndrome and Membranous greatest risk of forming what pulmonary
renal biospy shoes thickened glomeryuil nephropathy disorder?
BM and granular deposits of IgG and C3,
64. A patient with hypertension and string of Fibromuscular
what is the diagnosis ?
bead appearance? dysplasia
54. Mechanism of action of metformin? Inhibits hepatic
65. Peptic ulcer disease is a increased due to H. Pylor
gluconeogenesis
___________________. infection
and the action of
glucagon. 66. A person has abdominal cramps that is Loperamide!
Increase relieved with defecation. They have Accentuation of
glycolysis, watery loose stools, a drug targeting mu-opioid
peripheral which of the following mechanism of myenteric
glucose uptake action is appropriate for this patient? plexus receptor
(increasing
67. A person has bronchitis what is the Bronchioles are
insulin sensitivity)
pulmonary cell type? psuedostratified
.
columnar
55. MOA of Diphenhydramine ? Antagonist at epithelial cells
muscarinic M3
68. A person who seems unconcerned or la belle
receptors
unbothered by their symptoms has indifference
56. Multiple Sclerosis is characterized by IgG ___________________. Conversion
increased ___________ and ________ in CSF. Myelin Basic disorder
protein
69. Picture frame vertebrae is characteristic Paget's Disease.
57. A nasty yellow carpet looking cloth on a Fibrin of _____________. What would the Ca, Ca,
liver in an 80 yo man who has Phosphorus, AlkPhos, and PTH levels be? Phosphorus,
diverticulosis and diverticulitis. Whats and PTH no
the carpet thing? change
Elevated
AlkPhos
70. Prolongation of prothrombin time is kind Inducing a 81. What are the features of West Nile MENINGTITIS
of like Vitamin K Ecnephalitis FLACCID
deficiency-like PARALYSIS
state SEIZURE
COMA
71. Retinoblastoma is a mutation of what The retinal cells
_________________ 82. What are the principle targets of Block thrombin (2)
Antithrombin 3? and (Xa)
72. Rifampin interferes with the bacterial RNA
synthesis of which of what? What is its Inhibits DNA 83. What are the three types of Brain infarction-
MOA? dependent RNAP liquefactive necrosis? enzyme from
microglial cells
73. Slimy stools and multiple ulcers on Entamoeba
liquefy the brain.
colonoscopy? histolytica
74. Tenofovir NRTI Abscess- Proteolytic
75. To effectively follow a patients risk for Neutrophil enzymes from
infectious complications, you should neutrophils (purulent
monitor which of the following cells? exudate*)

76. Virus with wheel-like shape that causes Rotavirus

Pancreatitis-
vomiting, diarrhea, dehydration, in a 2 Double-stranded
pancreatic enyzmes
year old. RNA, segmented
What is is Envelope, RNA structure, and no envelope 84. What does the LAD supply (3 Anterior 2/3 IVS
capsid symmetry? Icosahedral things)? Anterolateral
papillary muscle
77. What 3 things increase power and Sample size
Anterior surface of
decrease type 2 error? Precision
ventricle
Increased
expected effect 85. What does the LCX supply (2 things)? Lateral and
size (WTF?!) posterior wall of LV
Anterolateral
78. What are the branches of the IMA? L colic
papillary muscle
Sigmoid arteries
Superior Rectal 86. What does the PDA supply (4 AV node
things)? Posterior 1/3 of IVS
79. What are the features of B12 deficiency? INCREASED
Posterior 2/3 wall of
What is your typical patient profile? Homocysteine &
ventricle
Methylmalonic
Posteromedial
acid
papillary muscle
+ Neurological
symptoms 87. What does the R(acute) marginal RV
artery supply?
Vegan, 88. What do salicyclates cause? Metabolic acidosis
malasborption AND
(Chron's) D. latum Respiratory alkalosis
(tapeworm)
89. What happens to arteriolar diameter, All increase
80. What are the features of folate INCREASED tissue adenosine consentratrion, and
deficiency? Homocysteine vascular conductance during
What is your typical patient profile? NORMAl excerice?
methylmalonic
90. What histological changes will you Obliterating
acid
see on a biopsy of a person with endarterectomy with
NO Neurological
syphillis? lymphocytes and
symptoms
plasma cells
Malnutrition,
alcoholic,
pregnancy
91. What is psychogenic
polydipsia?
92. What is the blood supply of the
SMA and where do the
branches supply?
93. What is the difference between
a cohort study and a clinical
trial?
94. What is the elevated
periosteum seen in
osteosarcoma ?
95. What is the pathophysiologic
process involved in
Niemann=Pick disease, what
enzyme is involved?
96. What is the pathophysiology of
Immune thrombocytopenia?
What would you see under
labs?
97. What is the treatment for
carbon monoxide poisoning ?
98. Whats the bacterial differential
diagnosis of a patient who
presents with large, flaccid
bullous lesions over the trunk
and abdomen?
99. Whats the difference in K
levels in 11b hydroxylase
deficiency versus 21
hydroxylase deficiency?
100. Whats the treatment for
someone with GAD? Ie:
symptoms of paranoia post
partum?
101. What will you see in a person
with poliomyelitis ?
When a person drinks
excessive water without
being thirsty.
Diagnosed when urine
osmolarity is increased
during water deprivation
Ileocolic- cecum
R colic-
Middle colic- transverse
colon
Cohort study- compares
exposure to the risk of
developing a disease
Clinical trial- a person
already has the disease
and you're trying to see if
an intervention will
determine the outcome
Pleomorphic neoplastic
cells producing new
woven bone
Decreased lysosomal
hydrolase activity
Anti- Gp2b/3a antibodies
Labs: increased
megakaryocytic
O2
S. aureus
S. pyogenes
Bullous impetigo
11b--low K because the 11
deoxy acts like aldo
21--high K
SSRI
SNRI
Fasiculations in the lower
extremities
LMN signs because polio
affects the anterior horn.
102. What would a healing
incision on the skin show
one week later?
103. Which conditions do you
see Erythma Nodosum?
104. Which drugs cause a
photosensitivity reaction?
105. Which drugs have the
reaction of
agranulocytosis ?
106. Which of the following
drugs can interact with a
patient's oral antibiotic ?
aldendronate
calcium carbonate
Exetimibe
HCTZ
simavastatin
107. Which of the following is
most likely to preclude
restoration of normal
tissue architecture?
108. Which of the layers of the
skin is associated with the
greatest risk for an
unfavorable prognosis ?
109. Why give acetaminophen
to a person with chronic
knee pain and epigastric
tenderness?
110. Why would 24,25-
dihydrocholecalciferol be
increased in a person with
increased [Ca serum]?
Granulation tissue
Sarcoidosis
TB
Leprosy
Strep infection
Coccidiomycosis
Histoplasmosis
IBD
Sulfonamides
Amiodorone
Tetracycline*
5-FU
Clozapine, Carbamazepine,
Propylthiouricil, Methimazole,
Colchicine,
Ganciclovir
Caclium carbonate
BASEMENT MEMBRANE !
Subcutaneous tissue - contains
your arterioles
unlike dermis that contains
branches of the capillary
Because it reversible inhibits
COX primarily in the CNS and
is inactivated peripherally- no
adverse effect of gastric ulcer
ASA- irreversibly blocks both
COX1/2
Ibuprofen, indomethacin, and
Naproxen- Reversibly inhibits
COX1/2
High levels of Ca
downregaulates the formation
of active 1,25 vitamin D to the
inactive 24,25 Vit D form.
111. Why would an ACTH secreting tumor cause bone a compression factor? Extra cortisol causes: A BIG FIB
increased: appetite, BP, Insulin
resistance, gluconeogenesis

decreased: Firbroblast (wound

healing), Immune response, bone
formation
112. Why would a person with a skin graft of more tha n 30% of his body collapse of heat Because the grafted skin lacks
stroke? eccrine glands and limit your ability
to sweat
113. Winters formula to predict respiratory compensation compensation for metabolic acidosis: PCO2=1.5 [HCO3] +8 +/-2
114. A woman has fractured femur after a MVC and says she sees vague shapes coming out of Alcohol withdrawal
the walls. She is tachycardic, restless, and sweating. What is causing her condition?
115. A young woman recently developed nervousness. She has high BP, wide yes staring gaze, Thyrotropin RECEPTOR
and fine tremor in her hands. Her thyroid is difusely enlarged. What's is wrong with her? autoantibodies