NBME

homeless 28 year with 3 month hx of decreased appetite generalized wasting, low grade fever and worsening cough, productive of bloody mucopurulent sputum.he has 4 yearhx of alcohol abuse, x ray film of chest show consolidation and cavitary lesion in apices of lung,which foll most likely inflamatory immune resp to lung? epitheloid cells.multinucleated giant cells ,caseation necrosis 43 yr old man come to physician with chest pain, he live with his daughter family, he has numerous weltsabrasions, and appears malnourished, he says diet is fine, which app step in patient care/\notify social services of potential abuse 67 year old woman suden onset dyspnea and chest pain, within minutes, stage 4 ovarian cancer was diagnosed 1year ago, and she bedridden 2 months,which following is likely found on autopsy? deep venous thrombosis 34 year old man 6 month hx of burning pain, that begins in epigastric area and asends into chest, episodes occur most frequently after large meals and at night,endoscopic exam show moderately severe inflamation in distal 3 cm of esophagus, which foll cause of this condition? inappropriate relaxation of lwer esophageal sphincter 45 year old woman has acute coronary occlusion within seconds, ischemic region show mitochondrial swelling and depletion of glycogen granule,which foll metabolic event is likely cause of cellular changes?\degradation of membrane phospholipids 65 year old man dies of bronchopnemonia, he hs 4 year hx of progressive loss of facial expression,tremors,rigidity and slowing of voluntary movement,an autopsy loss of pigmented cells, noted in substantia nigra,which foll abnormalities likely in patient]\ eosinopholic inclusions,Lewy bodies in neurons of substantia nigra 56 year male wit NHL accidental overdose of VINCRISTINE , you suspect overdose s.e of FINGER NUMBNESS AND TINGLING 45 year treated fr pain and swelling soon after begining treatment, present with painful mouth ulcer and nausea LFT high, which respnsible/ methotrexate

45 yer wth flank pain and hematuria similar present in past now manage with hydration and analgesic, abd imaging show radio opacity,which prevent occurence hydrochlorothiazide non polar hydrophobicaa glycine,a lanine valine leucine and isoleucine have alkyl side chains, serine and threonine are small polar aa that have hydroxyl groups, sulfur group containing cysteine and methionine aromatic amin acids phenylalanine, tyrosine and tryptophan have ring struct and are non polar with exception of hydroxyl group of tyrosine acidic amino acids aspartic acid and glutamic acid are having carboxyl groups amides of carboxylic groups asparagine and glutamine are uncharged and polar members of basic grup , histidine, lysine and arginine have weak base side chains' proline is unique,it is imino acid becuase its side chain loop to form kinks in polypeptde backbone 12 year localised nausea fever, physical exam show neck stiffness, gram negative org during CSF. which best way to prevent gonococci infection rifampin 15 year with acne with tender cyst like abscesses on scalp.face and trunk, inflamatory condition is due in part to excessive mitotic activity which foll sebaceous glands 31 year old hiv positive for 5 years. he is developing resistance to current regimen of antiretroviral drugs and is enrolled in clinical trial of new antiretroviral drug,other drugs in this class associated with peripheral neuropahty in some patient due to demyelination, which foll stain reveal demyelnation using light microscoope osmium tetrxide it dmonstrate unsaturated lipids which appear black 48 year old with flank pain and hematuria, he had similar presentation managed wit iv hydration analgesics, abd imaging show radioopacity, which

prevent recurence HCT 2 year gul with copios watry diarhea accompanied by abdominal crampsvomiting and low grade fever.her eyes sunken, her skin rough,on PE , she dehydrated and admited to hospital for suportive care.diagnosis, no blood detected in fecal sample which component of infect agent allow it to survive harsh environmental condition such as stomach acid patient clinical finding is rotavirus. it is double capside, account approximately 50 percent of gastroenteritis in children that acqure hospitalisation due to dehydration, virus is transmitd by fecal oral route,rotavirus in family retroviridae, which have double capsid and ds RNA genome, the outer capsid protects virus as it passed through stomach,, once in intestine,proteases cleave oter capsid , releasing intermediate, infective sbviral particle ISVP. whichattaches and penetrates host cell,the DS rna remains in ISVP whre it is transcribed by viral enzymes rotavirus lab identification viral antigens ins tool specimen Dected by ELISA, OR LATEX AGGLUTINATION tst, free virions in stool specimen visualised by electron microscopy, partial digestion of virion within GI tract, yields infectious particles that directs penetrate plasma membrane, of intestinal epithelial cells loss of electrolyte and inability to reabsorb water result from infection of intestinal mucosa massive shedding of virions occur during diarrhea, contributng to transmission of infex secretory Ig a Antibodies in the intestine, confer immunity to rotaviral infection incubation period 48 hrs 59 year old with long standing mild to moderate HTN was advised by her physician to lose 9 kg and begin an exercise program,her physician also prescribed thiazide diuretic, 3 month later patient was reviewd and found to have 6.8 kg , and her bp was normal during examination,serum potassium concentration found to be low, which renal effect of thiazide diuretics is most likely account for patient;s hypokalemia? potassium secretion in collecting duct is increased 17 year man has knife fight and sustained multiple stab injuries to back,one

of whch invlved his spinal crd, on examination ,he is found to have weakness,fasiculations of his left biceps, and hyperreflexia of left patellar and achilles tendons, strength of his left triceps was found to be slightly decreased as well muscle tone and strength, and biceps, patellar,achiles tendon reflexes were normal on right side, based onexam findings,where is spinal injury? left 1/2 of spinal cord at C5 54 YEAR OLD male diagnosd with hypokalemia, ct scan mri of abdomen reveal 4 cm tuor right suprarenal gland cortex, when contrmplating surgery,which anatomic association should first be considered> part of adrenal gland is wedged behind IVC 69 YEAR OLD brought to er sudden onst palpitatio dyspnea ecg show hr `120 btmin, iregular QRS complez, and No P wave, which determine ventricular contraction rate av node refractory period

41 year old woman evaluated hx of menorrhagia with lab evidence of low Hb, she has IDA, and oral ferrus treatment, after 3 months therapy, values have improved, she ask stopping her supplement as concerned over treating her anemia, after reassuring her, you explain hemotasis mechanism ,which foll regulation of body iron content? hepatic parenchymal cells when undergoing surgeryo repair an indirect inguinal hernial 14 year old boy suffer damage ilioinguinal nerve damage to nerve case which fol sx numbness of scrotum and inner part of thigh 28 year old to office 4 weeks after hitting his head in automobile accident,after acident , he devlepedincreased thirst and urination sx related ADH PATient has central DI va -f*VT -VD 22 YEAR old man fell from bcycle and fractured medial epicondyle of

humerus, the physician determine integrity of ulnar nerve. whichmuscle allow patient to hold dollar bill between fngers against resistance dorsal interossei palmar interossei ld man experience seizure in local shopping mall and is brough t to th emrgency departtment,on admission, he is drowsy and confused and consistently report visual disturbances, analysis of venous blod show serum glucose bun sodiun and cl within nrmal limits pco2 low phlow hco3 v low methanol intoxicaion philadelphia has fusion related unregulated tyrosine kinase,activity casing malignant growth immature cells of myeloid lineage primary aldosteronism conns syndrome due to elevvated aldosteroe prodction and symptoms presented by patient, this disorder due to small adenomas of glomerulosa cells of kidney, the associatd hypertension,hyperkalemia and hypernatremia lead to reduction in renin release from JGA cells,renin required for conversion of angiotensinogen to angiotensin `1 so redced level renin redced level ang 2 defficiency of UGT in crigler najjar syndrome `1 is complete due to loss of coding exons of UGT gene and is consequence affected individuals will die from profound kernicterus menke disease referred to as steely hair syndrome, characteristic of britlessness of hair,which easily broken 3 yae old boy with polyuria, polydypsia and polyphahia and enuresis 2 week duration, unexplained 1.5 kg weight loss, dipstick positive for ketones and glucose his fasting serum glucose is 300 ,high, boy doagnosed with autoimmune disorder,causing destruction of pancreatic islet cells of langerhans the enzyme ferrochelatase and ALA synthetase are extremely sensitive to lead poisoning which lead to severe anemiaand high exretion of coproporphyrinogen and ALA BNK teller has flash backs and dreams about robbery that occured at her bank 3 days ago, she says she always voids driving near scene of robbery she experience anxiety where money exchanged,teller experienxing acte stress disorder

leishmenia donovani Spread toblood stream enter liver,spleen lymph node and bonemarroww wolmans disease result from deficiency of lysosomal acid lipase enzyme, and is nearly always fatal disease in infancy, sx of disorder arise from massive acumulation of cholesteryl esters and TG in most tisue, clnical manifestation include hepatosplenomegaly, leading to abdominal distension, gastrointestinal abnormalities ,steatorrhea and adrenal calcification refsum disease defect in oxidation of phytanic acid, lipid requiring alpha oxidation pathway,as consequence, phytanic acid accumulate in tissue and blood.the hallmark sx of diseaseretinitis pigmentosa,cerebellar ataxia and chronic polyneuropahty person in coast suffer mild dyspea, arterial blood drawn, from PaO2 70 MMHG AND PACO3 35 MM hg, WHICH INCREASED pAO2 AND Pao2 diff, vit k lead to hemoragic disease of new born in 1st week of life

34 year old living in coast suffer mild dyspnea, arterial blood drum,Pao2 70 paco2 35 mm hg which is increased in patient, pAO2-Pao2 DIff,