wrong answers NBME 17, 16 & 15 Flashcards
40.
A 70-year-old man is admitted to the hospital for evaluation of the recent loss of mental function. He has a history of weight loss. He is not taking any drugs. Vital signs are normal, and he is not dehydrated. Aside from mild disorientation, findings on neurologic examination are unremarkable. He has mild anemia. Laboratory studies show:
Serum
Na+ 110 mEq/L
Cl− 85 mEq/L
K+ 4.4 mEq/dL
Urea nitrogen (BUN) 15 mg/dL
Creatinine 0.9 mg/dL
Plasma osmolality 250 mOsmol/kg
Urine osmolality 750 mOsmol/kg
Which of the following is the most likely diagnosis?
A
)
Adrenal carcinoma
B
)
Chronic interstitial nephritis
C
)
Diabetes mellitus
D
)
Pneumococcal meningitis
E
)
Pulmonary neoplasm
Small cell carcinoma, ACTH,SIADH,Lambert eaton, neuroendocrine tumour
A 27-year-old woman is brought to the emergency department 30 minutes after she was ejected through the windshield during a motor vehicle collision. She was the unrestrained front-seat passenger. Physical examination shows marked edema and tenderness of the jaw. A Panorex x-ray of the mouth is shown. Which of the following additional structures is most likely injured by this abnormality?
A
)
Inferior alveolar nerve
B
)
Levator labii superioris
C
)
Maxillary artery
D
)
Parotid gland
E
)
Tongue
Inf alveolar nerve
A 19-year-old man is admitted to the hospital following a motor vehicle collision. Physical examination shows a penetrating wound to the right cerebral cortex with complete paralysis of the left lower extremity, fracture of the right mid humerus with severing of the radial nerve, and a fracture of the right tibia. Treatment includes cast immobilization of the right upper extremity and right knee and ankle. After 10 weeks, the casts are scheduled to be removed from the right upper and lower extremities. At this point, the deep tendon reflex is most likely to be strongest in which of the following locations in this patient?
A
)
Left Achilles tendon
B
)
Left biceps tendon
C
)
Right brachioradialis tendon
D
)
Right patellar tendon
umn everything up, left achilles
A 55-year-old man is admitted to the hospital for treatment of sepsis. He appears anxious and confused. Treatment with vancomycin and ceftriaxone was initiated in the emergency department. His temperature is 39.8°C (103.6°F), pulse is 132/min, respirations are 28/min, and blood pressure is 85/48 mm Hg. Physical examination shows warm, flushed skin that is moist with diaphoresis. There is no edema. It is most appropriate to administer which of the following solutions at this time?
A
)
5% Dextrose in water and 0.45% saline
B
)
5% Dextrose in water only
C
)
0.45% Saline only
D
)
0.9% Saline
E
)
3% Saline
0.9% saline, bump up bp
A previously healthy 72-year-old man is brought to the physician because of weakness and fatigue. His hemoglobin concentration is 9.2 g/dL, leukocyte count is 5400/mm3, and platelet count is 350,000/mm3. A peripheral blood smear is shown. Which of the following is the most likely cause of these findings?
A
)
Aplastic anemia
B
)
Chronic myelogenous leukemia
C
)
Gastrointestinal blood loss
D
)
β-Thalassemia major
E
)
Vitamin B12 (cobalamin) deficiency
- C, very common cause of anemia is older person is GI blood loss. Different sizes of RBCs would give a wide red cell distribution width (RDW) which implies blood loss. The other answers do not make sense with the rest of the question stem. (A) would have pancytopenia, (B) would likely have a higher WBC and smear would have leukemia-looking cells, (D) would be severe microcytic anemia and would not be presenting now at age 72, and (E) no history to correlate with B12 deficiency/ no megaloblastic cells.
A 27-year-old primigravid woman at 34 weeks' gestation is admitted to the hospital because of nausea and vomiting, and abdominal pain for 12 hours. Her pregnancy has been otherwise unremarkable. Prior laboratory studies, including a complete blood count and serologic tests for HIV and hepatitis, have shown no abnormalities. Her blood pressure now is 164/102 mm Hg. Abdominal examination shows right upper quadrant tenderness. Laboratory studies show:
Hemoglobin 7.4 g/dL
Hematocrit 24%
Platelet count 72,000/mm3
Serum
Creatinine 1.2 mg/dL
Total bilirubin 2.3 mg/dL
AST 112 U/L
ALT 126 U/L
Examination of a peripheral blood smear is most likely to show a predominance of which of the following in this patient?
A
)
Acanthocytes
B
)
Heinz bodies
C
)
Howell-Jolly bodies
D
)
Schistocytes
E
)
Spherocytes
F
)
Target cells
probably schistocytes, hellp syndrome
A 45-year-old man comes to the physician because of yellow skin for 4 days. He lost his job 10 days ago, and he has been drinking eight to ten 12-ounce cans of beer daily since then. Physical examination shows jaundice. The liver is tender to palpation. Serum studies show: Total bilirubin 5.9 mg/dL Alkaline phosphatase 210 U/L AST 110 U/L ALT 69 U/L γ-Glutamyltransferase 35 U/L (N=0–30)
Histologic examination of a liver biopsy specimen will most likely show which of the following in this patient?
A
)
α1-Antitrypsin globules
B
)
Glycogen
C
)
Hemosiderin
D
)
Lipofuscin
E
)
Mallory hyaline
probably mallory hyalin, ALP>AST so alcoholic hep
A protein found in the brown adipose tissue of mice causes a leak of H+ ions inward across the inner mitochondrial membrane. Which of the following is the most likely effect of this protein on oxidative phosphorylation and energy metabolism?
A
)
Decreased ratio of oxygen consumption to ATP generation
B
)
Decreased ratio of oxygen consumption to CO2 production
C
)
Increased ratio of oxygen consumption to ATP generation
D
)
Increased ratio of oxygen consumption to CO2 production
E
)
No change in the ratios of oxygen consumption to ATP generation and oxygen consumption to CO2 production
C
A 63-year-old woman is brought to the emergency department because of a 2-day history of fever, abdominal tenderness, and painful urination. She appears agitated. Her temperature is 38.8°C (101.8°F). Laboratory studies show a leukocyte count of 14,000/mm3. She is admitted to the hospital. Two hours later, the nurses note that she has torn up four breakfast menus because she found them to be too confusing. She is highly educated, and her husband says that she does not behave this way at home. Which of the following is the most likely cause of this patient’s current mental status?
A
)
Amnesia
B
)
Delirium
C
)
Dementia
D
)
Mild cognitive impairment
E
)
Occult cerebral infarction
Delirium- most common in recently hospitalised
A 62-year-old man with alcohol-induced liver disease develops massive ascites. Infection is ruled out. The most appropriate diuretic treatment, in addition to loop diuretics, includes which of the following drugs?
A
)
Acetazolamide
B
)
Hydrochlorothiazide
C
)
Indapamide
D
)
Metolazone
E
)
Spironolactone
Spironolactone to mitigate k wasting
20 year old man with suspected appendicitis has periumbilical burning and discomfort, which eventually localize to a region in the lower right quadrant about 5 cm superomedial to the anterior superior iliac spine. The best explanation for this finding is that the periumbilical region of the body wall and appendix are both supplied by afferent fibers with sensory cells bodies located in the dorsal root ganglia of the spinal nerves at which of the following levels? a. T5 B. T10 C. T12 D. L1 E. S2
T10
Three days after unprotected sex with a new partner, a sexually active 24-year-old man noticed the development of small tender blisters on his penis. Some of the blisters broke and left open sores. He does not use condoms. A photograph of the lesions is shown. Which of the following is the most likely causal agent?
A
)
Calymmatobacterium granulomatis
B
)
Chlamydia trachomatis
C
)
Haemophilus ducreyi
D
)
Herpes simplex virus type 2
E
)
Treponema pallidum
HSV 2 photo phone nbme 2
A 27-year-old woman comes to the physician because of fever, malaise, abdominal pain, and vaginal discharge for 4 days. Her last menstrual period ended 5 days ago. She had an ectopic pregnancy 1 year ago. Her temperature is 38.3°C (101°F). Abdominal examination shows bilateral lower quadrant tenderness with rebound and guarding. Pelvic examination shows cervical motion tenderness and bilateral adnexal tenderness. Her leukocyte count is 18,000/mm3. A pregnancy test is negative. Which of the following is the most likely diagnosis?
A
)
Appendicitis
B
)
Bacterial vaginosis
C
)
Chancroid
D
)
Diverticulitis
E
)
Gonorrhea
F
)
Herpes genitalis
G
)
Trichomoniasis
gonorrhea with s/s PID
A 24-year-old man comes to the physician because of a 2-day history of an itchy rash on his arms and legs. He returned from a camping trip in the woods 5 days ago. Examination of the upper and lower extremities shows a widespread edematous, erythematous rash with linear vesicles. The most likely cause of these findings is activation of which of the following cell types?
A
)
B lymphocytes
B
)
Mast cells
C
)
Natural killer cells
D
)
Neutrophils
E
)
T lymphocytes
T-cell lymphoctyes—poison ivy..Dealayed T cell mediated type, Mactrophage activation.
A 70-year-old man dies in a motor vehicle collision. He had been undergoing evaluation for occult blood in the stool. A photograph of a section of the transverse colon obtained at autopsy is shown. Which of the following is the most likely diagnosis?
A
)
Hyperplastic polyp
B
)
Inflammatory pseudopolyp
C
)
Juvenile polyp
D
)
Peutz-Jeghers syndrome
E
)
Tubular adenoma
its pedunculated in the picture—TUBULAR ADENOMA Picure nbme 3
An 80-year-old woman is being evaluated for suspected temporal arteritis (TA). Her erythrocyte sedimentation rate (ESR) is 100 mm/h. Treatment of TA involves the use of glucocorticoids, which could have serious adverse effects. The pretest probability for TA is 50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and a specificity of 60%. Based on the results of the ESR testing in this patient, which of the following is the most appropriate next step in management?
A
)
Additional testing to confirm the diagnosis of TA
B
)
Corticosteroid therapy, since the diagnosis of TA has been established with 99% certainty
C
)
Elimination of TA from further diagnostic consideration
D
)
Repeat ESR; if again positive, corticosteroid therapy
E
)
Repeat ESR; if normal, additional testing to confirm the diagnosis of TA
Additional testing to confirm dx of TA. going for biopsy +/- CRP. It’s extremely unlikely that ESR would be falsely elevated as high as 100, and it commonly reaches levels that high in TA. So a repeat ESR would be useless acutely
A 38-year-old man comes to the physician because of a 1-week history of watery, itchy eyes and a runny nose. He works as a crane operator. Physical examination shows inflamed nasal mucosa. There is no congestion in the lower lung. Which of the following is the most appropriate pharmacotherapy?
A
)
Brompheniramine
B
)
Diphenhydramine
C
)
Hydroxyzine
D
)
Loratadine
E
)
Ranitidine
d I think because a-c are first gen and could make him sleepy. He works a crane..
A 66-year-old man with stage IV colon cancer comes to the physician because of a 3-day history of severe diarrhea after receiving chemotherapy with fluorouracil, leucovorin, and irinotecan. The physician prescribes an opioid antidiarrheal agent with little or no ability to produce central nervous system effects, even when given in relatively high doses. Which of the following agents was most likely prescribed?
A
)
Buprenorphine
B
)
Codeine
C
)
Hydrocodone
D
)
Loperamide
E
)
Morphine
loperamide i guess
A 28-year-old woman, gravida 1, para 1, comes to the physician because of a 2-day history of a painful mass in her right breast. She delivered a healthy female newborn at term 3 weeks ago, and she has been breast-feeding successfully since then. Her temperature is 37°C (98.6°F). Physical examination shows a 3-cm, tender mass surrounded by an area of erythema beneath the right areola. Which of the following is the most likely causal organism?
A
)
Bacteroides fragilis
B
)
Escherichia coli
C
)
Haemophilus influenzae
D
)
Staphylococcus aureus
E
)
Streptococcus agalactiae (group B)
Staph
A 45-year-old woman comes to the physician for a follow-up examination 8 weeks after beginning tamoxifen therapy for estrogen- and progesterone-positive invasive ductal carcinoma of the breast. Her 50-year-old sister also has hormone-sensitive breast cancer treated with tamoxifen. Physical examination shows no abnormalities. Serum studies show decreased concentrations of endoxifen, the active metabolite of the prodrug tamoxifen. Genetic analysis shows the homozygous presence of cytochrome P450 2D6*4 alleles. Which of the following best represents the likelihood that this patient’s sister has the same alleles?
A
)
0%
B
)
25%
C
)
50%
D
)
75%
E
)
100%
25% AR
A 15-year-old girl comes to the physician’s office for a health maintenance examination. Her mother was recently diagnosed with squamous cell carcinoma of the face, and her maternal grandfather died of metastatic melanoma. During the visit, the physician advises her about methods of photoprotection, including daily use of a sunscreen. In a patient of this age, which of the following factors is most likely to predict compliance with photoprotection?
A
)
Ability to tan
B
)
Advice of the physician to wear sunscreen
C
)
Concern about premature aging of skin
D
)
Desire to prevent sunburn
E
)
Family history of skin cancer
F
)
Use of sunscreen by her peers
peers
A 22-year-old woman, gravida 1, para 1, is brought to the emergency department because of a 2-day history of fever and severe vaginal bleeding. Four days ago, she delivered a healthy male newborn spontaneously at term. Her temperature is 38.1°C (100.6°F). Pelvic examination shows an open cervix and heavy vaginal bleeding. Ultrasonography of the uterus shows no retained placental tissue or large thrombi. If an operation is required to control the bleeding, ligation of a branch of which of the following arteries is most appropriate?
A
)
External iliac
B
)
Internal iliac
C
)
Internal pudendal
D
)
Median sacral
E
)
Obturator
external iliac (gives femoral and inferior epigastric artery)
b. internal iliac ( Correct answer I think, bcz Uterine artery is a branch of internal iliac artery)
c. internal pudendal (supplies the external structure, but also a branch of internal iliac)
d. median sacral (supply coccyx)
e. Obturator (gives blood supply to the leg obturator muscles)
A physician is sad because he has to inform a patient of recent test results that indicate progression of carcinoma to the terminal phase. When the patient sees the physician’s face, he begins to cry and says, “It’s bad news, isn’t it?” Which of the following responses by the physician is most appropriate?
A
)
“How have you been since the last time I saw you?”
B
)
“Let’s talk about the positive aspects first.”
C
)
“Look on the bright side of things.”
D
)
“Tell me how you are feeling.”
E
)
“There are other people who have it a lot worse than you.”
F
)
“Yes, it is.”
G
)
“You’ve had several years better off than many others with this disease.”
yes it is
A previously healthy 48-year-old nulligravid woman comes to the physician because of excessive uterine bleeding for 3 months. She says the bleeding occurs both during her menses and at irregular intervals. Menses had occurred at regular 28- to 38-day intervals. She is 165 cm (5 ft 5 in) tall and weighs 72 kg (160 lb); BMI is 27 kg/m2. During pelvic examination, the adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which of the following is the most likely cause of this patient’s symptoms?
A
)
Adenomyosis
B
)
Endometrial hyperplasia
C
)
Endometrial metaplasia
D
)
Endometriosis
E
)
Endometritis
B
This is classic pre-menopausal symptoms. As the ovaries begin to fail, cycles become irregular. Without the estrogen consistently there you lose the surge and the whole luteal phase of the cycle, or it happens at odd times and is delayed. This leads to the endometrium building up further and further until a delayed menstruation, so the periods are much heavier than normal. BB is definitely the right answer.
I should note: If this was a 58 year old woman who hadn’t had a period in 8 years and suddenly had uterine bleeding, we’d be thinking much more along the lines of metaplasia/neoplasia.
A 15-year-old girl who recently emigrated from India is brought to the physician because of several lesions on her neck for 2 weeks. Physical examination shows a hypopigmented, hypoesthetic area over the left side of the forehead and 4-cm lesions on the neck. A biopsy specimen of a lesion shows acid-fast bacilli. Which of the following best explains why the causal organism results in dermal rather than in visceral infections?
A
)
CO2 requirement
B
)
Innate antibacterial compounds
C
)
Lipid content
D
)
Oxygen tolerance
E
)
Temperature sensitivity
Temperature sensitivity (this is leporosy)
A 16-year-old boy is brought to the physician by his father because he has no signs of puberty. Sexual development is Tanner stage 2. Physical examination shows a circumcised penis. The testes are soft and small with a volume of 5 mL (N=20–30). The prostate is firm, nontender, and of appropriate size. There are no lesions or discharge. His serum testosterone concentration is in the prepubertal range. Measurement of which of the following hormones in serum is most likely to determine whether the decreased serum testosterone concentration is a result of a lack of pituitary hormone stimulus in this patient?
A
)
Adrenocorticotropic hormone
B
)
Estrogen
C
)
Follicle-stimulating hormone
D
)
Inhibin
E
)
Luteinizing hormone
LH
An 18-year-old man with Crohn disease is admitted to the hospital because of a 1-day history of severe abdominal pain and intermittent bloody diarrhea. His temperature is 38°C (100.4°F), pulse is 98/min, and respirations are 18/min. Physical examination shows a draining anal fistula. Treatment with broad-spectrum antibiotics and prednisone, along with intravenous hydration and parenteral nutrition, is initiated. He recovers over the next 3 weeks. In addition to resolving the infection, the most likely mechanism of action of this pharmacotherapy is suppression of which of the following?
A
)
Antibody binding
B
)
Complement activity
C
)
Mast cell degranulation
D
)
Neutrophil function
E
)
T-lymphocyte function
E
An 81-year-old woman is admitted to the hospital because of a massive pulmonary embolism from a deep venous thrombosis. Her platelet count is 160,000/mm3. Appropriate pharmacotherapy is started. One week later, her platelet count is 55,000/mm3. The thrombocytopenia was most likely caused by a drug with which of the following mechanisms of action?
A
)
Activates tissue plasminogen
B
)
Interferes with the carboxylation of coagulation factors
C
)
Irreversibly inactivates cyclooxygenase
D
)
Potentiates the action of antithrombin III
E
)
Selectively inhibits factor Xa
DVT- heparin - increases antithrombin 3 activity—> decrease thrombin, Xa
A 27-year-old woman is admitted to the hospital because of a 12-hour history of fever and abdominal pain. She has a history of recurrent urinary tract infections. Her temperature is 39°C (102.2°F). Abdominal examination shows tenderness of the right flank. Abdominal x-rays show bilateral staghorn renal calculi. Urinalysis shows a pH of 8, many RBCs, WBCs, and bacteria. The calculi are most likely composed of which of the following in this patient?
A
)
Calcium oxalate
B
)
Calcium phosphate
C
)
Cystine
D
)
Hemoglobin
E
)
Struvite
F
)
Uric acid
Also known as STRUVITE
A 34-year-old man is evaluated after becoming lightheaded after running 12 miles of a marathon on a hot day. His pulse is 130/min and his blood pressure is 80/60 mm Hg. Which of the following changes in his autonomic nervous system most likely occurred?
Sympathetic Efferent Activity Parasympathetic Efferent Activity
A
)
↑ ↑
B
)
↑ ↓
C
)
↔ ↑
D
)
↔ ↓
E
)
↓ ↑
F
)
↓ ↓
sympathetic increase para decrease
A 63-year-old man comes to the physician because of a 3-month history of difficulty sleeping. He indicates that he sleeps better if he sits upright in bed. His pulse is 90/min, and blood pressure is 110/60 mm Hg. Physical examination shows increased jugular venous pressure and mild ankle edema. Which of the following is the most likely cause of the edema in this patient?
A
)
Decreased capillary hydrostatic pressure
B
)
Decreased capillary permeability
C
)
Decreased plasma colloid osmotic pressure
D
)
Increased capillary hydrostatic pressure
E
)
Increased capillary permeability
F
)
Increased plasma colloid osmotic pressure
D, :/
A previously healthy 17-year-old girl is brought to the emergency department because of a 1-day history of shortness of breath, weakness, and muscle tenderness. She completed a triathlon the previous day. She appears restless. She is 163 cm (5 ft 4 in) tall and weighs 50 kg (110 lb); BMI is 19 kg/m2. Her temperature is 38°C (100.4°F), respirations are 20/min, and blood pressure is 150/90 mm Hg. Bilateral crackles are heard in the lower lung lobes on auscultation of the chest. Physical examination shows muscle tenderness. Her serum creatinine concentration is 4 mg/dL. Urinalysis shows 3+ protein and 4+ hemoglobin. The most likely cause of this patient’s condition is an increased release of which of the following substances?
A
)
Aldolase
B
)
Creatine kinase
C
)
Hemoglobin
D
)
Myoglobin
E
)
Troponin I
myoglobin
A 15-year-old girl is brought to the physician by her mother because of a 1-day history of redness and painful skin following sunbathing. She reports that she used sunblock every few hours. She takes no medications. Physical examination shows severe erythema of the back and extremities. There are no blisters. Which of the following best describes her condition?
A
)
Allergic reaction to the sun
B
)
First-degree burn
C
)
Rhus dermatitis
D
)
Second-degree burn
E
)
Third-degree burn
1st degree burn
A 5-year-old boy is brought to the physician because of an 8-month history of recurrent middle ear and upper respiratory tract infections. He has a history of impaired motor and cognitive function. Physical examination shows hepatosplenomegaly. Analysis of cultured skin fibroblasts shows the presence of inclusion bodies and a deficiency in the activity of N-acetylglucosamine-1-phosphotransferase. The cells secrete abnormally large amounts of acid hydrolases into the culture medium. These enzymes are unable to target which of the following organelles in this patient?
Lysosomes, I-cell disease
A 35-year-old man comes to the physician because of a 3-year history of an enlarging nose, coarsening of his facial features, muscle weakness, and increased hand and foot size. Physical examination shows a large fleshy nose and prognathism. Serum studies show an increased insulin-like growth factor-I concentration. An MRI of the brain shows a pituitary adenoma. Morphologic analysis of a biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the Gαs subunit of G proteins in the tumor lack GTPase activity. The tumor cells in this patient most likely have an increased activity of which of the following enzymes?
A
)
Adenylyl cyclase
B
)
Guanylyl cyclase
C
)
Janus kinase
D
)
Phospholipase C
E
)
Tyrosine kinase
Adenylyl Cyclase….see gtpase missing so alpha GTP wont breakdown so increased adenylyl cyclase activity
A 67-year-old woman comes to the physician for a health maintenance examination. Her brother and mother have a history of colon cancer. The physician recommends colonoscopy, but the patient says that she would prefer only for her stool to be tested for blood. The physician explains that testing the stool for occult blood is not appropriate in this case. The physician is most likely concerned about which of the following regarding this test?
A
)
Low sensitivity
B
)
Low specificity
C
)
Potential for a false-positive result
D
)
Uncertain negative predictive value
E
)
Uncertain positive predictive value
A
A 2-year-old boy is brought to the physician because of developmental delay. There is a history of hearing loss in his mother and delayed speech in his older sister. His maternal uncle had stroke-like episodes at the age of 25 years. Physical examination shows ophthalmoplegia and hypotonia. His serum lactic acid concentration is increased. Which of the following best explains the findings in this family?
A
)
Autosomal dominant inheritance
B
)
Decreased penetrance
C
)
Heteroplasmy
D
)
Imprinting
E
)
X-linked recessive inheritance
Answer = C, Heteroplasmy. It’s a mitochrondially inherited disorder - the stroke-like episodes and lactic acidosis scattered throughout a family history tip you off. See page 86 of FA 2014.
The specific disorder is probably MELAS – Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes.
An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes is most likely to be observed?
Mucus Alveolar
Production Activity of Macrophage
and Secretion Airway Cilia Function
A
)
↑ ↑ ↑
B
)
↑ ↑ ↓
C
)
↑ ↓ ↓
D
)
↓ ↑ ↑
E
)
↓ ↓ ↑
F
)
↓ ↓ ↓
C
A 45-year-old man has fever, chills, dysuria, and a tender, enlarged prostate. Which of the following is the most likely causal organism?
A
)
Adenovirus
B
)
Chlamydia trachomatis
C
)
Escherichia coli
D
)
Pseudomonas aeruginosa
E
)
Ureaplasma urealyticum
C - E. Coli
A 4-month-old boy is diagnosed with a rare autosomal recessive skeletal dysplasia involving abnormal endochondral bone formation. Genetic analysis shows null mutations in a gene for a protein that controls the traffic of vesicles into the Golgi complex. Electron microscopy of this patient’s cells will most likely show which of the following findings?
A
)
Decreased rough endoplasmic reticulum
B
)
Decreased smooth endoplasmic reticulum
C
)
Dilated rough endoplasmic reticulum
D
)
Increased smooth endoplasmic reticulum
E
)
Large lysosomes
F
)
Small lysosomes
maybe is C since proteins are not able to reach their destination => being degraded in proteasomes. maybe cell will increase synthesis in an attempt to produce the needed proteins
A 9-year-old boy is brought to the physician by his mother because of a 1-year history of cough productive of mucoid sputum, wheezing, and shortness of breath with exertion. He has a history of recurrent upper respiratory tract and sinus infections since birth. He is at the 25th percentile for height and weight. The mother says that his younger sibling is beginning to develop similar problems. Physical examination shows mild clubbing of the fingers. Laboratory studies show markedly increased sweat chloride and sodium concentrations. A defect of which of the following in this patient’s bronchial epithelium is most likely causing these symptoms?
A
)
Adrenoreceptors
B
)
Membrane receptors
C
)
Nuclear receptors
D
)
Protein regulation
E
)
Protein structure
CFTR is a PROTEIN (Transmembrane protein) whose structure is altered so Protein Structure
A 54-year-old woman with terminal metastatic pancreatic cancer comes to the physician for a follow-up examination. She asks the physician to prescribe her a sufficient quantity of medication to allow her to commit suicide if the pain becomes unbearable. The physician refuses to do so, but he informs the patient that he will do everything he can to manage her pain. The physician’s decision in this situation is most consistent with which of the following ethical principles?
A
)
Autonomy
B
)
Beneficence
C
)
Dignity
D
)
Justice
E
)
Nonmaleficence
Nonmaleficience
