CERTIFICO QUE ESTE DOCUMENTO ES FIEL COPIA DEL ORIGINAL
LA DIRECTORA NACIONAL DE DERECHOS DE AUTOR Y DERECHOS CONEXOS DEL SERVICIO NACIONAL DE DERECHOS INTELECTUALES (SENADI)
3)SUPEROXIDE DISMUTASE 4) COX 1
93. over the course of 10 years, urine creatinine excretion and clearance increases, but the serum levels stay the same if the patient is 75 years old now, and takes supplemental calcium and vitamin d, what causes all this?
high protein diet over supp of vit d polycystic kidney renovasc disease normal aging
94. pregnant 16 year old came because of a tonic clonic seizure. unable to urina. her bp, respirations, and pulse are elevated. elevated uric acid, ldh, creatinine, ast, alt. what is the diagnosis?
drug od eclampsia epilepsy renal disease sepsis
95. in vsd and truncus arteriosus, is the extraembryonic mesoderm absent or is it the splanchopleuric mesoderm?Neuroectoderm
96. 52 yo comes in with 3 week history of polydipsia, polyuria and weight loss. he's on metoprolol and simvastatin for hyperlipidemia and htn. what is increased?
choices:
(a) fasting glucose concentration (b) glycogen synthesis
(c) insulin-mediated glucose disposal rate (d) serum calcium concentration
(e) serum HDL-cholesterol concentration (f) urine sodium concentration
97. 23 y/o woman with sjogrens has burning pain in her toes for past month. neuro exam shows decreased perception of temp over feet bilat. sensation is all normal. which neurotransmitter is mediating the pain
gaba dopamine enkephalin serotonin substance p
98. 18 y/o with ALL has 3 day h/o fever and left side chest pain. he is on chemo (asparaginase, daunorubicin, prednisone, vincristine). pmn is below 500. temp is 102.6. chest xray shows left lower lobe infiltrate and pleural effusion on the left. there is a pas thoracocentesis pic shown.
what treatment should be given?
amphotericin b ertapenem ganciclovier infliximab rituximab
99. the pathogenesis of asthma is involved with elastase
hydrogen peroxide ifn gamma
il-10 lactoferrin leukotriene c4
100. elevated ptt, normal pt – Hemophilia, vWB
101. in mcad, i know that the deficiency is in medium chain acyl coa dehydrogenase,. long chain suffice
102. 38 y/o woman seems to have a gastrinoma (serum gastrin concentration is 2000 (normal
<100). She also has multiple lipomas and two large non bleeding ulcers. she is started on a proton pump inhibitor. what measurement should you follow?
serum ca serum cortisol
serum tissue transglutaminase stool alpha 1 antitrypsin urine 5hiaa
104. a newborn female is diagnosed with hypothyroidism 2 days after birth. ultrasonography of the neck shows no gland tissue. p/e and reflexes are normal. maternal to fetal transfer of which of the following explains the normal development in the newborn?
iodine thyroglobulin tsh
thyrotropin releasing hormone t4
105. chloroquine spares which two plasmodium species? P. vivax and P. ovale a dormant stage (hypnozoites) can persist in the liver and cause relapses by invading the bloodstream weeks, or even years later.
105. 68 y/o woman has 1 year history of severe ab pain after meals. also has an unintentional 20lb weight los. pain is relieved when she decreases the amount of food she eats. p/e shows soft, nontender abdomen and abdominal bruit. pedal pulses diminished. which artery is stenosed?
greater pancreatic hepatic
right gastric
superior mesenteric supraduodenal
106. Hantavirus with the big chart asking about
which segment is associated with temperature sensitive phenotype associated of Hantavirus A? I think whenever the A strain had the L segment it was temperature sensitive and that was the answer.. (Don't remember too well but I think the right answer was A)
107. A 32-year-old man begins to laugh while eating dinner with his friends. A small particle of food irritates his larynx and provokes him to cough. Which of the following best describes the position of his vocal cords throughout this sequence?
Immediately After
While Swallowing Laryngeal Irritation While Coughing A) Closed closed open
B) Closed open closed C) Closed open open D) Open closed closed E) Open closed open F) Open open closed
108. A 33-year-old man comes to the physician because of a 3-month history of muscle weakness and cramping. He says that the symptoms appear shortly after he begins exercising. Physical examination shows no abnormalities. Serum creatine kinase concentration is increased. After the forearm muscles are exercised, venous blood obtained from the antecubital vein shows that lactate concentrations do not increase compared with preexercise values. This patient most likely
has a deficiency in the activity of which of the following enzymes in muscle?
A) Carnitine palmitoyltransferase-1 B) Fumarase
C) Glucose-6-Phosphatase D) Glycogen phosphorylase E) Succinate Dehydrogenase
109. 75 year old lady, one alcoholic beverage per day, does knitting gardening reading, goes to swimming pool occasionally, BMI 21
Which of the followning would decrease patients risk for additional hip fractures?
- Discontinue alcohol - Discontinue gardening
- Swimming pool based exercises 3 times - Long walk outside daily
- Lose weight
110) Fanconics syndrome, what are the Amino Acids, HC03, Phosphate and Glucose levels ? Everything decreased
111. When you prescribe appropriate pain medications to a patient who wanted to kill herself through pain medications which core ethical principal are you using?
Justice Beneficence Non maleficence Dignity
Autonomy
112. A 64 year old man is evaluated for cough dyspnea and chest pain.afebrile. a chest x ray density in hilar region.lung biopsy shows round cells with little cytoplasm that are twice the size of lymphocye infiltrating sheets that are neither glandular nor squamous in origin.serum
abnormalities?
1 hyperkalemia 2hyperlipidemia 3 hypmagesemia 4hypoalbuminemia 5 hypogylcemia 6hyponatremia
113. . An increase in the amount of iron inside cultured hepatocytes leads to an increase in the amount of ferritin gene products detected by Westem blotting.
It does not change the amount of ferritin gene products detected by Northem blotting or by the polymerase chain reaction.
These results suggest that iron increases the frequency of which of the following events?
A) Maturation of the ferritin gene transcript B) Transcription of the ferritin gene
C) Translation of ferritin mRNA
D) Transport of ferritin mRNA out of the nucleus
114. a 51 yr old man with 3 month history of HBV negative PAN presents with myalgia .biopsy will show?
cental vacuolization with gycogen central vacuolization with lipid mitochondia increase
mucopolysaccharide
PAS + myofibrillar vacuolization segmental ishemic necrosis
115. test for occult blood for colon cancer has?
low sensitivity low specificity uncertain PPV uncertain NPV
potential for False positive
116. A 62-year-old woman with chronic renal disease comes to the physician for a follow-up examination.
She is 157 cm (5 ft 2 in) tall and weighs 52 kg (115 lb); BMI is 21 kg/m2. Her pulse is 78/min, and blood pressure is 140/100 mm Hg. Laboratory studies show anemia. Treatment with intravenous recombinant erythropoietin is started.
Measurement of which of the following is most
appropriate to monitor the effectiveness of this pharmacotherapy?
A) Arterial blood pH
B) Arterial pressure of carbon dioxide C) Oxygen saturation of the blood D) Plasma hemoglobin concentration E) Serum urea nitrogen concentration
117. 70 year old man comes to the emergency department 30 minutes after the onset of weakness, nausea, and lower abdominal and back pain that radiates to the lower extremities. he appears pale and has a cold sweat. pulse is 110/min and blood pressure is 90/60mm Hg. pulses in the lower extremities are weak. a Faint bruit is heard in the lower abdomen. muscle stretch reflexes are normal in both lower extremities. Which of the following is the most likely diagnosis?
A) Acute compression fracture of the L3 vertebral body B) Herniated L3 to L4 intervertbral disc
C) Leaking aortic aneurysm
D) Leaking left renal artery aneurysm E) Perforated rectum
F) perforated sigmoid colon
118. Male with a h/o abd pain and diarrhea, pain relieved by eating and antacids. Labs show gastrin of 500 and gastric acid secretion of 80. what is the most definitive treatment? low protein diet/abx therapy/antihistamine therapy/sectioning of the vagus nerve/surgical removal of the suspected tumor
119. 25 year old man that after running his temp is 38, they ask how does the temp return to normal??
EVAPORATION OF SWEAT
INCREASED MINUTE VENTILATION INCREASED MUSCLE TONE
PERIP. ARTERIOLAR VASOCONSTRICTION PERIP. VENOUS VASOCONSTRICTION
120. what about the woman that thinks she has sleep apnea and came to get checked for this??
Reassurance
121. which one of these doesn't have microtubules?
corticol thymocytes
enterocytes in duodenal crypts erythroblasts in the bone marrow keratinocytes in stratum basale ventricular cardiac muscle fibers
122. A 5-year-old boy with mental retardation is grossly obese and has facial features of Prader-Willi syndrome (PWS).
Karyotyping and fluorescent in situ hybridization studies do not show deletion in the usual site on chromosome 15. Which of
the following findings is most likely to confirm PWS in this child?
~ A) Deletion in the short arm of chromosome 15 B) Duplication within chromosome 15
C) Large trinucleotide repeat expansion in the PWS area of chromosome 15 D) Maternal origin of both chromosomes 15
E) Translocation in the short arm of chromosome 15
123. Old man with fever chills fatigue SOB and weight loss. Underwent urinary catheterization for prostatic obstruction. High temp/pulse/BP. Soft s1 and normal S2. 2/6 early diastolic murmur and accentuated when pt leans forward with held expiration. Clear lungs. Which is most likely dx?
Bacterial endocarditis, peritonitis, prostatitis, PE, Viral pneumonia
124. Cause of patient's sx of stenosis in which artery? She had 1 year hx of severe abdominal pain after meals and weight loss; pain relieved with less food. hx of atherosclerosis and underwent CABG 2 yrs ago; exam shows soft nontender abdomen and abdominal bruit. Diminished pedal pulses
Greater pancreatic, Hepatic, Right Gastric, SMA, Supraduodenal
125. Boy homozygous for HbS; daily tx w/ penicillin to decrease risk of infection with what?
E. coli, H. flu, Neisseria mening, Salmonella, Strep pneumo; I put salmonella but incorrect 126. The pedigree with Fragile x syndrome that asks the probability that III-5 will have similar expansion? Would love an explanation of the answer. 0% recall that the male only needs one allele to manifest the dz, so
he is diseased and thus cannot have the same trinucleotide repeats as the woman which is a carrier.
127. With regards to the erection, asking for an intact spinal reflex arc between the sacral parasympathetic nerves and which of the following?
Genitofemoral, ilioinguinal, lumbosacral trunks, obdurator nerve, pudendal nerve
128. A 35-year-old man is referred for psychiatric evaluation by a work-sponsored depression screening program. He has no history of serious illness, and his last routine examination was 12 years ago. He says that for the past 2 years he has felt down and has not fully enjoyed life. He is generally unmotivated and pessimistic about the future and has little energy for
relationships or work. He wonders if he is just getting old. He has not had any changes in his appetite or sleep pattern, and his symptoms have not afiected his ability to work. Although he has had occasional thoughts that life is not worth living, he has not
had suicidal thinking or planning. Which of the following is the most likely diagnosis‘?
A) Adjustment disorder with depressed mood B) Avoidant personality disorder
C) Bipolar disorder D) Dysthymic disorder E) Major depressive disorder F) Schizoafiective disorder
129. A 43-year-old woman comes to the physician because of progressive difficulty walking during the past 3 months. Neurologic examination shows weakness and decreased muscle bulk of the lower extremities. Patellar and Achilles tendon reflexes are diminished. Sensations of joint position, pain, and temperature in the lower extremities are normal. Which of the following is the most likely cause of the findings in this patient?
A) Acute peripheral neuropathy
B) Degeneration of motoneurons of the lumbar cord C) Demyelination of the corticospinal pathways
D) Loss of afferent la axons innervating muscle spindles E) Myotonic muscular dystrophy
130. It was about the niacin cholesterol mechanism a. antagonizes VLDL cholesterol secretion
b. increase catabolism of LDL
c. inhibits cholesterol uptake (i think this is the answer) d inhibit HMG COA
e. stimulates PPARa
131. just to confirm the elliptical, purple budding organism that grows on sheep agar- candida 132. 43 yr old woman, who has immune thrombocytopenic purport resistant to corticosteroid treatment, will undergo an operation to improve her condition. removing which organ in the ct scan will help? Splenectomy
133. Systolic murmur is loudest at the point marked by X. Which cardiac abnormality is causing the murmur?
aortic valve regurgitation (diastolico), aortic valve stenosis (base irradiado a carotidas), mitral valve regurgitation (apex y axila), mitral valve stenosis(diastolico), pulmonic regurgitation (diastolico), pulmonic stenosis, tricus regurgitation(tricuspida), tricuspid stenosis(diastolico)
134) 51 yr old woman w/ pheochromocytoma. preoperative treatment w propranolol prescribed to decrease tachycardia. which drug should be admins. before starting propranol?
atenolol, clonidine, nifedipine, phenoxybenzaminem sildenafil?
135) 70 yr old lady brought to er by husband 45 min after he found her unresponsive. She has anxiety disorder trted w/ diazepam. She recently started taking over the counter med for heart burn. she only responds to painful stimuli. interaction with which drug causing this prob? i know its a cytp450 inhibitor so is it cimetidine or ranitidine?
calcium carbonate, cimitidine, famotidine, magnesium trisilicate, ranitidine 136) 66 yr old man brought to er sudden substernal chest pain..jogging when pain
began..hypertension trted w indapamide..pulse 90 min bp 150/90 cardiac exam s4. treatment w sublingual med fixed pain in 2 min…mech of action of which drug let to relaxation of vascular smooth muscle in this patient? Obv nitroglycerin so is the answer increased cGMP?
decreasing intracellular calcium, increasing camp, increased cGmp, inhibiting the sodium pump, stabilizing depolarization of the vascular smooth muscle cell membranee
137) previously healthy 67 yr old lady w 3 day history of fever, shortness of breath, nonproductive cough, headache, and muscle pain. Temp is 102 F. lungs clear to auscultation. Exanm shows no abnormalities. which vaccine coulda prevented this stuff?
diphteheria tetanus acellular pertussis, h. influ type b, hepatitis b, inactivated polio, influenza virus, mmr, typhoid, 23 valent pneumococ, varicella
138) 35 yr old man w long history of atrophic gastritis has increased lethargy and fizziness during past 2 weeks. pale skin and mucous membranes. no palpabl adenopathy. liver edge palpable.
decreased vibratory sensation. hct of 27%, mcv 112, and platelet count 200,000. absence of sufficient numbers of which cell types explains these findings?
chief, columnar absorptive, enteroendocrine, goblet, mucous, paneth, parietal, undifferentiated crypt
139) 80 yr old woman fever cloudy urine after knee replacement. Temp is 100.4 F. Bandaged left knee and indwelling foley cath. Micro shows numerous gram negative rods. urine culture brain heart infusion medium grows more than 100,000 bacterial colonies predominantly one thats oxidase positive and produces diffusible green pigment. whig organism? Is this p.aueroginosa?
ecoli, kleb.pneumoniae, proteus mirabilis, p.aureoginosa, group a step pyogenes
140) 4 month boy w recurrent sinopulmonary infections since birth. Phys exam shows hypo pigmentation of skin, eyes, hair, ecchymoses over trunk and extremities. Blood smear shows giant granules in neurtophils and eosinophils. I know this is chediak higashi lol but still wanna double check
acute myeloblastic leukemia, ataxia telangiectasia, chediak higashi syndrome, leukocyte adhesion deficency, sezary syndrome
141) 62 yr old man has pain in the left hip for 3 wks. X-ray of ship shows 4.5 cm destructive osteoblastic lesion w an associated fracture in proximal femur and 2 separate similar smaller lesions in the bony pelvis. Needle core biopsy of femur shows metastatic carcinoma. Whats the most likely primary site of the cancer? prostate right cuz of the clues? if its not this then lung(most common metastasis site)
colon, kidney, lung, pancreas, prostate
142) previously healthy 52 yr old lady has 2 mo history of progressive difficulty swallowing, double vision, and slurred speech. pays exam shows ptosis of the eyelids and waddling gait. muscle strength shows fatigable weakness of the neck, arms, hands, and fingers. Repetitive nerve stimulation shows a 25% decrease in muscle action potentials in several muscles. Which of the following mechanisms is the most likely cause of this patients disease?
binding of acetylcholine by an antibody, binding of antibody to the acetylcholine receptor, deceased acetylcholine production, decreased release of acetylcholine from the receptor, decreased reuptake of acetylcholine
143 )5 yr old stares blankly into space for several seconds. doesn’t respond to questions during these episodes. pays exam shows no abnormalities. reg shows 1-3 second hurts of 3 sec spike and wave activity. no abnormal motor movements are observed during this reg activity.
carbamazepine, ethosuximide, gabapentin, phenobarbital, phenytoin
144) 5 year old boy brought to the ER. with vomiting and sleepiness, he had a flu like illness 5 days ago that she treated with aspirin. Serum studies show increased ammonia, lactate, and
transaminase levels. what's the most likely cause of the patient's coma?
a) cerebral edema b) metabolic alkalosis c) subarachnoid hemorrhage d) venous sinus thrombosis e) viral encephalitis
145). Liver showing centrilobular pallor and swelling of hepatocytes and kidneys showing proximal convoluted epithelial cells. Which is the mechanism?
A) activation of aspartate-spcific caspase B) Binding of Fas ligand to receptor C) Decreased function of Na/K ATPase D) Ribosomal degradation
E) Stimulation of PFKase
146)60 yr old woman has 2 history of hypertension comes to doc for follow up examination.
Hypertension has been poorly controlled during the past six months despite availability of appropriate pharmacotherapy. which of the following statements by the physician is most appropriate to begin a discussion about this patients possible noncompliance w her medication regimen?
Is it “it is hard to take pills every day for a condition that has no symptoms”
“i will arrange for nurse to visit to make sure you’re taking meds properly”
“I’m sorry but i must say missing your meds can kill you”
“you clearly have not been taking your meds. you must be more responsible”
“you realize that your high blood pressure could have been avoided”
147) 38 yr old lady w/ 10 wk history of epigatric pain and frequent stool. She had two episodes of renal calculi during the past 2 yrs. Physical exam shows multiple superficial lipomata and mild epigastric tenderness. Upper endoscopy show two large non bleeding duodenal ulcers. her gastric pH is 2.3, and serum gastrin concentration obtained immediately after the procedure is 2000 pg/ml(N<100). Proton pump inhibitor therapy is begun. measurement of which of the following is the most appropriate next step in management?
MEN syndrom...so check Parathyroids---> they make PTH-> increased CA2+
148) 12 year old with walking abnormality for 6 months. mild atrophy and hammer toes.nerve biopsy shows
abnormal myelin sheaths
absence of shwann cells (would be MS- patient too young and more likely in females) lymphycytic infiltrate
abnormal astrocytes (brain)
abnormal oligodendrocytes (oligodendrocytes are in the brain)
149) 54 yr old man w/ aneurysm in distal portion of his abdominal aorta. Estimated cross-sectional area of the aneurysm is 2 cm^2 and the mean velocity of blood flow thru the aneurysm is
20cm/sec. which of the following best represents the flow rate in L/min thru the aneurysm? Can someone please help me out with this?
1.0, 2.4, 3.2, 3.6, 4.0
150)55 yr old dude w contipationsine taking meds for chronic persistent cough n sinus congestion.
which ingredient in this med most likely cause of this patients new symptom? dextromethorphan right?
acetaminophen, dextromethorphan, guafenesin, loratidine phenylephrine
151) 54y F admitted with acute MI, at which point there were no murmurs or signs of heart failure; but 2 days later, she has acute SOB and sweating; HR 100, RR 24, BP 160/98. Crackles bilaterally, +murmur. Which murmur is most likely?
So SOB and Crackles must be fluid backing up into the lung... therefore left sided heart failure ->
the concept is that ischemia of the papillary muscles lead to Mitral insuff. -> murmur is holosystolic high pitched loudest at apex
152) 28 yr old lady w/ 1 month history of pelvic pain that has become increasingly severe during the past week. Her mensrual flow has been unusually heavy during her last three menstrual periods. Menses have occurred at 24-28 day intervals since menarche at the age of 12 years. Phys exam shows a palpable mass in the left adnexa. Serum studies show an increased CA 125
concentration. Vaginal ultrasonography shows an 8 cm mass in the left ovary. During surgical removal of the ovary, which of the following structures passing inferior to the ovary must be protected?
Ureter
153) 16 yr old boy dove into pool, unable to move right upper and lower extremities. Most likely cause of movement deficits in this patient is damage to which region of the spinal cord? Is it G, by
153) 16 yr old boy dove into pool, unable to move right upper and lower extremities. Most likely cause of movement deficits in this patient is damage to which region of the spinal cord? Is it G, by