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Final Tips

please do not solely use this or rely on this THIS WAS ~40% similar to our exam THAT
MEANS THERE WERE 60% NEW QUESTIONS -STUDY YOUR BUTTS OFF and GET
OFF THE ISLAND

1. Woman is trying to delay labor, so the doctor gives her Terbutaline. What is the
mechanism of action of this drug? B-2 Agonist
2. Person has prostate cancer that has already metastasized to the bone. What can
you do to shrink the cancer/prevent the spreading? Give a GnRH analog. Other options
included androgen antagonists, estrogen antagonist, and resect the primary tumor and
metastasis, but they don’t make sense.
3. Lady comes in for an abortion and you give her Mifepristone. What is the
mechanism of action of this drug? Progesterone Antagonist
4. Described athletes foot and shedding, particularly between the 3 and 4 toes.
rd th

What topical agent can you give to this person? The only one that really seemed to fit
was Nystatin.
5. 19 year old girl comes in for acne treatment. She is sexually active and doesn’t
always use contraceptives. What drug should you NOT prescribe for her as long as she
isn’t on birth control? Isotretinoin – 2 semester drug that he didn’t even talk about,
nd

but it is teratogenic.- THIS IS SO HIGH YIELD TO KNOW


6. Prescribing a laxative to a patient and you want one that will soften the stool
without bulk forming. Answer was Docusate sulfate or something like that.
7. Girl has cancer and is undergoing chemotherapy. You prescribe her a drug that
would reduce nausea/vomiting adverse effects of the therapy. What is the mechanism of
action of a drug that would do this? 5-HT3 ANTAGONIST. He had literally every option
on there, make sure you know it’s 5-HT3 and an antagonist. He had 5-HT1, agonists,
etc. There was like 8 choices.
8. Treating a person with the drug infliximab, what is the mechanism of action?
Inhibits Tumor Necrosis Factor.
9. Person with AIDS comes in and there is a pneumonia issue in the hospital. What
can you give him as a prophylactic to prevent him from getting Pneumocystic Jiroveci?
Ridiculously random question, can’t believe he picked this. The answer choices
consisted of a bunch of mechanisms, but according to my notes, you’d give a DHFR
inhibitor. That wasn’t an option, but there were something related to DNA and nucleic
acids so it might have been that one.
10. Person’s got Hyperthyroidism. Which drug can you treat him with?
Propylthiouracil. Not sure if he gave a specific mechanism in the vignette, I just
remember all the other choices were extremely wrong.
11. Weird question about the use of Triamcinolone. I can’t remember the vignette,
honestly didn’t expect a question on GC’s. It wanted a mechanism of action that was
special about this drug. In my notes I have that it has no mineral effect, but I don’t think
that was on there. I think the drug was insignificant, you just had to recognize it was a
GC, but GC’s do so many things that I wasn’t sure which one was right. The answer I
picked was Prevents Ag-Ab binding because that sounded similar to
immunosuppression, but I don’t know if that’s actually a real mechanism.
12. What kind of cells would Somatostatin act on? Somatotrophs – Not sure if pharm
or Kalle.
13. Lady with Type II Diabetes gets diagnosed, so you give her a drug. Here are her lab
values a week after using the drugs. Lab values show normal stuff, but the [HCO3]
concentration is decreased which implies Lactic Acidosis. Question is what drug is she
on? Metformin
14. Person is in the hospital and is put on multiple drugs. As a result of your treatment,
he is unresponsive and has pinpoint pupils. What should you give him? I think this is an
Opioid OD, so the answer was Naloxone.
15. Which of the following drugs can be fatal upon overdosing? Barbiturates (it was a
drug though, so a barbital)
16. Girl is on benzos for anxiety. She OD’s and passes out. What can you give her that
would immediately bring her back? Flumazenil
17. Where does Furosemide act? NKCC Channel
18. Schizophrenic has been on haloperidol for years. [Goes on to describe adverse
effects, particularly Tardive Dyskenisia]. What is the mechanism behind this adverse
effect? She had literally every pathway you can think of as an option. I think I picked
Dopamine inhibition in Nigrostriatal Pathway. Not sure if that’s right, check your
notes.
19. Described boy with ADHD. What drug can you give him to treat? Methylphenidate
20. Person is put on Clozapine. What do you need to monitor her for? Leukocytes.
(Main AE of Clozapine is Agranulocytosis).
21. Kid presents with a blank stare for 20 seconds every couple minutes, what
treatment can you put him on to resolve this problem? Ethosuximide
22. Person presents with gingival hyperplasia. What drug is she on? Phenytoin
23. Something about MAC and solubility. Conceptual Babbini question.
24. Vignette about person with serious anxiety. What treatment should you start her on?
Paroxitine (always SSRI first! SNRI added on if it’s not doing the job)
25. Person is put on sulfonamides. Know the adverse effects.
26. Guy is 56 years old and has had parkinsons for 2 years. He presents now
complaining that sometimes he’s functioning fine, and then suddenly he freezes and is
unable to move for 10 minutes. What drug is he probably on? Levodopa/Carbidopa
27. Another question about Parkinsons and what you should add to his regimen or
something like that. The answer again was Levidopa.
Things I’m not sure if they’re just in my head, or if they were on the exam:
1. Question about Lidocaine acting on Na+ channels.
2. Question about Metronidazole and not drinking alcohol while on it.
3. Aminoglycoside AE’s. Ototoxic/Nephrotoxic
4. Question about Heroin OD (I think there were to Opiate OD questions).

Block 1
Advice: Trust your gut, know your bacteria, and most of all, USE FIRST AID FOR ALL
BEHAVIORAL. There were things that just didn’t make sense to me because it wasn’t
taught properly, but all of the buzzwords from First Aid were there.
1. Person gets into a severe car accident and nasal bone gets shattered. Presents
later with meningitis symptoms. What is the causative agent? Had a picture that was
hard to see. Looked like Strep Pneumo.
2. Neonate presents with meningitis. Can’t remember what other information was in
there, but I’m pretty sure it was Listeria. Strep Agal wasn’t an option.
3. Guy with AIDS presents with ring enhancing lesion in the periphery of the brain.
What is the likely causative effect? Toxoplasmosa Gondii I think.
4. Lady is approaching the 1 year anniversary of the death of her husband. She has
loss interest in anything, can’t stop crying, ridiculously sad, etc. What is wrong? Major
Depressive Disorder. I don’t think the answer was normal grief, there was too much in
the vignette. She was effed up.
5. Girl was a drug addict and has been off drugs for 4 years. She presents with
hallucinations and delusions etc. She believes the radio speaks to her. Yadda yadda
what’s the diagnosis? I put Schizophrenia, but based on First Aid, I think it was
Schizoaffective. Not sure. Just know all those subcategories. I didn’t think he’d test us
on them.
6. Boy presents with blank stares every 2 minutes for 10 seconds. Mom takes him
to the doctor. Looking at the following presentation, what is the diagnosis? Picture
showing 3/sec spike and wave. Answer was Absent Seizure. Don’t need the picture at
all for this.
7. Guy gets into an accident because his vision is messed up. He says he can’t see
on the left side of each eye (forgot how it really presented). Anyway, doctor says he has
homonymous left-sided inferior quadrantanopia (or something like that). Where is the
lesion? I think Parietal lobe. Don’t know why this was asked, we weren’t taught it this
semester. Expect the unexpected I guess. I didn’t check my Sem 2 notes for this, so
don’t know if I was wrong.
8. Person presents with attacks of discomfort, hypercapnia, inability to breathe for
one month. On examination, he appears normal. What is his problem? Panic Disorder.
9. Lady was once stuck in a building that was set on fire, but was rescued. Since
then, she has episodes where she can suddenly smell smoke and feels discomfort in
certain places. She hates going out because of it. What is the problem? Post-Traumatic
Stress Disorder.
10. Guy has a heart attack and is in the hospital. On the third day in the hospital, he
presents with hemiparesis and aphasia. What happened? You know it’s an MCA
stroke. Problem is the answer choices had 2 that I thought could be right. 1 was
mural embolus from the left ventricle to the MCA. Other was Thrombosis of the
MCA. I don’t know which was right. We figure that they mentioned the heart attack
for a reason so it was an embolus, but at the same time, it could be justified that
the MI caused thrombosis. Another answer choice was embolus from the leg to the
MCA. Doesn’t make sense though.
11. 50 year old guy is moving furniture when suddenly he has the “worst headache of
his life”. He goes to the hospital and is now complaining of nuchal rigidity, photophobia,
pain on moving his eyes to the left. His glucose was normal. What lab values would you
see in his CSF? I was torn between subarachnoid and viral meningitis. The “worst
headache” comment and sudden onset would imply subarachnoid, but all of the
other symptoms are hallmark Viral Meningitis. I think they wanted subarachnoid
though, so the answer would be the lab values that had erythrocytes in it. All of
the other lab values had no erythrocytes and either elevated
neutrophils/lymphocytes, etc.
12. Classic Parkinsons symptoms vignette. Nothing tricky. Answer is Parkinsons
Disease.
13. Same as above, except what would you see? Loss of Dopamine in the Substantia
Nigra
14. Classic Huntingtons, Chorea etc. What would you see? Caudate Nucleus lesion.
15. Person presents with tinnitus, and other CN VIII defects. You see a tumor in the
pontocerebellar region. What are you likely to see proliferation of? Schwannoma Cells.
16. Insidious onset memory loss, classic presentation of Alzheimers.
17. Guy who is a chronic alcoholic comes in and presents with a bunch of symptoms
and stories. After he’s done, his wife said that nothing he said was true. Where do you
expect to see lesions in his brain? Mammillary Bodies
18. Person dies. In the past, he has had problems walking, on and off eye
pain/blindness, numbness of his limbs, etc. What do you expect to see on autopsy?
Demyelination of Oligodendrocytes
19. Person presents the same as above. What is the disease? Multiple Sclerosis.
20. Person has issues with muscle weakness. In order to treat it, you give him a
thymectomy. What was his problem? Myasthenia Gravis mechanism. There was no
answer that directly said Autoimmune Ab’s against ACh-Receptors. You just had
to pick the closest one to that. There were a lot of options.
21. Kid presents with seizures. They began when he moved to a new school 9 weeks
ago. On examination, no abnormalities were found and no abnormal neural activity. He
doesn’t seem to care very much about the impact it’s having on his life. What is wrong
with him? Conversion disorder. He NEVER talked about this in class, but
apparently if you have a neurodisorder and you don’t really care about its impact
on your life, then it’s conversion. This is in first aid. I got it wrong because I thought
the kid’s not caring was a sign that he was faking it.
22. Lady presents with a multitude of problems and is transferring to you after seeing
multiple doctors. On exam, she is normal. She is frustrated that no one seems to be able
to figure out what’s wrong with her. What is wrong? Somatization Disorder
23. Guy presents with hyperpigmentation of his gums as well as his appendix scar (no
idea the relevance of that particular area). What do you expect to see? I think it was
Cortical Adrenal Atrophy implying Addison’s Disease.
24. 36 year old obese woman presents with problems. Which of the following diseases
could be most significantly be prevented by her loss of weight? Diabetes Mellitus.
There was like 9-10 options, none made sense.
25. I think there was a question about pituitary adenoma and asked how you could
diagnose it, and you’re supposed to check for ACTH suppression upon Dexamethasone
application. Not sure if the answer was diagnosing that it was in the pituitary or what.
Just know this concept.
26. What would be elevated in the serum of a person with renal failure? Phosphate
27. There was a question about hyperparathyroidism, and I think the answer was
Adenoma on a single lobe.
28. Person presents with exophthalmos, hypermetabolism, etc. What is wrong?
Antibody stimulation of TSH-Receptor (Graves)
29. Person again presents with weight loss, elevated T4, etc. What disease? Graves
30. Person wakes up every morning feeling extremely dizzy and nauseous. It is relieved
after he eats breakfast. What is wrong? B-Islet pancreatic tumor (Insulinoma)
31. Person presents with a lump lateral to the trachea, below the cricoid cartilage. It
moves upon swallowing. What is it? The only 2 that I considered possibilities are
Brachial Cyst and Thyroid Nodule. Brachial Cyst is not really on the throat though, so I
went with Thyroid Nodule. I feel like thyroglossal duct cyst is a lot more applicable here,
but it wasn’t an option.
32. Person presents with course facial features, protruding forehead, and other
symptoms. Acromegaly. The thing that could throw people off is that there were other
unrelated symptoms that pointed at thyroid, but the physical features were just too
obvious to not be acromegaly.
33. I want to say there was a question about 21-hydroxylase in regards to a kid
presenting with constant thirst and all the other symptoms.
34. Person has down syndrome. What is he at risk for developing by the age of 40?
Alzheimers.
Random Question – There was something about a protein being moved from asparagine
or some nonsense. It was a semester 1 block 1 question that appeared out of nowhere.
Since it was protein transport related, I picked Endoplasmic Reticulum.
Block 2
1. Person presents with jaundice and pancreatic issues. He also has gall stones.
Where are you likely to have a gall stone be lodged in order to cause these symptoms? I
picked Pancreatic Ampulla. Don’t know if this is right though. It had every duct as an
option.
2. Person presents with GB obstruction, jaundice, abdominal pain. It did NOT say
upper right quadrant pain, so the answer I picked was Pancreatic Carcinoma.
(Courvoisier’s Law).
3. Person comes in with extreme abdominal pain and is unable to eat. Which of the
following could present as a possible diagnosis? I thought this question was really vague
as any of them could be the answer, but I picked Appendix Scar implying that prior
surgery could lead to adhesion of the intestines. Only other option I can think of off the
top of my head was “Diffuse Abdominal Tenderness” but that seemed too vague and I
felt like they wanted one that would lead to a specific diagnostic possibility.
4. Person presents with 100’s of polyps at a young age. What treatment should this
person undergo? Possibilities were chemo and other things. I think the answer is
Colectomy.
5. Person presents with mucocutaneous hyperpigmentation of the lips and other
areas and has hamartomas in his colon. What is this disease? Peutz-Jeghers
6. Person presents with weight loss and difficulty swallowing food. He later presents
with the inability to swallow either liquids or foods. On physical exam, no abnormalities in
the face or neck. What’s wrong? I put Achalasia because he presented with inability to
swallow liquids. However, it’s possible that it is an Esophageal Adenocarcinoma
because initially he presented with only inability to swallow food. I’m not sure, check your
notes. I stuck with Achalasia because of the lack of abnormalities aside from that.
7. Person presents with a mass at the junction of the esophagus. It looks like this
(shows picture of adenocarcinoma histo). What predisposed to this? This question had
both Barrett’s and H. Pylori as options. It depends how you understood the question. I
put H. Pylori because I thought it was asking about the most likely cause. Others
interpreted it as “what would you have seen beforehand” and put Barrett’s. Go with your
gut I guess. GERD was not mentioned, so it could have just been Barrett’s. But I
Barrett’s is most often caused by GERD…so yeah idk.
8. Kid presents with pain in his stomach after eating. Histo shows villi atrophy.
Celiac
9. Lady presents with stomach abnormalities. Histo shows nothing. Irritable Bowel
Syndrome.
10. Gram (-) flagellated rod causing GERD. H. Pylori
11. Lady drinks from a stream when she goes hiking. Gets diarrhea. Giardia
12. AIDS patient gets diarrhea. Nothing shows on culture. You see cysts on Acid Fast
stain. Cryptosporidium
13. Interesting question. Person presents with cancer. Metastasis seen at
Supraclavicular Node and Periumbilical nodes. Person has trouble with urinary bladder
and you find that it has metastasized there too. What type of carcinoma do you expect to
see there? I put Adenocarcinoma because this is the classic metastatic presentation of
Gastric Adenocarcinoma. However, another answer option was Transitional which is
classic bladder cancer. I’m not sure if I thought too hard or not, but I was torn between
the 2.
Spoke to Dr. Loy in passing and asked him about this. He said that this
presentation is actually common for other cancers, and chances are the answer to
this question was Transitional, and the metastasis to these nodes was probably
from a primary bladder cancer.
14. Person ate Oysters and got sick. Mucus flecks, etc. Vibrio cholera
15. Cholera epidemic but too broke to give everyone IV drips. What should you add to
electrolytes in an oral treatment? Glucose – Second semester material
16. Person got sick. You culture a Gram (-) curved rod at 42 degrees Celsius. What is
it? Campylobacter.
17. Hemorrhagic Diarrhea. Gram (-) bacteria. What is it? EHEC, but answer was just E.
Coli.
18. Got sick from egg paste or something at a pot luck. What is the bacteria? Had a
really long incubation time, like 2-3 days later the person got sick. I might have put
Salmonella, can’t remember tbh. Just make sure you know your special things like
incubations and foods.
19. What is the most likely person to eventually present with Chronic Hepatitis? I put
Neonate that is HBsAg+. The others didn’t seem to make sense.
20. Person presents with Hepatitis. What’s the cause? He just gives serology again and
you need to figure it out.
21. Autoimmune destruction of the ducts – Primary Biliary Cirrhosis
22. Person presents with Renal Failure. Says his mother had the same problem and
needed an immediate kidney transplant (or maybe she died I don’t remember). What do
you expect the kidney to look like upon gross inspection? Large with nodules (ADPKD)
23. Put a histo picture of a kidney. Asked what is this? I think it was Renal Cell
Carcinoma.
24. Picture of a staghorn calculus and asked what is this likely to lead to?
Hydronephrosis.
25. Person is on antibiotics. Gets acute kidney failure. Shows a histo slide that shows
Interstitial Nephritis.
26. Guy comes in complaining about Polyuria/dipsia. Upon vasopressin administration,
his urine osmolality doesn’t change. What’s the problem? Nephrogenic Diabetes
Insipidus.
27. Person presents with flank pain. Bacteria is urease +, whats the bacteria? Proteus
28. Kid presents with proteinuria, but otherwise normal. Treated with Corticosteroids
and comes out fine. What is it? Minimal Change Disease
29. Picture of a glomerulus. Looked to me like a crescent, maybe it wasn’t idk. Asked
what you would see an increase in serum concentration. I put C3. Complete guess
though. I don’t know what I was looking at whatsoever.
30. Person presents with blood in urine + hemoptysis. Shows picture of
Immunofluorescence. I picked Goodpastures.
31. Pain in upper right quadrant radiates to the scapula. What is the most likely cause?
Supersaturation of the bile with cholesterol
32. Semester 2 nutrition question about calculating the amount of Fat calories a person
must consume. Answer was 630. I guess go back and learn how to do those calculations
if you don’t know how to do them.
33. Another diarrhea question. Just know your bacteria, and know them well.
Block 3
1. Hydatiform mole question about girl coming pregnant but no fetus. 46XX
expected.
2. Girl comes in with pelvic pain. She has a history of STDs and does not use
contraception. She has been amenorrheic for 2 months. What is the likely diagnosis? I
put Ectopic Pregnancy.
3. Most likely complication if the placenta is implanted over the cervical os? I think
this is talking about Placenta Previa, so I put Hemorrhage. I think that’s what would
happen anyway.
4. Elevated AFP à Yolk Sac Tumor
5. Girl presents with pelvic pain. You find in her ovaries there is a tumor with hair,
teeth, and skin. What is your prognosis? I put that she’ll be fine once you take it out. I
forgot what the other options were. Teratomas can be malignant in females so that
might be wrong.
6. I think she may have asked Serous Cystadenocarcinoma again.
7. Risk factor for Endometrial Carcinoma? Options included Early Menopause, Late
Menopause, Early Menarche, Late Menarche, Late First Pregnancy. Not sure about the
answer.
8. She put a picture of a histo slide of something I’ve never seen before. Some
thought t was Adenomyosis, another option was Endometriosis with Cysts.
9. Woman does self-check on her breasts and finds lumps. They cause her pain
mostly during onset of her menstrual cycle. It is B/L. What is this? Fibrocystic
Changes.
10. Woman is breast feeding and one of her breasts gets super swollen. What is it?
Abscess
11. Bag of worms – Varicocele
12. Which of the following is a Germ Cell tumor (or something like this)? Seminoma.
13. Consequences of long term Gonorrhea infection in males? Epididymitis
14. Diagnostic test in 17 week of pregnancy? Amniocentesis
th

15. Which of the following curves represents estrogen during the menstrual cycle?
Graph rises at the start and slowly falls in the middle
16. Which of the following spots on the curve is the most likely location of implantation?
Only one of them was even near the ovulation period.
17. 14 year old kid presents to the doctor with Gynecomastia. He is in stage 2 of the
tanner stages of puberty. What is the likely diagnosis? We didn’t even learn this so I
don’t know the answer. I put Kleinfelters because it was B/L plus he’s only in
stage 2 despite being 14 years old, which is really slow. However, another answer
choice was “Leave him alone, this will self-resolve” or something along those
lines. I did see this on a practice NBME question, but in that question it was a)
unilateral, and b) did not mention that the kid was only stage 2 tanner. I don’t
know the answer, Keator never taught this.
18. Another male physio question, idk what’s going on in Keators mind. I forgot the
question, I guess you should study semester 2 notes before going into your final.
Something about one of the germ cells malfunctioning, what would the boy be low on? I
put Testosterone.
19. Girl presents with fishy odor and milky discharge from her vagina. Upon
examination, you see oval cells. I have no idea what this is. I put Chlamydia even
though it doesn’t fit in my head. There was no mention of Flagella for Trich, no hyphae
for candida, Gardnerella isn’t milky, and there was nothing that screamed Neisseria to
me. The oval cells could be clue cells, but idk.
20. Guy presents with a chancre on his penis and says it doesn’t hurt, but he doesn’t
want girls to see it. What is the diagnosis? This threw me off because both Chancre and
Syphilis were options. It’s really annoying that they keep doing this. I picked Syphilis,
idk if it’s what they wanted.
21. STD, vesicles, fever, etc. Herpes
22. Person presents with dome lesion on his nasolabial (or something like that) region. I
put Basal Cell Carcinoma.
23. Person presents with Target Lesions. Erythema Multiforme
24. Cat scratch. Bartonella Henslae
25. Weird question about Strep Pyogenes. Described Impetigo, and then asked
something about “non-sequelae to it” as a result. I had no clue what it was talking about.
26. Determining prognosis of skin cancer – Depth of Invasion - HAD THIS ON MY
STEP ALSO
27. Girl is having trouble conceiving. What drug should you give her? I think this was
something estrogen related. I don’t think it was pharm.
28. PCOS leads to Endometrial Carcinoma
29. Lady comes in, you diagnose her with HIV. She says she cheated on her husband.
Doctor says he’s gotta tell her spouse. She says no please don’t tell him, he’ll beat me if
you do. What do you say next? Had multiple answers that looked correct. According to
someone else, there was an answer that said “you should tell him yourself” or something
along those lines, but I don’t remember reading it. I only remember the answer choice “if
you don’t tell him, I have to”, but on top of that, they decided to throw in “Has your
husband ever hit you before?” That’s the answer I picked because I assume that any
doctor would immediately follow up with that BEFORE addressing the HIV situation, but
at this point we all know that Behavioral has nothing to do with logic. Long story short, I
don’t know the answer.
30. Girl comes in pregnant and says she wants an abortion. You are morally opposed to
doing it, what should you do? Refer her to a doctor that will discuss all of her
options with her, including abortion. Only other answer that was remotely possible
was “schedule her for an abortion with a doctor that would perform it”, but I’m pretty sure
the other one is correct. Always discuss all options first (I think).

Since you HAVE NO physio you will 100% will be having new questions to replace
the physio you were not taught

Random tidbits

Hydatiform mole - know the complete vs partial, know which one goes to cancer.
and know the genetics of each one...they like this subject so review it

there will be multiple questions on chlamydia/Neisseria - asking for identification


of cause in patient and other questions on treatment for them. remember both
were heavily discussed in the eye lectures/std repro lectures/and when you have
one STI, you treat for the other as well just in case so know both treatments.

The drug Ceftriaxone is high yield drug as well

know the ages for meningitis and the likely causative agents at each age

food borne illness question wasn’t too hard but you need to review that lecture or
the step CS book for their simplified chart on which foods match with what
bacteria
WAIT THERE’s MORE

disclaimer: à= and

1. Identifying the seizure with the EEG image and description of kid who would
just blankly stare several times an hour. Showed graph with more than 3 waves
per second à Absence Sz.
2. DOC for Absence Seizures à Ethosuximide
3. Description of the kid who had ADHD and what the DOC was à
Methylphenidate
4. Women who had been in a traumatic accident (fire?) 3 years ago and
constantly has flashbacks & doesn't trust the people around her à PTSD
5. Girl who recently changed schools and started having seizures. Even during
seizure tests could not indicate anything actually wrong. She is not concerned
with going to the doctor or how the disorder is affecting her à Conversion
Disorder
6. Women who thinks she is chosen from God, hears voices telling her to do
things, has started having disordered clothing and speech, she was hospitalized à
Schizophrenia
7. Gave a clinical vignette describing chorea onset in a middle age male and
asked what area of the brain that this disease acted on. Recognize this is
Huntigton’sà Caudate Nucleus
8. Described a Parkinson's patient who was on Levidopa and Rasagiline (or
some other drug, it is irrelevant) and the patient started to develop dyskinesias
and other symptoms and it asked why à Long term use of Levidopa
9. AIDs patient with ring enhancing lesions à Toxoplasmosis
10. Obese person and asked if they dieted and exercised what they would
decrease their risk of à developing diabetes
11. Which antiepileptic drug causes gingival hyperplasia à Phenytoin
12. Described women who had visual problems one week and problem writing
another, etc…and then says you see plaques in the brain and asks what cells are
being destroyed à Oligodendrocytes.
13. Listed drugs and asked which one would cause possibly lethal effects in
withdrawal à barbituate NOT cocaine
14. Someone came in with benzo od à give flumazenil
15. Pt had tinnitus in one ear and something near cerebellar pontine angle and
asked what cell was involved in this tumor à Schwann cells
16. Alcoholic having confusion symptoms (showing Wernicke's) and asked where
you would see hemorrhages à Mamillary Bodies
17. Guy had resting tremor, hard time starting motion, shuffling in a circle gait.
And pill rolling. What will you see a deficit in? à Decreased dopamine in
substantia nigra (It was Parkinson's)
18. Parent brings in a kid who has been acting strange – pupils dilated, shaky, etc
à Acetaminophen Abuse
19. Patient presented with head and nuchal rigidity and gave the CSF findings =
increased protein, normal glucose, increased lymphocytes and asked what this
indicated à viral meningitis
20. Parathyroid was removed because of increased parathyroid activity had
increased calcium and decreased phosphate and asked what the cause of
parathyroid dysfunction was (showed picture) à Parathyroid Adenoma
21. A child with Down Syndrome has an increased risk of developing what at an
earlier age à Dementia
22. Patient was on Haloperidol and starting getting motor side effects like tongue
twitching etc. What neuron pathway is affected? à Answer is Dopamine in the
Nigrostriatal pathway
23.Patient had a thymoma removed what is found in the associated condition? à
Antibodies to the Acetylcholine in the NMJ blocking some and complement
fixation destroying others. Look for answer with the words “T cell and cytokines”
24.What does a low solubility for an inhaled anesthetic indicate à rapid induction
and recovery
25. Women's husband died 1 year ago and in the last 8 weeks she has been not
sleeping, lost significant weight, lost interest in normal things, has heard her
name being called à Major Depressive Disorder??? If not this, then it was
Schizoaffective.
26. Patient was put on Clozapine what needs to be monitored? White blood cells
because it can cause agranulocytosis
27. Patient was on Haloperidol and starting getting motor side effects like tongue
twitching etc. What neuron pathway is affected? à Answer is Dopamine in the
Nigrostriatal pathway
28. Patient comes in with chest pain, on day 2 the creatinine-MB ration has
increased and on day three there was another value that was higher? The patient
then had sudden L sided hemiparesis and aphasia what happened? à Embolus in
the MCA from mural thrombi,
29. Guy was in a trauma and was unconscious for 30 minutes, a week later he
came in with anosmia what happened? à uncal herniation, axonal damage to the
taste center, damage to the cribiform plate. Other answers were olfactory nerves,
olfactory tract.
30. Lady who has started becoming antisocial, pulling away from her husband, it
scares her to be in public places – what drug treats? Antianxiety drug, only one
that made sense was Parexetine, a SNRI.
31. Guy had a fractured cribiform plate what infection caused meningitis?
32. Man had the worse headache of his life and then developed meningitis like
symptoms with no organism or increased white blood cells in the blood what will
you see in the CSF? Chart had variables of erythrocytes, glucose, and protein.
Pick the one with the most erythrocytes, as it is a subarachnoid hemhorrage.
33. One about girl with headache and fever doesn’t say anything about neck
stiffness à mcc of meningitis – s pneumo. Could have also been n. meningitidis
since this girl was 18.
34. Gives levels of thyroid hormones. Inc. T3 and T$, low TSH. May or may have
not been clinical stem with Graves. Asks what drug do you give: àPropothiouracil
35. Another question with woman who clearly had Graves, it was the answer.
36. Man has coarse bones, big tongue what is the Dx? à Acromegaly
37. Stem with clitoral hypetrophy, lowered adrenal cortex hormones, and
aldosterone. Dx? àdef of 21 alpha hydroxylase
38. Described a patient with pancreatic tumor with hypoglycemia. Answer was
Beta Islet cell tumour.
39. Asked what would be affected with pituitary tumor. àSomatotrophs
40. Also asked what you would see on MRI/CT if had congenital tumor
41. Dark pigmentation and problem in adrenal cortex. Recognize this is Addison’s
diseaseà
42. Baby with meningitis, gram positiveàlisteria monocytogenes
43. Girl who has nothing wrong with her, is frustrated with going to
doctorsàfactitious disorder.
44. Cyst that was fixed (?)or moves up when swallowed but was lateral to the
midline, under the cricoid cartilageàbranchial cyst
45. Acts what insulin acts on in the cellàtyrosine kinase

BLOCK 2
1. Kid with minimal proteinuria was given a glucocorticoid and the proteinuria
resolved after a few weeks à Minimal Change Disease
2. 40 year old women had a long term problem with fatty stools and gas and on
biopsy they found flattened papillae in the jejunm à Celiac's
3. Man was found to have like 150 polyps in his colon and it asked what would
be the next thing you do à remove the entire colon.
4. Person has cancer just proximal to the esophageal gastric junction what is the
main risk factor à Barrett's esophagus
5. Person is suffering from chronic gastritis, endoscopy shows a bacteria in the
antral area of the stomach what is it à H. Pylori
6. Bolus of insulin vs. IV insulin
7. Something about hyperpigmented spots on the oral mucosa and lips
associated with GI stuff à Peutz-Jeuger Syndrome
8. Crohn's disease that is not responding to other medications so give Infliximab
and asks what endogenous compound will be affected à TNF-alpha
9. Asked what bug that caused UTI was urease positive à Proteus
10. Showed a picture of a staghorn caluculi and asked what would happen à
hydronephrosis
11. Somebody ate something at a picnic and had GI symptoms 1 hour later what
was the cause à Staph Aureus
12. A kid ate a picnic and then got GI symptoms, thrombocytopenia, and kidney
issues. Recognize its HUS-so EHECà E. Coli
13. Someone who traveled to some remote place and got bloody diarrhea. The
bug was non-motile and did not ferment lactose à Shigella
14. Gave someone furosemide and asked what it worked on à Na+/K+/Cl- (it's a
loop diuretic)
15. Described an ATN with granular casts and asked what was being deposited in
the casts à tubular epithelial cells
16. Described a biliary tracts with lymphocyte infiltrations and granulomas à
primary biliary cirrhosis
17. Said there is a cancer in the head of the pancreas what kind of cancer is it
most likely to be. Options were: different cancers of endocrine cells (they are
NOT in head), carcinoma with cysts, or adenocarcinoma à Adenocarcinoma
18. 2O something female has epigastric pain that is associated with bouts of
constipation and diarrhea and it is occurs sporadically usually associated with
stress. à Irritable Bowel Syndrome
19. Someone went camping, brought prepackaged food, but drank from the
stream had diarrhea a week later with some malabsorption à Giardia Lambia
20. Diarrhea in an AIDS patient à C. parvus. (I don’t think its microsporidium.)
21. Gave a scenario of a person with proteinuria, hyperlipidemia, and
hypoalbuminemia and then gave and IF picture à Membranous
Nephropathy. They were trying to trick you between that and Goodpastures
because Membranous has a similar IF but it is a granular pattern.
22. Cancer patient who needed an antiemetic medication and it asked what the
MOA of action would be à Med would be Ondansetron which is a 5-HT3 antagonist
23. 35 year old male has elevated creatinine levels and his mom had a history of
kidney failure and had to start dialysis at age of 40. What would the gross
appearance of the kidney be? à Choices: Large & smooth, large & lobular, small &
necrotic, small & smooth à Large & Lobular. ADPKD.
24. Described an impetigo disease in a kid and asked if there was a non-infective
process what organ could be affected à kidney
a. Not sure about this one. I thought that it was heart, because it was strep, and
clearly you could have endocarditis. We will never know.
25. Described failure of one kidney that showed diffuse scaring, lymphocytic
infiltration of glomerulus, tubular swelling and asked the cause à Chronic
polynephritis
26. Person starts with having difficulty swallowing solids and then slowly begins
to have problem swallowing softer foods what is the likely problem? Some answer
choices were SCC of esophagus, achalasia, loss of innervation by.
27. Cholera infection and you want to give supportive treatment but you don't
have enough IVs for everyone, what is needed to help Na+ absorption in the gut:
Magnesium, Iron, Glucose, Gut Motility Inhibitor
28. What could you give to soften the stools but not change bulk or increase?
Docusoft.
29. Said a stone blockage lead to pancreatitis where would the stone have to be?
Answers: Common bile duct, hepatic bile duct, cystic duct, the opening into
duodenumàmajor papilla because that’s the last part. It would have to be
something that blocked the pancreas.
30. Picture of a glomeruli with dark deposits. It said it was a 10 year old boy with
oliguria and asked what was elevated in his serum: glucose, albumin, creatinine, ?
31. 12 year old boy with severe periumbilical pain, only mild pain when pushed on
the RLQ but severe pain when push on LLQ and try to flex R hip against
resistance. DiagnosisàAppendicitis.
32. Patient with abdomen pain that is severe and radiates to the back with a
history of chronic alcohol use asked what other signs would be diagnostic?
Diffuse abdomen tenderness, ecchymosis of the flanks, …?
33. Man who drinks frequently drinks had a two day binge and now has pain in his
epigastric region. àPancreatitis?
34. Picture of acute interstitial nephritis. Has lots of eosinophils. Stem also
mentions drug use.
BLOCK 3
1. Described a tumor in the ovary that had hair, teeth, etc and asked what this
meant à answer was something about it being benign (Mature teratoma in female
is benign while in male it is almost always malignant).
2. What determines the prognosis of a melanoma à Depth of the malignancy
3. Farmer with a lesion that was clearish with blood vessels that could be seen à
Basal Cell Carcinoma
4. Described an outbreak of painful lesions, the patient remembers a previous
more painful outbreak that also had systemic systems à HSV2
5. Gave a scenario with a mom who had a higher than expected hCG and then
said it was 46 chromosome what was the genetic makeup à 0 from mom , 46
chromosomes from dad (Complete Mole)
6. Swollen testes that felt like a bag of worms à Varicocele
7. Described prostate cancer that had already metastasized to the spine and
asked how you would shrink the tumor & metastases àGonadotropin releasing
hormone analog
8. Described PID and asked what is likely to happen à ectopic
pregnancy/infertility
9. Asked which was an increased risk for breast cancer à later age of 1 child
st

born (it is always anything that causes longer estrogen exposure unexposed)
10. Lumpy breasts that have pain premenstrual seen bilaterally in a 30 something
woman what is the cause à Fibrocystic change
11. Mom who is breast feeding has a sore, hot, red boob à Abscess
12. Asked how Mifepristone causes a medical termination of pregnancy à
competitive inhibitor of progesterone at progesterone receptors
13. Terbutaline mechanism of action for delay the onset of labor ànd B2 agonist
14. Girl was on medication for acne and got a rash from being outside in the sun
what medication was she on? à Tetracycline
15. Someone came in with lesions all over their body that varied with different
colors, types, sizes and some were target lesions à Erythema Multiforme
16. 18 year old girl needed to be put on something idk what for and it asked what
was contraindicated unless she was on birth control ànd Isotretinoin
17. Man had a undescended testes removed and ten years later he had a tumor
appear in that area that was a mixed germ cell tumor with yolk sac remnants, What
is the marked for testicular malignant metastases? àincreased AFP
18. Pregnant woman with increased bp and proteinuria what is the underlying
pathology for this disease? Know it is preeclampsia. Answer choices were
necrosis of blood vessels, endothelial damage, …
19. Placenta covering the os what is the most likely complication ànd
bleeding/HEMHORRAGE. NOT placenta abruption/accreta
20. Male has an STI gonorrhea or chlamydia what happens if this goes
untreated?cystitis
21. Male had a painless lesion and rubbery lymph nodes ànd Primary syphyllis or
Lymphogranulma Venereum
22. Graph of the female menstrual cycle and asked which line represented
Estrogen. Find this graph.
23. In the males what feedbacks to inhibit FSH release and inhibin
24. Graph of where does implantation occur in the menstrual cycle.
25. Screening for pregnant lady with abnormal findings ànd you would do a fetal
sonogram because it’s the least invasive
26. What do you give for BPH and GNRH analogue
27. Described variocele as bag of worms, stop reading the question and pick
variocele
Who Knows What Block?
1. Person has suspected ascites, how do you test? à shifting dullness
2. Person is going on a crazy diet and is cutting down to 2000 calories a
day. They need to get a certain protein (they tell you like 52 g?) and then says
needs the correct amount of calories from fat and carbohydrates and that the ratio
of calories of fat to carbs should equal 30:55 and asks how many calories should
come from fat? Answer choices were 510, 340, 600 etc ***Repeated stupid
calculation question***