Form 6 http://forums.studentdoctor.net/showthread.php?p=12639410 http://www.usmle.net/step-1/messages2006a/201142.

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2. 46 year old woman with a chronic illness and a picture of a gigantic heart. What disorder did she have? alcoholic cardiomyopathy, ASD, mitral stenosis, primary pulmonary HTN, systemic HTN (systemic HTN?) Alcoholics -> wet beri beri -> dilated cardiomyopathy (systemic HTN causes concentric hypertrophy which doesn't increase the size of the heart... just decreases ventricular volume) So the answer is 1. Compared w/ freshly secreted bile, the proportion of what is decreased in bile stored in the gallbladder? Bilirubin, Ca, cholesterol, potassium, water (ans: water) A 43yr old female with slow relaxation of stretch reflexes and hoarse voice. Plasma TSH level is low that increases in concentration after she is given TRH. The cause of hypothyroidism in what? I thought it is Hypothalamus (tertiary hypothyroidism), but the correct answer is Pituitary gland

2. benzene causes
3. Norepinephrine solution bathing cardiac myocytes. An increase in what leads to an increased work by the muscle? overlap of thin and thick filaments, sarcoplasmic Ca concentration, sarcoplasmic phosphocreatine, stiffness of the series elastic elements NE -> b1 receptor -> inc cAMP -> inc Ca2+ -> contraction (answer is sarcoplasmic Ca conc) 4. 17 year old girl with episodes of visual loss. There's a picture of her optic disc. What is the problem? optic atrophy, optic neuritis, papilledema, retinal infarction, retrobulbar infarction Headaches + visual loss = I thought it was papilledema from the pic 22yo marathon women with stress fracture and decreased bone density. Is it due to estrogen def? If yes, then why is it deficient in 22 yo girl? It has something to do with GnRH dysfunction with extreme exercise. So loss of normal GnRH excretion ultimately leads to lack of estrogen. married 78 yo man who took 10 temazepam pills. Which one is the most important in assessing his risk for suicide? -early morn awakening with decr.appetite -family history of suicides -male gender -marital status

-his belief that temazepam would kill him. The last one? Yeah, it's the last one. If he just took a bunch of temazepam because he was stressed out, rather than trying to kill himself, that would definitely make you think he's not planning on committing suicide, at least not intentionally I guess I'm overthinking with this one: 49 yo woman hasn't slept 2 wks, denies previous history of sleep difficulty, drunk 1 bottle of wine for the past week, but hasn't drunk in the past. Demands to be seen by the head of the department. Speech is rapid, pressured, she is irritable. She got major depressive disorder 6 years ago. What's her Dx now? -alcohol withdrawal -alcohol halucinosis -alcoholism -bipolar disorder (ans) -cyclothymic disorder: milder form of bipolar disorder For cyclothymia they 100% have to tell you she's been having minor mania and depression bouts for at least 2 years. Same thing with dysthymia (minor depression for 2 years). Bipolar disorder - pressured speech, irritability, lack of sleep, etc. (DIG FAST) Fish oil/olive oil in preventing of renal disease in patients with IgA nephropathy. Over the next 5 years: incidence of end-stage renal disease significantly lower in group that took fish oil. What is the design study? Cohort is not answer, controlled trial is answer The key is that the researchers made the patients take either fish oil or olive oil. So it's a randomized trial or whatever the choice said. Things like cohort studies and case-control don't involve any manipulation by the experimenters. The people being studied do whatever they want and the researchers just observe and record what happens.

Another biostat: 4 columns with UTI in children, what is the median number? median value there were 4 bars for 0-3, the 0 and 3 bars were similar in size, so median value was the larger bar (either 1 or 2). Pretty sure it was 1. Don't have the exact question, but wasn't it 100 people total, 30 without a UTI and 25 with 1 UTI. So the median value would be the 50th value. Since values 31-55 (when placed in sequential order) are all 1 UTI, the answer is 1.

Question about mannitol: so will it cause only decrease of water reabsorption? Na will be reabsorbed in kidneys and this is why osmolarity goes up, right? As for the mannitol Q, mannitol is an osmotic diuretic (so volume goes down and sodium concentration up)

Mannitol causes loss of free water. So think about there being essentially no change in any electrolytes. If you just lose water, then your serum osmolality will increase 2) 6 y/o girl with dark urine and periorbital edema, noted in the morning after waking, for the past 3 days. Physical exam shows mild HTN and ankle swelling. Urinalysis shows the prsence of RBCs, red blood cell tubular casts, and increased protein concentration. Over the next few days, urine output is diminished despite adequate fluid intake. Which of the following is the most likely location of the dz process? A) Glomerular B) Interstitial C) Postrenal D) Prerenal E) Tubular 42) A 31 y/o woman has had several episodes of retrosternal chest pain while at rest during the past 6 months. The most recent episode occurred while she was asleep and produced several minutes of ST segment elevation on a home cardiac monitor. She has no known cardiac risk factors. Which of hte following events in a large eicardial artery is most likely responsible for the chest pain? A) Endothelial cell dysfunction B) Formation of a thin fibrous-capped plaque C) Neutrophilic infiltration within the intima D) Plaque rupture and coronary embolization E) Plaque rupture and mural hemorrhage A - prinzmetals angina. complete occlusion of the artery can produce ST elevation. Plus young patient (31 yo) with no cardiac risk factors (only thing to really consider @ this age is hypercholesterolemia w/ early MI, but the question stem says no cardiac risk factors)

1) Four days after admission to the hospital with multiple fractures sustained in a motor vehicle collision, a 27 year old man has the sudden onset of shortness of breath. His respirations are 30/min. Doppler ultrasonography of the lower extremities shows a DVT, and a spiral CT scan of the chest shows evidence of multiple subsegmental pulmonary emboli. Anticoagulant therapy is begun. One week later, a follow up CT scan of the chest is done to evaluate atypical chest pain. Results show no abnormalities, and the pain was considered to be MSK. Collateral circulation from which of the following best explains the lack of identifiable pulmonary parenchymal infarcts in this patient? A) Bronchial arteries B) Bronchial veins C) Pulmonary arteries D) Pulmonary veins E) SVC It's bronchial arteries, isn't it? Because it's about parenchymal infarcts. yes

48) Certain chromosomal abnormalities can result in rudimentary development of the cerebral hemispheres. Which of the following labeled structures in the xsection of a nl brain stem is expected to be most underdeveloped as a result of such an anomaly?

(Pic attached) I get that it's Pateau's syndrome... Could it be E for the CST?

1. 51-year-old woman has 9 lb weight loss over past 6 mo. Smoked 2 packs cigarrettes per day for 20 yrs. No meds, normal vitals. Labs: Hemoglobin - 17 Hematocrit - 52% Leukocytes - 5100 urea - 17 creatinine - 1 RBC/hpf in urine - 14 What's her problem? endometrial carcinoma polycythemia vera renal carcinoma renal vein thrombosis 2. You inject 2L isotonic saline. How much ends up extracellular? I thought the answer would be 0.6L as usually fluid volume is 2/3 intracellular and 1/3 extracellular, but that was not even an answer choice...

I put 1.6

Social phobia: really afraid to give presentations. excessive fear of embarrassment in a social situation
(public speaking, using public restroom) 5.Hydroxylase =hydroxylations and dealkyliations are reaction of modification performed by liver P450 enzymes.These enzymes shows genetic polymorphisam within the P4502C and P4502d group.Basicly this means that patients will react different on the same dose of drug,cause their biotransformation will be differente.. (got this from another forum) 12. The organism was Borrelia recurrentis 1. 68 yo woman with lower back pain after carrying groceries. Took no meds or HRT. Tenderness over lumbosacral spine, neuro exam normal. compression fracture L4 It's an old lady who is post-menopause, so she's at risk for osteoporosis --> she's not on any meds or HRT --> increased risk of fractures. Side note: I think L4 is the most commonly fractured vertebra, but I don't think you had to know that for this question. 2. This one got a graph so I'm just gonna explain it.. Newborn with respiratory distress syndrome asking

which cell is secreting surfactant. How can you tell which 1 is type2 pneuomocyte!? It's D, the cell that's within the interstitium instead of outside of it like that alveolar macrophage (E). A is the endothelial cell, B is the RBCs, and C is the type I pneumocyte making its thin epithelium. 3. Biostat Q comparing surgery done at tertiary center vs community care facility. I put unequal sample sizes but it's wrong. Any thoughts? I believe I put lack of control of case complexity for this one. You can sort of rule out all of the other ones because they're either not true or not relevant to the study. It kind of makes sense because you're dealing with mortality, which can happen for a lot of reasons, but I don't have a definite or clear explanation for you. 4. X-ray of the humerus asking which nerve is in danger. I put median N because it looks like the fracture was near medial olecranon? But guess that isn't the case... It's the radial nerve, and it was a midshaft fracture of the humerus, which tends to injure that nerve. 5. A slice image of the pons asking where the substantia nigra pars compacta is. Anyone got a good source where I can review these brain slices? No good source, but the answer was C, as seen here:http://www.upright-health.com/images...tianigra3.png 6. which of the following receptor classes are found in both presynaptic and postsynatic terminals

alpha2

Remember the alpha-2 receptors that sit on the presynaptic terminals? When NE is released, they bind some of that NE and inhibit its release. 7. 74yo man unable to repeat phrases and name objects after left sided stroke. Reading comprehension preserved but difficult reading aloud and writing. Speech is fluent, comprehension normal. Which of following is damaged arcuate fasiculus Speech fluent, comprehension normal. That eliminates Broca's and Wernicke's right off the bat. Repetition impaired --> arcuate fasciculus. 8. A slice image of the pons/medulla asking certain chromosomal abnormalities can result in rudimentary development of the cerebral hemispheres. What and which spot is this? It's alluding to the medullary pyramids, which should be the most anterior structures.

9. Long stem asking what best describes result of loss of PTH on vitD metabolism. I put decreased intestinal absorption of dietary vitD... and it's wrong =/ PTH increases the intestinal absorption of calcium and phosphate. The more correct answer is decreased renal conversion of 25-OH-vitD to 1,25-OH-vitD (PTH activates 1-alpha-OHase in the PCT of the kidneys). 10. 52yo man with gout, treated w/ indomethacin and now still has uric acid of 800mg/day(N300-600). Which drug is most appropriate to decrease uric acid concentration for this guy? Allopurinol is used for chronic gout and for suppressing the overproduction of uric acid, which is the more correct answer here. Colchicine is used in acute gout ATTACKS since it has antiinflammatory effects, at least that's how I think of it. 11. AIDS+ man treated on HAART started treatment w/ a hematopoietic growth factor and started having dyspnea, muscle pain, vomiting. sinus tach. Which of following could cause this? Sargramostim Ppl online say it's filgrastim..? It's not filgrastim because that's what I put and it was wrong. It's sargramostim; I looked it up and the side effects showed up in some obscure PubMed article.

12. Where is bicarb absorbed the most? The process of bicarbonate reabsorption occur predominantly in the proximal tubule (about 90%). The rest occur in the thick ascending limb and in the collecting tubule. All involve hydrogen ion secretion as shown in the diagram below. To completely reabsorb bicarbonate,the kidney must secrete 4320 meq/day of hydrogen ions in addition to the amount required to exrete the daily acid load. 13. relationship between giving dextrose than adh secretion in graph

14. if u inject a hormone that makes more platelets where do u inject it? Cytoplasm, cell membrane or nuecleus of megakryote or hepatocyte ni the liver?

15. systolic ejection murmur at base that radiates to neck. ecg = LVH
a. dissection b. bicuspid aortic valve (my ans) c. mitral insufficiency d. mitral stenosis e. tricuspid stenosis

Renal
Oval fat bodies are usually renal proximal tubular cells with lipid in the cytoplasm. Oval fat bodies are usually a sign of nephrotic syndrome. They can be identified under microscope by their characteristic 'maltese cross' appearance. Fatty casts.

Behavioral Science

Normal

Biochemistry

Answer is probably Urea or Ammonia.