NBME 27

Question 1

Cellulitis C/P. No purulence and gram stain shows gram +ve cocci in chains. Cause?

A) Strep pyogenes grp B
B) Staph aureus

Answer 1

Answer is A

Why?

Purulence + gram positive cocci in clusters = staph aureus - MCC
No purulence + gram positive cocci in chains = step pyogenes!

Question 2

What vaccines are capsular polysaccharide conjugated vaccines?

Answer 2

Haemophilus influenza B
Nisseria meningitis
Streptococcus pneumonia

All three of these bacteria have conjugated polysaccharide capsule are vaccinations

Other type of vaccination include specifically for: diphtheria, tetanus, and pertussis (DTap)

Polysaccharide vaccines induce a T cell mediated immune response but with conjugation they stimulate a B and T cell mediated response

Question 3

What is the most important wrist factor for endometrial adenocarcinoma:

A) early menarche
B) estrogen therapy

Answer 3

Answer is B estrogen therapy is the most important factor for endometrial adenocarcinoma.

Question 4

Most important side effect of acute injection of 25 metformin tablets?

A) increase creatinine concentration
B) increase lactic acid concentration

Answer 4

Acutely metformin will lead to increase lactic acid concentration - manifest as diarrhea nausea abdominal pain.

Acute kidney injury is caused by nephrotoxic drugs such as vancomycin, NSAIDs etc.

Question 5

Which of the following has a plasma membrane bound receptor?

A) Aldosterone
B) Prl

Answer 5

Note that aldosterone has a DNA binding domain based nuclear receptor so the answer is prolactin

Question 6

How to increase the sensitivity of a test to 100% in case of a curve which represents TP, TN, FP and FN?

Answer 6

The way to increase the sensitivity to 100% would be by increasing the number of false negatives and decreasing the number of false positives.

Check page 14 of NBME 27

Question 7

Car shifting from Y to Z shows an increase in pH decrease in HCO3 and increase in H+. Cause;

A) metabolic alkalosis
B) injection of an acid
C) breathing a gas mixture with low Po2

Answer 7

The idea of increasing pH and decreasing bicarbonate indicates that the increasing pH is because of low CO2. Respiratory alkalosis is the diagnosis and only C sits well with this diagnosis.

Question 8

Which enzyme is most important for remodeling of a wound?

MMPs
TGF-beta

Answer 8

MMPs - obvvvvv

Question 9

Which one of the following enzymes is most important for remodeling of a scar?

Answer 9

MMPs obv

Question 10

Why would someone have a priapism and flushed skin? Where is the defect?

Answer 10

Sympathetic fibers from the prostatic plexus. Priapism is mediated by parasympathetic nervous system. If afferents from sympathetic nervous system are defective erection process

Question 11

Advance likely, oscillation, and products need to increase synthesis of which one of the following extra cellular metrics by human renal mesangial cells?

Hint is look for an option that involves cellular, matrix protein.

A) nitric oxide
B) NADPH oxidase
C) VEGF
D) fibronectin

Answer 11

Out of all the options, only fibronectin is present in the extra cellular matrix thus is the answer

Question 12

What happens in case of botulism if nl is:

End Plate potential: 10 mv
miniature EPP: 1
Response to Ach: 1

Answer 12

in botulism no epp is made so all is 1 mv!

(Miniature endplate potentials are the small depolarization events that occur from the release of a single vesicle of acetylcholine into the neuromuscular junction. These potentials are not sufficient for reaching the action potential threshold on the muscle cell membrane.
These miniature potentials occur sporadically when no depolarization signal is given to the neuromuscular junction as there is a small amount of baseline vesicle release.)

Question 13

CB tumor so which sign indicative:

a) Tinel sign
b) Dolt’s eye (oculocephalic) maneuver
C) glabellar tap
d) Rapid alternating movements

Answer 13

A) D

Tinel sign: refers to pain on percussing the median nerve as it passes through the wrist. A positive Tinel sign is suggestive of carpal tunnel syndrome.

The doll’s eye (oculocephalic) maneuver: brainstem reflex when we move the patient’s head and the eyes move in the opposite direction to hold the patient’s gaze on an object. In a negative oculocephalic reflex, the patient’s eyes remain midline: which indicates severe brainstem dysfunction.

The glabellar tap or glabellar reflex: blinking in response to repetitive tapping on the forehead. It is related to frontal lobe immaturity in infancy and also occurs in advanced dementia as a frontal release sign.

Question 14

An old pt with problems reading only. Visual acuity is nl bas he places his book a little away when reading. Cause:

Normal age related changes
Hypermyopia

Answer 14

A) presbyopia

Hyperopia occurs when the focal point of the eye is found at a point behind the retina.
Patients present with blurry vision both at a distance and when near. The condition usually presents in childhood.

Question 15

MCA infarct left-sided wud cause?

Global aphasia
Right sided facial muscle weakness
Left sided weakness of upper third of face

Answer 15

A is the answer - all Broca, Wernicke’s effected

Right sided weakness of lower half of face s valid not these 2 options

Question 16

Recruiting members for a study locally and regionally based off on how many reply to advertisements is?

Geographic
Self-selection
Popln based control

Answer 16

B is the answer- ppl select themselves as participants of a research

Geographic sampling chooses individuals from a population on the basis of geographic location. For example, sampling of the population of a city may select certain numbers of ppl from each city block.

Population-based control is when the control group is selected directly from the population of interest. This is often done in case-control studies when the control group is selected directly from the same population from which the cases are selected.

Question 17

If corneal clouding is +ve. What LSD?

Answer 17

Hurler - acc of a-lduronidase

Hunter - no clouding + aggressive behavior - acc of steroid sulfates

Question 18

All genital organs drain in the para-aortic LNs. Location?

Answer 18

Along the ovarian/testicular BVs

Question 19

Acute intermittent porphyria Mode of inheritance?

Answer 19

AD

Question 20

Septic arthritis vs viral synovitis?

Answer 20

Viral synovitis (Choice E) Commonly, it occurs in pediatric hip joints and may mimic septic
arthritis: however, the laboratory studies generally do not show leukocytosis and will likely only show mildly increased erythrocyte sedimentation rate and C-reactive protein.

Opp for SA

Question 21

Fn of kB in NFkB?

Answer 21

Releases NF-KB after undergoing phosphorylation

Question 22

The laceration has stopped bleeding and is covered with a clot. This finding results from hepatic synthesis of which of the following?

A ) Enzymes that increase production of platelets
B) Proteins that result in the production of fibrin strands

Answer 22

B is the answer - F-2,7,9,10 is produced to cause fibrin to be produced.

A isnt the answer - Certain mutations in genes such as JAK2. MPL, and CALR can cause unregulated production of platelets in the bone marrow and are a cause of disorders such as essential thrombocytosis, polycythemia vera; and myelodysplastic syndrome, but these are not hepatically produced enzymes.

Question 23

Neonatal conjunctivitis txt?

a) Bact CW inhibitor
b) Bact protein inhibitor

Answer 23

Within 1st 5-7d + purulent discharge - Gonorrhea

Chlamydial conjunctivitis presents within 5-14d of birth and is characterized by watery discharge.

Herpetic conjunctivitis presents more than 14 days after birth.

At the moment neonate is given erythromycin prophylaxis to stop progression to conjunctivitis!

Question 24

A CT scan and Bx of the abdomen shows a mass in the liver. Results show nuclear chromatin margination under the nuclear membrane, intact cell membranes, and cells that are smaller in size than normal cells in the tissue. The mechanism causing the cell size anomaly is cause of:

Cyt C
BAX
Bcl2
Procaspase-8
Procaspase-9

Answer 24

Ans) A

Intrinsic pathway activation - BAX + BAK act Cyt c release

all in all - cyt c is the main one released from mitochondria that causes karyorrhexis and pyknosis - dec cell size

Question 25

Post transplant, renal Bx shows arterioles inf + BUN/Cr inc. Cause?

Answer 25

Host CD8+ T lymphocytes recognize class 1 MHC molecules on renal allograft cells

Question 26

Resident on how to improve sleep hygiene?

Answer 26

“Try getting up the same time every day. even if you d dn’t get much sleep”

Question 27

Pt comes to ED with elbow swelling with well-defined borders. Its a fluctuant mass, swollen, mildly tender. Cause:

Bone
Ligament
Bursa
Synovium
Jt capsule

Answer 27

Bursae are thin, sac-like, fluid-filled structures that decrease friction and permit motion between layers of connective tissue. When inflamed or injured, fluid can collect inside the potential space of the bursa, causing swelling that can be
appreciated on examination as a fluctuant, tender circumscribed mass.

Question 28

Pg 73 on NBME 27

Answer 28

pts to PCA infarct - contralat vision loss

Question 29

Post baby is born and is extrauterine, What changes to the lung?

Answer 29

Pulm BF

post being extrauterine - all shunts start to close off and BF to actual organ inc

PA pr dec due to O2 - VD

Question 30

Gluconeogenesis and glycogenolysis done by?

Answer 30

Liver and Kidney

Question 31

PCV inc VP and VD caused by?

Bradykinin
TNF-alpha
TxA2

Answer 31

A!

3 mediators of VD: histamine, prostaglandin-E2, and bradykinin.

Question 32

what drug reverses the effect of succinylCh?

Dantrolene
Neostigmine

Answer 32

B!!

Its an AchE inihibitor - inc natural Ach in cleft to displace SuccinylCh.

Dantrolene is a ryanodine receptor antagonist, used in the treatment of malignant hyperthermia.

Question 33

Pt comes with HTN + hypoK. Dec ald + renin but inc cortisol/cortisone ratio. She is consuming a supplement that inhibits?

21-Hydroxylase

11p-Hydroxysteroid dehydrogenase type II

3-Oxosteroid A4-dehydrogenase

Answer 33

B

The patient likely consumed a supplement containing licorice:
the active ingredient of which is glycyrrhetinic acid; or enoxolone. This compound inhibits a variety of enzymes; including the
enzyme 11p-hydroxysteroid dehydrogenase type II which catalyzes the conversion of cortisol to cortisone in the zona fasciculata of the adrenal gland -
increased cortisol to cortisone ratio. Cortisol demonstrates a weak mineralocorticoid effect and inserts ENaC channels
into the renal collecting tubule, which cause sodium and water reabsorption in exchange for potassium excretion, leading to hypertension and a mild hypokalemia.
The enzyme also inhibits the metabolism of prostaglandins E2 and F2a to their respective inactive metabolites, which causes a downstream effect of inhibiting gastric acid secretion by the stomach.

Question 34

If u consume soft drinks instead of milk as a 12 yr old. U get?

Answer 34

Decreased peak bone accretion during adolescence

Question 35

Bact infections since birth. Inc Ns and Inc band cells. Cause is:

A } C9
B) IgG
C ) Beta2 Integrin
D) Interferon alpha

Answer 35

C!

LAD - caused by dysfunctional LFA-1 integrin (CD18) protein on the leukocyte surface, which does not allow for the normal attachment of leukocytes to the vascular endothelium. The absence of the Beta2-integrin subunit that leads to impaired LFA-1 function.

Question 36

Perianal infection + worms in stool + abd pain n distention. Cause?

ascariasis lumbricoides
Enterobius vermicularis

Answer 36

A!!

Ascariaisis - worms in stool + abd C/P + pulmo C/P

Enterobius - no worms but eggs in stool + perianal itching

Question 37

Woman donates huge sum to help prevent cardiac arrest. Best way to utilize it is?

Answer 37

Place defibrillators everywhere

Question 38

FTT + malabsorbtion + steatorhea, edema + low albumin.

Trypsinogen
Chymotrypsinogen
Proelastase

all inc. Defect in?

Answer 38

Enteropeptidase enzyme obv

Question 39

In systemic sclerosis what happens to esophageal peristalsis + LES motility.

Answer 39

Both dec

Question 40

How to reach uterine art via femoral art?

Answer 40

External iliac artery –> internal iliac artery –> uterine artery

Question 41

Resp distress + dislocated lens + LL edema. Serum concentrations of methionine and homocysteine are increased, and serum cystine concentration is decreased. Enzyme issue?

Cystathionine p-synthase
Fumarylacetoacetate hydrolase
Hepatic adenosyltransferase
Methylmalonyl-CoA mutase

Answer 41

A is the answer!

Homocystinuria is an autosomal recessive metabolic disorder most commonly caused by a defect in cystathionine p-synthase, leading to increased serum and urine concentrations of homocysteine and Increased serum concentrations of methionine indicate that the defective enzyme is cystathionine (3-synthase, rather than methionine synthase; another enzyme that causes homocystinuria when deficient.
Patients with homocystinuria present with characteristic signs and symptoms including intellectual disability, a tall Marfanoid habitus with long limbs: pectus excavatum and pes cavus. ocular fens
subluxation (with the lens typically subluxated inferomedially): and vascular disease such as thrombosis and atherosclerosis

Question 42

pg 101 NBME 27. Qns talks abt NNT.

Answer 42

See the qn

Question 43

Genital examination shows shallow, vesicular lesions on the shaft of the penis + painful _ inguinal LNs.
Cause:

Herpes
Chanchroid
Syphilis
Lymphogranuloma venereum

Answer 43

Ans) A

Chancroid presents with an exudative painful genital ulcer with inguinal lymphadenopathy. It is caused by infection with the organism Haemophilus ducreyi.

Lymphogranuloma venereum - s caused by infection with Chlamydia trachomatis subtypes L1, L2, and L3. It presents as small painless genital ulcers with tender inguinal
lymphadenopathy.

Question 44

How can PEEP dec PCO2?

Answer 44

The arterial pressure of oxygen (Pa02) is dependent on positive end-expiratory pressure
(PEEP) as it prevents alveolar collapse and inc the fraction of inspired oxygen (FIO2).

PaCO2, in contrast, is dependent on minute ventilation which is dictated by the tidal volume and respiratory rate, with increases in either variable being
associated with an increased exchange of carbon dioxide from the blood into the alveoli for exhalation which results in a decreased arterial PaCO2.
So inc TV or RR - dec PaCO2!

Question 45

Patient with type I diabetes mellitus has experienced weight loss and a worsening of her glucose control as demonstrated by the increase In hemoglobin A1C from 5.8% to 8.4%. Cause:

Decreasing the amount of self-administered insulin doses

Restricting calorie consumption

Starting an intense aerobic exercise program

Answer 45

A is the best answer

C wud be good if her HbA1C got better but no!

Question 46

Effect of smoking on airway mucus pdtn, cilia and Ms?

Answer 46

Tobacco smoke directly disrupts the ability of the airway to clear foreign material by resulting in increased mucus production, decreased activity of airway cilia, and inhibition of alveolar macrophage function.

Question 47

What to do to a pt who has grief experienced but n DPN signs?

Answer 47

Monitor him via scheduled appointments

Question 48

Why does a lady RR inc post getting pregnant ?

Answer 48

Inc Minute ventilation in order to expel CO2 produced by bby. CO2 produced from the fetus travels through the umbilical artery and across the placental membrane into the maternal circulation.

Others include: increased cardiac output, increased oxygen
demand, and increased minute ventilation,

Question 49

Which of the following sets of cancer types and tumor antigens is most likely to produce the highest antibody titer?

Answer 49

Out of the options check which cancer has a non-human Ag.

Like HPV E6 is non human so Abs for it will be highest.

Question 50

Alcoholic + B1 def + causes downregulation of the glial high-affinity glutamate transporter before neurons are lost. Cell effected?

Astrocytes
Ependymal cells
Microglial

Answer 50

A

In response to damage to the (CNS) glutamate is released rapidly into the synaptic clefts and neuronal apoptosis ensues. High-affinity glutamate transporters on astrocytes are the main mechanism for the removal of glutamate from synapses, thereby protecting the brain from glutamate-induced
excitotoxicity.

When these high-affinity glutamate transporters are downregulated, neurons may be more likely to undergo apoptosis and produce the characteristic pattern of brain atrophy in
Wernicke-Korsakoff syndrome. The mammillary bodies are typically atrophied in Wernicke-Korsakoff syndrome, a neuropsychiatric disorder most commonly related to chronic alcohol abuse and
malnutrition. Patients who chronically abuse alcohol can demonstrate a significant thiamine (vitamin B-1)

Question 51

2nd gen v/s 1st gen antipsychotic. Why does 2nd gen not produce Parkinson’s like side effects?

Answer 51

Partial agonism at D2

Question 52

How many ATPs for H+ secretion in gastric acid?

Answer 52

1 ATP hydrolysis

Reduction of a single molecule of FADH2 leads to the generation of two molecules of ATP

NADH leads to generation of three molecules of ATP.

Question 53

Inc Ch in stool but dec in blood. Defect where?

Answer 53

Apo B

Hypobetalrpoproteinemia results from defects in the function of apolipoprotein B (APOB), which is encoded by the gene APOB. Deficiency of APOB causes malabsorption of dietary fats
APOB plays an important
role in the function of chylomicrons, very-low-density lipoprotein (VLDL); and LDL-cholesterols; serum concentrations of which are characteristically decreased. HDL alone is not dependent on
APOB and has normal serum concentrations in these patients. Treatment includes high-dose supplementation with vitamin E.

Question 54

Apo C def?

Answer 54

HSM + inc VLDL and Chylomicrons

Question 55

Apo A def

Answer 55

Dec HDL

APOD encodes apolipoprotein D (APOD). APOD forms a minor component of HDL-cholesterol

Question 56

Apo E def?

Answer 56

APOE (Choice E) encodes apolipoprotein E (APOE). APOE is expressed in all major cholesterol and lipoproteins other than LDL-cholesterol It plays an important role in the uptake of chylomicron remnants.

Question 57

How does malaria activate CD8 TCs?

Answer 57

Invasion of the malaria parasite into the cell cytoplasm leads to processing of parasite proteins and presentation by class I MHC molecules

Question 58

17 year old + irreg mensus + chiromegaly. Inc 17-hydroxyprogesterone and androstenedione. Cause:

Answer 58

21 alpha Hydroxylase def

11B-Hydroxylase (Choice A) deficiency is a rare form of CAH in which the production of cortisol and aldosterone are interrupted later in the pathway in comparison to 21-hydroxylase deficiency. Thus decreased cortisol and aldosterone concentrations with an increased concentration of the intermediate mineralocorticoid, 11-deoxycorticosterone.

17a-Hydroxylase deficiency is a form of CAH that decreases the synthesis of glucocorticoids and androgens and therefore shunts precursors toward the production of mineralocorticoids. Consequently causing hypertension and hypokalemia. Genetically male patients typically demonstrate ambiguous genitalia and undescended testes
whereas genetically female patients may not demonstrate morphological differences until puberty, when their secondary sex characteristics are underdeveloped. Concentrations of androstenedione and 17-hydroxyprogesterone would be decreased.

3B-Hydroxysteroid dehydrogenase deficiency leads to decreased synthesis of mineralocorticoids, glucocorticoids, and androgens. However, an intermediate in the androgen synthetic
pathway, (DHEA), is increased (as a result of decreased metabolism of DHEA by 3B-hydroxysteroid dehydrogenase), which can lead to virilization of genetically female infants, children, or young adults (depending on the severity of the deficiency). However, concentrations of androstenedione and 17-hydroxyprogesterone would be decreased.

Question 59

During an experiment, a strain of knockout mouse with deficiency of carbonic anhydrase in erythrocytes. Compared with normal mice, venous blood in the knockout mouse will have a higher concentration of which of the following substances?

HCO3
Cl

Answer 59

Chloride will be present in greater concentrations in the venous blood of mice with erythrocytes that are deficient in carbonic anhydrase, an enzyme utilized in erythrocytes to convert (C02) and (H2O) to (HC03 + H+)
It binds to hemoglobin and modulates the unloading and loading of oxygen while HC03
is shuttled out of the
erythrocyte in exchange for chloride via a chloride/bicarbonate exchange pump located on the surface of the erythrocyte. A deficiency in carbonic anhydrase would lead to lower concentrations of
intracellular bicarbonate, which would result in an increased influx of bicarbonate into the cell in exchange for chloride efflux out of the cell. This would consequently result in higher
concentrations of chloride in the serum.

Question 60

The cell line is infected with a newly discovered coronavirus. Which of the following steps is essential for the reproduction of this new virus?

Answer 60

Translation by host ribosome

Question 61

Female with no complaint of incontinence except she pees when she hears sound of running H20. Cause:

Polyuria
Uninhibitted UB contract

Answer 61

Uninhibitted UB contract

Question 62

Norepinephrine is the primary neutransmitter for which of the following nerves?

A ) Postganglionic sympathetic nerves in sweat glands
B) Postganglionic sympathetic nerves in the prostate
C ) Preganglionic sympathetic nerves
D ) Sympathetic nerves innervating the adrenal gland

Answer 62

Postganglionic fibers to sweat and adrenal glands - Epi

Preganglionic - Ach

Postganglionic to rest - NE!

Question 63

Right skewed?

Answer 63

In right-skewed distributions, the mode (while potentially occurring anywhere) is often less than
the median, which is less than the mean.

Mode < median < mean

Question 64

Left skewed?

Answer 64

Mean < median < mode

Question 65

Graph A shows the results obtained with sarcoma cells. Graph B shows the results obtained with a variant of the tumor that fails to express class I MHC molecules. The difference in growth of the variant tumor is best explained by the action of which of the following cell types in the tumor cell recipient?

CD8 TCs
NK cells

Answer 65

Natural killer (NK) cells are a primary line of defense against tumorigenesis. Classically, NK cells target tumor cells in response to an absence of surface MHC class 1 molecules.

Whereas, CD8+ TCs identify Ags on MHC1 and then induce apoptosis.

Question 66

if gout C/P in M>60 with high uric acid. Cause?

HGPRT def
No renal or enzyme defect?

Answer 66

B

Cuz with age inc muscle turnover - inc AA n uric acid so yes nl

Question 67

A 34-year-old man with AIDS comes to the physician because of muscle aches and reddish brown urine for 12 hours. He began treatment with trimethoprim-sulfamethoxazole 1 day ago as prophylaxis against Pneumocystis jirovecii (formerly P. carinii) infection. A sample of blood after centrifugation shows red serum. Which of the following is the most likely explanation for these
changes?

Answer 67

Ans: G6PD deg - red urine meaning intravascular hemolysis!

Tendonitis is cause of crystal deposition not red urine! Also if crystals deposit in kidney - cause cystitis not red urine.

Question 68

SMA inheritance?

Answer 68

AR

Question 69

Development of the metanephros begins with initial specification of the metanephric blastema and sprouting of the ureteric bud and culminates with nephron differentiation and formation of
the glomerulus. This cascade is best described as a sequence of which of the following interactions?

Answer 69

Reciprocal inductive

Question 70

If qn says single allele mutation at freq rate of 10% thats what?

P or P2

Answer 70

p = 0.1

q=0.9

2pq = 0.18 = 0.2

Question 71

Recurrent headaches + papilledema + retinal hemangioblastoma + CT shows cystic pancreas lesions + Cb midline lesion. Cause/Dx?

Answer 71

VHL synd

This patient with a retinal hemangioblastoma, cerebellar lesion, and cystic lesions of the pancreas likely has von Hippel-Lindau disease. Many tumors originate from the vasculature, including hemangioblastomas of the retina and cerebellum and angiomatosis of the
skin and mucosa. Additional tumors include renal clear cell carcinomas, pancreatic masses, and pheochromocytomas.

Question 72

NF1 v/s TSC?

Answer 72

NF1is a heritable neurocutaneous disorder that presents with cutaneous neurofibromas (benign neoplasms derived from neural crest cells), cafe-au-lait spots,
pigmented iris hamartomas (Lisch noduies), optic gliomas, and pheochromocytomas This autosomal dominant disorder results from a de novo or inherited mutated NF1 tumor suppressor gene.

TSC:an autosomal dominant neurocutaneous disorder characterized by benign tumors in several organ systems. Hamartomas can form in the skin (leading toshagreen patches and hypomelanofic macules known as ash leaf spots) or brain (leading to epilepsy and intellectual disability), along with cardiac rhabdomyomas (leading to mitral regurgitation),
and renal angiomyolipomas. Though these tumors are benign, patients are at risk for developing malignancies in the soft tissues, brain, or kidney.

Question 73

Port wine skin lesion?

Answer 73

Sturge-Weber syndrome is a neurocutaneous disorder that presents with proliferation of capillary-size blood vessels, seen on examination as nevus flammeus (a benign birthmark
also known as a port-wine stain), angiomatosis of the leptomeninges (leading to seizures, intellectual disability, focal neurologic deficits), and episcleral hemangioma (leading to early-onset
glaucoma). The causal activating mutation of the GNAQ gene is typically sporadic rather than inherited.

Question 74

Recurrent pneumonia in old. Dx via?

Answer 74

Bronchoscopy cuz recurrent matlab obstruction in airway. The presence of a lesion (eg;
tumor) results in the impaired clearance of mucus; microbes, and foreign debris, which is a risk factor for the development of clinically significant infection of the alveolar space and lung parenchyma.

Question 75

Opening of a a painless, slowly enlarging mass on the left side of her neck. Physical examination shows a freely mobile, soft,
cystic mass?

Answer 75

Brachial cysts open ant to SCM.

Question 76

Clavicular fracture repair via what component of bone?

Answer 76

Periosteum

Question 77

A 27-year-old woman has had severe lower left quadrant abdominal pain and vomiting for 3 hours. She is weak and hypovolemic. She has a history of regular menstrual cycles and
frequent pelvic infections. Her last menstrual period began 9 weeks ago and lasted 4 days. Which of the following is the most likely site of the primary pathologic process?

Ovary
Fallopian tube

Answer 77

Missed period + acute ppt - think pregnancy ectopic - so pathology in tubes!

Question 78

Mast cells synthesis Hz and??

Answer 78

PGs

Question 79

A previously healthy 54-year-old man comes to the clinic because of light-headedness for 6 hours. His symptom began after skiing at a resort at an altitude of 2743 m (9000 ft). He has
been taking a carbonic anhydrase inhibitor since 2 days before arrival at the resort + has orthostatic hypotension. Why?

High-altitude sickness
Hypovolemia
Hypoxia
Impaired sympathetic nerve activity

Answer 79

B

Used a diuretic so had loss of fluid via urine + sweat post exercise.

D is wrong as pt drug Hx is insignificant.

Question 80

Diarrhea electrolytes?

K , Cl and HCO3

Answer 80

Low K
Low HCO3

Inc Cl (compensatory) - Hypovolemia (manifested in this patient’s decreased blood
pressure and increased pulse) leads to increased sodium and chloride reabsorption from the renal proximal tubule, resulting in hyperchloremia.

Question 81

Marker of Langerhans cells?

B7
CD3

Answer 81

B7 not CD3

CD3 is TCs
CD28 is Ms

Question 82

u see BVs + coiled glands on Bx of endometrium.

Answer 82

Secretory phase

Question 82

A 4-year-old boy is brought to the physician by his parents because of developmental delays and speech difficulty. He has two maternal uncles with intellectual disability. His height and weight are at the 30th percentile. Physical examination shows a large, tong head with a prominent jaw, wide forehead, and large ears. There is a high arched palate, and hyperextensible
fingers and joints. His speech is difficult to understand, he has a 15-word vocabulary, and he uses single words only. Which of the following is the most likely diagnosis?

Answer 82

X lined h fr

Fragile X synd

Question 83

A 55-year-old man comes to the physician because of a 3-month history of intermittent pain in his right hip + the pain is exacerbated by walking and resolves with rest + increased pain on abduction. Which of the following types of collagen is most likely affected in this patient?

Answer 83

Type 2

Hyaline cartilage - a case of OA

Type 1 - bone + tendons - OI
Type IV - Good pasture (BM)
Type 3 - BVs n granulation tissue - EDS
type 5 in skin - EDS
type 6 - ECM

Question 84

Hypochondriasis?

Answer 84

irrational fear of disease or dx