NBME 24 Explanations PDF

hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Sect...

hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 1 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 57 min 11 sec 1. A 40-year-old woman with a 25-year history of type 1 diabetes mellitus has a serum creatinine concentration of 2.5 mg/dl. A creatinine clearance test is ordered to determine the glomerular filtration rate. This test is limited, compared to an inulin clearance test, because of which of the following properties of creatinine? CJ A) Actively pumped into the distal convoluted tubule B) Crosses freely into the loop of Henle C) Reabsorbed into the collecting duct U D) Secreted by the proximal tubule D. Page 570 (636) of FA2019. GFR = Clearance of inulin. Normal GFR = 100 mL/min Creatinine clearance overestimates GFR because creatinine is excreted by tubules. Remember the definitions. The afferent arteriole brings many nutrients and substances to the glomerulus, where filtration happens based on pressures. Then along the tubule, some things are reabsorbed (all sugar, proteins, etc in PCT), while some things are secreted (PAH). Everything that was filtered and secreted gets excreted (clearance). Inulin is neither reabsorbed nor secreted so it is freely filtered and best indicates GFR. Creatinine is secreted by the kidney, so it overestimates GFR. ~ ~ p , ,.,,. Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 2 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 57 min 19 sec 2. A 10-year-old boy who was adopted from the Democratic Republic of Congo 2 weeks ago is brought to the physician for an initial examination. He appears slim, has thin extremities, and is in no distress. His temperature is 37.3°C (99.1 °F), pulse is 100/min, respirations are 20/min, and blood pressure is 118/68 mm Hg. The lungs are clear, and heart sounds are normal. The abdomen is soft and nontender, and there is no hepatosplenomegaly. There are four 0.5-mm, firm , nontender nodules: two over the right iliac crest, one on the left thigh, and one on the left knee. Examination of a skin snip from one of the nodules shows microfilariae. Which of the following is the most likely vector of this patient's infection? A) Black fly B) Bodylouse A. Page 159 (164) FA2019 u C) Cu/ex species mosquito Onchocerca volvulus by the female black fly. U D) lxodes species tick The other answer chocies are generally related to bacteria or unrelated to any nematodes. E) Reduviid bug This child is presenting with practically no symptoms besides the four black skin nodules indicative of O volvulus. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 3 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 57 min 28 sec 3. A 3-year-old girl is brought to the physician for a well-child examination. She has had a flat purplish lesion that measures 2.1 cm in diameter on the right side of her face since birth. The lesion shows large cavernous vascular channels. Which of the following is the most likely outcome of the lesion? CJ A) Concurrent congenital heart disease B) Local invasion C) Malignant degeneration U D) Necrosis and scarring E) Spontaneous regression E. Page 467 (525) FA2019. Nevus simplex. Not in First Aid. This is not a Strawberry Hemangioma, which would be raised or nodular. But if you did think it is a strawberry hemangioma, then that also regresses. This patient has a nevus simplex. Another similar lesion is a stork bite (port-wine stain). These lesions disappear/regress by age 5-6 years. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 4 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 57 min 49 sec 4. At 2:00 AM , after sleeping for 5 hours, a 32-year-old man with type 2 diabetes mellitus has a decrease in serum glucose concentration to 37 mg/dl. In response to the hypoglycemia, cortisol secreted by the adrenal cortex induces the synthesis of which of the following enzymes in the adrenal medulla? CJ A) Acetyl-CoA carboxylase B) Homocysteine methyltransferase C) Methionine adenosyltransferase U D) Methylmalonyl-CoA racemase E) Phenylethanolamine N-methyltransferase E. Page 83 FA2019. This question is a simple biochemistry question regarding mechanisms of managing hypoglycemia. Cortisol is one of the defenses against hypoglycemia. The question asks for an enzyme in the adrenal medulla, which synthesizes NE and Epi. Choice E is the only relevant enzyme. It works with SAM to convert NE to Epi and is upregulated by cortisol. You should know exactly what the other enzymes are for. Acetyl-CoA carboxylase is the first enzyme for fatty acid synthesis and takes Acetyl CoA and yields Malonyl CoA. Choice B is related to homocysteine becoming methionine and is related to homocystinuria. Choice C is a relevant enzyme because it makes the SAM that PMNT uses it is not upregulated by cortisol. Choice D, a "racemase" is probably an enzyme youve never heard of. It is an epimerase involved in fatty acid and amino acid breakdown. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 5 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 57 min 59 sec 5. A 25-year-old woman takes an overdose of barbiturates and is found unresponsive several hours later by her husband. She is comatose and undergoes endotracheal intubation and placement on a mechanical ventilator. Three weeks later, she opens her eyes spontaneously and has roving conjugate eye movements. She has no purposeful responses to stimuli. Brain stem reflexes remain intact. An EEG is diffusely slow without evidence of cortical reactivity. The patient has signed a living will and, consistent with its directives, her husband requests that mechanical ventilation be discontinued. Which of the following is the most appropriate next step in patient care? A) Extubate the patient and discontinue mechanical ventilation; do cardiopulmonary resuscitation if her heart stops beating B) Extubate the patient and discontinue mechanical ventilation; make no attempt to do cardiopulmonary resuscitation in case of cardiac or respiratory failure u C) Extubate the patient and discontinue mechanical ventilation; reintubate the patient if spontaneous respirations cease U D) Obtain a court order to maintain mechanical ventilation E) Refer the case to the hospital ethics committee B Very simple and straightforward. Patient is unresponsive, has no EEG activity, and no purposeful movement. The question states "consistent with its directives" so her husband is simply requesting what the patient wanted. The patient does not have a DNI or DNR since she was intubated. She must just be allowed to die rather than sustaining her body alive. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 6 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 58 min 9 sec 6. A 63-year-old woman undergoes operative repair of a leaking berry aneurysm in the circle of Willis. Two days later, a CT scan of the head shows a widening of the subarachnoid space. Which of the following changes in cerebrospinal fluid is the most likely cause of this finding? CJ A) Decreased absorption by the choroid plexus B) Decreased movement through the arachnoid villi C) Decreased movement through the cerebral aqueduct U D) Increased absorption by the choroid plexus E) Increased movement through the arachnoid villi F) Increased production by the choroid plexus B. Page 510 (570) and page 491 (571). This patient has a communicating hydrocephalus, as is evident by the fact that there is no obstruction that is impeding the CSF flow. The patient has a widening of the subarachnoid space because the arachnoid granulations are not absorbing the CSF, most likely due to inflammatory injury. Blood is inflammatory. Her leaking aneurysm has caused inflammation and damaged the arachnoid granulations. The arachnoid granulations absorb CSF and send it to the dural venous sinuses, which empty into the internal jugular vein. The other choices also do not make much sense. The choroid plexus does not absorb CSF, it produces CSF. Choice C is indicative of a noncommunicating (obstructive) hydrocephalus. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 7 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 58 min 34 sec 7. A 23-year-old woman is brought to the emergency department because of shortness of breath for 2 weeks. Her respirations are 28/min. Physical examination shows no other abnormalities. Laboratory studies show: Serum Na+ 135 mEq/L K+ 4.0 mEq/L c1- 110 mEq/L Hco3- 15 mEq/L Arterial pH on room air 7.25 Urine Sodium 20 mEq/L Chlorine 30 mEq/L Potassium 15 mEq/L Which of the following is the most likely diagnosis? A) Alcoholic ketoacidosis E. Page 580 (649) FA2019. B) Crohn disease This patient has a non-anion gap metabolic acidosis that she is immediately compensating for with hyperventilation. CJ C) Diabetic ketoacidosis You can remove A, C, D, and F since those are part of the MUDPILES. D) Lactic acidosis Choice B would present with malabsorption symptoms. E) Renal tubular acidosis IBD patients tend to have reduced Na and Cl absorption and increased K secretion. F) Salicylate poisoning , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 8 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 56 min 59 sec 8. A 30-year-old woman comes to the physician because of a 2-week history of right flank pain. Her blood pressure is 168/98 mm Hg. Physical examination shows a 7-cm mass that is palpated in the right side of the abdomen. A CT scan shows a mass in the retroperitoneal space on the right side that is compressing the renal artery. If the perfusion pressure to the affected kidney is decreased, but glomerular filtration rate and renal plasma flow remain unchanged, which of the following mechanisms mediates the autoregulation in the renal arterioles in this patient? A) Decreased afferent and efferent arteriolar resistance B) Decreased afferent arteriolar resistance u C) Decreased efferent arteriolar resistance U D) Increased afferent and efferent arteriolar resistance E) Increased afferent arteriolar resistance B. Page 571 (638) and page 295 (317) FA2019 Glomerular dynamics and autoregulation are high-yield. For the kidney there are myogenic and tubuloglomerular feedback mechanisms of autoregulation. The myogenic mechanism is where the afferent arteriole controls blood flow purely based off of blood pressure entering the kidney. The tubuloglomerular feedback mechanism involves the JGA and a paracrine signaling mechanism utilizing ATP, adenosine, and NO. For our patient, there is decreased blood entering the renal artery. They also mention that the autoregulatory mechanism will preserve GFR and RPF. If you constrict either arteriole, you will alter the GFR and the RPF, so delete choices D and E. Afferent arteriole dilation (usually caused by prostaglandins, PDA) usually increases GFR and RPF but since perfusion into the kidney is reduced, nothing will be severely altered. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 9 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 56 min 52 sec 9. A male newborn is delivered in the hospital at 40 weeks' gestation to a 31-year-old primigravid woman following an uncomplicated spontaneous vaginal delivery. The mother immigrated to the USA from Brazil at 20 weeks' gestation. At 8 weeks' gestation, she was evaluated because of a 1-month history of low-grade fever, marked fatigue, and diffuse lymphadenopathy. Her symptoms resolved spontaneously, and she received no treatment. At that time, test results for Epstein-Barr virus and cytomegalovirus were negative. The mother's only medication was a prenatal vitamin. The newborn is 33 cm (13 in; 25th percentile) long and weighs 2438 g (5 lb 6 oz; 35th percentile); head circumference is 31 cm (12 in; 3rd percentile). Temperature is 37.0°C (98.6°F), pulse is 120/min, respirations are 18/min, and blood pressure is 80/50 mm Hg. Eye examination shows chorioretinitis. CT scan of the head shows hydrocephalus and cranial calcifications. This newborn's congenital infection was most likely acquired by the mother via which of the following modes of transmission? U A) Contact with fomites B) Ingestion of undercooked meat C) Inhalation of air droplets u D) Kissing E) Tick bite B. Page 156 (161). Toxoplasma gondii. The mother is fine. The baby has the triad of chorioretinitis, hydrocephalus (head circumference is in 3rd percentile), and intracranial calcifications. In the USA, ingestion of undercooked pork is the most likely answer choice. Oocysts in cat feces are dangerous so pregnant women should avoid cat litter. But even if contact with cat litter is an answer choice, cysts in meat is the most common route of infection and more likely. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 10 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 56 min 44 sec 10. A 53-year-old woman comes to the physician because of a 2-week history of fainting precipitated by exercise and intermittent substernal chest pain that is relieved by rest. Her blood pressure is 120/80 mm Hg. Cardiac examination shows a prominent left ventricular impulse. A late-peaking, harsh midsystolic murmur is heard best at the second right intercostal space with radiation to the carotid arteries bilaterally. An ECG shows evidence of left ventricular hypertrophy. Angiography shows no coronary artery lesions. Which of the following is the best explanation for the syncope? A) Coronary artery compression by hypertrophic left ventricular myocardium B) Coronary artery spasm u C) Fixed cardiac output in spite of increased demand U D) Mitral valve prolapse E) Vasopressor-induced hypotension C. Page 289 (308) FA2019). The midsystolic murmur that radiates to the carotid arteries bilaterally is indicative of aortic stenosis. The SAD symptoms of syncope, angina, and dyspnea are a result of not being able to increase CO when there is demand. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 11 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 56 min 36 sec 11. A 4 7-year-old man comes to the physician because of abdominal enlargement and rectal bleeding for 3 days. He drinks approximately twelve 12-ounce cans of beer daily. Physical examination shows scleral icterus and bleeding internal hemorrhoids. Increased pressure in which of the following veins is the most likely cause of the hemorrhoids in this patient? CJ A) Inferior rectal vein B) Inferior vena cava E. Page 360 (401) FA2019. C) Internal pudenda! vein This patient has internal hemorrhoids, which are above the pectinate line. That area has the superior rectal vein (suprior above). U D) Middle rectal vein Below the pectinate line are external painful hemorrhoids, which have the inferior and middle rectal veins (inferior below). Easy. E) Superior rectal vein , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 12 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 56 min 27 sec 12. A new screening test for colon cancer is done in 86 patients with colon cancer and 124 persons who do not have colon cancer. The results are shown: Colon Cancer Present Absent Positive 67 6 73 Test Results Negative 19 118 137 86 124 210 The specificity of the test is which of the following? C. Page 257 (268) FA2019. Very straightforward question with an ideal table. A) 67/73 = 92% Plug and chug. U B) 67/86 = 78% C) 118/124 = 95% Specifcity is the TNrate, which is 1- FPrate, which is TN/(TN + FP). D) 118/137 = 86% 118/ (118+6) = 118/124 = 95% E) 137/210 = 65% , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 13 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 56 min 13 sec 13. A clinical study is designed to evaluate the association of caffeine consumption and pancreatic cancer. In this study, alpha is set at 0.05 and beta at 0.10. Wh ich of the following best describes the likelihood of missing an association between caffeine consumption and pancreatic cancer in this study? CJ A) 5% B) 10% B. Page 262 (274) FA2019. The "likelihood of missing an association" is a false-negative. Stating there is no effect or difference when there reall yis one is beta. C) 85% Type 2 error is the beta value itself, 0.10 which is 10%. Very straightforward question. U D) 90% E) 95% Do not confuse this with power, which is 1-beta, and that would be 90% here. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 14 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 56 min 5 sec 14. A 68-year-old woman comes to the emergency department 2 hours after she vomited blood. Three weeks ago, she began pharmacotherapy after experiencing a vertebral compression fracture secondary to osteoporosis. Her temperature is 36.8°C (98.2°F), pulse is 104/min, respirations are 16/min, and blood pressure is 110/60 mm Hg. Physical examination shows mild epigastric tenderness. Endoscopy shows multiple lower esophageal erosions. Which of the following medications is the most likely cause of the hematemesis? A) Alendronate A. Page 475 (533) FA2019. B) Calcitonin Bisphosphonates have significant side effects such as esophagitis, osteonecrosis of the jaw, and atypical femoral stress fractures. u C) Calcium carbonate It is important to take this medication with abundant water and to remain upright after taking it. U D) Conjugated estrogens E) Raloxifene 0 F) Sodium fluoride , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 15 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 55 min 58 sec 15. A 33-year-old woman at 34 weeks' gestation has a grade 2/6 systolic ejection murmur heard at the second intercostal space. The remainder of the physical examination is unremarkable. The best explanation for this finding is an increase in which of the following? CJ A) Blood pressure E. Page 305 ( 331) FA2019. B) Peripheral vascular resistance Pregnancy is one of the risk factors for dilated cardiomyopathy. C) Pulmonary vascular resistance There is no problem with her valves or blood pressure (A and B are the same answer). U D) Pulse An increase in pulse or HR would not cause a murmur. And she does not have pulmonary HTN (choice C). E) Stroke volume Dilated cardiomyopathy increases stroke volume. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 16 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 55 min 46 sec 16. A 27-year-old man sustains a spinal cord transection at C-8 in a skiing accident. In which of the following situations is he most likely to be able to achieve and sustain an erection? A) Erotic dreams U B) Penile stimulation U C) Reading erotic literature D) Testosterone injections E) Viewing erotic material B. Page 612 (689) FA2019. Also -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896089/ The physiology of an erection involves cerebral control, autonomic control, and molecular mechanisms. Cerebrally controlled erections are induced by erotic visual stimuli or thoughts, which is related to choices A, C, and E. The medial preoptic area (memorized as medial penis area and the penis is medial) and paraventricular nucleus of the hypothalamus are the main structures involved. Dopamine is the most important brain neurotransmitter for an erection, most likely through its stimulation of oxytocin release. Autonomic control is through parasympathetic stimulation and central suppression of the sympathetic nervous system. The sacral S2-S4 provide parasympathetic supply through the sacral reflex arc that mediates an erection through tactile penile stimulation, which would work in our patient. Patients with a lesion above T9 cannot maintain a psychogenic erection because central suppression to the sympathetic stimulation is necessary for that. Patients with sacral spinal cord injury may maintain a psychogenic erection but it will be weaker than normal. The molecular control is through NO such as through the use of viagra. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 17 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 55 min 37 sec 17. A 40-year-old man comes to the physician because of a 6-month history of constipation and weakness. He has a family history of colorectal carcinoma in multiple members of both sexes. Physical examination shows no abnormalities. Laboratory studies show a hemoglobin concentration of 10 g/dl, hematocrit of 32%, and mean corpuscular volume of 73 µm 3. A colonoscopy is done, and a lesion is found. A photograph of a section of the colon removed during subsequent colectomy is shown. Analysis shows mutations in the MHS2 gene. Which of the following is the most likely diagnosis? U A) Familial adenomatous polyposis B) Fanconi anemia U C) HNPCC syndrome D) Li-Fraumeni syndrome E) Neurofibromatosis, type 1 F) Xeroderma pigmentosum C. Page 382 (425) of FA2019. First of all, they meant MSH2 (typo). This question is about Lynch syndrome, which usually has extensive family history. The 3-2-1 rule of 3 relatives in 2 generations with 1 being under 50 (such as the patient himself) will all have history of CRC. The most important thing here is that this is NON-POLYPOSIS so there will be no polyps. The gross image is a beautiful example of what would appear as an "apple core" lesion on barium enema x-ray. HNPCC is related to endometrial, ovarian, and skin cancers and there are many genes involved such as MSH2, MLH1, MSH6, and PMS2. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 18 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 55 min 26 sec 18. A 22-year-old woman comes to the physician because of nausea and vomiting for 1 week. She has a 6-month history of headaches. She works as a data entry technician and has recently found it difficult to focus on the text. She also has had trouble looking up from her desk at the clock on the wall without moving her head. Neurologic examination shows marked vertical gaze palsy and impaired accommodation. Horizontal gaze is normal. An MRI of the brain is most likely to show a tumor at which of the following locations? A) Arcuate nucleus B) Frontal cortex C) Pineal gland D) Pituitary gland E) Pontine paramedian reticular formation C. Page 516 (576) FA2019. This patient is presenting with Parinaud syndrome, which has a vertical gaze palsy due to compression of the tectum. She most likely has a pinealoma. This is a very straightforward and simple question. In males, this can lead to precocious puberty and they would have elevated hCG because this is similar to germ cell tumors like a seminoma. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 19 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 55 min 7 sec 19. In a study of antibiotic resistance, a strain of Escherichia coli resistant to ampicillin but sensitive to streptomycin is cultured with a strain of Salmonella enteritidis sensitive to ampicillin but resistant to streptomycin. After 4 hours of cocultivation, the broth is plated onto solid medium containing both ampicillin and streptomycin. S. enteritidis bacteria that are resistant to both antibiotics grow at a frequency of one per 100 cells. Which of the following is the most likely mechanism of the acquisition of ampicillin resistance by the S. enteritidis? A. Page 130 FA2019. A) Conjugation Conjugation is when two bacteria mate through a conjugal bridge and transfer a plasmid from one to the other. B) Gene duplication Here the E coli is resistant to ampicillin and the Salmonella is resistant to streptomycin. They are cultured together. U C) Point mutation Now the Salmonella is resistant to both antibiotics. This is because the E coli gave its ampicillin resistance plasmid to the Salmonella. U D) Transduction E) Transposition Gene duplication and point mutation are irrelevant. Transduction involves a virus. Transposition is an event that occurs within the same one bacteria, not between 2 different bacteria. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 20 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 59 sec 20. A 15-month-old boy is brought to the physician by his mother because of a 9-month history of recurrent bacterial infections. The patient has not had recurrent viral infections. He is at the 10th percentile for length and weight. Physical examination shows multiple areas of honey yellow, crusted lesions over the lower extremities. A Gram stain of one of the lesions shows many gram-positive cocci in clusters but no leukocytes. Laboratory studies show no abnormalities except for a leukocyte count of 30,000/mm3. This patient most likely has a rare autosomal recessive disease leading to a lack of CD18 expression. The leukocytes would be deficient in which of the following characteristics? A) Cytokine production E. Page 117 FA2019. B) Helper T-cell function This patient has LAD1, a deficiency in LFA1 integrin CD18. Autosomal recessive. u C) lmmunoglobulin gene rearrangement Patients present with recurrent skin and mucosal bacterial infections due to phagocyte dysfunction. U D) Killing of intracellular bacteria There is impaired migration and chemotaxis. Delayed separation of the umbilical cord is usually a notable problem. E) Migration , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 21 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 52 sec 21. A 10-year-old girl is brought to the physician by her mother because of increased hair growth on her face and increased muscle mass during the past 3 months. Breast development is Tanner stage 1, and pubic hair development is Tanner stage 5. Physical examination shows clitorimegaly. Pelvic examination shows a normal-appearing vagina. Serum studies show: Luteinizing hormone 0.8 mlU/mL (N=1.0-5.9) Dehydroepiandrosterone 6.2 nmol/L (N=5.2-19.8) Dehydroepiandrosterone sulfate 0.9 µmol/L (N=0.9-3.4) Testosterone 14 nmol/L (N=0.2-0.7) An unregulated increase in hormone production by which of the following types of cells is the most likely cause of this patient's hirsutism? A) Adrenal zona fasciculata cells B) Adrenal zona glomerulosa cells D. Page 632 (711) of FA2019. C) Ovarian follicle cells She has a SL tumor that resembles testicular histology and produces androgens, leading to virilization. D) Ovarian Sertoli-Leydig cells The patient's presentation is classic for this tumor. E) Pituitary acidophils Choices A (cortisol) and B (aldosterone) are irrelevant and this patient does not have a CAH. F) Pituitary basophils Choices E (prolactin and GH) and F (FLAT) are irrelevant and this patient does not have a pituitary adenoma. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 22 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 45 sec 22. A 45-year-old man is brought to the emergency department 2 hours after the sudden onset of severe pain in the left flank that awakened him from sleep. He reports that the pain moved over the next 30 minutes to the left lower abdomen and now is principally localized in the scrotum. Physical examination shows no palpable masses in the abdomen or the scrotum. There is no rebound tenderness of the abdominal wall. Which of the following is the most likely cause of the pain? A) Appendicitis B) Carcinoma of the testis C) Diverticulitis of the descending colon D) Renal calculi in the left ureter E) Testicular torsion D. Pretty obvious. The pain was of sudden-onset. It started in the left flank and moved to the scrotal area because the stone travelled to the penis. No palpable masses in the abdomen or scrotum rules out any tumors. No rebound tenderness rules out anything related to the appendix. Classic "loin to groin" pain of nephrolithiasis. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 23 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 38 sec 23. A 38-year-old woman , gravida 4, para 4, comes to the physician because of a 6-month history of urinary incontinence when sneezing and coughing. Physical examination shows normal-appearing female external genitalia. When the patient is asked to perform a Valsalva maneuver, leakage of urine from the urethra is detected. She is given instructions to perform Kegel exercises to strengthen the muscles of the perineum. Which of the following muscles in this patient is most likely to remain unaffected by the exercises? A) Bulbospongiosus B) Deep transverse perinea! muscle C) External urethral sphincter D) Internal anal sphincter E) lschiocavernosus D. Page 588 (660) FA2019. This patient has stress incontinence, as is evident from her urine leakage after extensive intra-abdominal pressure from a cough or sneeze. The problem is due to urethral hypermobility or the intrinsic urethral sphincter. Kegel exercises strengthen the pelvic floor. The main targets for treatment are the levator ani muscles; iliococcygeus, pucococcygeus, & puborectalis. Pessaries are another treatment option. Regardless, any exercise will generally strengthen skeletal muscle. The internal anal sphincter is smooth muscle under autonomic control. It will not strengthen from exercise. The external anal sphincter, on the other hand, is under pudendal nerve control (feces leakage during delivery) and would strengthen from exercise. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 24 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 29 sec 24. A 1-week-old newborn is brought to the physician because of poor feeding , vomiting, and progressive lethargy during the past 4 days. She was born at term ; pregnancy, labor, and delivery were uncomplicated, and she had no congenital anomalies. She is being breast-fed. She has a healthy 2-year-old brother; a sister died at the age of 10 days after a full-term birth. Physical examination shows decreased muscle tone and poor responsiveness; reflexes are normal. Her serum bicarbonate concentration is 8 mEq/L, pH is 7.15, and plasma ammonia concentration is 10 times the upper limit of normal. Which of the following is the most likely cause? A) Mitochondrial disorder B) Mucopolysaccharidosis disorder u C) Organic acid metabolism disorder U D) Renal tubular acidosis E) X-linked leukodystrophy C. Page 82 and 85 FA2019. Page 85 of FA2020. This patient has hyperammonemia. Everything else is alright though. This is most likely some organic acid metabolism issue. There are plenty, like propionic acidemia, methylmalonic acidemia, etc. In methylmalonic acidemia patients have hypoglycemia (accumulation of methylmalonate inhibits gluconeogenesis), ketosis (to make up for hypoglycemia), and hyperammonemia (accumulation of methylmalonate inhibits the urea cycle). , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 25 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 23 sec 25. A 45-year-old man comes to the physician because of a 3-day history of fever and muscle pain. He recently went on a hunting expedition to northern Canada, where he consumed polar bear meat. His temperature is 39.5°C (103.1 °F). Physical examination shows periorbital edema and muscle tenderness. Which of the following tests is most likely to establish the diagnosis? A) Eosinophil count E. Page 159 (164) FA2019. B) Examination of the stool for ova This patient has the classic symptoms of Trichinella spiralis. C) Gram stain of the stool The nematode travels the bloodstream and enters striated muscle. D) X-ray survey of large muscular masses E) Muscle biopsy , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 26 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 16 sec 26. A 71-year-old woman with non-Hodgkin lymphoma is diagnosed with lymphomatous meningitis. Her serum creatinine concentration is 2.3 mg/dl. A course of intrathecal methotrexate is planned. Intravenous administration of which of the following adjuvant agents is most appropriate for this patient? CJ A) Folic acid B) Leucovorin C) Vitamin B 1 (thiamine) U D) Vitamin 8 6 (pyridoxine) E) Vitamin C B. Page 432 (478). Methotrexate is a folic acid analog that competes with folate and prevents DHF reductase from making dTMP, inhibiting DNA synthesis to treat cancers. If you give these patients concomitant folic acid, it will not work since methotrexate will just compete with it. Leucovorin is 5-formyl-THF that works downstream from DHF reductase, bypassing the step that methotrexate inhibits. Leucovorin effectively works like folate and prevents the myelosuppression. In comparison, you must give leucovorin the patients taking 5FU because leucovorin increases the binding of 5FU with its target, thymidylate synthase. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 27 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 10 sec 27. A 55-year-old woman is brought to the physician by her husband because of a change in behavior during the past 2 days. Her husband says, "Yesterday, she didn't recognize a picture of her own mother." Neurologic examination shows that she has an inability to recognize objects unless she touches them or hears the sound that they make. These findings most likely indicate a lesion involving the area supplied by which of the following arteries? A) Anterior cerebral B) Anterior choroidal C) Lenticulostriate D) Posterior cerebral E) Thalamoperforating D. The patient is clearly having difficulty with visual association. She is seeing things but not sure what it is related to until touching it. This is prosopagnosia due to a PCA stroke. Since its a visual problem for the most part, but neurologic exam is fine otherwise, you can choose PCA. ACA has loss of sensation and paralysis in legs, while MCA has loss of sensation and paralysis in the face and arms. Lenticulostriate is related to the striatum and internal capsule and often has lacunar infarcts due to hypertension. Would just have paralysis. Anterior choroidal would have loss of sensation and paralysis also. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 28 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 54 min 5 sec 28. A 24-year-old woman who has diffuse toxic goiter (Graves disease) undergoes a partial thyroidectomy. Several months later, she develops muscle cramps, tetany, and hypocalcemia. Which of the following sets of laboratory findings in serum is most consistent with these findings? Parathyroid Phosphate Hormone 25-Hydroxyvitamin D A) i i l B) i l normal C) i l l D) l i normal E) l l l B. Page 330/360 discusses PTH. Page 341/373 discusses PTH disease. This patient's parathyroid glands were probably removed along with the thyroidectomy. PTH is phosphate trashing hormone, so without PTH the phosphate will be high. PTH is obviously gonna be low. Vitamin D is not related to PTH levels. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 29 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 53 min 56 sec 29. A 56-year-old man has a 3-year history of progressive memory loss followed by aphasia, visuospatial disorientation, and inappropriate behavior. His father died in a nursing home at age 65, 6 years after the onset of progressive dementia. His 55-year-old brother has had some difficulty remembering recent events and recalling familiar names. The patient dies 5 years after the onset of these symptoms. At autopsy, examination of the brain shows cerebral atrophy, predominantly in the mesial temporal and parietal cortices; in these areas there are neurofibrillary tangles , neuritic plaques, and marked neuronal loss. This disorder most likely indicates a mutation in a gene encoding for which of the following molecules? A) Amyloid A protein B) ~ 2-Microglobulin u C) Neurofilament protein U D) Presenilin D. Page 508/568. This patient has the familial form of Alzheimer's disease (neurofibrillary tangles of tau protein, neuritic plaques of beta amyloid, and neuronal loss due to cortical atrophy). The familial form is due to presenilin1 and 2 as well as APP. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 30 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 53 min 48 sec 30. A 60-year-old woman is receiving cisplatin therapy for advanced transitional cell bladder cancer. She develops paresthesias, and the medication is stopped. The medication likely damaged the largest cells in the region labeled "B" in the drawing of the spinal cord shown. The damage to these cells would most likely lead to which of the following motor signs? A) Babinski sign B) Clonus U C) Fibrillations 0 D) Hyporeflexia U E) Muscle atrophy D. Page 518/601. Area B is the dorsal root ganglion. This area carries afferents. This is basically what you check for with the knee jerk. Hence, that reflex would be missing in severe DRG damage. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 31 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 53 min 41 sec 31. A 30-year-old woman comes to the physician for follow-up treatment of chronic renal failure and normocytic, normochromic anemia. Following the administration of recombinant human erythropoietin, her hemoglobin concentration increases in part due to increased activity of 5-aminolevulinic acid (o-ALA) synthase in erythrocytes. This enzyme regulates the reaction involving the condensation of which of the following compounds? A) Acetate and hexacarboxylic porphyrinogen B) Ferrous ion and protoporphyrin C. Page 417/461. C) Glycine and succinyl CoA Very straightforward question about heme synthesis. D) Lysine and o-ALA The first step involving ALA synthase makes ALA by combining glycine and succinyl-CoA. E) Zinc and porphobilinogen , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=3f50c3c0-1874-400e-af3a-5036e79dec9f Exam Section 1: Item 32 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 53 min 35 sec 32. An investigator is studying an outbreak of Escherichia coli 0157:H7 among university students who had eaten at the on-site cafeteria. The investigators administer a food questionnaire to 100 students with E. coli 0157:H7 and 100 healthy control subjects. Two exposures emerge as possible concerns: cookies made from frozen commercial dough (odds ratio=6.0; p N-Acetylglutamate Ornithine Citrulline CoA-SHl(!l Acetyl CoA + glutamate Mitochondrial inner membrane Mitochondrial outer membrane Ornithine Citrulline C. Page 82 and 83 FA2019. This is a straightforward question on OTC deficiency. High orotate and hyperammonemia with a low BUN. AMP + PPj The excess carbamoyl phosphte upregulates pyrimidine synthesis, forming excess orotate. Arginine Argininosucc in ate Fumarate 0 A) B) u C) D) E) , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hf Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=54cd3e5f-e4bf-49d0-8371-ba261251f2a1 Exam Section 2: Item 1 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 59 min 50 sec 1. An 11-year-old boy is brought to the emergency department by ambulance with his mother 30 minutes after she was unable to awaken him from a nap. The mother states that he was recently diagnosed with type 1 diabetes mellitus and she has been having difficulty adjusting his insulin regimen. He is unconscious, and his breath smells of acetone. He is responsive only to sharp pain. A rapid test shows a serum glucose concentration greater than 500 mg/dl. Which of the following best explains this patient's altered state of consciousness? A) Altered affinity of oxygen from hemoglobin A 1c B) Diminished transport of glucose across the blood-brain barrier u C) Excess free fatty acids in the cerebrospinal fluid U D) Inability of neurons to perform glycolysis E) Intracellular and extracellular dehydration E. Page 346/379. This patient has diabetic ketoacidosis, which is most commonly seen in DM1 patients that missed their insulin. The body starts breaking down fats to increase ketogenesis, which is great for them. However, the extremely high glucose levels cause severe dehydration that can lead to delirium. The osmotic diuresis needs to be managed with IV fluids along with the IV insulin and K+. ~ ~ p, ,.,,. Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=54cd3e5f-e4bf-49d0-8371-ba261251f2a1 Exam Section 2: Item 2 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 59 min 35 sec 2. A researcher hypothesizes that exposure to more than 50 µg/L of arsenic in drinking water is associated with an increased risk for development of a common cancer compared with persons whose drinking water contains less than 5 µg/L of arsenic. Which of the following is the most time-efficient experimental design to investigate this hypothesis? CJ A) Case-control study A. Page 256/266. B) Case series study Classic NBME trash. The question asks for a time-efficient, experimental design. C) Cohort study While case-control studies are time-efficient, they are observational studies. U D) Open-label, dose-ranging study You would need a case (people drinking high arsenic) and control (people with no arsenic). E) Randomized, double-blind, controlled trial Experimental studies are usually randomized controlled trials, where E would be the best answer. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=54cd3e5f-e4bf-49d0-8371-ba261251f2a1 Exam Section 2: Item 3 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 59 min 26 sec 3. A 43-year-old woman with a 2-year history of labile hypertension comes to the physician for a follow-up examination. Her blood pressure has ranged from 123/84 mm Hg to 165/ 112 mm Hg since being diagnosed. One day after propranolol therapy is started, she develops a severe headache and her blood pressure is 214/132 mm Hg. Serum and urine catecholamine concentrations are four times the upper limit of the reference ranges. A CT scan shows a 2-cm nodule in the right adrenal gland. Which of the following is most likely responsible for the increased blood pressure in this patient after propranolol therapy was started? A) Anxiety reaction B) Impaired degradation of catecholamines u C) Increased adrenocorticotropic hormone release U D) Infarction of the adrenal tumor E) Stimulation of aldosterone production 0 F) Unopposed a-adrenergic tone F. Page 335/366. This patient must have a pheochromocytoma, which is treated with an irreversible alhpa blocker (to stop vasoconstriction), followed by a beta blocker (to decrease HR but these also cause vasoconstriction so they are given a week after the alpha blocker is initiated). , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=54cd3e5f-e4bf-49d0-8371-ba261251f2a1 Exam Section 2: Item 4 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 59 min 17 sec 4. A 4-year-old girl is brought to the physician because of a 6-month history of foul-smelling stools and failure to gain weight appropriately. She is at the 3rd percentile for height and weight. Abdominal examination shows distention. Stool analysis shows an increased fat concentration. Serum concentrations of anti-endomysial and anti-tissue transglutaminase antibodies are increased. Which of the following findings in the gastrointestinal tract is the most likely cause of the disorder in this patient? A) Eosinophilic infiltration of the mucosa of the small intestine B) Erosions of epithelial cells in the small intestine C) Lactase deficiency D) Periodic acid-Schiff (PAS)-positive granules in macrophages in the lamina propria of the small intestine E) Villous atrophy E. Page 375/416. This patient's serum antibodies are diagnostic of Celiac disease. The answer choice was very easy. A -- Probably some parasitic infection. B -- Erosions are irrelevant. Small intestine erosion is related to IBD. C -- Irrelevant. D -- Whipple disease. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=54cd3e5f-e4bf-49d0-8371-ba261251f2a1 Exam Section 2: Item 5 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 59 min 10 sec 5. A 26-year-old man comes to the physician for a follow-up examination. One month ago, his total serum cholesterol concentration was 325 mg/dl, and the physician prescribed a 3- hydroxy-3-methylglutaryl (HMG) CoA reductase inhibitor. At the time of the present examination, his total serum cholesterol concentration is 235 mg/dl. Which of the following is the most likely cause of the decrease? A) Decreased absorption of dietary cholesterol B) Decreased conversion of chylomicrons to VLDL E. Page 315/344. C) Increased concentration of HDL in plasma Statins work by indirectly causing an increase in hepatic LDL receptors. D) Increased intracellular esterification of cholesterol Same question as question 43 block 1. E) Increased number of LDL receptors on hepatocytes F) Increased synthesis of apolipoprotein B-100 , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=54cd3e5f-e4bf-49d0-8371-ba261251f2a1 Exam Section 2: Item 6 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 59 min 1 sec 6. A 28-year-old man with AIDS has fever, headache, and lethargy. Examination shows papilledema and nuchal rigidity. A mucicarmine- stained smear of his cerebrospinal fluid is shown. Which of the following is the most likely primary site of infection with this organism? A) Eyes B) Gastrointestinal tract C) Lungs CJ D) Middle ear C. 153/155. E) Skin This was the best answer to pick given the image and patient's AIDS history. This image shows budding but it is not broad-based, its narrow budding. Crypto is stained with india ink or mucicarcmine and can also be found with latex agglutination. This is a heavily encapsulated yeast that causes meningitis, encephalitis, and cryptococcosis. Patients inhale this so its found in the bronchoalveolar lavage. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=54cd3e5f-e4bf-49d0-8371-ba261251f2a1 Exam Section 2: Item 7 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 58 min 51 sec 7. A 68-year-old woman with acute myelogenous leukemia begins treatment with standard induction chemotherapy. After completion of the regimen , her leukocyte count is 1200/mm 3 with an absolute neutrophil count of 475/mm 3. Which of the following is the most appropriate pharmacotherapy? CJ A) Bcr-Abl tyrosine kinase inhibitor B) Erythropoietin C) Granulocyte-macrophage colony-stimulating factor U D) lnterleukin-2 (IL-2) E) Thrombopoietin F) Transforming growth factor-13 C. Page 121 and page 424/469. This patient's leukocyte count and neutrophil count are very low. She simply needs something that will help her make new WBCs. AML is treated with vitamin A and arsenic (if its the APL variant with t(15;17). The problem in AML is the high amounts of myeloblasts not becoming mature, so vitamin A and arsenic induce differentiation. , ~ ~ p , ,.,,. Previous Next Lab Values Calculator Review Help Pause hi Comprehensive Basic Science Self-Assessment - Google Chrome x i starttest.com/ITDVersions/19.3.0.1/ITDStart.aspx?SVC=54cd3e5f-e4bf-49d0-8371-ba261251f2a1 Exam Section 2: Item 8 of 50 National Board of Medical Examiners Time Remaining: Mark Comprehensive Basic Science Self-Assessment 4 hr 58 min 43 sec 8. A 70-year-old man is brought to the emergency department because of a 1-week history of progressive shortness of breath with mild exertion, cough, fatigue, and weakness. The shortness of breath frequently awakens him from sleep and is partly relieved by sitting or standing. He has a 20-year history of hypertension treated with diuretics and ACE inhibitors; however, he does not always take his medications. His pulse is 85/min, respirations are 20/min, and blood pressure is 180/110 mm Hg. Crackles are heard on auscultation. A chest x- ray shows cardiomegaly. Echocardiography shows decreased left ventricular systolic function. Which of the following patterns best characterizes this patient's cardiovascular variables at this time? Left Ventricular Stroke End-Diastolic Cardiac Volume Volume Output 0 A) i i i B) i i l C) i l i U D) i l l E) l i i U F) l i l G) l l i H) l l l F. Page 306/332. This patient clearly has left heart failure. The fact that the x ray shows cardiomegaly and auscultation reveals crackles, it is decompensated. He has orthopnea, paroxysmal nocturnal dyspnea, and the pulmonary edema. Since the heart is not working well, ob