grile USMLE Step 1

...ca nu se mai poate
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grile USMLE Step 1

Postby originaltup » Sun Feb 22, 2004 4:52 pm

O sa mai pun pe aici niste grile tip step 1 (bazandu-ma si pe experienta proprie), de dificultate medie sau mare, ca usoare gasesti peste tot.
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Postby originaltup » Sun Feb 22, 2004 4:52 pm

Question 1

A seven-year-old female presents with progressively worsening difficulty walking over the last six months. In the last few weeks, hand clumsiness and difficulty speaking clearly have appeared, prompting this visit. On examination, the patient's extensor plantar reflex is 2 + ; all others are 1 + 0. Which type of disorder is likely involved?

A. CAG trinucleotide repeat expansion disorder

B. CGG trinucleotide repeat expansion disorder

C. GAA trinucleotide repeat expansion disorder

D. GAC trinucleotide repeat expansion disorder

E. It is not a trinucleotide repeat expansion disorder
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Postby adi » Sun Feb 22, 2004 5:04 pm

cand ti-am citit primul post am crezut ca o sa pui vreo arhiva cu un numar cat de cat semnificativ de grile. cand colo, 1 grila :lol: . e ca in almanahurile alea calendar, 1/day?

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Postby Elefantica » Sun Feb 22, 2004 11:02 pm

Raspund A
Myotonic Dytrophy
?????

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Postby originaltup » Sun Feb 22, 2004 11:16 pm

Mai Adi, las ca asa e mai bine, se mentine interesul constant :twisted:
De acum o sa pun raspunsul ca atachement la fiecare grila.

Raspuns corect: C, care este friederich ataxia (nici eu nu am facut-o cand am dat peste ea :( )
in myotonic dystrophy este CTG.
raspunsul A (CAG) este Huntington
si ar mai fi CGG care este in Fragile X syndrome.
GAC nu stiu daca e pe undeva, n-am cautat.
Si astea au fost cam toate bolile cu triplet repeat.
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Postby originaltup » Sun Feb 22, 2004 11:38 pm

Question 2

While on the Medicine service, a third-year medical student admits a 63-year-old woman with longstanding hypertension, diabetes, and hyperlipidemia. The woman was seen in the emergency room, where she was noted to have vomiting, left–sided Horner's syndrome, and loss of facial sensation on the left, but loss of body sensation on the right. A diffusion-weighted MRI and MRA are ordered. Before the radiologic studies are performed, the team asks the medical student where the problem lies. The best explanation for this patient's stroke presentation is occlusion of which artery?

A. Left middle cerebral artery

B. Right middle cerebral artery

C. Left anterior cerebral artery

D. Right anterior cerebral artery

E. Left posterior cerebral artery

F. Right posterior cerebral artery

G. Left posterior inferior cerebellar artery

H. Right posterior inferior cerebellar artery
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Postby petru » Mon Feb 23, 2004 12:38 am

e vorba de clasicul sindrom Wallenberg, consecinta a afectarii vascularizatiei in portiunea laterala retroolivara a bulbului pe STANGA aici, care provine totdeanuna din artera vertebrala, aici probabil trebuie sa iei cerebeloasa postero-inf stanga

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Postby originaltup » Tue Feb 24, 2004 1:09 am

A 37 year old male, HIV+, CD4 count 45/mm3, Hgb 11g, in treatment with zidovudine, lamivudine and ritonavir, and prophylaxis with pentamidine and azythromycine, develops visual problems in his left eye. What treatment is best for the most probable pathogen:
a. interferon
b. foscarnet
c. ciprofloxacin
d. ganciclovir
e. itraconazole

Si inca 2 chestii:
1. ce profilaxie se da pt AIDS, CD4 45/mm3
2. poate o femeie insarcinata sa-si ia o pisica?
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Postby petru » Tue Feb 24, 2004 9:37 pm

ganciclovir pentru o retinita cu CMV

profilaxia ideala este biseptol, cea mai eficace pt p. carinii si t. gondii. in caz de intoleranta se recurge la pentamidina care e mai bine tolerata, dar e ineficace pe toxoplasma si ultima varianta e fansidarul (asociere de doua medicamente care imi scapa) dar care nu e asa eficient.

o femeie gravida cred ca am lasat balta HIV-ul bineinteles ca poate sa-si ia o pisica. la toxoplasma, asemanator cu multe infectii virale teratogene, e primoinfectia care e periculoasa. prima cauza de toxoplasmoza umana nu sunt pisicile ci legumele nespalate. daca isi ia pisica si nu e imunizata contra toxoplasmei trebuie sa nu scurme prin litiera pisicii.

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Postby originaltup » Wed Feb 25, 2004 2:54 pm

Raspunsul este corect, intrebarea era de fapt de ce ganciclovir si nu foscarnet? Pt ca din cate ai vazut pacientul este usor anemic, este pe tratament cu zidovudina care da anemie iar daca i-ai da ganciclovir (care la randul lui da anemie) risti sa-i sa cresti gradul anemiei. Foscarnetul in schimb nu da anemie si e practic la fel de eficient ca si ganciclovirul pt o retinita CMV. Si totusi in cazul dat ganciclovirul e cea mai buna varianta, cu riscul agravarii anemiei. De ce?


Cu gravida si pisica: este un risc sa ia toxoplasma de la pisica care nu trebuie asumat decat daca a mai avut pisica (si are IgG anti toxoplasma) si ii curata zilnic locul de caca, caci chisturile de toxoplasma devin infectante abia la 48h. Teoretic fiecare dintre conditiile de mai sus ar fi suficienta de una singura, dar sarcina cam scade imunitatea si pisica nu face mereu unde trebuie, asa ca nu are rost riscul daca nu intruneste ambele conditii.



PROFILAXIA IN AIDS

organism ---- conditions ---- prophylaxis
Pneumocystis carinii--- CD4<200 OR oral candidiasis --- TMP/SMZ [dapsone, pentamidine, dapsone plus pyrimethamine]

Mycobacterium tuberculosis --- PPD>5 mm OR history of positive test without treatment OR contact with active case of TB --- INH plus pyridoxine [rifampin or rifabutine]

Toxoplasma gondii --- IgG to Toxoplasma and CD4<100 --- TMP/SMZ [dapsone plus pyrimethamine plus leucovorin]

Mycobacterium avium complex --- cd4<50 --- clarithromycin or azithromycine [rifabutin]

Influenza---all patients---vaccine

Hepatitis B--- all patients susceptible (AgHBc negative)---vaccine

Hep A--- all patients susceptible (hep A seronegative) and high risk (homosexuals, IV drug abusers) or chronic liver disease --- vaccine

Streptococcus pneumoniae --- all patients --- vaccine

CMV --- IgG to CMV and CD4<50 --- oral ganciclovir

Varicella zoster --- exposure to person with acute chickenpox or zoster --- VZ immune globulin

Candida --- CD4<50 --- fluconazole [ketoconazole]

Cryptococcus neoformans --- CD4<50 --- fluconazole [ketoconazole]

Histoplasma capsulatum --- CD4<100 and endemic area --- itraconazole [fluconazole]

Coccidioides immitis --- CD4<50 and endemic area --- fluconazole [itraconazole]



PS. fansidar este pyrimethamina plus sulfadoxina si se da pt cloroquine-resistant P. falciparum (pt toxoplasma este pyrimethamina plus sulfadiazina)
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Postby originaltup » Sat Feb 28, 2004 12:28 pm

Pentamidina cu foscarnet poate provoca o hipocalcemie fatala asa ca aceasta combinatie este contraindicata.
Daca ar fi fost pe profilaxie cu TMP/SMZ cea mai buna solutie ar fi fost foscarnetul.
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Postby originaltup » Sat Feb 28, 2004 12:33 pm

Question 4

You are assigned to the pediatric clinic one day to perform routine health maintenance exams on children. You examine a child whose mother states she is able to speak in two- to three-word sentences, walk downstairs holding one hand of her caregiver, and build a tower of four blocks. The child is developmentally and chronologically matched. Given these skills, you believe the child fits into which of the following category of theories of development?

A. Freud's oral phase and Erickson's trust versus mistrust

B. Freud's oral phase and Erickson's autonomy versus shame and doubt

C. Freud's anal phase and Erickson's trust versus mistrust

D. Freud's anal phase and Erickson's autonomy versus shame and doubt

E. Freud's anal phase and Erickson's initiative versus guilt
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Postby tzukmik » Sat Feb 28, 2004 3:13 pm

Cred ca e D-ul. Are intre 1-3 ani, ma gandesc.

Dar chestiile astea se invata la pedi pt stepuri, sau la psihologie??
Ca eu le citesc la psihologie educationala...nu pt step ci pentru examenu meu de marti.
Whatever

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Postby originaltup » Sat Feb 28, 2004 11:05 pm

Da, e D. Chestiile astea eu le-am invatat (cat de cat) din Behavioral Sciences care se cere in primul rand pt step 1, si care mai include in afara de psihologie, psihiatrie, dependenta de droguri, relatie medic-pacient, etc.
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Postby originaltup » Sun Feb 29, 2004 11:07 pm

Question 5

A 65-year-old male has noticed increasing fatigue, anorexia, and abdominal and bone pain over the last several months. His family has noted increased dyspnea with the things he used to do with ease and some level of confusion with slurred speech. The patient goes to see his doctor. After looking at his lab results, the physician sends him immediately to a hematologist/oncologist, who confirms his diagnosis of chronic myelogenous leukemia (CML). Further workup is done and the patient is placed on hydroxyurea. Which of the following best describes the method by which hydroxyurea will help this patient?

A. 5-Fluorouracil inhibits thymidylate synthase and prevents cell progression in the S phase

B. Hydroxyurea inhibits ribonucleotide reductase and prevents the formation of dNTPs for DNA synthesis

C. Hydroxyurea inhibits thymidylate synthase, thereby stopping cell progression in the M phase

D. Hydroxyurea stimulates thymidylate synthase, thereby accelerating the progression of apoptosis

E. Hydroxyurea and 5-fluorouracil both inhibit thymidylate synthase, thereby inhibiting the S phase
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Postby originaltup » Sat Mar 06, 2004 11:28 pm

A mother rushes her four-year-old son to the emergency room one day while you are on duty. The child appears short of breath, is experiencing stridor, and has a barking cough. You correctly diagnose the child as having croup. Which of the following statements is true about the virus that causes croup?

A. It is a DNA virus.

B. It is a double-stranded RNA virus.

C. It is a member of the same family of viruses as the mumps virus.

D. It generally causes a less common and more severe illness in adults.

E. Years after infection, a child can develop a form of encephalitis due to this virus
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Postby originaltup » Sun Mar 07, 2004 12:49 pm

A three-month-old patient presents to your clinic with a coarse face, hepatosplenomegaly, and no history of a social smile. The child also seems to be startled by the softest of sounds, and an ophthalmic exam reveals a cherry-red spot visible on the macula. Which deficiency best explains this patient's underlying disorder?

A. Alpha-galactosidase A

B. Alpha l-iduronidase

C. Beta-glucocerebrosidase

D. Ceramidase

E. Hexosaminidase
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Postby originaltup » Mon Mar 08, 2004 2:14 pm

Your 59-year-old patient was diagnosed with Parkinson's disease five years ago. You have decided that it is time to switch his medication from selegiline to a combination of levodopa and carbidopa. What is the difference in using carbidopa with levodopa as opposed to levodopa alone?

A. With carbidopa, there will be a reduced incidence of nausea and vomiting.

B. With carbidopa, there will be increased production of prolactin.

C. With carbidopa, there will be a lower incidence of dyskinesias.

D. Without carbidopa, there will be increased body temperature.

E. Without carbidopa, there will be an increased incidence of psychotic behavior.
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Postby pafaristu' » Mon Mar 08, 2004 4:18 pm

carbidopa reduce efectele periferice ale L-dopa:varsaturi, hipotensiune arteriala). raspuns corect la ultima grila A

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Postby originaltup » Wed Mar 17, 2004 9:59 am

A 43-year-old woman calls you for treatment of her morbid obesity. She is afraid to leave the house and refuses to take pills, because she says that evil little men from Mars make all the pills in the world. She is oriented to her surroundings and functions adequately with ?meals on wheels? and weekly visits from her family. The only treatment you know of is an experimental shot for this condition. Can this patient participate in the study?

A. Psychotic patients cannot participate in research experiments.

B. Psychotic patients can participate in research experiments.

C. Being psychotic bears no relation to participation in research protocols.

D. The patient's family should be consulted for permission.

E. The patient should be convinced to leave her house for treatment.
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Postby cerbu » Thu Mar 18, 2004 3:19 am

cred ca persoanele psihotice pot participa in studii daca la data obtinerii consimtamantului sunt considerate competente. as alege B, desi fata are delusions.

"Meals on wheels" este un program care furnizeaza mancare gatita la domiciliu persoanelor handicapate. este destul de eficient, mai ales ca poti specifica si dieta pe care e pacientul( diabet, low salt, etc)

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Postby originaltup » Fri Mar 19, 2004 9:10 pm

A four-year-old girl is brought in by her parents for a high fever. Her temperature in the office is 102°F, but she is playing and smiling during the visit. The physical exam is unremarkable. The pediatrician provides acetaminophen, reassurance to the parents, and sends the family home. A few days later, the fever breaks and the parents call the office urgently, reporting a maculopapular rash that is ?all over their baby girl.? What is the most likely causative agent?

A. Coxsackie A virus

B. Parvovirus B19

C. Roseola infantum

D. Rubella

E. Rubeola

F. Varicella
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Postby plure » Sat Mar 20, 2004 8:43 pm

C. Roseola infantum- HH6

Nu reusesc sa deschid fisierul raspuns.
Images of innocence and terror, not easily described in words alone, nonetheless "speak" across time, space and culture with a power to give meaning to otherwise meaningless facts.

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Postby originaltup » Sat Mar 20, 2004 11:19 pm

incearca sa-l salvezi si dupa aceea sa-l deschizi.
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Postby originaltup » Thu Mar 25, 2004 9:29 pm

A 20-year-old college student comes to your clinic Monday afternoon. She has been vomiting since last night and feels very ill. She has not produced urine in the past 12 h, which she can remember. She continues vomiting while in your office. You give her an antiemetic IV and she starts to calm down. Laboratory samples are drawn, a urinalysis is taken by catheter, and an ABG is drawn. What are the results likely to show?

A. Decreased serum K, U/A high spec grav, ABG: metabolic alkalosis

B. Decreased serum K, U/A high spec grav, ABG: metabolic acidosis

C. Decreased serum K, U/A low spec grav, ABG: metabolic acidosis

D. Increased serum K, U/A low spec grav, ABG: metabolic acidosis

E. Increased serum K, U/A low spec grav, ABG: metabolic alkalosis

F. Serum increased K, U/A with high specific gravity, ABG: metabolic alkalosis
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Postby originaltup » Fri Mar 26, 2004 11:05 pm

Am gasit pe undeva niste grile:


Question number 1
A dysphagia that respond to ketoconazole is most likely to be secondary to
a) scleroderma
b) amyloidosis
c) achalasia
d) candidiasis
e) Chagas disease
The correct answer is D
Explanation
Candida infection of the esophagus is a yeast infection of the esophagus. Treatment:The objective of treatment is to eliminate the infection with antifungal medications such as ketoconazole and fluconazole. Amphotericin B may be used if other treatment fails. Expectations (prognosis):Esophagitis can usually be treated effectively; the outcome depends upon the underlying immunodeficiency that makes the person more susceptible to the infection.

Question number 2
bilaterally symmetric hearing loss of the high frequencies is in the elderly is most commonly secondary to
a) Meniere's disease
b) Presbycusis
c) Multiple sclerosis
d) Aminoglycosides
e) Acoustic neuroma
Explanation
Presbycusis is hearing loss associated with aging and is the most common cause of diminished hearing in the elderly. The hearing loss is bilaterally symmetric and gradual in onset. The majority of cases begin with a loss of the high frequencies with slow progression. Eventually, middle- and low-frequency sounds also become difficult to perceive

Question number 3
adenoid cystic carcinoma is the most common malignancy of
a) parotid gland
b) lacrimal gland
c) parathyroid gland
d) pituitary gland
e) pineal gland
The correct answer is A
Explanation
Mucoepidermoid carcinoma is the most common malignancy of the parotid gland; adenoid cystic carcinoma is the most common malignancy of the submandibular and minor salivary glands.

Question number 4
radiation therapy is widely used in the treatment of
a) Lymphogranuloma Venereum
b) Testicular Torsion
c) Hydrocele
d) Epididymitis
e) seminoma
The correct answer is E
Explanation
Both the relatively low rate of spread and the radiosensitivity have made radiation therapy the most widely accepted form of treatment for seminomas following inguinal orchiectomy
Question number 5
a linear branching pattern of a cluster of microcalcification on a screening mammogram is most suggestive of
a) Paget's disease
b) fibroadenoma
c) simple cyst
d) carcinoma in-situ
e) galactocele
The correct answer is D
Explanation
About half of all cases of clustered microcalcification would turn out to be malignant, of which in-situ carcinoma is the commonest cause in screening mammograms.

Question number 6
A newborn is noted to have obstructive jaundice. A sweat test is postive. The most likely diagnosis is
a) septicemia
b) hepatic veno-occlusive disease
c) cystic fibrosis
d) viral hepatitis
e) physiologic jaundice
The correct answer is C
Explanation
Obstructive jaundice in newborns with CF requires no specific therapy. Hepatomegaly with steatosis requires careful attention to nutrition and may respond to carnitine repletion. Rarely, biliary cirrhosis proceeds to hepatocellular failure, which should be treated as in other patients with hepatic failure The sweat test has been the gold standard for diagnosing cystic fibrosis (CF) for more than 40 years. When it is performed by trained technicians, and evaluated in an experienced, reliable laboratory, the sweat test is still the best test to diagnose CF. It is painless, relatively inexpensive, and gives definitive answers. The test can be performed on individuals of any age. However, some young babies may not make enough sweat for the laboratory to analyze. If a baby does not produce enough sweat on a sweat test, it should be repeated. The sweat test is a simple, diagnostic procedure which determines the amount of sodium and chloride in the sweat. In the first part of the test, a colorless, odorless chemical, known to cause sweating, is applied to a small area on the arm or leg. An electrode is then attached to stimulate a weak electrical current to the area. This part of the procedure lasts approximately five minutes. The second part of the test consists of cleaning the stimulated area and collecting the sweat on a piece of filter paper or in a plastic coil. Thirty minutes later, the collected sweat is sent to a hospital laboratory for analysis. The entire procedure takes approximately one hour.

Question number 7
A four year old boy with generalised weakness is suspected of having Duchenne's muscular dystrophy. The most specific diagnostic test to confirm the diagnosis is
a) muscle biopsy
b) thyroid microsomal antibody titer
c) serum complement levels
d) radiograph of the wrist
e) erythrocyte sedimentation test
The correct answer is A
Explanation
EXPLANATION/NOTE Electromyogram (EMG) shows characteristic myopathic features but is not specific for Duchenne muscular dystrophy. No evidence of denervation is found. Motor and sensory nerve conduction velocities are normal. DIAGNOSIS. The muscle biopsy material is diagnostic Myopathic changes include endomysial connective tissue proliferation, scattered degenerating and regenerating myofibers, foci of mononuclear inflammatory cell infiltrates as a reaction to muscle fiber necrosis, mild architectural changes in still functional muscle fibers, and many dense fibers. These hypercontracted fibers probably result from segmental necrosis at another level, allowing calcium to enter the site of breakdown of the sarcolemmal membrane and trigger a contraction of the whole length of the muscle fiber.

Question number 8
A single 32 year old lawyer complains of severe lower abdominal pain and vaginal bleeding developing during a long court session. Her urine hCG level is abnormally raised. The most likely cause of the vaginal bleeding is
a) ectopic pregnancy
b) vaginal adenosis
c) atrophic endometrium
d) dysfunctional uterine bleeding
e) vaginal clear cell carcinoma
The correct answer is A
Explanation
The triad of irregular menses, unilateral adnexal pain, and adnexal mass, combined with a positive urine or serum hCG level, signifies ectopic pregnancy unless proven otherwise.

Question number 9
a 61 year old diabetic complains of pain in the thigh and gluteal region on walking up the stairs for the last 5 months.she is a smoker and has ischaemic heart disease.
a) thromboangitis obliterans
b) ruptured baker`s cyst
c) deep vein thrombosis of the lower limb
d) aortoiliac artery artherosclerosis
e) embolus
The correct answer is D
Explanation
An accurate diagnosis of the presence of vascular disease, as well as its location and severity, can often be made after completing a focused history and physical examination. Patients with peripheral vascular disease usually complain of pain. Careful analysis of the location, quality, and intensity of the pain and factors that aggravate and relieve it yields important information. Ischemic pain has a characteristic quality that is unlikely to be confused with other conditions. The term claudication is applied to the cramping pain felt in specific muscle groups when nutritive blood flow is inadequate to meet the metabolic demands of exercise. The distance walked before onset of this leg pain is strikingly reproducible, and the pain is promptly relieved simply by cessation of ambulation. Claudication of the buttock and thigh muscles is indicative of an aortoiliac obstruction, whereas calf claudication usually indicates femoral artery disease. When blood flow is inadequate to meet metabolic requirements at rest, continuous pain (rest pain) may be described. This pain is usually felt in the toes and forefoot. It is often prominent at night. In the recumbent position, there is loss of the hydrostatic pressure component due to the gravitational force of the column of blood between the heart and the site of vascular obstruction. Loss of this component may cause the flow across a stenosis to decrease below a threshold value and awaken the patient with pain. Patients often discover that restoring a component of hydrostatic pressure by hanging the foot over the side of the bed or by standing relieves this pain. Rest pain is an ominous symptom and demands prompt evaluation, not only because of the considerable discomfort for the patient but also because it indicates such severe vascular compromise that the involved limb may soon progress to frank gangrene in the absence of intervention.

Question number 10
A patient with intermittent claudication is found on angiography to have a localised stenosis of his superficial femoral artery with three calf runoff vessels and good vascular supply to the calf and foot. The treatment of choice is
a) reassurance
b) warfarin
c) balloon angioplasty
d) laparoscopy
e) bypass grafts
The correct answer is C
Explanation
Good results are obtained in femoropopliteal stenoses with two or three patent calf runoff vessels (78% patency at 3 years)

Question number 11
transmission of Lyme disease usually occurs through
a) bite of ticks
b) mosquito bites
c) drinking water
d) sharing of needles
e) fecal-oral route
The correct answer is A
Explanation
Lyme disease is spread by the bite of ticks of the genus Ixodes that are infected with Borrelia burgdorferi

Question number 12
blindness is the most feared complication of
a) temporal arteritis
b) factitious fever
c) tuberculosis
d) polymyalgia rheumatica
e) Still's disease
The correct answer is A
Explanation
Blindness, the most feared complication of temporal arteritis, can generally be averted through the use of corticosteroid therapy. Nodules or diminished temporal artery pulsations need not be present for an arterial biopsy to reveal active arteritis. Because pathologic abnormalities may be confined to short segments of the artery, extensive (bilateral) segments of the temporal artery may need to be examined to establish the diagnosis .
Question number 13
toxicity in the outer hair cells of the organ of Corti is a feature of
a) Meniere's disease
b) Presbycusis
c) Multiple sclerosis
d) Aminoglycosides
e) Acoustic neuroma
The correct answer is D
Explanation
Aminoglycosides-eg: gentamicin, streptomycin, tobramycin, neomycin may ototoxicity. The site of aminoglycoside toxicity is the outer hair cells of the organ of Corti

Question number 14
A middle aged woman complains of progressive dysphagia to solids and liquids. A barium swallow examination shows a 'bird-beak like' narrowing of the esophago gastric junction. The most likely diagnosis is
a) scleroderma
b) amyloidosis
c) achalasia
d) candidiasis
e) Chagas disease
The correct answer is C
Explanation
Achalasia - nerve degeneration in the Auerbach´s plexus. Achalasia is a primary esophageal motor disorder characterized by lack of esophageal peristalsis and poor lower esophageal sphincter (LES) relaxation. Clinically, achalasia manifests as progressive dysphagia to solids and liquids and mild weight loss. Predisposition to esophageal cancer is not prevalent, but certain tumors may mimic achalasia. The diagnosis of achalasia is relatively easy to make with a good hitory, radiography, and esophageal motility testing. The esophagogram reveals a typical bird-beak narrowing of the esophagogastric junction and esophageal dilation, the degree of which depends on the stage of the disease. Esophageal manometry reveals poor LES relaxation, aperistalsis, and often elevated intra-esophageal pressure. Endoscopic examination is important to rule out malignancy as the cause of achalasia. The traditional treatment of achalasia is forceful dilation of the LES. Bougienage may be helpful in some cases. Pharmacological agents, such as nitroglycerin and calcium channel blockers, provide some relief by decreasing LES pressure. However, they are not a viable, long-term choice. Surgical myotomy offers slightly better results than pneumatic dilation, but it is accompanied by some increased gastroesophageal reflux
Question number 15
A patient with long standing renal insufficiency develops mild generalised ecchymoses. Platelet dysfunction is suspected despite a normal platelet count. Which test would be most useful in this patient?
a) Platelet count
b) Clot retraction
c) Tourniquet test
d) Bleeding time
e) Prothrombin time (PT)
The correct answer is D
Explanation
Renal insufficiency is associated with a bleeding tendency. Hemorrhagic manifestations are usually mild (i.e., ecchymoses or purpura) but can be severe in occasional patients who may have gastrointestinal tract or intracranial bleeding. Modern techniques for the management of uremia have definitely reduced the incidence of severe bleeding episodes in patients with renal failure, but hemorrhages still represent a major clinical problem, particularly for patients undergoing surgery or invasive procedures. The bleeding time is frequently abnormal in acquired platelet function abnormality such as that seen in uremia and the myeloproliferative syndromes. The bleeding time is usually abnormal in congenital defects of platelet function such as Glanzmann's thrombasthenia. The bleeding time is most helpful as an indicator of platelet abnormality, either in number or function. The bleeding time is usually normal when the platelet count is decreased but still more than 100,000/mm3 (100 × 109 /L). With platelet counts less than 100,000/mm 3 , there is a rough correlation between severity of thrombocytopenia and degree of bleeding time prolongation. The bleeding time is usually abnormal in congenital defects of platelet function such as Glanzmann's thrombasthenia. The bleeding time is frequently abnormal in acquired platelet function abnormality such as that seen in uremia and the myeloproliferative syndromes. In uremia, there frequently are demonstrable abnormalities in platelet function tests but not sufficient to entirely explain bleeding problems. In addition, up to 50% of uremic patients develop some degree of thrombocytopenia
Question number 16
A patient with hypertension is found to have a pheochromocytoma. and is being prepared for surgical removal. What is the medication of choice in the stabilisation of the patient's blood pressure in the weeks before surgery?
a) Beta blockers with intrinsic sympathomimetic activity
b) Central alpha agonists
c) High-dose diuretics
d) Nicotinic acid
e) Alpha blockers
The correct answer is E
Explanation
Once pheochromocytoma has been diagnosed, the patient is prepared for surgery with adrenergic blockade for a period of 1 to 4 weeks. During alpha-blockade, any catecholamine-induced plasma volume contraction is allowed to correct itself. alpha-Blockade is usually accomplished with oral phenoxybenzamine, an irreversible, non-competitive antagonist that acts predominantly at alpha1 ?receptors
Question number 17
A mother brings her one year old infant to her pediatrician. She describes that following a common cold her child's voice has become hoarse and has developed a cough that sounds harsh and brassy and was worse at night. On examination the child was noted to have trouble drawing air into its lungs between coughs and had trouble drawing air into its lungs. There was visible stridor on inhalation .The cause is most likely to be
a) Epstein-Barr
b) Rhinovirus
c) Parainfluenza
d) Flavivirus
e) HIV
The correct answer is C
Explanation
The parainfluenza viruses are the most common causes of croup in children. Croup is usually caused by the parainfluenza virus, but other possible culprits include: the respiratory syncytial virus (RSV), adenovirus, influenza (flu) virus or the measles virus. Croup usually affects younger children from 6 months to 3 years old, most commonly during the fall and winter months Croup usually begins after a child has had a cold for 1 to 4 days. Gradually the child's voice becomes hoarse, and she develops a cough that sounds harsh and brassy (like a seal's bark). Between coughs she has trouble drawing air into her lungs, and there is a rough or raspy sound (called stridor) when she inhales. As she struggles to breathe, her nostrils flare and her rib muscles retract (suck inward). Although a child usually has a fever, it rarely reaches higher than 102°F. A child's croup symptoms are usually worse at night, and often become more intense for several nights in a row before finally getting better. Cough and breathing problems are also worse if she cries, or if she becomes frightened or excited. Many children feel better if they sit up in bed rather than lie down

Question number 18
an elderly patient complains of vertigo experienced only in specific positions. Onset is sudden, usually within a few seconds of assuming the triggering position. Symptoms cease after several minutes if the patient does not move, but will resume with further change in position. The most likely pathology is
a) basilar artery disease
b) acoustic neuroma
c) benign positional vertigo
d) vestibular neuronitis
e) Meniere's disease
The correct answer is C
Explanation
Benign positional vertigo is a common problem in the elderly, consisting of vertigo experienced only in specific positions. Onset is sudden, usually within a few seconds of assuming the triggering position. Symptoms cease after several minutes if the patient does not move, but will resume with further change in position. In most patients, the condition resolves within 6 months; recovery is usually complete
Question number 19
A two week old baby has had continous noisy inspiratory breathing and stridor most prominent when the infant is lying on his back. On bronchoscopy collapse of the tracheal walls was noted during expiration . The likely diagnosis is
a) Choanal Atresia
b) Laryngomalacia
c) Tracheoesophageal Fistula
d) Double aortic arch
e) Foreign body aspiration
The correct answer is B
Explanation
Laryngomalacia is benign and the most common laryngeal problem found in the newborn. This disorder may become obvious within the first two weeks of life, with noisy inspiratory breathing. This type of noisy breathing is known as stridor and has a high pitched, harsh quality. The stridor is usually more prominent when the infant is lying on his/her back, crying, feeding,excited or has a cold. The cause of laryngomalacia is not clearly understood. What is known about the condition is that the epiglottis which protects the airway when the child feeds also partially obstructs the airway during breathing. The partial obstruction is the source of noise with breathing.
Question number 20
A 25 year old has a recurrent high spiking fever and polyarticular joint pain for several months. He has had a recent transient maculopapular rash and a sore throat. On examination he has lymphadenopathy and hepatosplenomegaly. On investigation the rheumatoid factor and antinuclear antibody tests are negative. A likely diagnosis is
a) temporal arteritis
b) factitious fever
c) tuberculosis
d) polymyalgia rheumatica
e) Still's disease
The correct answer is E
Explanation
Still's disease usually affects young adults between 16 and 35 years of age. Still's disease is a diagnosis based solely on clinical findings, because serologic markers and other diagnostic tests for the disorder do not exist. Its clinical features include high spiking fever, arthralgias or arthritis, a transient maculopapular rash, lymphadenopathy, hepatosplenomegaly, serositis, and sore throat. Leukocytosis is generally marked, and rheumatoid factor and antinuclear antibody tests are negative. The fever of Still's disease is characteristically high and spiking, with temperatures reaching levels of as high as 41.6°C. The fever pattern may be either intermittent (quotidian) or remittent. Although most patients seek medical attention within 2 weeks of the onset of symptoms, some 25% suffer for more than 4 weeks before doing so. A distinctive, evanescent, salmon-pink, macular or maculopapular rash is typically present during the course of the illness. Hepatomegaly or abnormal liver function tests, or both, are common. Severe liver failure, however, is seen almost exclusively in conjunction with aspirin or other nonsteroidal anti-inflammatory drug therapy. In a third of patients, the disease has a self-limited course, in a quarter an intermittent course, and in a third a chronic course. In occasional patients, Still's disease has a fatal outcome. Three predictors of an unfavorable outcome include root joint (shoulder and hip) arthritis on presentation, polyarthritis, and rash. No other clinical or laboratory manifestations, including human leukocyte antigen (HLA) tests, predict the outcome.
Question number 21
Symptomatic presentations of Meckel's diverticulum is most likely at
a) at birth
b) 1-5 months
c) 6-12 months
d) 1-5 years
e) 6-14 years
The correct answer is C
Explanation
Symptomatic presentations are secondary to hemorrhage, small bowel obstruction, diverticulitis, perforation, associated umbilical abnormalities, and tumors. More than half of patients presenting with symptoms are younger than 2 years of age.
Question number 22
A 35 year old woman develops flat and itchy skin papules with a lacy white pattern on the flexural surface of the wrist. She is also noted to have destruction of the nail bed matrix. These findings are commonly associated with
a) yellow nail syndrome
b) leukonychia
c) onychomycosis
d) lichen planus
e) pellagra
The correct answer is D
Explanation
lichen planus is an inflammatory process involving the skin and mucous membranes, which can be acute or chronic, and affects females more often than males in the 30 to 60 year old age group. Lesions are described with the 'FIVE Ps - Planar, Purple, Polygonal, Pruritic Papules. On the oral mucosa, these appear as milky white papules. It is best treated with topical corticosteroids with occlusion. An inflammatory skin disease, lichen planus is characterized by a wide, flat, violaceous, itchy papules and involves flexural areas, particularly the flexural surface of the wrist. . Nail involvement may occur in about 10% of patients with lichen planus and may appear in the absence of skin disease. The lesions of lichen planus frequently show a reticulate or lacy white pattern called Wickham's striae As with psoriasis, lichen planus tends to involve the nails on both hands and both feet. Lichen planus may be associated with onycholysis, yellow discoloration, and subungual hyperkeratosis. The most common clinical manifestations that distinguish it from onychomycosis are Wick- ham's striae -- typical lesions of the skin or mucous membranes -- and pterygium -- destruction of the nail matrix with resultant formation of a scar, causing a break in the nail plate connecting the proximal nail and nail bed epithelium.
Question number 23
A 50 year old patient has an assymptomatic apical midsystolic murmur. This is most likely secondary to
a) papillary muscle rupture
b) ventricular septal defect
c) valvular aortic stenosis
d) supravalvular aortic stenosis
e) subvalvular aortic stenosis
The correct answer is C
Explanation
The high-frequency apical midsystolic murmur of aortic stenosis should be distinguished from the high-frequency apical murmur of mitral regurgitation. Aortic valvular stenosis is secondary to fusion of commisures between cusps and is present in 1-2% of population
Question number 24Question number 24
a 40 year old has a small sessile nodule with smooth contour on the labial mucosa. It is firm to palpation. The most likely cause of this swelling is
a) torus
b) exostosis
c) pleomorphic adenoma
d) verruca vulgaris
e) fibroma
The correct answer is E
Explanation
Fibroma (Fibrous Hyperplasia) is the second most common oral exophytic lesion and the most common benign soft tissue neoplasm in the oral cavity. It may occur at any age, but is most frequently seen in the third to fifth decades. There is no gender or racial predilection. The lesion appears as a small nodule, often no larger than a centimeter in diameter, with normal overlying mucosa, is sessile or slightly pedunculated with a smooth contour, and is firm to palpation . It may be seen on the buccal and labial mucosa, tongue, palate, gingiva, and edentulous ridges

Question number 26
A pre-term neonate is noted to be jaundiced. The most common cause of jaundice in preterm neonates
a) septicemia
b) hepatic veno-occlusive disease
c) cystic fibrosis
d) viral hepatitis
e) physiologic jaundice
The correct answer is E
Explanation
Jaundice is common in neonates, especially among prematures, and usually results from the inability of an immature liver to conjugate bilirubin, leading to an elevated indirect component Persistent elevation of indirect bilirubin levels in nursing infants may be a result of breast milk jaundice, which is usually a benign entity in full-term infants Diseases that cause jaundice in the newborn, often accompanied by anemia and sometimes a few peripheral blood nucleated RBCs, include septicemia, cytomegalic inclusion disease, toxoplasmosis, and syphilis. Physiologic jaundice of the newborn is a frequent benign condition that may be confused with hemolytic disease or vice versa. There is, however, no significant anemia. Elevated direct bilirubin is never normal and suggests liver disease, although in infants it may be a result of extrahepatic infection (e.g., urinary tract infection). The direct bilirubin fraction should account for no more than 15-20% of the total bilirubin. Indirect hyperbilirubinemia, which occurs commonly in normal newborns, tends to tint the scleras and skin golden yellow, whereas direct hyperbilirubinemia produces a greenish-yellow hue.
Question number 27
a male teenager went to the local emergency room for a severe left testicular pain. On questioning he also admitted to pain in his left loin and was noted to be restless and unable to find comfort in any position. He was seen to stand, pace, recline, and move continuously in an attempt to 'shake off' the discomfort. On investigation his blood pressure was raised, he was afebrile and had microscopic hematuria. A likely diagnosis is
a) sickle cell anemia
b) Alport's syndrome
c) ureteric lithiasis
d) Goodpasture's syndrome
e) Systemic lupus erythematosus
The correct answer is C
Explanation
Individuals with urinary lithiasis rarely can find comfort in any position. They sit, stand, pace, recline, and move continuously in an attempt to 'shake off' whatever it is that is creating discomfort. Fever is not present unless urinary infection occurs along with the calculus. Pulse rate and blood pressure may be elevated because of pain and agitation. Examination of the abdomen reveals moderate deep tenderness on palpation over the location of the calculus and the area of the loin. To begin with a good physical exam should be able to differential between testicular pathology versus renal colic from a stone. Renal colic is usually associated with acute intense flank pain with nausea and vomiting. There is often blood in the urine although rarely infection
Question number 28
An alcoholic has severe ascites causing compromisation of respiratory function. What procedure is mot likely to relieve the paient's symptoms?
a) manual compression
b) paracentesis
c) balloon tamponade
d) nasogastric feeding tube
e) gastrostomy feeding tube
The correct answer is B
Explanation
Therapeutic paracentesis may be undertaken in the emergency setting to relieve the cardiorespiratory and gastrointestinal manifestations of tense ascites.
Question number 29
An elderly male patient complains of pain and stiffness in the muscles of the neck , the shoulder, and the pelvic girdle of about eight months in duration for which he has been extensively investigated several times . Examination and investigations were all normal except for a markedly raised ESR. There was an immediate positive response to corticosteroids. A likely diagnosis is
a) temporal arteritis
b) factitious fever
c) tuberculosis
d) polymyalgia rheumatica
e) Still's disease
The correct answer is B
Explanation
Patients with factitious fever are generally young women, approximately 50% of whom have had training in some aspect of health care, often as nurses. Patients with factitious fever may induce fever through the self-administration of pyrogenic agents. Agents injected for this purpose have most often consisted of bacterial suspensions. Patients with fraudulent fever are characteristically healthy in appearance and exhibit relative bradycardia during febrile episodes. They have unusual fever patterns (e.g., lack of diurnal rhythmicity) that are unresponsive to antipyretics. Laboratory studies are typically normal. In such patients, the diagnosis is usually confirmed by close observation and careful attention to temperature-monitoring procedures.
Question number 30
The presence of photosensitivity and nephritis in a 14 year old with fever and joint pain is suspicious of
a) Acute Lymphoblastic Leukemia
b) Juvenile rheumatoid arthritis
c) Infectious mononucleosis
d) Idiopathic thrombocytopenic purpura
e) systemic lupus erythematosus
The correct answer is E
Explanation
The presence of photosensitivity or nephritis should suggest the possibility of systemic lupus erythematosus (SLE).
Question number 31
oral fluconazole is the treatment of choice for
a) yellow nail syndrome
b) leukonychia
c) onychomycosis
d) lichen planus
e) pellagra
The correct answer is C
Explanation
Oral therapy has the highest success rate with fingernail and nail infections in young individuals.
Question number 32
A 2 year old has a chronic cough. A frontal radiograph reveals hyperinflation of the left hemithorax. Bilateral decubitus views were obtained. They showed that the right lung becomes appropriately atelectatic with decubitus positioning. However, the left side shows no change in appearance with decubitus positioning. The likely diagnosis is
a) Choanal Atresia
b) Laryngomalacia
c) Tracheoesophageal Fistula
d) Double aortic arch
e) Foreign body aspiration
The correct answer is E
Explanation
Asymmetric hyperinflation suggests the possibility of an aspirated foreign body in this two year old infant. These findings suggest the diagnosis of an aspirated foreign body or a possible obstruction of the left main stem bronchus from a central etiology. Bronchoscopy was performed and a peanut was identified within the airway. The follow up chest radiograph shows symmetrically, normally aerated lungs. Discussion:Foreign body aspiration is a common cause of focal hyperinflation or pneumonia in toddlers. The aspiration event frequently is undetected even in the most vigilant of households. Bronchoscopy is both diagnostic and therapeutic. Often the history of a child with a choking episode and subsequent dysphagia makes the diagnosis obvious. Other presentations may be less evident. Complications typically occur at the initial occurrence (prior to intervention) or when foreign bodies persist for a longer period of time. Diagnostic evaluation varies by presentation, but therapeutic intervention involves foreign body removal
Question number 33
A 35-year-old male with abdominal pain and diarrhoea has evidence of hundreds of polyps in the colon and rectum. The most likely diagnosis is
a) Muir-Torre syndrome
b) Turcot's syndrome
c) Cowden's disease
d) Adenomatous polyposis
e) Familial adenomatous polyposis [FAP]
The correct answer is E
Explanation
FAP is an autosomal dominant condition with the defect localized to the APC gene on chromosome 5q21. There are several thousand polyps in the colon. The polyps appear between the age of 10 and 35 years. The potential malignant change is 100% by the age of 40 years. Hence all relatives ought to be screened annually from the age of 12 years and all patients ought to have prophylactic colectomy by the age of 30. Recently, a protein assay has been developed that can diagnose the genetic defect in 87% of such families and 150mg sulindac twice daily has been shown to reduce the number and size of the adenomatous polyps in the rectum.
Question number 34
The presence of anti-glomerular basement membrane antibodies in a patient with hematuria and pulmonary hemorrhage is a feature of
a) sickle cell anemia
b) Alport's syndrome
c) ureteric lithiasis
d) Goodpasture's syndrome
e) Systemic lupus erythematosus
The correct answer is D
Explanation
The presence of anti-glomerular basement membrane (GBM) antibodies in patients with lung hemorrhage (Goodpasture's syndrome) and without lung hemorrhage (anti-GBM disease) aid in diagnosing anti-GBM-mediated glomerulonephritis Crescentic glomerulonephritis may be associated with most forms of primary glomerulonephritis or with systemic diseases such as SLE, Henoch-Schonlein purpura, and systemic vasculitis. Patients with a rapidly progressive clinical course usually have large epithelial crescents in more than 50% of their glomeruli on renal biopsy.
Question number 35
The following features: micrognathia, epicanthal folds, high-arched palate, short neck and broad, webbing of the neck are features of
a) XX karyotype
b) XXY karyotype
c) XO karyotype
d) XXX karyotype
e) XY karyotype
The correct answer is C
Explanation
Turner's syndrome - XO female (or mosaic XO/XX) incidence 1:2500 liveborn females There is a distinctive facies, in which micrognathia; epicanthal folds; prominent, low-set, rotated and/or deformed ears; a fish-like mouth with a narrow, high-arched palate; ptosis; and strabismus are present with varying degrees of frequency. The chest is usually square and shield-like with microthelia and inverted nipples. The areolae appear to be widely spaced. The neck is short and broad, and the hairline in back is low. Webbing of the neck is present in 25 to 40%, and coarctation of the aorta occurs in 10 to 20%. Those with coarctation usually also have webbing of the neck. Additional anomalies include congenital lymphedema of the feet and hands (30%) or puffiness of the dorsum of the fingers; short fourth metacarpals (50%); renal abnormalities (40%); high-arched palate; various skeletal anomalies, including cubitus valgus, Madelung's deformity of the wrist, genu valgum, and scoliosis,increased number of pigmented nevi; tendency to keloid formation; abnormal nails; recurrent otitis media, which may result in conductive hearing loss (as well as progressive sensorineural loss of hearing); unexplained hypertension; and, rarely, gastrointestinal bleeding secondary to intestinal telangiectasia, hemangiomatoses, or dilated veins
Question number 36
a patient with a pleural mass and a pleural effusion is noted to have a history of calcified pleural plaques. The pleural mass is most likely to be secondary to
a) Congestive heart failure
b) Hypoalbuminemia
c) Mesothelioma
d) Meigs' syndrome
e) Pulmonary embolization
The correct answer is C
Explanation
The plain chest film may show pleural plaques associated with asbestosis before the onset of mesothelioma. Later, as the tumor develops, pleural effusion may appear and pleural thickening can become evident.
Question number 37
a dermatitis confined to the nipple is a characteristic feature of
a) Paget's disease
b) fibroadenoma
c) simple cyst
d) carcinoma in-situ
e) galactocele
The correct answer is A
Explanation
Histologically, this disease is produced by intraductal carcinoma occurring in the large sinuses just under the nipple. Carcinoma cells invade across the epidermal-epithelial junction and enter the epidermal layer of the skin of the nipple. Clinically, this histologic variant produces a dermatitis that may appear eczematoid and moist or dry and psoriatic. It is usually confined to the nipple, although it can spread to the skin of the areola
Question number 38
a history of alkali ingestion is a recognised contra-indication for
a) manual compression
b) paracentesis
c) balloon tamponade
d) nasogastric feeding tube
e) gastrostomy feeding tube
The correct answer is D
Explanation
Nasogastric tubes are contraindicated in a few groups of patients with special predispositions to injury from tube placement. Patients with facial fractures who have a cribriform plate injury may suffer intracranial penetration with a blindly placed nasal tube. Patients who have esophageal strictures or a history of alkali ingestion, especially recent alkali ingestion, may suffer esophageal perforation
Question number 39
an association with gastrinomas is a feature of
a) Ulcerative colitis
b) Hyperthyroidism
c) amebiasis
d) Zollinger-Ellison syndrome
e) crohn's disease
The correct answer is D
Explanation
Gastrinomas may be sporadic or be associated with specific genetic predisposition. Approximately one third (15% to 77% in different studies) of patients with gastrinomas have multiple endocrine neoplasia type 1 (MEN-1), which comprises tumors or hyperplasia of parathyroid, pancreatic islet, and pituitary glands
Question number 40
hereditary nephritis, high-frequency hearing loss, and ocular abnormalities are features of
a) basilar artery disease
b) acoustic neuroma
c) benign positional vertigo
d) vestibular neuronitis
e) Meniere's disease
The correct answer is B
Explanation
Acoustic neuroma (benign schwannoma of the eighth cranial nerve) represents the most worrisome of the peripheral lesions, retrocochlear in location and distinguished from the others by its retrocochlear type of hearing loss (see below) and capacity to produce serious brainstem compression if untreated. Symptoms start out almost imperceptibly with mild hearing loss, tinnitus, and vague dizziness and may resemble other forms of peripheral vestibular disease. However, the clinical course is progressive, differentiating it from other peripheral etiologies. Most patients do not come to medical attention until later stages, when the expanding tumor compresses adjacent structures in the cerebellopontile (C-P) angle, causing cranial nerve and brainstem deficits to develop (eg, facial numbness, gait ataxia, weakness). A decreased corneal reflex is one of the earliest signs of damage outside the internal auditory meatus.
Question number 42
A neonate at 6 hours of age is lethargic and develops seizures. On examination he is found to have a bulging fontanel. Meningitis is suspected. The most appropriate treatment would be
a) stibogluconate sodium
b) sulfonamides
c) chloramphenicol sodium succinate
d) ampicillin
e) erythromycin
The correct answer is D
Explanation
Management of neonatal meningitis requires antibiotic therapy to be directed against E. coli, the group B streptococci, and the rare Listeria monocytogenes initially. Thus, typical initial therapy should include ampicillin and a third-generation cephalosporin (e.g. ceftriaxone
Question number 43
an 28 year old girl exposed to diethylstilbestrol during pregnancy develops intermenstrual vaginal bleeding. This patient is most likely to be have
a) ectopic pregnancy
b) vaginal adenosis
c) atrophic endometrium
d) dysfunctional uterine bleeding
e) vaginal clear cell carcinoma
The correct answer is B
Explanation
There is a significant association between clear cell carcinomas of the vagina and maternal ingestion of diethylstilbestrol (DES) during pregnancy. However only about 1 of every 1000 women exposed to DES in utero develops clear cell carcinoma. Although the risk of clear cell carcinoma of the vagina is small in DES-exposed women, 45% of these patients have areas of vaginal adenosis and 25% have structural abnormalities of the uterus, cervix, or vagina. It has been recommended that women exposed to DES in utero be examined initially at menarche and that a careful examination of the cervix and the vagina be performed in addition to cytologic examinations.
Question number 44
A 60 year old complains of a hard swelling in his mouth. On examination he is seen to have a nodular bony shelf on the buccal aspect of the the maxilla. The most likely cause of this swelling is
a) torus
b) exostosis
c) pleomorphic adenoma
d) verruca vulgaris
e) fibroma
The correct answer is B
Explanation
Buccal exostoses are less common than the palatal or lingual tori, and they tend to form a nodular bony shelf on the buccal aspect of the jaws, more commonly in the maxilla than mandible and without gender predilection.
Question number 45
An 18-year-old female with a history of colonic polyps develops a supratentorial glioblastoma. These findings are commonly associated with
a) Muir-Torre syndrome
b) Turcot's syndrome
c) Cowden's disease
d) Adenomatous polyposis
e) Familial adenomatous polyposis [FAP]
The correct answer is B
Explanation
The term Turcot's syndrome applies to a syndrome of familial colonic polyposis with primary tumors of the central nervous system. The phenotypic spectrum may be broad, with colonic manifestations ranging from a single adenoma to profuse adenomatosis coli, and brain tumors representing different histopathologic types.It is though to be autosomal recessive and has an onset in teens
Question number 46
Chronic occlusion of the lower abdominal aorta and aortic bifurcation by thrombosis is typically managed by
a) reassurance
b) warfarin
c) balloon angioplasty
d) laparoscopy
e) bypass grafts
The correct answer is E
Explanation
Although thromboendarterectomy with direct reconstitution of flow is appropriate in a few patients, the majority of patients with occlusion of the abdominal aorta are managed by bypass grafts from the aorta to the iliac or more often the common femoral arteries Balloon angioplasty can be effective therapy in selected patients
Question number 47
35 year old obese women develops painful leg on the 10th post operative day following emergency surgery for a ruptured ectopic pregnancy. There is calf pain on dorsiflexion of the foot She is likely to have
a) thromboangitis obliterans
b) ruptured baker`s cyst
c) deep vein thrombosis of the lower limb
d) aortoiliac artery artherosclerosis
e) embolus
The correct answer is C
Explanation
Studies using radioactive fibrinogen scans indicate a prevalence of deep vein thrombosis (DVT) in excess of 40% in postoperative patients. One percent of general surgical patients die from pulmonary embolism. Clinically, the classic features of DVT are calf swelling and tenderness, elevated temperature, and a positive Homans' sign (calf pain on dorsiflexion of the foot).
Question number 48
Osgood-Schlatter disease is most likely to present at
a) at birth
b) 1-5 months
c) 6-12 months
d) 1-5 years
e) 6-14 years
The correct answer is E
Explanation
The patellar tendon inserts into the tibia tubercle, which is an extension of the proximal tibial epiphysis. This area is vulnerable to microfracture during late childhood or adolescence, especially in athletes, producing Osgood-Schlatter disease. It is most common in males. The natural history is usually benign. Physical examination demonstrates swelling, tenderness, and increased prominence of the tibia tubercle. Radiographs are usually necessary to rule out other lesions. Rest, restriction of activities and, occasionally, a knee immobilizer may be necessary, combined with an isometric exercise program. Anti-inflammatory medications usually are not beneficial. Complete resolution of symptoms through physiologic healing (physeal closure) of the tibia tubercle usually requires 12-24 mo.
Question number 49
in the emergency department acute procidentia may be treated by
a) manual compression
b) paracentesis
c) balloon tamponade
d) nasogastric feeding tube
e) gastrostomy feeding tube
The correct answer is A
Explanation
Rectal prolapse, also known as procidentia, is a relatively uncommon condition in which some or all of the layers of the rectum protrude through the external anal sphincter. Definitive treatment of rectal prolapse is usually surgical, but the acute prolapse may be reduced in the emergency department by gentle manual compression. Failure to reduce the prolapse can result in long-term complications of atonic anal sphincters with resultant incontinence, or, at worst, actual gangrene of the bowel wall.
Question number 50
A small effusion on chest x-ray in a patient with pleuritic chest pain and sudden shortness of breath is suspicious of
a) Congestive heart failure
b) Hypoalbuminemia
c) Mesothelioma
d) Meigs' syndrome
e) Pulmonary embolization
The correct answer is E
Explanation
Pulmonary Embolization has been found to be accompanied by pleural effusion in up to 50 percent of cases. The effusions are usually small and not dependent on occurrence of pulmonary infarction. There is considerable variation in cell count, differential, and protein concentration. The transudative effusion associated with a pulmonary embolus may result from localized interstitial edema. The effusions that result from infarction are more likely to be bloody. Bilateral effusions can be seen when emboli affect both lungs. A small effusion on chest x-ray in a patient with pleuritic chest pain can be an important clue
"There is a big difference between knowing the path, and walking the path"

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Postby originaltup » Fri Apr 02, 2004 10:17 pm

A 44 year old patient, with previously total thyroidectomy last year for Graves disease, comes to the doctor for regular check-up. She is on levothyroxine therapy since then. Clinically she is mildly confuse with no other signs. Her serum TSH is 7.0 uU/ml (normal range 0.5-5 uU/ml) and her serum T4 is 7 ug/dl (normal range 5-12 ug/dl).
What is the explanation for these values?
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Postby med1703 » Sun Apr 04, 2004 9:42 pm

posibil adenom tireotrop?!?

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Postby originaltup » Mon Apr 05, 2004 12:01 am

Da, ar fi o posibilitate dar nu prea se explica confuzia care in termeni de stepuri ar putea fi asociata cu o insuficienta tiroidiana.
Raspunsul este noncomplianta. Pacienta uita sa-si ia fiecare doza de tiroxina, drept care nivelul mediu de tiroxina este scazut cu confuzia de rigoare (plus celelalte semne, nu le-am mai pus sa nu complic cazul prea tare) si cu cresterea nivelului TSH. La check-up are nivelul normal de tiroxina pt ca probabil nu a mai uitat sa-si ia ultima doza, insuficienta insa pt a-i scadea TSH si a-i compensa semnele de insuficienta tiroidiana (stiti ca ia ceva timp pana se simt efectele tiroxinei)
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Postby pafaristu' » Tue Apr 13, 2004 11:07 pm

mai vrem niste cazuri noi....la fel de grele ca ultima....ca sa ne mai antrenam putin :lol:

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Postby originaltup » Wed Apr 14, 2004 12:13 pm

A 34-year-old African American man presents with multiple hyperpigmented patches. His history reveals that his mother died of breast cancer, but she had similar hyperpigmented patches, to a lesser degree. On exam, he has axillary freckling and pigmented changes in his eyes, but normal auditory acuity. FISH analysis identifies a deletion at 17q11. Which of the following statements is correct regarding his condition?

A. The characteristic cutaneous tumors undergo malignant degeneration to sarcomas.

B. The degree of expressivity of this trait across generations approaches 100%.

C. Mean life expectancy is 40 years old.

D. The protein deleted is a cytoskeleton-associated protein.

E. This trait is X-linked dominant.
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Postby pafaristu' » Wed Apr 14, 2004 1:22 pm

NF1 17q11 -> Schwannoma, PNET, Glioma, Melanoma, Neuroblastoma, Pheochromocytoma, Juvenile CML, Sarcomas, NF-type 1

buna e metoda asta FISH, pacat ca la noi nu se face :(
:wink:

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Postby originaltup » Wed Apr 14, 2004 6:16 pm

stiu un loc in Bucuresti unde se face, desi foarte rar :wink:
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Postby MMM » Fri Apr 16, 2004 10:33 pm

Intrebarea mea nu e grila, ci mai degraba o (mare :!: ) nelamurire: ce inseamna pana la urma visceral/somatic :?: Credeam ca e simplu, da' High-Yield Neuroanatomy m-a bulversat de tot :roll:
-fibrele motorii din V (pt masticatori) si din VII (pt muschii mimicii)-sunt trecuti SVE(special visceral efferent); (si, oricum, nici "special" n-am inteles de ce);
-II si VIII sunt SSA (special somatic), in schimb I, SVA. De ce sunt celulele receptoare pt auz si vaz mai somatice decat cele pt miros :?:
Mi s-a parut oricum labirintica materia de stepuri, da' acum m-am ratacit de tot... :what:

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Postby originaltup » Fri Apr 16, 2004 10:45 pm

stiu schema aia din neuroanatomy dar drept sa-ti spun nu prea mi-am batut capul cu ea, mi s-a parut mai important sa recunosc sindroamele importante & stuff
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Postby originaltup » Wed Apr 21, 2004 9:33 am

A 58-year-old former alcoholic is brought in to the clinic by his wife. She tells you in private that she's worried her husband has begun drinking again because his face 'is red all the time these days'. When you speak with the patient, he denies any alcohol use in the last 12 years. He says his only problems are that he's been 'wheezing a lot lately' and that his 'stomach's been acting up' lots of diarrhea.' The physical exam is normal and vitals are within normal ranges. Routine screening reveals no serum ethanol. However, his liver function tests return abnormal results. Which of the following tests would be the next appropriate diagnostic exam?

A. Barium swallow test

B. Colonoscopy

C. Echocardiogram

D. Liver biopsy

E. Urine metabolite analysis
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Postby pafaristu' » Wed Apr 21, 2004 11:21 am

inteligenta grila,originaltup, mai vrem grile asa finute... :D

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Postby originaltup » Thu Apr 22, 2004 9:03 am

A 23-year-old piano and violin player is working diligently to prepare for an upcoming concert in two weeks. She comes to your office to see you and says, ?I can?t move my right thumb as fast as I used to and sometimes it even feels numb.' Upon further questioning, she states that she has also experienced some tingling in her thumb. Which treatment option is best for this patient?

A. Do nothing at this time

B. Get an MRI, CT scan, or X ray

C. Perform an EMG of her wrist

D. Recommend the use of NSAIDs and a wrist splint

E. Refer the patient to a surgeon for further care
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Postby originaltup » Thu Apr 22, 2004 9:17 am

Men, 29 years old, known HIV positive for 6 years, presents with diarrhea, weakness and low-grade fever. An acid-fast stain of the stool is presented below.

Image

What treatment is best:

a) Rifabutin + INH
b) clarythromycin
c) metronidazole
d) fluconazole
e) supportive
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