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  1. #1
    marceverett is offline Junior Member 510 points
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    Questions from NBME Form 4.

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    If you have not taken Form 4, please do not read this thread, you will lose the ability to assess your progress when you take it.
    Please post an answer and the explanation. Thanks so much.




    21.
    A 72-year-old man comes to the emergency department because of a 2-hour episode of loss of vision in the left eye. He has never smoked. Laboratory studies show:
    Hemoglobin
    20 g/dL
    Hematocrit
    62%
    Leukocyte count
    14,200/mm3
    Differential
    normal
    Mean corpuscular volume
    87.2 μm3
    Platelet count
    375,000/mm3
    Which of the following is the most appropriate initial therapy?


    A)Administration of allopurinol
    B)Administration of aspirin
    C)Administration of chlorambucil
    D)Administration of hydroxyurea
    E)Administration of warfarin
    F)Phlebotomy
    G)Splenectomy


    25.
    A 45-year-old man has had four episodes of involuntary twitching of the right foot. Following the last episodes, he had a tonic-clonic seizure. Which of the following structures on the left is the most likely origin of the seizure?
    A)Inferior frontal cortex
    B)Inferior temporal cortex
    C)Insular cortex
    D)Primary motor cortex
    E)Supplementary motor cortex

    30.
    A 77-year-old man has had repeated episodes of difficulty speaking, facial numbness, and clumsiness of the left hand. Doppler ultrasonography of his carotid arteries shows no abnormalities. Which of the following drugs is the most appropriate therapy to prevent future episodes?
    A)Aspirin
    B)Diflunisal
    C)Methyl salicylate
    D)Olsalazine
    E)Salicylic acid
    F)Salsalate
    G)Sodium salicylate
    H)Sulfasalazine

    3.
    A 23-year-old woman has skin blistering that results from a point mutation in a single gene. Epidermal cells in these patients become fragile and rupture. Which of the following is the most likely effect of the genetic mutation?
    A)Defective transport of vesicles from the centrosome to the cell membrane
    B)Disrupted assembly of keratin into intermediate filaments
    C)Lack of GTP required to form polymers of tubulin
    D)Phosphorylation of actin monomers to promote polymerization


    7.
    A 75-year-old man has a painless mass in the left upper anterior neck. Examination of tissue obtained on biopsy shows partial replacement of a lymph node by a neoplasm; the neoplasm is composed of cohesive sheets of polygonal cells with granular eosinophilic cytoplasm, prominent intercellular bridges, and pleomorphic round nuclei. Immunocytochemical preparations show a strongly positive reaction of the neoplastic cells to a high-molecular-weight keratin antibody. There is no reaction to antibodies against vimentin and leukocyte common antigen (CD45). Which of the following is the most likely diagnosis?


    A)Adenocarcinoma
    B)Malignant melanoma
    C)Non-Hodgkin lymphoma
    D)Sarcoma
    E)Squamous cell carcinoma


    32.
    A 78-year-old man comes to the physician because of progressive swelling of the right side of his face and neck and his right upper extremity. His right jugular vein is engorged. Which of the following diagnoses is most likely to be confirmed on an x-ray of the chest?


    A)Aortic arch aneurysm
    B)Mass in the upper lobe of the right lung
    CRight cervical rib
    D)Right pneumothorax
    E)Thoracic duct blockage in the posterior mediastinum

    48.
    A 28-year-old woman with AIDS has chronic diarrhea of unknown origin. After the failure of typical treatment approaches, subcutaneous injections of octreotide are begun. Which of the following best describes the therapeutic benefit of this structure analogy of somatostatin as compared with native somatostatin?

    A)Decreased lipid solubility
    B)Decreased volume of distribution
    C)Delayed onset of action
    DIncreased bioavailability
    E)Prolonged duration of action


    50.
    A 54-year-old man is brought to the emergency department because of a 2-week history of progressive shortness of breath with exertion and leg swelling. He now requires two pillows for sleeping because of shortness of breath when lying flat. He has had a 4.5-kg (10-lb) weight gain during this period. He has a 15-year history of type 2 diabetes mellitus and hypertension that are poorly controlled despite treatment with a variety of medications. Two months ago, he began receiving a new diabetic medication that has been titrated upward during the past month. Crackles are heard at the lung bases bilaterally. Cardiac examination shows an S3 gallop. There is 2+ peripheral edema of the lower extremities. Which of the following medications is the most likely cause of the new symptoms in this patient?

    A)Acarbose
    B)Glyburide
    C)Metformin
    D)Repaglinide
    E)Rosiglitazone


    21.
    Two hours after the onset of chest pain, a 48-year-old man comes to the emergency department. An ECG indicates acute myocardial ischemia. He receives tissue plasminogen activator as thrombolytic therapy. Which of the following adverse effects is most likely?
    A)Acute allergic reaction
    B)Hemorrhagic stroke
    CHypertensive crisis
    D)Pulmonary embolus
    E)Tonic-clonic seizure

    33.
    A 26-year-old woman with stable asthma wheezes when exposed to cats. Which of the following is the most appropriate prophylactic therapy?
    A)Inhaled cromolyn
    B)Inhaled ipratropium
    C)Oral cimetidine
    D)Oral corticosteroids
    E)Oral theophylline

    34.
    The largest proportional increase in left ventricular afterload and myocardial oxygen consumption is most likely to occur following a 20% increase in which of the following?
    A)Aortic pressure
    B)Coronary blood flow
    C)Heart rate
    D)Right atrial pressure
    E)Stroke volume

    45.
    A previously healthy 63-year-old man comes to the physician because of difficulty starting urination, decreased force and size of the urine stream, and dribbling when he tries to stop urinating. Cystoscopy shows hypertrophy and thickening of the bladder wall and dilation of the ureters. If untreated, which of the following sequelae is most likely?
    A)Renal papillary necrosis
    B)Retroperitoneal fibrosis
    C)Transitional cell carcinoma of the bladder
    D)Urethral diverticulum
    E)Urinary tract infection

    47.
    Which of the following is the role of iodine in the biosynthesis of thyroxine (T4)?
    A)It activates a membrane transporter that increases the import of tyrosine
    B)It is added to tyrosine residues in thyroglobulin in the first step of T4 biosynthesis
    C)It is covalently bound to free tyrosine to form T4
    D)It is an essential cofactor for thyroperoxidase

    49.
    An otherwise healthy 80-year-old man is scheduled for endoscopy for evaluation of rectal bleeding. A standard dose of midazolam is administered intravenously when the patient is admitted to the endoscopy suite. A few minutes later, he develops cyanosis and labored respirations and requires ventilation with an oxygenated resuscitation bag. An age-related increase in which of the following is the most likely cause of these adverse effects?
    A)Enterohepatic recycling
    B)Metabolite formation
    C)Plasma protein binding
    D)Sensitivity to sedatives
    E)Volume of distribution

    13.
    A 16-year-old girl is febrile and incoherent but able to indicate that she has severe lower abdominal pain. Pelvic examination shows a foul-smelling cervicovaginal discharge, and a septic abortion is suspected. Which of the following procedures is most appropriate for identifying the microbial agents causing her infection?
    A)Inoculation of anaerobic transport media at the bedside
    B)Inoculation of the specimen into tissue culture
    C)Quantitation of the bacteria in the discharge by using a calibrated inoculating loop
    D)Streaking a swab specimen onto Thayer-Martin media at the bedside
    E)Use of Löwenstein-Jensen and Sabouraud media for acid-fast bacteria and fungi, respectively

    32.
    A 34-year-old woman is brought to the emergency department after she collapsed when she returned from a nonstop flight from New Delhi to New York City. She has smoked 1 pack of cigarettes daily for 16 years. She is sexually active and uses an oral contraceptive. Her pulse is 125/min, and blood pressure is 75/50 mm Hg. Physical examination shows jugular venous distention. The lungs are clear to auscultation. Pulmonary artery catheterization shows a pulmonary systolic/diastolic arterial pressure of 50/25 mm Hg (N=15–30/3–12) and a pulmonary artery wedge pressure of 5 mm Hg (N=8–16). Which of the following is the most likely cause of her pulmonary hypertension?
    A)Decreased cardiac output
    B)Increased left atrial pressure
    C)Increased left ventricular diastolic pressure
    D)Increased pulmonary blood flow
    E)Increased pulmonary venous resistance
    F)Occlusion of left ventricular outflow tract
    G)Occlusion of pulmonary arteries
    H)Pericardial tamponade

    40.
    A 6-year-old girl who is recovering from a severe "strep" throat is brought to the physician because her urine has had a "smoky" appearance several times in the past week. Urinalysis shows trace amounts of blood and protein. Which of the following cell types initiates the repair mechanism necessary to resolve the proteinuria and hematuria?
    A)Erythrocytes
    B)Juxtaglomerular cells
    C)Mesangial cells
    D)Plasma cells
    E)Polkissen
    F)Proximal tubule epithelial cells


    48.
    Triiodothyronine (T3) is more potent than thyroxine (T4) for the treatment of hypothyroidism because of which of the following?
    A)Active transport into target cells
    B)Greater accumulation in mitochondria
    C)Greater receptor affinity
    D)Higher oral bioavailability
    E)Longer plasma half-life



    Last edited by marceverett; 07-31-2006 at 02:46 PM.

  2. #2
    wcb22 is offline Elite Member
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    first off, i don't think all my answers are right, but with a combined effort, maybe we can come to the right answers.

    21.
    A 72-year-old man comes to the emergency department because of a 2-hour episode of loss of vision in the left eye. He has never smoked. Laboratory studies show:

    Hemoglobin
    20 g/dL
    Hematocrit
    62%
    Leukocyte count
    14,200/mm3
    Differential
    normal
    Mean corpuscular volume
    87.2 μm3
    Platelet count
    375,000/mm3
    Which of the following is the most appropriate initial therapy?


    A)Administration of allopurinol
    B)Administration of aspirin
    C)Administration of chlorambucil
    D)Administration of hydroxyurea
    E)Administration of warfarin
    F)Phlebotomy
    G)Splenectomy

    F - look at that hematocrit, polycythemia vera, these people start looking purple when it gets a little higher. these people have to become blood donors (except it cannot be used).




    25.
    A 45-year-old man has had four episodes of involuntary twitching of the right foot. Following the last episodes, he had a tonic-clonic seizure. Which of the following structures on the left is the most likely origin of the seizure?
    A)Inferior frontal cortex
    B)Inferior temporal cortex
    C)Insular cortex
    D)Primary motor cortex
    E)Supplementary motor cortex

    D?


    30.
    A 77-year-old man has had repeated episodes of difficulty speaking, facial numbness, and clumsiness of the left hand. Doppler ultrasonography of his carotid arteries shows no abnormalities. Which of the following drugs is the most appropriate therapy to prevent future episodes?
    A)Aspirin
    B)Diflunisal
    C)Methyl salicylate
    D)Olsalazine
    E)Salicylic acid
    F)Salsalate
    G)Sodium salicylate
    H)Sulfasalazine

    A

    3.
    A 23-year-old woman has skin blistering that results from a point mutation in a single gene. Epidermal cells in these patients become fragile and rupture. Which of the following is the most likely effect of the genetic mutation?
    A)Defective transport of vesicles from the centrosome to the cell membrane
    B)Disrupted assembly of keratin into intermediate filaments
    C)Lack of GTP required to form polymers of tubulin
    D)Phosphorylation of actin monomers to promote polymerization

    B

    7.
    A 75-year-old man has a painless mass in the left upper anterior neck. Examination of tissue obtained on biopsy shows partial replacement of a lymph node by a neoplasm; the neoplasm is composed of cohesive sheets of polygonal cells with granular eosinophilic cytoplasm, prominent intercellular bridges, and pleomorphic round nuclei. Immunocytochemical preparations show a strongly positive reaction of the neoplastic cells to a high-molecular-weight keratin antibody. There is no reaction to antibodies against vimentin and leukocyte common antigen (CD45). Which of the following is the most likely diagnosis?


    A)Adenocarcinoma
    B)Malignant melanoma
    C)Non-Hodgkin lymphoma
    D)Sarcoma
    E)Squamous cell carcinoma

    E


    32.
    A 78-year-old man comes to the physician because of progressive swelling of the right side of his face and neck and his right upper extremity. His right jugular vein is engorged. Which of the following diagnoses is most likely to be confirmed on an x-ray of the chest?


    A)Aortic arch aneurysm
    B)Mass in the upper lobe of the right lung
    CRight cervical rib
    D)Right pneumothorax
    E)Thoracic duct blockage in the posterior mediastinum

    E is my guess (there is a very similar kaplan question), but a mass pushing on the SVC could be right too (B).

    48.
    A 28-year-old woman with AIDS has chronic diarrhea of unknown origin. After the failure of typical treatment approaches, subcutaneous injections of octreotide are begun. Which of the following best describes the therapeutic benefit of this structure analogy of somatostatin as compared with native somatostatin?

    A)Decreased lipid solubility
    B)Decreased volume of distribution
    C)Delayed onset of action
    DIncreased bioavailability
    E)Prolonged duration of action

    E

    50.
    A 54-year-old man is brought to the emergency department because of a 2-week history of progressive shortness of breath with exertion and leg swelling. He now requires two pillows for sleeping because of shortness of breath when lying flat. He has had a 4.5-kg (10-lb) weight gain during this period. He has a 15-year history of type 2 diabetes mellitus and hypertension that are poorly controlled despite treatment with a variety of medications. Two months ago, he began receiving a new diabetic medication that has been titrated upward during the past month. Crackles are heard at the lung bases bilaterally. Cardiac examination shows an S3 gallop. There is 2+ peripheral edema of the lower extremities. Which of the following medications is the most likely cause of the new symptoms in this patient?

    A)Acarbose
    B)Glyburide
    C)Metformin
    D)Repaglinide
    E)Rosiglitazone

    E?

    21.
    Two hours after the onset of chest pain, a 48-year-old man comes to the emergency department. An ECG indicates acute myocardial ischemia. He receives tissue plasminogen activator as thrombolytic therapy. Which of the following adverse effects is most likely?
    A)Acute allergic reaction
    B)Hemorrhagic stroke
    CHypertensive crisis
    D)Pulmonary embolus
    E)Tonic-clonic seizure

    B


    33.
    A 26-year-old woman with stable asthma wheezes when exposed to cats. Which of the following is the most appropriate prophylactic therapy?
    A)Inhaled cromolyn
    B)Inhaled ipratropium
    C)Oral cimetidine
    D)Oral corticosteroids
    E)Oral theophylline

    A


    34.
    The largest proportional increase in left ventricular afterload and myocardial oxygen consumption is most likely to occur following a 20% increase in which of the following?
    A)Aortic pressure
    B)Coronary blood flow
    C)Heart rate
    D)Right atrial pressure
    E)Stroke volume

    A



    45.
    A previously healthy 63-year-old man comes to the physician because of difficulty starting urination, decreased force and size of the urine stream, and dribbling when he tries to stop urinating. Cystoscopy shows hypertrophy and thickening of the bladder wall and dilation of the ureters. If untreated, which of the following sequelae is most likely?
    A)Renal papillary necrosis
    B)Retroperitoneal fibrosis
    C)Transitional cell carcinoma of the bladder
    D)Urethral diverticulum
    E)Urinary tract infection

    E


    47.
    Which of the following is the role of iodine in the biosynthesis of thyroxine (T4)?
    A)It activates a membrane transporter that increases the import of tyrosine
    B)It is added to tyrosine residues in thyroglobulin in the first step of T4 biosynthesis
    C)It is covalently bound to free tyrosine to form T4
    D)It is an essential cofactor for thyroperoxidase

    B


    49.
    An otherwise healthy 80-year-old man is scheduled for endoscopy for evaluation of rectal bleeding. A standard dose of midazolam is administered intravenously when the patient is admitted to the endoscopy suite. A few minutes later, he develops cyanosis and labored respirations and requires ventilation with an oxygenated resuscitation bag. An age-related increase in which of the following is the most likely cause of these adverse effects?
    A)Enterohepatic recycling
    B)Metabolite formation
    C)Plasma protein binding
    D)Sensitivity to sedatives
    E)Volume of distribution

    E?

    13.
    A 16-year-old girl is febrile and incoherent but able to indicate that she has severe lower abdominal pain. Pelvic examination shows a foul-smelling cervicovaginal discharge, and a septic abortion is suspected. Which of the following procedures is most appropriate for identifying the microbial agents causing her infection?
    A)Inoculation of anaerobic transport media at the bedside
    B)Inoculation of the specimen into tissue culture
    C)Quantitation of the bacteria in the discharge by using a calibrated inoculating loop
    D)Streaking a swab specimen onto Thayer-Martin media at the bedside
    E)Use of Löwenstein-Jensen and Sabouraud media for acid-fast bacteria and fungi, respectively

    A?


    32.
    A 34-year-old woman is brought to the emergency department after she collapsed when she returned from a nonstop flight from New Delhi to New York City. She has smoked 1 pack of cigarettes daily for 16 years. She is sexually active and uses an oral contraceptive. Her pulse is 125/min, and blood pressure is 75/50 mm Hg. Physical examination shows jugular venous distention. The lungs are clear to auscultation. Pulmonary artery catheterization shows a pulmonary systolic/diastolic arterial pressure of 50/25 mm Hg (N=15–30/3–12) and a pulmonary artery wedge pressure of 5 mm Hg (N=8–16). Which of the following is the most likely cause of her pulmonary hypertension?
    A)Decreased cardiac output
    B)Increased left atrial pressure
    C)Increased left ventricular diastolic pressure
    D)Increased pulmonary blood flow
    E)Increased pulmonary venous resistance
    F)Occlusion of left ventricular outflow tract
    G)Occlusion of pulmonary arteries
    H)Pericardial tamponade

    G?


    40.
    A 6-year-old girl who is recovering from a severe "strep" throat is brought to the physician because her urine has had a "smoky" appearance several times in the past week. Urinalysis shows trace amounts of blood and protein. Which of the following cell types initiates the repair mechanism necessary to resolve the proteinuria and hematuria?
    A)Erythrocytes
    B)Juxtaglomerular cells
    C)Mesangial cells
    D)Plasma cells
    E)Polkissen
    F)Proximal tubule epithelial cells

    C




    48.
    Triiodothyronine (T3) is more potent than thyroxine (T4) for the treatment of hypothyroidism because of which of the following?
    A)Active transport into target cells
    B)Greater accumulation in mitochondria
    C)Greater receptor affinity
    D)Higher oral bioavailability
    E)Longer plasma half-life

    C
    M.D., PGY-3 Internal Medicine

  3. #3
    marceverett is offline Junior Member 510 points
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    [quote=wcb22]first off, i don't think all my answers are right, but with a combined effort, maybe we can come to the right answers.


    25.
    A 45-year-old man has had four episodes of involuntary twitching of the right foot. Following the last episodes, he had a tonic-clonic seizure. Which of the following structures on the left is the most likely origin of the seizure?
    A)Inferior frontal cortex
    B)Inferior temporal cortex
    C)Insular cortex
    D)Primary motor cortex
    E)Supplementary motor cortex

    For this one though, I couldn't help but think the hippocampus is the most epileptogenic part of the brain, even if the seizures appear to be from the primary motor cortex.. and I guess it could just spread from there.



    3.
    A 23-year-old woman has skin blistering that results from a point mutation in a single gene. Epidermal cells in these patients become fragile and rupture. Which of the following is the most likely effect of the genetic mutation?

    B)Disrupted assembly of keratin into intermediate filaments
    Any idea what the disorder is?

    7.
    Immunocytochemical preparations show a strongly positive reaction of the neoplastic cells to a high-molecular-weight keratin antibody.
    E)Squamous cell carcinoma
    Because of the keratin specific stain?

    32.
    A 78-year-old man comes to the physician because of progressive swelling of the right side of his face and neck and his right upper extremity. His right jugular vein is engorged. Which of the following diagnoses is most likely to be confirmed on an x-ray of the chest?
    B)Mass in the upper lobe of the right lung
    E)Thoracic duct blockage in the posterior mediastinum

    E is my guess (there is a very similar kaplan question), but a mass pushing on the SVC could be right too (B).
    It says Thoracic duct, not right thoracic duct and I wasn't sure if the "posterior mediastinum" part was enough to insist it is the right thoracic duct.. and what about Pancoast tumor causing superior vena caval syndrome or is that no good because the both jugular veins would be distended?


    50.
    A 54-year-old man is brought to the emergency department because of a 2-week history of progressive shortness of breath with exertion and leg swelling. He now requires two pillows for sleeping because of shortness of breath when lying flat. He has had a 4.5-kg (10-lb) weight gain during this period. He has a 15-year history of type 2 diabetes mellitus and hypertension that are poorly controlled despite treatment with a variety of medications. Two months ago, he began receiving a new diabetic medication that has been titrated upward during the past month. Crackles are heard at the lung bases bilaterally. Cardiac examination shows an S3 gallop. There is 2+ peripheral edema of the lower extremities. Which of the following medications is the most likely cause of the new symptoms in this patient?

    A)Acarbose
    B)Glyburide
    C)Metformin
    D)Repaglinide
    E)Rosiglitazone

    E?



    33.
    A 26-year-old woman with stable asthma wheezes when exposed to cats. Which of the following is the most appropriate prophylactic therapy?
    A)Inhaled cromolyn
    B)Inhaled ipratropium
    C)Oral cimetidine
    D)Oral corticosteroids
    E)Oral theophylline

    A
    I went with A also but why is inhaled cromolyn a better prophylaxis than oral theophylline?


    49.
    An otherwise healthy 80-year-old man is scheduled for endoscopy for evaluation of rectal bleeding. A standard dose of midazolam is administered intravenously when the patient is admitted to the endoscopy suite. A few minutes later, he develops cyanosis and labored respirations and requires ventilation with an oxygenated resuscitation bag. An age-related increase in which of the following is the most likely cause of these adverse effects?
    A)Enterohepatic recycling
    B)Metabolite formation
    C)Plasma protein binding
    D)Sensitivity to sedatives
    E)Volume of distribution

    E?

    13.
    A 16-year-old girl is febrile and incoherent but able to indicate that she has severe lower abdominal pain. Pelvic examination shows a foul-smelling cervicovaginal discharge, and a septic abortion is suspected. Which of the following procedures is most appropriate for identifying the microbial agents causing her infection?
    A)Inoculation of anaerobic transport media at the bedside
    B)Inoculation of the specimen into tissue culture
    C)Quantitation of the bacteria in the discharge by using a calibrated inoculating loop
    D)Streaking a swab specimen onto Thayer-Martin media at the bedside
    E)Use of Löwenstein-Jensen and Sabouraud media for acid-fast bacteria and fungi, respectively

    A?
    Listeria monocytogenes to cause the abortion or neisseria gonnorhea more indicative by cervicovaginal discharge?

    32.
    A 34-year-old woman is brought to the emergency department after she collapsed when she returned from a nonstop flight from New Delhi to New York City. She has smoked 1 pack of cigarettes daily for 16 years. She is sexually active and uses an oral contraceptive. Her pulse is 125/min, and blood pressure is 75/50 mm Hg. Physical examination shows jugular venous distention. The lungs are clear to auscultation. Pulmonary artery catheterization shows a pulmonary systolic/diastolic arterial pressure of 50/25 mm Hg (N=15–30/3–12) and a pulmonary artery wedge pressure of 5 mm Hg (N=8–16). Which of the following is the most likely cause of her pulmonary hypertension?
    A)Decreased cardiac output
    B)Increased left atrial pressure
    C)Increased left ventricular diastolic pressure
    D)Increased pulmonary blood flow
    E)Increased pulmonary venous resistance
    F)Occlusion of left ventricular outflow tract
    G)Occlusion of pulmonary arteries
    H)Pericardial tamponade

    G?


    40.
    A 6-year-old girl who is recovering from a severe "strep" throat is brought to the physician because her urine has had a "smoky" appearance several times in the past week. Urinalysis shows trace amounts of blood and protein. Which of the following cell types initiates the repair mechanism necessary to resolve the proteinuria and hematuria?
    A)Erythrocytes
    B)Juxtaglomerular cells
    C)Mesangial cells
    D)Plasma cells
    E)Polkissen
    F)Proximal tubule epithelial cells

    C

    /quote]

  4. #4
    md90's Avatar
    md90 is offline Senior Member
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    I will try and answer...

    I will and try and answer these questions.....
    Quote Originally Posted by marceverett

    21. A 72-year-old man comes to the emergency department because of a 2-hour episode of loss of vision in the left eye. He has never smoked. Laboratory studies show:
    Hemoglobin
    20 g/dL
    Hematocrit
    62%
    Leukocyte count
    14,200/mm3
    Differential
    normal
    Mean corpuscular volume
    87.2 μm3
    Platelet count
    375,000/mm3
    Which of the following is the most appropriate initial therapy?
    A)Administration of allopurinol
    B)Administration of aspirin
    C)Administration of chlorambucil
    D)Administration of hydroxyurea
    E)Administration of warfarin
    F)Phlebotomy
    G)Splenectomy

    Answer: F, why? Allopurinol and hydroxyurea are gout medications and it doesn't appear that the person has gout; Aspirin and warfarin will make you bleed.. and that is not needed; chlorambucil is for cancer treatment; splenectomy is not indicated in this case;

    25. A 45-year-old man has had four episodes of involuntary twitching of the right foot. Following the last episodes, he had a tonic-clonic seizure. Which of the following structures on the left is the most likely origin of the seizure?
    A)Inferior frontal cortex
    B)Inferior temporal cortex
    C)Insular cortex
    D)Primary motor cortex
    E)Supplementary motor cortex
    Answer: D, why? i'm thinking that this is the corticospinal tract and that area is 4,6, and 3,1,2 which is the Primary Motor, premotor, and Primary Somatosensory;


    30. A 77-year-old man has had repeated episodes of difficulty speaking, facial numbness, and clumsiness of the left hand. Doppler ultrasonography of his carotid arteries shows no abnormalities. Which of the following drugs is the most appropriate therapy to prevent future episodes?
    A)Aspirin
    B)Diflunisal
    C)Methyl salicylate
    D)Olsalazine
    E)Salicylic acid
    F)Salsalate
    G)Sodium salicylate
    H)Sulfasalazine
    It appears that the person may have had a stroke but the carotid arteries are normal; maybe another arterial source; OR maybe inflammation... therefore we want to give a NSAID... which can include the answers: A, B, F; ANSWER: A

    3. A 23-year-old woman has skin blistering that results from a point mutation in a single gene. Epidermal cells in these patients become fragile and rupture. Which of the following is the most likely effect of the genetic mutation?
    A)Defective transport of vesicles from the centrosome to the cell membrane
    B)Disrupted assembly of keratin into intermediate filaments
    C)Lack of GTP required to form polymers of tubulin
    D)Phosphorylation of actin monomers to promote polymerization
    Answer: B;


    7. A 75-year-old man has a painless mass in the left upper anterior neck. Examination of tissue obtained on biopsy shows partial replacement of a lymph node by a neoplasm; the neoplasm is composed of cohesive sheets of polygonal cells with granular eosinophilic cytoplasm, prominent intercellular bridges, and pleomorphic round nuclei. Immunocytochemical preparations show a strongly positive reaction of the neoplastic cells to a high-molecular-weight keratin antibody. There is no reaction to antibodies against vimentin and leukocyte common antigen (CD45). Which of the following is the most likely diagnosis?
    A)Adenocarcinoma
    B)Malignant melanoma
    C)Non-Hodgkin lymphoma
    D)Sarcoma
    E)Squamous cell carcinoma
    75 years.. painless mass to left upper anterior neck; appears like it's been replaced with cancer... don't GI cancers travel to the Left side (Virchow's nodes)? am thinking that the answer is A..; thought that it could be C but it's more likely would be Hodgkin's than Non-Hodgkin's... so I'm sticking to A: Adenocarcinoma...

    32. A 78-year-old man comes to the physician because of progressive swelling of the right side of his face and neck and his right upper extremity. His right jugular vein is engorged. Which of the following diagnoses is most likely to be confirmed on an x-ray of the chest?
    A)Aortic arch aneurysm
    B)Mass in the upper lobe of the right lung
    CRight cervical rib
    D)Right pneumothorax
    E)Thoracic duct blockage in the posterior mediastinum
    Answer: E, why? I'm just thinking... that is the best answer for the symptoms presentation


    48. A 28-year-old woman with AIDS has chronic diarrhea of unknown origin. After the failure of typical treatment approaches, subcutaneous injections of octreotide are begun. Which of the following best describes the therapeutic benefit of this structure analogy of somatostatin as compared with native somatostatin?
    A)Decreased lipid solubility
    B)Decreased volume of distribution
    C)Delayed onset of action
    DIncreased bioavailability
    E)Prolonged duration of action

    Answer: E.. Ostreolide is more potent than the natural somatostatin

    50. A 54-year-old man is brought to the emergency department because of a 2-week history of progressive shortness of breath with exertion and leg swelling. He now requires two pillows for sleeping because of shortness of breath when lying flat. He has had a 4.5-kg (10-lb) weight gain during this period. He has a 15-year history of type 2 diabetes mellitus and hypertension that are poorly controlled despite treatment with a variety of medications. Two months ago, he began receiving a new diabetic medication that has been titrated upward during the past month. Crackles are heard at the lung bases bilaterally. Cardiac examination shows an S3 gallop. There is 2+ peripheral edema of the lower extremities. Which of the following medications is the most likely cause of the new symptoms in this patient?
    A)Acarbose
    B)Glyburide
    C)Metformin
    D)Repaglinide
    E)Rosiglitazone
    Answer: B; am not sure on this one....


    21. Two hours after the onset of chest pain, a 48-year-old man comes to the emergency department. An ECG indicates acute myocardial ischemia. He receives tissue plasminogen activator as thrombolytic therapy. Which of the following adverse effects is most likely?
    A)Acute allergic reaction
    B)Hemorrhagic stroke
    CHypertensive crisis
    D)Pulmonary embolus
    E)Tonic-clonic seizure
    Answer: B


    33. A 26-year-old woman with stable asthma wheezes when exposed to cats. Which of the following is the most appropriate prophylactic therapy?
    A)Inhaled cromolyn
    B)Inhaled ipratropium
    C)Oral cimetidine
    D)Oral corticosteroids
    E)Oral theophylline
    Answer: A.. cromolyn is the BEST for prophylaxis...


    34. The largest proportional increase in left ventricular afterload and myocardial oxygen consumption is most likely to occur following a 20% increase in which of the following?
    A)Aortic pressure
    B)Coronary blood flow
    C)Heart rate
    D)Right atrial pressure
    E)Stroke volume
    It can't be stroke volume b/c if afterload increases, stroke volume would decrease; Anwers B, C, and D would not be directly affected by the Left Ventricular afterload... leaving A.. so my answer is A: Aortic pressure.


    45. A previously healthy 63-year-old man comes to the physician because of difficulty starting urination, decreased force and size of the urine stream, and dribbling when he tries to stop urinating. Cystoscopy shows hypertrophy and thickening of the bladder wall and dilation of the ureters. If untreated, which of the following sequelae is most likely?
    A)Renal papillary necrosis
    B)Retroperitoneal fibrosis
    C)Transitional cell carcinoma of the bladder
    D)Urethral diverticulum
    E)Urinary tract infection
    Renal papillary necrosis, Retroperitoneal fibrosis, and transitional cancer of bladder are from other causes, leaving the answers D and E... most likely the answer will be E.


    47. Which of the following is the role of iodine in the biosynthesis of thyroxine (T4)?
    A)It activates a membrane transporter that increases the import of tyrosine
    B)It is added to tyrosine residues in thyroglobulin in the first step of T4 biosynthesis
    C)It is covalently bound to free tyrosine to form T4
    D)It is an essential cofactor for thyroperoxidase
    Answer: B, why? remember from kaplan... that tyrosine residues can take up a max of 2 iodines.. and the final product is T4


    49. An otherwise healthy 80-year-old man is scheduled for endoscopy for evaluation of rectal bleeding. A standard dose of midazolam is administered intravenously when the patient is admitted to the endoscopy suite. A few minutes later, he develops cyanosis and labored respirations and requires ventilation with an oxygenated resuscitation bag. An age-related increase in which of the following is the most likely cause of these adverse effects?
    A)Enterohepatic recycling
    B)Metabolite formation
    C)Plasma protein binding
    D)Sensitivity to sedatives
    E)Volume of distribution
    Answer: E, why? the effects of Midazolam are increased in the elderly plus they need time for recovery from the sedation.... meaning that volume of distribution is increased (believe that my thinking is right on this... need help from fellow VMDers.... )


    13. A 16-year-old girl is febrile and incoherent but able to indicate that she has severe lower abdominal pain. Pelvic examination shows a foul-smelling cervicovaginal discharge, and a septic abortion is suspected. Which of the following procedures is most appropriate for identifying the microbial agents causing her infection?
    A)Inoculation of anaerobic transport media at the bedside
    B)Inoculation of the specimen into tissue culture
    C)Quantitation of the bacteria in the discharge by using a calibrated inoculating loop
    D)Streaking a swab specimen onto Thayer-Martin media at the bedside
    E)Use of Löwenstein-Jensen and Sabouraud media for acid-fast bacteria and fungi, respectively
    I have no idea... b/c it could be aerobic and/or anaerobic bacteria; Thayer-Martin is for Neisseria; Lowenstein-Jensen for Mycobacterium and Nocardia; Sabouraud for fungi; and we want something quick... so I will answer A...


    32. A 34-year-old woman is brought to the emergency department after she collapsed when she returned from a nonstop flight from New Delhi to New York City. She has smoked 1 pack of cigarettes daily for 16 years. She is sexually active and uses an oral contraceptive. Her pulse is 125/min, and blood pressure is 75/50 mm Hg. Physical examination shows jugular venous distention. The lungs are clear to auscultation. Pulmonary artery catheterization shows a pulmonary systolic/diastolic arterial pressure of 50/25 mm Hg (N=15–30/3–12) and a pulmonary artery wedge pressure of 5 mm Hg (N=8–16). Which of the following is the most likely cause of her pulmonary hypertension?
    A)Decreased cardiac output
    B)Increased left atrial pressure
    C)Increased left ventricular diastolic pressure
    D)Increased pulmonary blood flow
    E)Increased pulmonary venous resistance
    F)Occlusion of left ventricular outflow tract
    G)Occlusion of pulmonary arteries
    H)Pericardial tamponade
    Remember Goljan speaking about this... smoking decreases the effects of oral contraceptives and increase the chance of blood clot, vein, and heart problems... and this person has been sitting on a flight with little movement... smoking has already decreased cardiac output and coronary blood flow.... so my answer is A;


    40. A 6-year-old girl who is recovering from a severe "strep" throat is brought to the physician because her urine has had a "smoky" appearance several times in the past week. Urinalysis shows trace amounts of blood and protein. Which of the following cell types initiates the repair mechanism necessary to resolve the proteinuria and hematuria?
    A)Erythrocytes
    B)Juxtaglomerular cells
    C)Mesangial cells
    D)Plasma cells
    E)Polkissen
    F)Proximal tubule epithelial cells
    Juxtaglomerular cells is involved with the renin-angiotensin system; and remember from kaplan that polkissen cells may also be involved in the same system but it's unsure....; erythrocytes are red blood cells; plasma cells are mature B cells.. leaving answers C and F... and am guessing here but believe that the answer is C: Menangial cells... (have to look this one up)


    48. Triiodothyronine (T3) is more potent than thyroxine (T4) for the treatment of hypothyroidism because of which of the following?
    A)Active transport into target cells
    B)Greater accumulation in mitochondria
    C)Greater receptor affinity
    D)Higher oral bioavailability
    E)Longer plasma half-life
    T4 has the longer half-life b/c it binds more strongly to the protein.. but T3 binds more strongly to the receptor intracellularly when in the active form.. therefore the answer: C
    "SLAM-DUNK THE STEPS"

    “Peace, it does not mean to be in a place where there is no noise, no trouble, or no hard work…..it means to be in the midst of those things and still be calm in your
    heart.”

  5. #5
    Seentoomanyquestions Guest
    Quote Originally Posted by md90
    7. A 75-year-old man has a painless mass in the left upper anterior neck. Examination of tissue obtained on biopsy shows partial replacement of a lymph node by a neoplasm; the neoplasm is composed of cohesive sheets of polygonal cells with granular eosinophilic cytoplasm, prominent intercellular bridges, and pleomorphic round nuclei. Immunocytochemical preparations show a strongly positive reaction of the neoplastic cells to a high-molecular-weight keratin antibody. There is no reaction to antibodies against vimentin and leukocyte common antigen (CD45). Which of the following is the most likely diagnosis?
    A)Adenocarcinoma
    B)Malignant melanoma
    C)Non-Hodgkin lymphoma
    D)Sarcoma
    E)Squamous cell carcinoma
    75 years.. painless mass to left upper anterior neck; appears like it's been replaced with cancer... don't GI cancers travel to the Left side (Virchow's nodes)? am thinking that the answer is A..; thought that it could be C but it's more likely would be Hodgkin's than Non-Hodgkin's... so I'm sticking to A: Adenocarcinoma...
    Isn't keratin a marker for s.c.c?

    Quote Originally Posted by md90
    50. A 54-year-old man is brought to the emergency department because of a 2-week history of progressive shortness of breath with exertion and leg swelling. He now requires two pillows for sleeping because of shortness of breath when lying flat. He has had a 4.5-kg (10-lb) weight gain during this period. He has a 15-year history of type 2 diabetes mellitus and hypertension that are poorly controlled despite treatment with a variety of medications. Two months ago, he began receiving a new diabetic medication that has been titrated upward during the past month. Crackles are heard at the lung bases bilaterally. Cardiac examination shows an S3 gallop. There is 2+ peripheral edema of the lower extremities. Which of the following medications is the most likely cause of the new symptoms in this patient?
    A)Acarbose
    B)Glyburide
    C)Metformin
    D)Repaglinide
    E)Rosiglitazone
    Answer: B; am not sure on this one....
    Not 100% sure but the glitazones are associated with edema.

    Quote Originally Posted by md90
    3. A 16-year-old girl is febrile and incoherent but able to indicate that she has severe lower abdominal pain. Pelvic examination shows a foul-smelling cervicovaginal discharge, and a septic abortion is suspected. Which of the following procedures is most appropriate for identifying the microbial agents causing her infection?
    A)Inoculation of anaerobic transport media at the bedside
    B)Inoculation of the specimen into tissue culture
    C)Quantitation of the bacteria in the discharge by using a calibrated inoculating loop
    D)Streaking a swab specimen onto Thayer-Martin media at the bedside
    E)Use of Löwenstein-Jensen and Sabouraud media for acid-fast bacteria and fungi, respectively
    I have no idea... b/c it could be aerobic and/or anaerobic bacteria; Thayer-Martin is for Neisseria; Lowenstein-Jensen for Mycobacterium and Nocardia; Sabouraud for fungi; and we want something quick... so I will answer A...
    foul-smelling is a clue for anarobes.

    Quote Originally Posted by md90
    32. A 34-year-old woman is brought to the emergency department after she collapsed when she returned from a nonstop flight from New Delhi to New York City. She has smoked 1 pack of cigarettes daily for 16 years. She is sexually active and uses an oral contraceptive. Her pulse is 125/min, and blood pressure is 75/50 mm Hg. Physical examination shows jugular venous distention. The lungs are clear to auscultation. Pulmonary artery catheterization shows a pulmonary systolic/diastolic arterial pressure of 50/25 mm Hg (N=15–30/3–12) and a pulmonary artery wedge pressure of 5 mm Hg (N=8–16). Which of the following is the most likely cause of her pulmonary hypertension?
    A)Decreased cardiac output
    B)Increased left atrial pressure
    C)Increased left ventricular diastolic pressure
    D)Increased pulmonary blood flow
    E)Increased pulmonary venous resistance
    F)Occlusion of left ventricular outflow tract
    G)Occlusion of pulmonary arteries
    H)Pericardial tamponade
    Remember Goljan speaking about this... smoking decreases the effects of oral contraceptives and increase the chance of blood clot, vein, and heart problems... and this person has been sitting on a flight with little movement... smoking has already decreased cardiac output and coronary blood flow.... so my answer is A;
    She is hypercoagulable due to the smoking, contraceptives. On top of that she developed a DVT thanks to the venous stasis on the flight. And then she she threw a clot. Result PE. G)

    Quote Originally Posted by md90
    49. An otherwise healthy 80-year-old man is scheduled for endoscopy for evaluation of rectal bleeding. A standard dose of midazolam is administered intravenously when the patient is admitted to the endoscopy suite. A few minutes later, he develops cyanosis and labored respirations and requires ventilation with an oxygenated resuscitation bag. An age-related increase in which of the following is the most likely cause of these adverse effects?
    A)Enterohepatic recycling
    B)Metabolite formation
    C)Plasma protein binding
    D)Sensitivity to sedatives
    E)Volume of distribution
    Answer: E, why? the effects of Midazolam are increased in the elderly plus they need time for recovery from the sedation.... meaning that volume of distribution is increased (believe that my thinking is right on this... need help from fellow VMDers.... )
    Not sure, but I think it is D)

  6. #6
    Seentoomanyquestions Guest
    Originally Posted by md90
    7. A 75-year-old man has a painless mass in the left upper anterior neck. Examination of tissue obtained on biopsy shows partial replacement of a lymph node by a neoplasm; the neoplasm is composed of cohesive sheets of polygonal cells with granular eosinophilic cytoplasm, prominent intercellular bridges, and pleomorphic round nuclei. Immunocytochemical preparations show a strongly positive reaction of the neoplastic cells to a high-molecular-weight keratin antibody. There is no reaction to antibodies against vimentin and leukocyte common antigen (CD45). Which of the following is the most likely diagnosis?
    A)Adenocarcinoma
    B)Malignant melanoma
    C)Non-Hodgkin lymphoma
    D)Sarcoma
    E)Squamous cell carcinoma
    75 years.. painless mass to left upper anterior neck; appears like it's been replaced with cancer... don't GI cancers travel to the Left side (Virchow's nodes)? am thinking that the answer is A..; thought that it could be C but it's more likely would be Hodgkin's than Non-Hodgkin's... so I'm sticking to A: Adenocarcinoma...

    Isn't Virchow's node supraclavicular, not anterior neck?

  7. #7
    md90's Avatar
    md90 is offline Senior Member
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    Thank you for your response.... will look into those questions...
    "SLAM-DUNK THE STEPS"

    “Peace, it does not mean to be in a place where there is no noise, no trouble, or no hard work…..it means to be in the midst of those things and still be calm in your
    heart.”

  8. #8
    Seentoomanyquestions Guest
    Did some research on the midazolam question.

    http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

  9. #9
    marceverett is offline Junior Member 510 points
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    so we are going with increased sensitivity to benzos?

    "Likewise, mean concentration at half-maximal effect for sedation was lower (p = 0.025) among older patients (20.5 +/- 2.2 ng/ml) than among younger (29.7 +/- 6.6 ng/ml) patients."

    VD would affect duration of effect, probably not so much that he was laid-out immediately. Same with metabo effects, I doubt Versed has any active metabolites and if it does, they have to be short lived as well or else the drug wouldnt be the therapy of choice for short procedures.

  10. #10
    Seentoomanyquestions Guest
    http://www.asahq.org/clinical/geriatrics/safe.htm

    Midazolam and fentanyl are a common combination used for conscious sedation. Due to increased sensitivity in the elderly and decreased clearance of these agents, smaller doses and more delayed increments must be used.

    http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

    However, the sedative effects were much more pronounced in the elderly and this population demonstrated a significantly higher CNS-sensitivity to midazolam. All physicians should be aware that for various reasons drug response can be age-dependent and therefore more PK-PD data are needed for the elderly.

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