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RECALL 4/14/10

1. HGPRT patient is aggressive to himself and has hyperuricemia (Lech Neehan Syndrome) 2. There were one question about lady having a renal problem and it showed an image of clear cells so i think it was renal cell carcinoma

3. PKU patient had phenylalanine hydroxylase def what you have to supplement? Tyrosine (now becomes essential) 4. Ehrlichiaforest park ranger in Wisconsin, no rash, does not think she had any tick bite, she has fever, on micro there is organism inside of mononuclear cell with morulae

Figure Bottom. Electronphotomicrograph of morulae in a bone marrow leukocyte in a patient with ehrlichiosis. Arrows indicate individual ehrlichiae.

5. AZT causes neutropenia 6. Trichomonas vaginalis, why did it recur in the female? Failure to treat male partner (Should treat both with Metronidazole)

7. Phototoxicity: tetracycline (causes discoloration in teeth)

8. What drug should you give to decrease TGs? gemfibrozil (also can give niacin if gemfibrozil doesnt help) 9. Why doesnt statin decrease LDL? Mutant LDL receptor, doesnt go to membrane 10. What drug increases Lithium toxicity? Thiazides 11. What drug should you add to nitroglycerin? Beta blocker (b/c we dont want reflex tachycardia caused by nitroglycerin) 12. 3 or 4 Qs word for word came from the NBME questions....the JPEG ones i'm talking about. 2nd messangers Qs 2 or 3 of them....EX:b2 agonist drug....what will happen...increase cAMP...etc etc 13. Hiristisum above lips, secondary amenorrhea? Polycystic ovarian disease 14. Ace inhibitorshow they work. They dilate efferent arteriole and decrease GFR. 15. Hox2 questions. Works during embryogenesis

16. Kluver blucy syndromeCT pic of bilateral amygdale damaged. Pt has hypersexuality, hyperorality 17. Lady having operation on ovaries, and it had multiple cysts....i think it was polycystic ovarian sydrome....and answer choice had lady would present with hirsutism so i went with it.

18. Another dealing with endometriosis and another describing changes in breast tissue. 19. Glucose 6 phosphatase def: patent has normal glycogen but has hyperlipidemia, hyperureacemia and hypoglycemia on fasting. 20. Hurler : accumulation of Dermatan and heparin sulfate 21. Patient gets paresthesia, he was using a drug for glaucoma? Acetazolamide 22. Patient on phenelzine ate cheese, got Hypertensive crisis, what caused it? Tyramine 23. Patient gets C. difficile? Give Metronidazole (If not Vancomycin may also work?) 24. CT Scans that look like the ones in first aid...the ones that have abdomen CT scans. 25. Brain Stem with Cranial nerves...3 questions on them with two of them same pic. 26. Heart Murmurs straight up....3 or 4 of them.....Classical scenarios...if you know the classical scenarios....u got them. Also know how it looks like for example. crescendo/decrescendo for aortic stenosis 27. One calculation question of # of hours needed to reach 95% steady state (take 4 or 5 times the life and you get the hours to reach 95%) 28. One graph of three curves, must know which has better efficacy (for efficacy look for top part of curve and compare. Remember partial agonists have less efficacy than full agonists and u cant say anything about the potency). 29. There were two Qs Vit B12 deficiency you had to say they have segmented neutrophils.

30. Pic of face with lot of bumps on it and given that patient has bilateral hilar lymphadenopathy Sarcoidosis asked what they have: non caseating granuloma 31. Two qs on asbestos: one was person has lot of mass around the lung pleura he has : Mesothelioma

32. Person has breathing problem has calcification of pleura, what is his occupation: Ship Ward worker asbestosis

33. Pt had trichomoniasis, (pic showed organism with flagella): Tx Metronidazole 34. Where are tight junctions located in blood-testis barrier? Sertoli cells

35. Alveolar ventilation calculation = (TV-deadspace) * RR. Showed the lung graph and had to figure out TV. 36. Pic of Auer rods: AML M3 (can cause DIC so PT, PTT, and bleeding time increased but platelet count down).

37. DOC for certain diseases like Legionella (question described the disease)....other one i forgot

38. Digoxin mechanism and what it does to the heart....like a physiology question...does it increase ejection fraction or HR?

39. Ethosuximide for Absence Seizures...

Figure 14-5. Mechanism of absence seizure. A. EEG recordings of patients experiencing absence seizures are similar to sleep spindle patterns generated during slow-wave sleep. The 3-persecond oscillatory pattern is generated by the burst activity of a dendritic T-type calcium channel in the thalamus. 1. During the awake state, relay neurons of the thalamus are in transmission mode, in which incoming signals are faithfully transmitted to the cortex as single spikes. These signals to the cortex register on the EEG as small, desynchronized, low voltage waves. 2. During slow-wave sleep, signals relayed through the thalamus are altered because of the bursting activity of a dendritic T-type calcium channel (see below). During this stage, called burst mode, sensory information is not transmitted to the cortex. 3. Absence seizures result from abnormal activation of the Ttype calcium channel during the awake state, resulting in a similar spike-and-wave EEG pattern. B. The absence seizure is generated by a self-sustaining cycle of activity between the thalamus and the cortex. Synchronicity is initiated by hyperpolarization of the thalamic relay neurons (light gray). This occurs normally during slow-wave sleep and is caused by GABAergic input from the reticular thalamic nucleus (dark gray). The factors that cause hyperpolarization in relay neurons during an absence seizure are poorly understood. 1. Hyperpolarization of relay neurons induces burst activity of the T-type calcium channel, resulting in synchronous depolarization in the cortex via excitatory connections. This large depolarization in the cortex registers as a spike-and-wave pattern on the EEG. 2. Excitatory input from the cortex activates the reticular thalamic neurons. 3. The activated GABAergic reticular neurons hyperpolarize the thalamic relay neurons and reinitiate the cycle.

40. Image of Dipplocci of Neisseria....guy joint hurts, sexually active etc etc 41. Guy has torticolis ...which antipsychotic caused it...Haloperidol? 42. Woman's son is involved in car crash, woman tells Doctor that father had problem with anesthesia where he got high fever and died. Which anesthesia is cause of this? Succinylcholine? 43. Pic of brain, scenario is about a man with dementia (?) and mask-like facies, where is the area of decreased NT? Substantia nigra of midbrain

44. Pic of fatty liver, scenario about a boy fed only carbs, how would he present? Dehydration, generalized edema, hyperactive or jaundiced (Kwashiorkorno protein) 45. Newborn is breast fed and develops jaundice, why? Physiologic (unconjugated billrubin) 46. Whipples disease: PAS + (PAS + macs filled with Whipple tropheryma bacteria)

47. Pic of blood smear, schistocytes, pregnant woman = DIC so microangiopathic hemolytic anemia (DIC caused by amniotic emboli or abruptio placentapremature separation of placenta and have pain). 48. Pic of needles = monosodium urate (negative birefringence)

49. Volume-pressure curve of heart....something similar to UW where they ask what happens when curve goes up or down. answer choices were similar like AV malformation, CHF, Hemorrhage...etc etc. 50. FEV/FVC curve question where it showed normal and patient curve....UW did a great job with it and if you understand how to answer questions like that, ur Gold. 51. Fick Principle as mentioned above

52. One question on osteoarthritis, not swollen joints, but gets better with rest (also have stiffness for less than 30 minutes, cant look at synovial fluid b/c there is no problems with it, instead look at x-ray which will show osteophytes, subchondral cyst, and narrowing of joint space) Occurs in older people 53. Man is on terazosin drug.....which receptor is it working on? a1 antagonist 54. Lady has aspirin as her daily regiment, but also given clopidrogel b/c its not helping against her renal artery stenosis...she comes into ER with bruises on her arms and legs. 55. What is the drug interaction is causing the problem?? and it gave these long answer choices 56. 2 questions on INH....and its side effects 57. 1 question on ethambutol and its side effect....which was visual problem...classic!! so yeah, they like to test on TB drugs 58. How does increasing sample size change confidence interval? It decreases. Confidence Interval = mean z(SEM) = mean z (!/"#$ 59. Calculate specificity = TN/(TN+FP) 60. Two qs on middle meningeal artery tear diving epidural hematoma. 61. Patients ovarian arteries were lacerated they are found in: suspensory ligament of the ovaries. 62. Picture was shown of midbrain and scenario was given that person has rigidity and difficulty moving: parkinsonism and asked you have to identify substangtia nigra in real mid brain 63. You have the brain stem scenario was the person cannot look left with his left eye so it was : LR6 had to identify the nerve in the real brain 64. Asked about the arterial supply for thalamus: Choroidal artery 65. Person cant dorsiflex foot what sensation is missing: dorsal part of the foot not the planter part. 66. They showed the brachial plexus and gave the scenerio of a person dislocating his arm and damaging the supracondylar something and they asked you to point out nerve from brachial plexus 67. One on rheumatoid arthritis, nodes on extensors and elbow (Remember also Caplans syndrome with pneumoconiosis, rheumatoid nodules)

68. One of Parkinsons disease (CT of midbrain, must ID the substantia nigra)

69. One of huntigtons ID the caudate (atrophy of caudate, CAG repeat, decrease GABA, chorea, dementia, and suicide) 70. One ques on alzheimers (common cause of dementia, neurofibllary tangles (tau protein), amloyid angiopathy leads to intercebral hemorrhage. 71. One on prions (infectious proteins) 72. One of chrons vs UC (chrons has fistulas) Chrons also has strictures, transmular inflammation, skipped lesions, cobble stone appearance) 73. One on Turner XO on what defect they have they had coarctation of aorta 74. They have couple of Huntington on was that the transcription factor bind to TATA box 75. Woman has enlarged breast and breast mass that is not fixed. Gross pic is very fleshy/tan looking. Micro shows leaf like picture. It is cystosarcoma phyllodes 76. Picture of lung/chest wall compliance. Where is FRC? Right in the middle. 77. How does B cell activate T cell? B cell has B7 78. O2 disassociation curve.....asked what happens to the curve when patient has respiratory acidosis, so i assumed too much CO2 in system. 79. Autoregulation of Blood flow curve....and asked which one was correct... something similar i saw in UW question i believe pg. 133 of Kaplan physio if you dont know what i'm talking about. 80. Multiple myelomapt has hyercalcemia, lytic lesions, kidney problems

81. Picture of brain shows mass in frotal lobe. The pt was old and died recently of the brain tumor. Asked what is the origin of this tumor. Looked like it was giloblastoma multiforma b/c pt dies really fast and answer was astrocytes. Giloblastoma multiforma is grade IV astrocytoma. 82. On question on transduction showed 3 diagram has to chose the right one, it was the one with virus sitting on the bacteria. 83. One pic showed ballerina skirts type activated lymphocytes it was EBV and you had to chose infectious mononucleosis. 84. Drug inhibits Dehydrofolate reductase...what accumulates?? 4 choices had a tetrahydrolate stem to it or a number attached to it like 5,10?? 85. 2nd messengers......simple when u know where they are working on....what increases, Camp, IP3...etc......what receptors b1, b2 86. Lac operon ......lactose inhibits repressor gene 87. 2 pedigree questions...one described that child has macro-orchidism...and showed a pedigree with ages starting from Grandfather and dwindling down to the child....Fragile X---but it asked what kind of genetics was it....answer anticipation...or was it trinucleotide expansion. 88. Pharm person has SLE-like symptoms: procainamide 89. Person with HIV keeps having sex and has good CD4 count, why? CCR5 mutation 90. What receptor on HIV mediates attachment? Gp120 (gp41 allows virus to go into T cell or mac) 91. One on staph 92. Two on Strep pneumoniae (lancet shaped diplococci) 93. On on Strep pyogenes (beta hemolytic, bacitracin sensitive, bile soluble, can lead to post strep GN---pharyngitis or impetigo and rheumatic feveronly pharagntis) 94. One on Group B strep 95. Person had persistent embryo defect in his throat, between which structures would doc do surgery on?

96. Person can't abduct and adduct his fingers b/c he's a plummer and been using his hands to hammer big pipes in...which nerve is damaged...ulnar nerve 97. Child has difficulty breathing when born..docs find out that lung is squeezed by malrotation of foregut....which problem is child going to have in the future?? 98. One on botulisminhibits Ach release, associated with honey in kids but in kids the toxin is formed inside the gut so not preformed) 99. Not many questions on virusesNICE!!! 100. 101. How does ampho B work? On lanosterol (binds to ergosterol an forms pores) Person has allergic you have to say change medication

102. Person was given ciprofloxacin but bacteria resistance the resistance is due to dna gyrase mutation 103. Person was on TB medication including rifampin and isonazide and also using OCP, what does the patient has to do: use a barrier protection since rifampin will break OCP down. 104. 105. 106. Pic of metal rod going through persons palm, damages what? Deep palmar arch Pic of hypospadia, how is it caused? Urethral folds fail to fuse Patient cant abduct fingers? Ulnar nerve

107. Pedigree described a child who had Duchenes muscular dystrophy (child was getting up using Gower's maneuver) then asked whats are the chances of brother being affected?

108. Disease....must know its X-linked to figure out how to do the Punnet's square calculation XY, XX 109. Fragile X ....and another questions also mentioned Duchenne again. Although wasn't sure if it was duchenne are not b/c child had gross motor problems and developmental difficulty at the age of 4. I think Duchenne comes in at a later stage...but thats the only choice in answers that made sense to me so i just went with it. 110. Pyrimidine Synthesis pathway i think b/c child had accumulation of orotic acid and asked which pathway it belonged to. 4 choices were Purine synthesis, purine degradation, pyramidine synthesis, pyramidine degradation.....didn't know the answer to this one....i vageuly remembering reading about it in kaplan, and i thought it was in purine synthesis, but i was wrong. 111. Definition of an enhancer.

112. Description of person having lead poisoning...didnt say lead poisoning but just had to know the signs and symptoms.....what antidote you give him 113. 114. Patient falls off tree but hangs on, what nerve/muscle is affected? Fructose is made for sperm from what gland? Seminiferous tubules

115. AIDS patient drops CD4+ counts and is at risk of infection with Pneumocystis carinii, what does he need for prophylaxis? TMX-Sulfa 116. Person infected with Pseudomonas aeruginosa, the antibacterial used for this works on: cell wall: piperacillin 117. Person had Parkinsons disease and taking levodopa but its not doing a good job now what to use: bromocriptine 118. Guy is a Potter and makes pots for a living...loss of pain and temperature sensation on both hands...so he kept burning himself without knowing... i think guy had syringomyelia 119. Person on carbidopa and levodopa and he get nausea and vomiting: its b/c levodopa high concentration cause it so lower that and keep carbidopa stable I guess. 120. Pic of pituitary gland and hypothalamus, where does the inhibitory hormones come from? I thought it was the hypothalamus but im not sure 121. Pic of abdomen, which muscle is used in Valsalva? Rectus abdominis

122. What action do the external oblique muscles perform together on the spine? Do they flex, extend or rotate the vertebral column? I had no clue 123. Many questions about peripheral nerves, arms and legs mostly

124. Patient has asthma from the huge scenario and they asked what medication is contraindicated: propanalol 125. Child is born with testes and vagina but no internal female genitalia...which hormone defect is problem....so its male feminization, just understand how that came about. 126. CN distribution on Brainstem with images....3 questions on that....description of lesion and it will point to what CN is referring. 1 question asked what blood supply was this section of brainstem referring to. 127. Man is coughing out blood? What antibody does he have? Antibasement membrane antibody b/c he has Goodpastures. 128. Child has perianal pruritus, area is irritated, did scotch tape test. What is the drug of choice for this condition (Enterobius vermicularis)? Mebendazole 129. Mechanism of transport from ER to Golgi apparatus? Snares (?)

130. Pictures of a boy and mom. Mom is very fair but boy is very dark. He has decreased sodium in body. What is elevated in his body? Looked like he had addisons disease and he had increased ACTH causing hyperpigmenation. 131. Picture of neural tube with neural crest and basal and alar plate. Question asked which area produces ANS and melanocytes. You had to locate neural crest cells. 132. Picture of brain stem. Pt could not close eyes. Had to find where facial nerve was.

133. Receptor question on what happens to steroids....binds intracellularly? but all answer choices had similar answers so know exactly what happens to it 134. Question about retinoic acid and what does it work on?? answer choices were somethings i never heard of. 135. Child had blue sclera, fractured bone. What was missing? Type 1 collagen b/c he had osteogensis imperfecta. 136. 3 pedigrees: one was straight forward autosomal dominant. Other 2 were tricky I didnt get them 137. Anticipation (triplet repeat disorder, next generation it is more severe and shows up in early age) 138. Child has mental retardation, hypogonadism and obesity: Prader Willis Syndrome

139. Patient has pink urine, painful abdomen, what pathway is messed up? Heme synthesis (remember AIP is due to deficiency of HMB synthase or Uroporphyrinogen I synthetase and can lead to neurotoxicity but no phototoxcity). Phototociticy seen with Prophyra ctanea tarda which is def. of uroporphyrinogen decarboxylase) 140. Pt had a gun shut wound and there was a CT scan picture. You had to figure what the bullet hit. Showed liver on left side and on right side the spleen was damaged. 141. Pt had some abdominal problem, but when they were doing surgery they found a structure that was 2 ft from ileocecal valve, 2 inches long. It was Meckels diverticulum. Question asked what tissue can it be composed of? Pancreas (?) 142. 143. Pt had XX genotype and androgen insensitivity, so what is phenotype? Normal female. Patient on antifungal medication trifunidine and where does it work? Squalene epoxide.

144. About 3-5 questions on regulatory steps, e.g. what molecule stimulates citrate to become isocitrate (I put ADP, I dont know if its right) 145. 146. 147. What molecule stimulates 2,6 BP (PFK-2) One graph of O2 dissociation curve, what will make it go to the Left direction (fetal Hb) What reaction is FADH2 used in? I didnt know (complex II of Electron transport)

148. Patient has been given medication that block bile resorption what will increase: LDL receptors. 149. Picture of midbrain lateral section showing pointing to the cerebral aqueduct and asked if it is blocked what will the patient have: Non-communicating hydrocephalus 150. Patient has persistent infection with watery diarrhea and giardia what does he had : IgA deficiency 151. Patient has IgA deficiency and he has to get blood transfussion what is a contraindication: cant give units of blood with out taking out IgA from it. 152. Patient has very high heart rate what will decrease: Stroke volume

153. Patient has been given medication that blocks efferent arteriole what will happen: increase GFR, decrease RPF and increase FF 154. Patient has hypovolemia, what will happen with rennin system? Renin, angiotensin and aldosterone all will increase.

155. Pt had enlarged left ventricle, systolic ejection murmur? It was aortic stenosis, but did not say that in the answer. Instead it said calcified bicuspid valve. 156. Which virus has RNA-dependent RNA polymerase. Question looked so wrong b/c answer choices were: HIV, polio, adenovirus, herpes virus and EBV virus. Herpes, EBV, and adenovirus are dna virus and HIV and polio are ssRNA positive strand. Only negative ssRNA have RNA dependent RNA polymerase, so question looked wrong. 157. Damaged thoracic duct. Drainage of lymphatic fluid would still be functioning where? Right breast b/c it goes into right lymphatic duct. 158. 2 questions on portal systemic anastomoses

159. Pt had ovarian/uterine problem. Where does the physician have to be careful of not resecting the ovarian vessels? Suspensory ligament of ovary. 160. Showed picture of shaft of humerus which had a fracture. What nerve is damaged? It is radial nerve 161. 162. 163. Calculation of flow given 5 resistances in parallel and MAP of 100mmHg. Graph of pressure flow diagram, determine diastolic pressure. Calculate clearance given GFR.

164. Baby is normal, u can hear the murmur but when the patient cry you get cynosis: I think patient has ASD, b/c when he cry the pulmonary resistance increase and also Right arterial pressure increases and that will have right to left shunt through ASD not sure though. 165. Patient has paraumbical anastamosis b/c he has caput medusa and cirrhosis what are the vessel involved: paraumnilical and inferior epigastric 166. Patient cant abduct and adduct he has ulnar damage.

167. Picture of lady with dilated veins on the right and left side of the umbilical cord but not around it what does he has? What anastamosis she has: I chose paraumbilical and femoral. 168. What drains the region in rectum above pectinate line.

169. Ficks Principle was asked....but they had like 6 to 8 numbers from different heart chambers but u only needed to use 3 so u have to understand what numbers u are plugging in....for example venous and arterial blood etc.

170. Capillary hydrostatic/oncotic equation....you know what Im talking about?? (Pc- Pi) - (pi C - pi I) ...plug and chug those numbers and get the answer. 171. 172. 173. 174. Punnet Square calculation for X-linked inheritance. Aortic stenosis murmur Loss of function of biceps what nerve is damaged? Musculocutaneous nerve Nucleus

175. Picture of visual field defect. It was left upper quadrantic anopsia. Where was the lesion? Right temporal lesion 176. Pt had internuclear opthalmoplegia, problems that come and go. Pt has MS

177. Pt had dilated lateral and 3rd ventricle put normal 4th ventricle. Where was the problem? Cerebral aqueduct obstruction (non-communicating hydrocephalus) 178. Pt had ptosis, dilated pupil then ipsilateral paresis. Occuring very fast. Pt had uncal herniation. 179. Increased alpha feto protein in amniotic fluid? Child may have neural tube defect.

180. Physician asked another physician is it ok to see your patient who you like? Physician says no, unless you stop being the patients doctor. 181. 182. 183. 184. 185. 186. Cross over study What arterial supply to the esophagus? aortic branches (?) PDA machinegun murmur Patient has S4 has aortic stenosis he will have concentric hypertrophy of left ventricle. Patient has osteoblastic lesion of vertebra. Dx? prostate cancer Patient with sickle cell anemia has hip pain. Reason? avascular necrosis.

187. One question on toxoplasmosis on the mother who get infected and baby show lot of sings of congentical and others. 188. Two question on person has temporal lobe involvement so he has herpes infection and also they asked what medication you use Acyclovir should have been there but was not there also foscarnet was not there, they had gangcyclovir (for CMV)is soo i chose that.

189. Pic sure show of joint aspirtat it look soo messy with soo many irregular cells and bacteria in it look like pus soo septic joint was the answer. 190. Graph showed with heart rate increase but vascular resistance decrease.

191. one tough ques about defense mechanism, man is told he has cancer, he replys to the doc saying, Im sure we can take care of this doc, was it denial, sublimation, reaction formation, intellectualization 192. kid sleeps in class, tired all the time = narcolepsy 193. 2 on sleep apnea, one was what is the treatment = CPAP, other was just diagnose, fat man snoring = obstructive 194. Pt is unconscious had serious problem. Do you wait to do surgery and get consent or should u proceed? Proceed and treat patient 195. 13 year old girl comes in and want OCP pills because she wants to have sex? What do you say to her? Tell me what you know about sex. 196. Pt comes in and she has many health insurance cards. What is the cheapest insurance company which will allow the patient to pay the least amount? HMO 197. Mother is concerned about her daughter. She is writing letters, can draw a triangle, rides a back, can read simple words, is able to understand mother. Is there a problem? No she is perfectly normal. 198. widow is not taking care of herself, she is ungroomed, she cries a lot, she talks to her husband. Normal bereavement 199. Pt fell in class. He is sleeping excessevly and doing poorly in school. What did he have? Cataplexy b/c narcoleptic. 200. 201. Pt is heroin addict. What drug you give to decrease withdrawal symptoms? How do you treat heroin overdose?

202. Pt is 40 years old and has neurofilllary tangle, loss of memory, amyloid angiopathy. What disease does he have? Down syndrome 203. One question on down syndrome.

204. patient playing foot ball got hit on lateral side the anterior cruciate and medial meniscus is effected. 205. patient cannot stop walking and using her lef, she even kicks at night while sleeping and also feel a need to walk she has: restless leg syndrome 206. patient cannot taste from the anterior of her tongue what else she will have : facial muscle problem. 207. Pt has widely spaced nipples, skin on neck, what heart problem does she have? Coarctation of aorta b/c she has turners syndrome. 208. Pt had recent sexual intercourse and suddenly had numbness in lower half of body but on neurological exam there was no problem. What does she have? Conversion disorder b/c of fear of sex. 209. Pt cuts her self and tells her roommate dont leave me. What personality does she have? Borderline. 210. Child is fixated on objects and does not communicate much? Autism

211. Pt had organophoasphate intescide poisoning. Shows a picture of noradrenergic and adrenergic nerve terminal. The drug you want to use should work where? Had to choose the muscurinic receptors on postsynaptic terminal since you want to use atropine which is antimuscurnic. 212. How is clozapine better than haloperidol? It is better in treating hallucinations and flat affect so both positive and negative symptoms. 213. 214. 215. 216. Accurate base pairing is allowed only in 2 nucleotides, why? B/c of trna wobble. Problem in rRNA so what polymerase affected? RNA polymerase I TATA found in RNA transcription where does splicing of rRNA occur? Nucleolus

217. Pedigree of ducheene muscular dystrophy, what is chances of sister of Duchene muscular brother, to have a Duchene muscular boy? I think 1/8

218. coarse facial feature, has increased dermatan sulfate and hepran sulfate, what is the problem? Well child has hurlers and problem is that deficiency of ebctne ti degrade the product. 219. adhd what is treatment = methylphenidate

220. kid is having delusions and hallucinations of being killed, by aliens or his mother, for 1 wk, after someone was killed in the neighborhood, what does he have? Adjustment disorder, brief psychotic disorder, I dont know 221. 222. 223. 224. many ques from ethics, scenarios, I dont know how you could study for these one sensitivity ques one on confidence interval (should not include 1) many graphs and tables for epi

225. one about case control (retrospective, begins with disease, odds ratio, no prevalence or incidence) 226. Uvula of the palate is pointed in one direction problem problem with Vagus nerve that supply the motor part of palate , glossopharangeal provide the sensory part. 227. patient has problem with fingers of hand when she goes out in cold they get white, she has rynond phenomenon she might develop what: CREST I had the S. 228. patient cant see the left side of her visual field in both eyes she has right optic tract problem.

229. patient is sexually active and also she had many STD including clymedia she has risk of ectopic pregnancy. 230. patient has pain and bleeding from vagina and she didnt has her mensis for 2 months she has ectopic pregnancy 231. 232. patient has persistent infecton and antigen present in the blood she has infectin with HepB Hep A cause chirosis it does not cause HCC, fulminant hepatitis etc

233. patient went to st joaquin valley and she have stuff in sperules this fungi is tramistted thought: repirratory route by inhalation of arthospores. : cocccidiomycosis

234. Pedigree showing decreaseing age of onset of disease and increasing severity of disease, what is this an example of? Anticipation in trinucleotide repeat disorder. 235. 236. 237. 238. 239. 240. Picture of graph showing decrased vmax. Glucagon works on Gs and increases cAMP which increases what? PKA Local anesthetic, where does it bind to? Sodium channel What drug increases cGMP? Nitroprussoide Hydroxolyation needs what in collagen synthesis? Vitamin C Strict vegan what will be deficient? B12

241. Pt has lots of bacterial, viral, and fungal infections. Pt has SCIDS? What is pts body not able to break down. Cannot break down Adenosine. 242. Pt has catalase positive infections? Chronic granulomatous

243. Pt cannot convert oxygen to oxgen super radical. What pathway is deficient? HMP shunt b/c u need NADPH 244. Fructose 1,6 bisphosphtase not working? What pathway not working? Gluconeogensis.

245. Patient is on testicular cancer medication and he get repiratory problem they show an xray with fibrosis he is on Bleomycin 246. patient smoke for like 25yrs and he has decreased FEV1 and also has increased TV etcc. He has emphysema with alpha one antitrypsin deficiency. 247. xray showed like 6 of them and in senerio presented as emphysemia: I chose the x rasy with look like a long lung with straight diaphragm margin. 248. 249. Problem with C5C6, what else muscle will be damaged Pt had sudden flailing arm. Where is lesion? Contralateral subthalamic

250. patient got into accident and has difficulty breathing and x ray showed no lung field and also deviation so it was pneumothorax

251. patient got into accident and broke rib and he has pneumothorax where will you put the tube to inflate the lung, I said 5th intercostals. 252. two qs on hyperthyroid. One was patient has decreased TSH and he is losing weight and he has heart palpitation what is happeneing, I chose increase in sympathetic activity other answers look weird. 253. 254. Guy went hiking, swam in lake, has diarrhea, what would u find in stool sample... child is born, develops septicemia, dies right after even though was on antibiotic therapy..

255. Guy has Cytoscopy done, gets murmer, grows in NaCl.....Enterococcus Faecium...similar Q in UW. 256. scenerio of something and u had to know what it was...conjugation, transduction...etc...but there were like 6 choices so i forgot what the others were 257. pass stool and he sometimes dont pass stool for days and when he passes it he had pain associated with it I chose he has constipation. 258. patient has strict lettuce and toast diet what he had deficient.

259. patient has hallucination and other schizophrenic symptoms what medication is good in long run Olanzapine 260. Pt has black cartilage, what does he have? Alkaptonuria. 261. Pt has light blue eyes, white hair, fair face. What is problem. Deficiency of enzyme (phenyalalnin hydroxylase) leading to decreased product (tyrosine) 262. Burnt sugar urine, what is deficient? Branched chain alpha ketoacid dehydrogenase.

263. hypoglycemia, hyperurecemia, increase glycogen. Von gierghekes, what is defiant? Glucose 6-phosphatase. 264. Pt has photosensitivity and abdominal pain. Shows heme pathway, what is deficient? Uroporphyrinogen decarboxylase. 265. 266. Polio question...but it was about its RNA structure Clostridium difficile question....forgot the scenerio but it was a classic one i think.

267. Understand what autoclave means....scenerio asked that some surgical instruments weren't autoclaved...what could be a potential threat on the instruments?? Spores is a problem, but u have to know which bacteria has spores. ex: clostridium and bacillius anthrax 268. 269. child cannot What increases glycogenolysis? cAMP

270. What does chocolate agar provide for a pleomorphic gram negative bacteria? Hematin for H. influenzae. 271. 272. Pt was taking antibiotics and now has diarrhea? What drug do you give? Metronidazole Pt has dilated heart (dilated cardiomyopathy) what caused it? Cocksackie

273. Pt has pneumonia and has positive cold agglutinins, what drug do you use? Protein synthesis inhibitor and cant use pencillin b/c it has no cell wall. 274. 275. 276. Picture of girl with ring worm, what should you treat it with? Antifungal Virus has resistance to acyclovir, why? B/c of mutation of thymidine synthase. AIDS pt has keratitis? CMV

277. Know difference between operant and classical conditioning. Lady always got sick before she went off to vacation...she was worried who would take care of business while she was gone. 278. Ethic scenarios which answers were sooooooo out there, that u dont know which one to answer

279. 280. 281.

Classical narcolepsy Q......i think i had two questions on narcolepsy. Picture of vertebrae, and pt has Aids? What organism? TB Pt treated for UTI with TMP-SMX but gets a reaction, what is deficient? G6PD

282. Pt has green sputum/ also bloody, lobar pneumonia? How do you treat? Tobyramcyin pipercillin b/c it was pseudomonas. 283. 284. what drug causes a flare up of TB if used in rheumatoid arthritis? Infliximab Pt had decreased pulse in lower extremity. Coarctation of aorta

285. Medulloblastom in a child caused what? Increased intracranial pressure leading to hydrocephalus 286. 287. patient has hallucination what symptom he has: positive symptom patient using gentamycin what side effect can it have.

288. Some Question about HMOs...an insurance company thing....how the doctor gets paid....some stupid like that you don't learn anywhere 289. 17 year old girl has sexual transmitted disease like neisseria...do you give antiobiotics first? or tell parents first?? or just give antiobiotics and follow the request of girl and not tell parents....LOL 290. picture shown of skin with a mole like thing and in the question they said that it can be scraped off like soo I think it was Sebhorris keratosis. 291. one question on some gene on melanoma.

292. patient has multiple melanoma question with plasma cell picture they asked some weird relationship. 293. 294. Patient has candida infection what deficiency he has? Vit E? Cellular immunity Patient had involvement of bcl-2 gene he has follicular lymphoma (t14:18)

295.

Patient has long jaw and testis he has fragile x: X chromosome has a fragile site.

296. patient has not thymus and also has arotic arch problem he has : DiGeroge and what will he have: involvement of the parathyroid 297. PTH is needed to activate vit D by 1-alpha hydroxylase.

298. Patient newborn is fed only mother milk and no other vitamin supplement he has bow legs he has deficiency in vit D. 299. patient has vit C deficiency serior said has bleeding gum and only eat toast he has problem with: hydroxylation of a.a residues in rough endoplasmic reticulum 300. Shows a picture of liver with many mets? Where is the cancer? Colon

301. Pt is heavy smoker but micro pic shows gland like structures. Even though he is smoker looks like it is adenocarcinoma of lung. 302. Pt is very hot and fever what does he have? Sepsis

303. Pt has decrased platelets, increased bleeding time what does he have? ITP (antibody against GpIIb/IIIa) 304. Pt has perfollicular hemorrhage, bleeding teeth, what is deficient? Vitamin C

305. Pt has increase IgM spike, what does he have? Waldenstroms macroglobulienmia (if bone lesions then its multiple myeloma). 306. Pt wakes up in night and has acid reflux what is he have increased risk of? Esophageal adenocarcinoma 307. 308. 309. Pt has diabetes, now has cirrhosis, what does he have? Hemochromatosis Pt has decreased gastric acid b/c of what hormone? Somatostatin How does octreotide help in diarrhea? It acts like somatostatin

310. Pt has difficulty breathing out, smokes, what is the pH and CO2? Decrease pH, increase CO2 and slightly increase HCO3 for compensation. 311. Alpha 1 antitrypsin deficient pat will have problems in lung b/c of what? Neutrophil elastase.

312.

Pt has dilated airway, situs inversus, infertility, what is problem? Dyenin arm.

313. Showed crazy ass CT scan with everything inverted. Was it dextrocardia or situs inversus? Situs inversus b/c dextrocardia is just change in position of heart.

Dextrocardia

314. Pt had trachea deviated to opposite side with hyperresonance? Tension pneumothorax. 315. One weird qs said rRNA a 48s rRNA is cut into smaller ones like 28S etc.. where does this happen I chose nuclcolus. 316. Two questions on patient fasting for a long time and produce ketones: know then names of two ketones the acetoacetate and beta-hydroxybutyrate. 317. Patent has stone stuck in common bile duct and getting problems I said to take it out when you do endoscopy, other option was surgery. 318. Patient has marfans syndrome and has bad pain that goes to the back I chose aortic dissection. 319. Patient has epigastic pain that radiates to the back : pancreatitis

320. Patient has pancreatic insufficiency, he will also have: difficulty in night vision b/c of vit A which is a fat soluble vitamin. 321. 322. 323. 324. 325. There was one on glomerulonephritis with pharyngitis: answer was group A strep. Patient went on wood and he got this long streak liner vesicals, he has contact dermatitis. What u needed to attract neutrophils : IL-8 Role of CD4+ in TB and sarcoidosis: granuloma formation, CD4 Th1 and macrophages Patient has iron overdose: use Deferroxamine to remove it

326. Pt has interstitial lung disease, shows different values of FEV1 and FVC. Answer was FEV1 and FVC decreased but ratio is increased. 327. Pt had hot inflamed toe, monosodium urate crystals. How do you treat acute gout? Indomethacin 328. Again same scenario, what drug may have caused it? Thiazide

329. Pt had pheochromocytoma, what activates chromaffin cells? I thought it was Ach working on the adrenal medulla receptors, but was not sure. 330. Pt has palpitations, sweating, diarrhea, what does he have? Hyperthyroidism

331. Pt has hypertriglyceridimia, gemfibrozile wasnt effective so he was given niacin. What should you also give to prevent niacin side effect? Aspirin. 332. Child has hyperglycemia and urine ketones, what is the cause of this disorder. Multifactorial b/c type 1 diabetes. 333. 334. Pt has flushing, diarrhea, wheezing? Carcinoid syndrome Woman has osteoporosis, what should u be concerned about? Compression Fractures

335. Pt has endometrial hyperplasia caused by ovarian tumor? Granulosa cell tumor causing increased estrogen 336. Why arent there lymphatics in lung? IVC

Explanation: Lymphatic vessels of the lung: - Drain the bronchial tree, pulmonary vessels, and connective tissue septa. - Run along the bronchiole and bronchi toward the hilus, where they drain to the pulmonary (intrapulmonary) and then bronchopulmonary nodes, which in turn drain to the inferior (carinal) and superior t ra cheobronchial nodes, the t racheal (paratracheal) nodes, b ro n ch o med iast in al nodes and trunks, and eventually to the t horacic duct on the left and right lymphatic duct on the right. - Are not present in the walls of the pulmonary alveoli.

Bronchial veins
Receive blood from the bronchi and empty into the a z yg o s ve i n on the right and into the a c c es s o r y h e m i a z yg o s ve i n or the superior intercostal vein on the left. May receive twigs (small vessels) from the tracheobronchial lymph nodes

Pulmonary Physiology

Recall July 2010 (Annie Yang) I just got off the phone with Annie who took the exam today. She didn't send me an email but we talked on the phone for a while and discussed it; this is what I wrote down: Ok, she says that the difficulty level is more on par with the NBMEs than UW. Now, granted that she didn't actually finish UW completely, she told me that the closest thing to a repeat question on her test was an image that was reproduced from the 2010 NBME overview pdf, but the question itself was different. What she was really praising though was Doctors in Training. She said she was very glad she went through it all because all of the weird small additional things that Jenkins adds to FA is actually relevant and important and tested. For example, the rectum is the most accurate place to take a body temperature, and another example is in order to diagnose temporal arteritis you need to biopsy the vessel, etc. DIT also gave almost exact images and labeling of the brainstem, spinal cord, etc that will show up on the test. For example, a picture of a brainstem was shown and a question asking about which nerve causes the gag reflex (CN 9 btw) and another example is the medial lemniscus on brainstem. She said that FA was by far the biggest thing that helped her and DIT was great at additional annotating in FA that is relevant (again, she didnt finish UW, but said the details not in FA that UW tested weren't as relevant as the additional things DIT tells you. I am guessing because Jenkins is spewing out stuff from his surveys of actual exams). There was also

something than Jenkins said about the pupillary light reflex that was tested but not in FA but I couldn't understand what Annie was saying exactly. Other questions: - Reproductive path - b-hcg and estriol in Edwards syndrome (Trisomy 18) being down?

- Hormonal drugs - Sulfonylureas where its actions - Signaling sequencing (if lose where will the material will end up) - 10 questions on Cholesterol drugs, receptors, biochemistry, mechanisms of actions - Mechanisms of local anesthetics - 5 questions on stroke drugs - Phenylephrine - Effect on epinephrine why you use local anesthetics with it (to decrease the blood flow) - pancuronium, etc - Number needed to harm vs nnt - Apoptosis and caspases - Bunch of cell bio (organelles, ER, where things are made, etc) - Vimentin, desmin, etc - B hcg responsible for breast development in guys? - Allergic reaction IgE - Lots of murmurs. Apparently if you know if it is in diastole/systole and where you can hear them it will tell you the answer - the gag reflex (CN 9 btw) - pupillary light reflex - Substantia nigra location - images and labeling of the brainstem, spinal cord - Broad based Gait in alcoholic (vit deficiency) - Edema. Why you get edema, edema in chf, all pressures, etc know - 7 or 8 questions based just on filtration equations, etc in kidney - the rectum is the most accurate place to take a body temperature

- 5 qs on prostate carcinoma - 3 questions on Suprapinatus n actions - LE anatomy femoral nerve innervates what, know lumbosacral plexus EAQs f*cked up questions!!!!!!
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Guyhaspenetratinginjurytopalatinetonsils,hehasproblemsswallowing,whichmusclewas injured? Ovariancancer,wheredoeslymphaticdrainagegoesto? Lumbosacralplexus,nerveroots Structuresdamagedinkneeinjury Handfracture,structuresdamagedwithinanatomicalsnuffbox ATN,tubularcastscomefromwhichdamagedsectionofthenephron? Shoulderdislocation,injuredmusclesareinnervatedbywhichnerve(s)? Hornersyndromedescription,whatisdamaged? Facialpalsywithlackofsymmetryuponwhistling,whatisdamaged? Tasteintact,pain/tempsensationlostontongue,whatisdamaged? Swollenscrotum,transilluminationnegative,goesdownwhenlyingdown,whatisit? CT/XRays,someobstruction,whichpartofduodenum? CT/Xrays,obstructionagain,dilatedrenalpelvis/calices. Alcoholicpatientwithcirrhosis,whataresitesofvenouscongestion? Like1215questionsonvirology(includingpharm,patho,andmicro,micro,micro) Viruses,envelopedvsnonenveloped. Viruses,segmentedvsnonsegmented. Virusreplication,enzymes,steps. Viralreplication,pharmacology. Guywithbunchoftraumainjuries,needrapidinductionanesthesia,whattouse? Patientusesmedsforrheumatoidarthritischronically,whattogivehimtoprotectgastricmucosa? Patientwithgastriculcers,whattogivehimtohelpfixgastricmucosa? Patientwithgallbladderstonesdoesnotwantsurgery,whatotheroptiondoesshehave? PatientshavedifferentvolumesofdistributionforacompoundX,whatisthemajorreasonfor difference? Patientwithchronicacidrefluxistakingadrugthatisnotworking,why? Like3questionson:Epinephrinereversal

- Know all the stains for microbiology because there are a crap ton of micro images with a bunch you cant figure out just by the question stem.

Acid Fast Stain of M. tuberculosis (red rods)

Auramine Stain of M. tuberculosis (glowing yellow rods)

Histoplasma capsulatum seen inside macrophages

Cryptosporidia along small intestinal brush border

Criptosporidia seen on Acid Fast Stain (red circles)

PAS: Candida (budding yeasts and pseudohyphae)

GMS:Candida (budding yeasts and pseudohyphae)

CMV: large cells, large violet intranuclear inclusions with a small clear halo

Proteus mirabilis. The fog-like swarming of the cells away from the inoculation streak is characteristic. Proteus mirabilis produces urease and is associated with the formation of struvite stones.

- 3 questions on Myotonic dystrophy, ragged red fibers wanted to know the cause of it, etc - Myotonic dystrophy: due to Trinucleotide repeat expansion (CTG)n

DM1 and DM2 are both autosomal dominant disorders. New mutations do not appear to contribute to the pool of affected individuals. DM1 is transmitted by an intronic mutation consisting of an unstable expansion of a CTG trinucleotide repeat in a serine-threonine protein kinase gene (named DMPK) on chromosome 19q13.3. An increase in the severity of the disease phenotype in successive generations (genetic anticipation) is accompanied by an increase in the number of trinucleotide repeats. A similar type of mutation has been identified in fragile X syndrome (Chap. 62). The unstable triplet repeat in myotonic dystrophy can be used for prenatal diagnosis. Congenital disease occurs almost exclusively in infants born to affected mothers; it is possible that sperm with greatly expanded triplet repeats do not function well. DM2 is caused by a DNA expansion mutation consisting of a CCTG repeat in intron 1 of the ZNF9 gene located at chromosome 3q13.3-q24. The gene is believed to encode an RNA binding protein expressed in many different tissues, including skeletal and cardiac muscle. The DNA expansions in DM1 and DM2 almost certainly impair muscle function by a toxic gain of function of the mutant mRNA. In both DM1 and DM2, the mutant RNA appears to form intranuclear inclusions composed of aberrant RNA. These RNA inclusions sequester RNA binding proteins essential for proper splicing of a variety of other mRNAs. This leads to abnormal transcription of multiple proteins in a variety of tissues/organ systems, in turn causing the systemic manifestations of DM1 and DM2

- Ragged red fibers of MERRF (Myoclonic Epilepsy with Ragged Red Fibers, mitochondrial inherited disease):

- Heteroplasmy

- Pseudohypothyroidism: Knuckle knucle dimple dimple sign ! fourth and fifth metacarpals are shortened in Pseudohypoparathyroidism (Type Ia is Albrights osteodystrophy).

- Osteoporosis:

- Temporal arteritis: diagnose by biopsying the artery (long segment because of potential focal involvement). Granulomas are seen on the media of the temporal artery, symptoms are headache, possible vision loss, polymalgia rheumatic in many cases, elevated ESR.

- Hypertrophic cardiomyopathy

-Basal Cell Carcinmoa

- Recognize morphology of blood cells

- Appendicitis

Acute appendicitis The inflamed appendix is red, swollen and covered with a fibropurulent exudate.

- Pilocytic astrocytoma (low grade)

Most common primary brain tumor in children, benign, good prognosis. Cystic and solid areas, may be infra or supratentorial. Often countains intracytoplasmic eosinophilic cork screw fibers (Rosenthal fibers). Stains positive for GFAP. - Medulloblastoma (highly malignant)

PNET derived, highly malignant, arises behind 4th ventricle. Solid appearance that enhances with contrast media macroscopically. Histologically shows Rosettes and perivascular pseudorosettes with small blue cells. Responds to radiotherapy (radiosensitive). - Ependymoma (poor prognosis)

Ependymomas arise from ependymal cells in 4th ventricle and can cause hydrocephalus.

Perivascular pseudorosettes

Rosettes

Neurofibromatosis Type 1 (NF-1, Autosomal Dominant)

Lisch nodules (hamartomatous nodules), Caf-au-lait spots, optic gliomas, skin neurofibromas, pheochromocytomas. Due to mutation of NF-1 (chromosome 17) -Tuberous sclerosis (Autosomal Dominant)

Cardiac Rhabdomyoma

Renal Angiomyolipomas

Characterized by: CNS hamartomas, adenoma sebaceum, cardiac rhabdomyomas, renal angiomyolipomas, seizures, ash leaf spots (hypopigmented), and shagreen patches

- Normal Pressure Hydrocephalus (causes triad: incontinence, ataxia, dementia)

Cerebral and Brainstem Blood Flow