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+--- Thread: good for those whos exam is near - rizowana (/showthread.php?tid=340380)
0 - ArchivalUser - 09-20-2008
docchavs - 06/24/08 20:55
try this.....
HY anatomy................
Characteristic Disease
1 wrist drop (inability to extend the wrist and fingers) caused by damage to what nerve? radial nerve (posterior chord of BP)
2 this nerve supplies the flexors of the arm and is cutaneous in the forearm musculocutaneous nerve
3 most intrinsic hand muscles are supplied by what nerve? ulnar nerve
4 order of structures passing behind the medial malleolus (from ant to post) (anterior) tibialis posterior, flexor digitorum longus, posterior tibial aa, flexor hallucis longus (TOM, DICK, AND HARRY)
5 CN from which chorda tympani originates CN VII
6 chorda tympani controls salivation from which glands? sublingual and submandibular
7 parotid is innervated by which nerve? glossopharyngeal (CN IX)
8 median nerve paralysis causes … ulnar deviation of the hand (unopposed flexor carpi ulnaris innervated by ulnar)
9 innervation of the interossei ulnar
10 ulnar nerve lesion causes … radial deviation of the hand (unopposed flexor carpi radialis innervated by radial)
11 radial nerve paralysis causes … inability to extend the hand against gravity ("wrist drop"), loss of triceps and brachioradialis reflexes
12 what causes cleft lips? failure of maxillary and medial nasal processes to fuse during development
13 occlusion of the gastroduodenal aa would cause … no change (rich supply from various sources)
14 nerve that causes extension of the thumb radial
15 nerve which adducts the thumb ulnar
16 nerve that abducts, rotates, opposes, and flexes the thumb median
17 nerve that runs with the spermatic cord through the inguinal canals ilioinguinal
18 direct inguinal hernias are due to what defect? breakdown of transversus abdominalis aponeurosis and transversalis fascia
19 small bowel receives its blood supply from the … superior mesenteric aa.
20 what embryological defect puts an infant at risk for inguinal hernia? patent processus vaginalis
21 testicular histology shows many Leydig cells, few Sertoli cells, and absent germ cells; patient presents with gynecomastia and small testes Klinefelter's (46,XXY)
22 what nerve runs through the parotid gland? facial nerve
23 what nerve accompanies the superior laryngeal aa? internal branch of superior laryngeal nn
24 innervation of the superior laryngeal nn mucosa above the vocal folds
25 what is the ventral white commissure? crossing fibers of the spinothalamic tract
26 Cooper's ligaments connect… mammary glands to the dermis of overlying skin
27 alternative name for inguinal ligament Poupart's ligaments
28 multiple small openings in the depressed area of the nipple are … lactiferous ducts
29 # of lobes in every breast 10 to 15
30 derivatives of the uteric bud collecting ducts, calyces, renal pelvis
31 patients with verbal difficulties most likely have a lesion in which hemisphere? left
32 artery that supplies the distal lesser curvature of the stomach right gastric
33 movements mediated by the trapezius mm elevation of the acromion (upper fibers) and depression of the medial scapula (lower fibers)
34 on what day of embryonic life is the notochord formed? 17
35 during what week can a fetus move? 8 weeks gestation
36 the incision for a saphenous cutdown should be located …. anterior to the medial malleolus
37 the structure immediately medial to the insertion of the biceps (near the elbow) is … brachial aa
38 role of MIF in development suppression of paramesonephric ducts
39 the only mm that can elevate the eye in the abducted position is the … superior rectus
40 embyronic origin of the thyroid foramen cecum
41 the first pharyngeal pouch develops into … middle ear, eustacian tube
42 the second pharyngeal arch develops into … mm of face, styloid process of temporal bone
43 the third pharyngeal pouch develops into … thymus, inferior parathyroids
44 which mm lowers the jaw? lateral pterygoid
45 what CN(s) come(s) through the foramen ovale? What branch? V3
46 what CN(s) come(s) through the foramen rotundum? V2
47 what CN(s) come(s) through the superior orbital fissure? III, IV, V1, VI
48 which two CNs come through the internal acoustic meatus? VII, VIII
49 which three CNs come through the jugular foramen? XI, X, XI
50 which CN(s) come(s) through the cribriform plate? I
51 nerve that innervates all the thenar mm median
52 the medial aspects of the cerebral hemispheres are supplied by which aa? anterior cerebral
53 location of the AV node subendocardium of the interarterial septum
54 location of SA node wall of the right atrium
55 innervation of the stapedius facial (CN VII)
56 the heart begins to beat at what week of gestation? 4th
57 the heart is fully formed by what week of gestation? 6th
58 what muscle might avulse the lesser trochanter from the femur, resulting in fracture? psoas major
59 3 mm that insert into the greater trochanter of the femur gluteus minimus and medius, piriformis
60 most common form of ASD results from … failure of fusion of the septum primum and secundum
61 type of epithelium contained in the distal esophagus nonkeratinized stratified squamous
62 the median nerve is formed by which cords of the brachial plexus? lateral and medial
63 the medial nerve runs between which two tendons on the anterior aspect of the forearm? palmaris longus and flexor carpi radialis
64 the smooth part of the right ventricule is derived from … bulbus cordis
65 the smooth part of the right atrium is derived from… sinus venosus
66 the truncus arteriosis develops into … the proximal pulm aa and ascending aorta
67 lesion results in inability to dorsiflex and inversion of the foot when relaxed common peroneal nerve lesion
68 A patient's tongue deviates toward the right. What mm and nerve are affected? right hypoglossal (CN XII); right genioglossus
69 what is the role of the hyoglossus mm? retracts the tongue
70 information carried by the dorsal column system of the spinal cord proprioception, discriminative touch, vibration
71 pseudounipolar cells are derived from the … neural crest
72 Schwann cells are derived from the … neural crest
73 astrocytes and microglia are derived from the … neural tube
74 path of the superior sagittal sinus along the attachment of the falx cerebri
75 how does a mast cell look on EM? "scroll" inclusions (look like lamellar bodies), cell membrane irregularities, microvilli, evident nucleolus
76 "unhappy triad" medial meniscus, medial collateral ligament, and ACL tear
77 the sensory innervation of the posterior half of the external auditory meatus comes from …. auricular branch of the vagus (CN X)
78 sensory innervation of the anterior half of the external auditory meatus auriculotemporal nerve
79 abdominal viscera protrude through the anterior abdominal wall (not covered in skin, etc) when what fails to occur during embryogenesis? failure of fusion of the lateral body folds (4th wk)
80 failure of the yolk stalk to degenerate results in… Meckel's diverticulum
81 pain from the anterior two-thirds of the tongue is carried to the CNS by … V3
82 taste from the anterior 2/3 of the tongue is carried to the CNS by … VII
83 what is the role of CN IX in taste and pain sensation of the tongue? posterior 1/3 of the tongue (pain & taste)
84 the structure medial to a femoral hernia in a female patient lacunar ligament
85 indirect inguinal hernias pass just lateral to … inferior gastric aa
86 direct inguinal hernias pass just medial to … inferior gastric aa
87 anesthetic injected near the ischial spine will block which nerve? pudendal
88 what nerve runs just anterior to the anterior scalene mm? phrenic nn
89 brain structure involved with formation of memories hippocampus
90 the greater sciatic foramen is occupied by what mm? piriformis
91 what nn runs through the greater sciatic foramen just caudal to the piriformis? superior gluteal nerve (along with the aa and vv)
92 what nns run through the greater sciatic foramen just below the piriformis? pudendal & sciatic
93 the remnant of the embryological umbilical vein falciform ligament
94 in which part of the small intestine does a Meckel's diverticulum arise? ileum
95 neurons in the olfactory bulb synapse on which part of the brain? pyriform cortex
96 name the mm that causes internal rotation of the arm at the shoulder subscapularis
97 the inferior rectal nerve is a direct branch of the … pudendal nn.
98 innervation of the abductor pollicis longus median nn.
99 innervation of the adductor pollicis ulnar nn.
100 mostly unbrached vein existing on the medial side of the leg and continuing upward to meet with the femoral vein saphenous
101 what does the ansa cervicalis innervate? geniohyoid (pulls the hyoid bone anteriorly for swallowing)
102 the inferior mesenteric aa arises from the abdominal aorta directly posterior to what structure? third part of the duodenum
103 the superior mesenteric aa arises from the aorta directly posterior to what structure? neck of the pancreas
104 the ____ contains striated mm NOT under voluntary control esophagus
105 the foramen through which the saphenous vein passes to join the femoral vein fossa ovalis
106 mm that flexes the thigh at the hip psoas major
107 the fasciculus cuneatus carries what kind of fibers from where? proprioception, discriminative touch, vibration from the arms
108 the role of the sER steroid hormone synthesis and detox
109 decreased sensation over the first 3.5 digits of the hand indicates a lesion of … median nn.
110 what mm are supplied by the median nerve? opponens pollicis, abductor pollicis brevis, flexor pollicis brevis, 1st 2 lumbricals, anterior forearm flexors
111 the extensor pollicis longus is supplied by the … (nn) radial nerve
112 backward movement of the jaw during chewing is due to what mm? temporalis
113 gap junctions contain … connexons
114 tonofilaments are found in… hemidesmosomes and desmosomes
115 what type of collagen is found in the basal lamina? Type IV (under the floor)
116 the superior opthalamic vein drains into the … cavernous sinus
117 the sigmoid sinus drains into the … IJV
118 the posterior continuation of the cavernous sinus is the … petrosal sinus
119 three mm that flex the arm at the elbow biceps, brachioradialis, and brachialis
120 the median nerve passes through the two heads of what mm? pronator teres
121 the coracobrachialis is pierced by the … MC nerve
122 the flexor carpi ulnaris is pierced by the … ulnar nerve
123 the deep branch of the radial nerve pierces which mm? supinator mm
124 annular pancreas results from a failure in what part of normal development? failure of the ventral pancreatic bud to rotate around the second part of the duodenum
125 pain sensation from the upper part of the posterior pharynx is carred by the… glossopharyngeal (CN IX)
126 the cells that provide myelin in the CNS oligodendrocytes
127 to which nodes is a cancer of the descending colon most likely to metastasize? inferior mesenteric
128 the gastroepiploic lymph nodes drain … the greater curvature of the stomach
129 the superficial inguinal lymph nodes drain … rectum, vagina, and perineum
130 the internal iliac nodes drain … the bladder and male internal genitalia
131 the subpyloric nodes drain … the distal stomach, duodenum, and pancreas
132 upward traction on the upper limb may cause what brachial plexus injury? lower trunk (interossei and thumb problems)
133 two "ligaments" that separate the greater peritoneal sac from the lesser gastrohepatic, hepatoduodenal
134 claw hand is due to … ulnar nerve lesion
135 cord of the brachial plexus from which the ulnar nerve arises medial cord
136 cord of the brachial plexus from which the MC nerve arises lateral cord
137 obturator nerve innervates … mm of medial compartment of the thigh (adductors and gracilis)
138 is the lower trunk of the brachial plexus within the axillary sheath? no > formed in the neck and moves independently
139 hip abduction is mediated by what nerve? superior gluteal nerve
140 nn responsible for knee extension femoral nerve
141 the vertebral artery lies in what "triangle" of the neck? suboccipital
142 margins of the suboccipital triangle inferior & superior oblique, rectus major
143 margins of the posterior triangle of the neck trapezius, SCM, middle 1/3 of clavicle
144 margins of the anterior triangle of the neck neck midline, mandible, and SCM
145 in fetal life, what does the vitelline duct connect? terminal ileum with umbilicus and yolk sac
146 with what structures does the axillary aa travel in the axilla? cords of the brachial plexus (all three)
147 relative to the rib, where do intercostal nn run? in a notch above the rib
148 what is contained in the hepatoduodenal ligament? common bile duct and hepatic vessels
149 what structures are contained in the gastrohepatic ligament? none > can be cut in surgery without sequellae
150 sensation supplied by the median nerve palmer aspects of first 3.5 fingers, and dorsal digits of first 3.5 fingers (including nail beds)
151 nerves that supply sensation to the dorsal aspect of the hand radial (on the thumb side) and ulnar (on the pinkie side)
152 nerve that lies in the posterior tonsillar fossa CN IX
153 the muscles of mastication are derived from what pharyngeal arch? first
154 sensory innervation of the sole of the foot is by the …. posterior tibial nerve
155 nn that supplies the medial mm of the thigh obturator
156 the femoral nerve innervates … the mm of the anterior compartment of the thigh
157 the posterior compartment of the thigh is innervated by … sciatic nerve
158 the uterus develops from the … mesonephric ducts
159 the role of neural crest cells in the development of the heart invade the aorticopulmonary septum
160 retroperitoneal organs descending & ascending colon, duodenum, kidneys, adrenals
161 brief pathway of auditory sensation spiral ganglion > CN VIII > dorsal/ventral cochlear nuclei of the medulla > superior olivary nuceli > lateral lemniscus > inferior colliculus of the midbrain > medial geniculate body of thalamus > auditory cortex
162 the superior colliculus is involved in …. eye movements
163 Erb's palsy results from a lesion of the … upper part of brachial plexus (C5, C6)
164 the facial vein drains into the … cavernous sinus
165 name three structures in the hepatoduodenal ligament common bile duct and hepatic vessels
166 how are the three structures of the hepatoduodenal ligament arranged? portal vein is posterior, bile duct is on right, hepatic aa on left
167 mm that elevates the soft palate levator palatini
168 innervation of the mm that elevates the soft palate CN X
169 when the uvula deviates toward the right, the most likely lesion is … left CN X
170 course of the axillary nerve surgical neck of the humerous
171 innervation of the axillary nerve deltoid mm
172 a lesion of the axillary nerve would cause .. inability to raise the arm from the side
173 the posterior descending artery is a branch of the …. RCA
174 nerve in the posterior triangle of the neck accessory
175 the pancreas gets its arterial supply from … the celiac aa
176 the ductus deferens and the spermatic cord converge when … they pass through the internal inguinal ring
177 inability to read (alexia), with preservation of the ability to write (agraphia), is indicative of a lesion in the … left occipital cortex and splenium of CC
178 nerve that innervates the dorsum of the foot superficial peroneal
179 anesthesia of the medial surface of the leg suggests a lesion of the … saphenous nerve
180 when a female stands, where does fluid in the abdomen collect? rectouterine pouch (of Douglas)
181 venous place in the body with pressure oscillations of 25/0 RA
182 venous place in the body with no pressure oscillations peripheral veins
183 cell bodies for Pacinian corpuscles reside in … DRG
184 depression of the mandible is affected by what nerves? mandibular and facial (digastric) (NOTE: First Aid says that the lateral pterygoid lowers the mandible…. You decide)
185 the cremasteric reflex is elicited via what nerve roots? L1, L2
186 a waddling (Trundelberg) gait is indicative of …. lesion of the gluteus medius and minimus or the superior gluteal nerve
187 loss of the ability to climb stairs is indicative of … lesion of gluteus maximum or inferior gluteal nn
188 lesion of CN III would result in an eye that looks …. down and out
189 damage to Meyer's loop results in…. contralateral superior quadrantanopsia
190 the azygus vein drains the … posterior thoracic wall
191 the azygus vein empties into the … SVC
192 the paramesonephric ducts give rise to … the upper vagina, cervix, uterus, and fallopian tubes
193 the lower vagina develops from the …. urogenital sinus
194 what cell in the liver is derived from foregut endoderm? hepatocytes
195 nerve that accompanies the superior laryngeal aa superior laryngeal nerve (internal branch)
196 innervation of the superior laryngeal nn (internal branch) mucosa above the vocal folds
197 nn that provides sensory innervation to the laryngeal mucosa below the vocal folds recurrent laryngeal nerve
198 motor innervation to the cricothyroid superior laryngeal nerve (external branch)
199 what fascia encloses the thyroid gland? pretracheal
200 what is the best place to palpate the dorsalis pedis artery? on the dorsum of the foot, between the tendons of the extensor hallucis longus and extensor digitorum longus
201 lymph from the medial side of the foot drains via … lymphatics near the saphenous vein into the inguinal nodes
202 lymph from the lateral side of the foot drains via … lymphatics near the short saphenous vein into the popliteal nodes
203 what is the gap between the two embryonic atria called? ostium primum
204 what fills the gap between the two embryonic atria? septum primum
205 when the septum primum meets with the ___, the ostium primum is closed endocardial cushions
206 failure of the septum primum to fuse with the cushions results in …. ostium primum-type ASD
207 the ostium secondum usually forms within the … septum primum
208 the results of failure to form the septum secundum fetal death (no hole between atria means no oxygenation for most of the fetus)
209 run through the development of the foramen ovale, etc. ostium primum closed by septum primum > ostium segundum forms > septum primum fuses with endocardial cushions > septum segundum develops
210 the valve of the foramen ovale is made up of … the septum ostium (the part that does not regress)
211 does the septum segundum fuse with the endocardial cushions? no - only the septum primum does
212 the afferent arm of the corneal reflex CN V
213 the efferent arm of the corneal reflex CN VII
214 which nerve provides taste sensation over the anterior portion of the tongue? Facial VII
215 girl fracctures humerus through lateral epicondyle. What nerve might be damaged? radial
216 what type of nerve fibers innervate the radial dilator mm? only sympathetic postganglionic fibers
217 what is the status of the fetal heart once the arms, legs, and extremities are nearly fully formed? nearly fully formed, beating
218 from where does the levator veli palatini originate? petrous portion of the temporal bone
219 wrist drop is caused by damage to …. radial nerve
220 the lingula belongs to what lobe of the lung? left upper lobe
221 neonate with left-sided intestinal hermiation had a structural anomaly of the … pleuroperitoneal membrane (most likely)
222 decreased sensation over with posterior portion of the side of the tongue indicates a lesion of what nerve? CN IX
223 oocytes are derived from the … yolk sac
224 winged scapula results from lesions of what cervical nerves? C5-C7 (long thoracic nerve)
225 anterior horn motor neurons of the spinal cord are derived from the … basal plate
226 sympathetic plexus that provides pain sensation from the stomach celiac plexus
227 spinal tract that carries two-point touch, vibration, and proprioception dorsal columns
228 where (if anywhere) do the dorsal white columns cross? medullary pyramids
229 spinal tract that carried pain and temperature sensation spinothalamic tract
230 where (if anywhere) does the spinothalamic tract cross? lumbar region
231 where does the corticospinal tract cross? medullary pyramids
232 the smooth part of the right ventricle is derived from … bulbus cordis
233 what is located between the cells of the yolk sac and the cells of the cytotrophoblast in a 14-day blastocyst? extraembryonic mesoderm
234 the adult derivative of the ductus venosus ligamentum venosum
235 the ventromedial nucleus mediates what type of behavior? eating behavior (without it, we starve)
236 the transverse cervical ligament carries what aa? uterine
237 biological methylations are mediated by … SAM
238 the splenic aa is located in what ligament? splenorenal
239 what respiratory system component is derived from visceral mesoderm? endothelial cells
240 the artery supplying the anterior aspect of the interventricular septum runs in the … anterior interventricular sulcus (LAD)
241 the cystic aa is a branch of the … right hepatic
242 what nerve mediates the cremasteric reflex? genitofemoral
243 Schwann cells are derived from the … neural crest
244 what structure gives rise to the greater omentum? dorsal mesentery
245 from where is the spleen derived? embryonic dorsal mesentery
246 name two membranes that hold the ulna and radius together interosseous (big) and annular (small)
247 intention tremor of the ipsilateral extremity would result from a lesion of the … cerebellum
248 tremor that improves with purposeful movement indicates a lesion of the … basal ganglia
249 a lesion of the frontal eye field would cause … deviation of the eyes toward the lesion
250 the urachus is the remnant of the … allantois
251 the urachus connects … apex of bladder to umbilicus
252 branch of the axillary artery that forms an anastomosis with branches of the subclavian subscapular aa
253 hypothalamic nuclei involved with circadian rhythms suprachiasmatic nucleus
254 lymph from the scrotum drains into the … superficial inguinal nodes
255 the only laryngeal mm innervated by the superior laryngeal nn cricothyroid
256 most of the laryngeal mm are innervated by … recurrent laryngeal nerve
257 lies between the flexor carpi radialis and flexor digitorum superficialis median nerve
258 role of the pupillary sphincter muscle pupillary constriction
259 innervation of the pupillary sphincter mm parasympathetic
260 what mm dilates the pupil? radial dilator mm
261 the blood vessels that supply the skin are located in the … deep and superficial dermis (the epidermis does not have vessels)
262 what pores on the cell surface allow the passage of small molecules? gap junctions
263 muscle used to get up from a sitting position gluteus maximus
0 - ArchivalUser - 09-21-2008
good site for review ct head
elbamaritza - 07/12/08 17:06
i like this site a lot
http://www.med-ed.virginia.edu/courses/rad/headct/index.html
(posted by 2confused)
#1378971
elbamaritza - 07/12/08 17:07
and also this one
http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Harrisons/Harrisons_f.htm
0 - ArchivalUser - 09-21-2008
#313847
radiologist007 - 06/26/08 04:32
hi 2 every1,
i m sorry for posting my message for the first time. i am a silent visitor of this forum.I am an old post-graduate, a full timer Radiologist. i have a 2 year old naughty daughter. rarely got enough time 2 read along with the job. still managed 2 get at 3-4 hours a day, 6 days a week 2 read. i prepared for 3 months 4 step 1. 2 months reading and 1 month solving UW questions.
1 week before, slowed down my reading.travelled 2 mumbai by train.1 day before enjoyed the ambient atmosphere at Lonavla. slept for 6 hours night prior 2 exam.
reached 1 hour before with lot of Tea and snacks.
started by skipping Tutorials.
gave my blocks in this manner: first 2 blocks - break (5 min) - 3rd block - break (5 min) - 4th block - break (10 min) - 5th block - break (10 min)- 6 th block - break (15 min) - 7 block - feedback (8th block = 5 min ) - done.
it is an exhausting process. u need enough of energy, concentration and ability to sit constantly in front of a Computer for 8 hours.
i did the materials only once.
kaplans lecture notes (except biochem and Behavioral) + First aid + Goljan lectures + slides + UW (skipped renal and part of cardio).
i felt exam to be 40 % experimental. in those questons, i came to the situation of 2 close options remaining which were very difficult to cross.
2 blocks were easy. 5 were just Ok.
dont know about the results - whether +ve or -ve? and if positive, about the percentile?
i will recall the questions and will put in subsequent posts.
wishing u all a very best in ur coming exam.
please pray 4 me ...............c u soon
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* Re:gave step 1 on 23rd june
#1361213
radiologist007 - 06/26/08 04:50
¢ Few radiology images- 3 Q on EDH, SAH, fracture humerus, CT pseodocyst of pancreas,
¢ Few slides “ leishmania, N.gonorrhea, staph, chlamydia, giardia, kaposis sarcoma, heinz bodies, Osteogenesis imperfecta, Medial collateral ligament injury on MRI knee
¢ Specimens - 6th nerve frontal view brainstem, invasive choriocarcinoma, ca pancreas with invasion, hypertrophy heart, bicuspid valve,
¢ Standard deviation “ CI
¢ Tuberous sclerosis
¢ ADPKD
¢ Median nerve injury “ 2 Q
¢ Common perinela nerve injury
¢ Colchicine
¢ Newer antilipidaemics
¢ COX pathway
¢ Nonketotic hyperosmolar coma
¢ WPW syndrome
¢ Smoking-emphysema
¢ MEN syndrome type 1
¢ Crigglar najjar
¢ Allantois
¢ BPH
¢ Hypercalcaemia in malignancy
¢ Fibroid uterus
¢ G.vaginalis
¢ Topical antifungal
¢ Methotrexate “ S phase action
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* Re:gave step 1 on 23rd june
#1361214
radiologist007 - 06/26/08 04:58
¢ Central DI
¢ OA
¢ Ehler danlos
¢ Turners syndrome
¢ Pseudohermaphroditism”
¢ Consolidation
¢ Pneumothorax
¢ Renal stone
¢ PDA
¢ Asthma
¢ Anticonvulsant
¢ Post #, growth factor
¢ Fe def anaemia
¢ Lead posioning
¢ Action of ADH at..
¢ Effect of a ACE inhibitor on efferent arteriole
¢ Obstrcutive uropathy
¢ Wilms tumour
¢ MIF
¢ Collagen vascular disease
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* Re:gave step 1 on 23rd june
#1361215
radiologist007 - 06/26/08 05:06
¢ C diphth toxin and Cl.tetani “ action
¢ Streptococci pyogens
¢ Shigella
¢ Bacillus anthrax
¢ Yersinia pestis
¢ cAMP
¢ cGMP
¢ AKT
¢ Mycoplasma pneum
¢ Resistance in HIV
¢ EBV
¢ CMV
¢ HSV-2 “drug of choice
¢ Postmenopausal Osteporosis -curve of BMD
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0 - ArchivalUser - 09-21-2008
#303997
blackice - 05/21/08 16:42
Here are my ans for blk1. some i was able to verify - please check and repost if u find mistakes. good luck
Block 1
1. C?
2. I
3. C
4. A
5. D
6. A
7. A
8. C?
9. D
10. H
11. A
12. B
13. F
14. E
15. D?
16. D
17. A
18. A
19. A
20. E
21. E
22. C
23. D
24. A
25. C
26. A
27. C
28. D
29. D
30. A
31. A?
32. C
33. D
34. C
35. B
36. B?
37. A
38. C
39. F
40. D?
41. B
42. E
43. D
44. D
45. B
46. A
47. B
48. E?
49. C
50. D
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* Re:Form SIX
#1320998
blackice - 05/21/08 17:57
Block 2
1. C
2. E
3. C
4. E
5. B
6. C
7. C
8. A
9. B
10. E
11. A
12. C
13. B
14. E
15. A
16. B or D?
17. B
18. G
19. D?
20. A
21. B
22. D orF?
23. A
24. C
25. D
26. A
27. B
28. B?
29. C?
30. E
31. B
32. B
33. E
34. B
35. C
36. A
37. B
38. D
39. A
40. D
41. A
42. B
43. E
44. E
45. B
46. F
47. A
48. A
49. E
50. A
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* Re:Form SIX
0 - ArchivalUser - 09-21-2008
Questions:
p53: inhibit Rb phospohrylation
MS murmur,
androgen insensitivity symdrome,
4-5 blood questions ( CLL, Iron deficiency anemia, vWD,)
Treatment of Aplastic anemia,
8-10 immunology questions
which cell is responsible for positive PPD,
which cell release histamine,
MOA of vincristine, 5FU,
drug to maintain patency of ductus arteriosus,
8 - 10 experimental questins usually confused between 2 options,
drug in HT with prostatic hyperplasia,
loss of skin elasticity in elderly,
BZD and flumazenil graph (Actin of X drug decreased by flumazenil identify drug X),
Contraindication of lung transplantation(optins are Severe depression, Continued smoking, Obsessive Compulsive disorder),
Treatment of recurrent ulcer, H.Pylori,
MOA of C.botulism food poisoning,
Why less amount of salmonella is required to produce gastroenteritis( I choose acholrhydria ),
Know vitamins very well especially B12, folic acid, A , D K
3-4 questin on OC pills,
inhibin - they will show u a diagram and will ask where is inhibin,
2-3 questions on diuretics,
radial nerve injury ( X-ray with # mid shaft humerus)
Compartment sundrome ( Median nerve compression)
Hemiballimus : contralateral subtlalamic nuclei
treatment of absence seizures,
I think atleast 40 of my question shave diagrams ( Xrays, CT, MRI. Electron microscopy). In some question they will give clue but in some u have to just identify the structure and will ask question related to it.
treatment of pseudomonas ( I choose ticarcillin + tazobactam but i m no sure)
MOA of 5 fluoro uracil
S. pneunomiae ( optochin sensitive)
Type 1 and type 2 muscle fibre ( name of 5-6 muscles which one is Type 1 Pectoralis major,latissmus dorsi, paraspinalis, splenius cpaitus I just choose randomly)
IL which cause fever ( IL-1)
Picture of monocyte: i choose precursor of tissue macrophage
Edema of right side of face and right arm which vein obstruction
ash leaf patch : tuberous sclerosis
HMP shunt : i chose reduced product of NADP+
Treatment of aplastic anemia ( picture of hypocellular bonemarrow)
Pompes disease cardiomegaly which enzyme
Anaerobic glycolysis ( pyruvate to lactate)
Difference between RNA polymerase and peptidyl transferase very wierd choices i dont remember
smear of CLL exacly that of web path.
Macune Albright syndrome ( women has disease what are the chances in offspring )
Pressure difference between right and left arm,
Night terror ( Will not able to recall the event after awaking),
Characteristics feature of autism ( I choose communication impairment. There is also MR but i dont know what is the answer),
anti social personality disorder,
Borderline personality,
Mechanism of resistance of Ampicillin ( Penicillinase ),
Picture of nephron where Potassium sparing diuretic will act.
0 - ArchivalUser - 09-21-2008
HOX genes share a common domain which is the HOMEODOMAIN, as a result, the HOX genes are referred to as homeotic genes. There are 11 HOXA genes, and 9 HOXB, HOXC, and HOXD genes; or a total of 38 HOX genes - 39 HOX genes. The DNA sequence that codes the homeodomain is a highly conserved 180-base pair sequence termed the HOMEOBOX. The homeodomain is a helix-turn-helix structural motif that is common to DNA binding proteins, such as transcription factors.
HOX A1- inner ear malformations
(HOX A-1 overexpression- up regulation of bcl-2 (anti-apoptotic factor)
HOX A2: transformation of the pharyngeal arch 2 into the pharyngeal arch 1 with duplication of the malleus and the incus.
HOX B2: facial nerve palsy, motor nucleus deficiency of cranial nerve of pharyngeal arch 2
HOX A13 causes hand foot and genital syndrome: malformation of the thumb and great toe, bicornuate uterus, ectopic ureter openings and hypospadias.
Vertebral
Mutation of HOX C8 : A null mutation of HOX C-8 lead to transformation of the first lumbar vertebra into a 14th thoracic vertebra, and the eight rib became attached to the sternum.
Mutation of HOX 10 - no lumbar vertebrae are formed. Instead, ribs project from all posterior vertebrae, extending caudally from the last thoracic vertebrae to beyond the sacral region.
Mutation of HOX11 - sacral vertebrae are not formed and instead these vertebrae assume a lumbar identity
HOX-D 13 : is associated with synpolydactyly (fusion of fingers or toes)
SHH-Polydactyly
BMP-Syndactyly
Hox A-9 : AML
Hox-11 : T-cell ALL
PAX3 “ necessary for correct formation of caudal neural crest derivatives and migration of myoblasts into the limbs
Mutation causing loss of function- Waardenburg syndrome - a group of genetic conditions that can cause hearing loss and changes in coloring (pigmentation) of the hair, skin, and eyes.
Mutation causing gain of function- Alveolar Rhabdomyosarcomas:-Fusion of PAX-3 with FKHR gene (another transcription factor)
PIT-1 “ -( Pituitary-specific transcription factor ) Mutation cause Combined Pit hormone deficiency
Pbx-1: Pre-B cell ALL
GBX and NKX 3.1: Prostrate CA
PAX 6 - aniridia in humans, misplaced eye in Drosophila
TCOF 1 - Treacher Collins syndrome
SOX 10 “ Hirschsprung disease
HOX A-9, 10, 11 - epithelial ovarian cancer
HOX B-5 congenital lung abnormality
Chapter 11: Development of the Limbs
1. An infant exhibits amelia (total absence of a limb). Findings of experimental studies in birds and mice are consistent with the possibility that the limb bud AER failed to express which of the following factors?
A. HOX gene transcription factor
B. Bone morphogenetic substance
C. LIM gene transcription factor
D. WNT gene factor
E. Fibroblast growth factor
2. Recent studies support the likelihood that syndactyly caused by failure of apoptosis between the digital rays may result from disruption of expression of which of the following factors?
A. Bone morphogenetic substance
B. Fibroblast growth factor
C. WNT gene factor
D. Insulin-like growth factor
E. LIM gene transcription factor
3. An infant is born with absence of the ulna and radius and malformations of the carpals and hand. Recent studies show that unique limb segment identities are encoded by HOX genes as follows (scapula - HOX9; humerus - HOX9HOX10; ulna,radius - HOX9HOX10HOX11; proximal carpals - HOX9HOX10HOX11HOX12; distal carpals, metacarpals, phalanges - HOX9HOX10HOX11HOX12HOX13). Therefore, disruption of expression of which of the the following HOX gene families would most likely account for this anomaly?
A. HOX9
B. HOX10
C. HOX11
D. HOX12
E. HOX13
4. An infant born with teratogen-induced phocomelia was probably subjected to which of the following teratogenic substances during the indicated sensitive period.
substance sensitive period
A.
B.
C.
D.
E.
alcohol
thalidomide
phenytoin
cadmium
retinoic acid
4-8 weeks
2-3 weeks
4-8 weeks
2-3 weeks
4-8 weeks
5. In cases of mirror polydactyly, which of the following factors, produced within the early limb bud, is both expressed by and restricted to the newly formed caudal orthotopic ZPA and the cranial ectopic ZPA?
A. BMP4
B. FGF4
C. SHH
D. IGF1
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ans
1. E
2. A
3. C
4. E
5. C
0 - ArchivalUser - 09-21-2008
egyptwithin - 07/20/08 23:21
CARDIOLOGY
1) Patient™s pain relieved by sitting and leaning forward “ pericarditis!
2) Showed an EKG with 2nd degree AV block. Exact picture from NBME exam.
3) Scenario with a person having bicuspid valve problem “ Left heart failure.
4) Patient with angina. Treat w/ Nitroglycerin “ asked about cGMP mechanism.
5) Dehydration stimulates a mechanism involving increased renin activity.
6) Patient w/ ANCA antibodies but steroid tx not working “ Churg Strauss
7) Patient w/ sinusitis, hematuria, and steroid tx works “ Wegener™s
8) Aortic aneurysm associated anatomically to the tunica media.
9) Carcinoid syndrome indicated by high levels of 5HIAA
10) Physiologically, cardiac tamponade will have decreased cardiac output
11) Rheumatic fever has the possibility of causing complications like arthritis
12) Aortic stenosis is AGE RELATED!
13) You had to identify the location of mitral stenosis on a photo of a chest
14) You would see an overriding aorta in Tetralogy of Fallot.
15) Here™s a really weird one: you had to know the association between rectal temperature and blood flow when drinking ice water (plotted on a graph)
16) Calcium-channel blockers will treat tachycardia
17) Cyanide poisoning is associated with nitroprusside
18) You had to know the mechanism of Sildinafil (i.e. Viagra)
19) A patient had a œheavy heart “ most likely CHF and edema
20) Loop diuretics cause hypokalemia, which is assoc. with torsades de pointes
21) Mydriasis = alpha-1 agonist (options were a-1, a-2, b-1, b-2, m-1, m-2)
22) Cholecystarimine = prevents cholesterol absorption
23) Fibrates = defective because decreased chylomicron degradation
24) You had to pick the appropriate graph that showed relationship between Epinephrine & Prazosin, and then followed by a beta-blocker being given.
25) Treatment for glaucoma = only appropriate choice was Pilocarpine
26) The most anterior structure in the superior mediastinum from the answer choices given “ Trachea
27) What is the function of the peptide found in the atrium “ secretes sodium
RESPIRATORY
28) Patchy consolidation “ how is it associated to Pseudomonas?!?
29) Tracheal shift in relation to tension pneumothorax
30) V/Q mismatch is associated to - Pulmonary emboli
31) œStippling seen in lead poisoning
32) If you work for 30 yrs w/ occupational exposure, and at the same time smoke, what is the most appropriate treatment for this patient? -Stop smoking!
33) #1 cause of death in smoking “ heart disease (lungs is #1 for cancer, not death)
34) If patient has low FEV, how do you treat? Beta-agnonist
35) Dynein arm defect seen in what pulmonary problem “ Bronchiectasis
36) Pancoast tumor is associated to sympathetic trunk lesion
37) Treatment for bilateral hilar lymphadenopathy = corticosteroids
38) Function of clara cells “ protect against toxins
39) They show an oxygen dissociation curve and ask which side it shifts in relation to pH. Keep an eye on how the curve looks when it shifts, because there were different designs of curves in both directions.
40) Dipalmitoyl-phosphatidylcholine is a deficiency usually seen in what age group?
Newborns.
41) Affected in vasalva maneuvar “ Levator Ani
42) What arachidonic product is associated to hives? Leukotrine
RENAL
43) A child presents w/ red cell casts = Post-Strep Glomulonephritis
44) Person has one large kidney and one shrunken kidney “ Chronic Renal Disease
45) A woman presents w/ fever and kidney problem “ Pyelonephritis (wbc™s)
46) They show a photo of a cystic kidney & ask for its genetic assoc “ autosomal
dominant.
47) They show a diagram of a kidney & ask site of most water “ collecting duct
48) They show the same diagram & ask site that is most hypertonic
49) Function of heparin sulfate “ prevents albumin filtration
50) They show a photo with a mass at the upper poles = renal cell carcinoma
51) JG cells associated to increased renin
52) A patient had a kidney transplant and undergoes chemotherapy “ you would give him xanthine oxidase inhibitor to decrease his odds of leukemia
53) Another weird one: what happens to renin-angiotenisin-aldosterone levels when you eat a black licorice?
54) Allantois remnant = urachus
55) Weird question: What are the urine levels of calcium and phosphate after treating the patient for PTH, if the person was originally hypocalcemic?!?
56) A patient with a mass in testes likely has obstruction in the renal vein
HEMATOLOGY
57) Beta-thalassemia will show 5% increase in HbA2.
58) Megaloblastic anemia has impaired DNA purine (or pyrimidine) synthesis?
59) Megaloblastic anemia is associated to increased homocysteine levels
60) CLL occurs in patients over age 60
61) Follicular lymphoma™s association to BCL-2
62) Segmented neutrophils “ what does their presence indicate?
63) Fragmented RBC™s “ are seen in what disease? TTP.
64) You had to ID granulocytes in a photo
65) Factor 5 Leiden “ associated to Protein C defect
66) Factor 5 Leiden “ occurs due to inheritence
67) Tyrosine kinase mechanism “ associated to nerve cells
68) Where does erythropoesis take place in 40 y/o? Answer is œend of long bone (other choices were spleen, kidney, liver, pancreas)
69) Decreased LTD4 /LTDF4 is due to decreased lipoxygenase
70) Aspirin™s effects on blood = increases bleeding time by inhibiting TXA2
71) Mechanism of Cisplatin = close answers were œacts on DNA or œacts on DNApolymerase?
72) Treatment for hemorrhagic cystitis “ MESNA.
73) Longterm use of prednisone leads to what complication “ vertebral fracture.
CNS
74) Patient presents w/ TIA, what is the next best treatment option after aspirin?
75) You had to identify alpha-synuclein accumulations on a photo
76) Upper quatratinopia is assocated to the temporal lobe
77) Radial muscle is associated to Gq mechanism
78) A lesion to what structure causes plantar reflex to increase? Internal Capsule.
79) Intranuclear ophtalmoplegia is associated to MLF lesion
80) Can™t move any part of their face except their eyeballs “ Pons lesion
81) Rapid intake of sodium can lead to lesion in what structure “ Pons
82) Teenage chick comes in with migraines? Due to menses
83) Guy comes in with bitemporal headache? œTension is the cause of it.
84) Identify photo of epidural hematoma
85) Weird one: they show a photo of nerve cell, does the action potential propagate towards the cell body, away from it, or both directions at the same time?
86) What nerve cell innervates chewing? I saw no CN5 options in the choices.
87) What glial cells are seen in HIV? Microglia
88) Confabulations in a drunkard are due to a lesion in the amygdala
89) What is the precursor of GABA? Glutamate
90) Patient is dizz with movement but no ear problems “ Benign Positional Vertigo
91) An oldy lady with presbycusis is accompanied by an adult daughter, would you communicate with her in writing or via talking to her daughter? Tough choice!
92) Lesion in anterior cerebral artery affects the lower extremities
93) A person has nystagmus, can™t remember his wife, and stumbles a lot? He has alcoholic intoxication.
94) Dorsal root ganglions are neural crest derivatives
95) You are given a picture of 3 hertz spike waves “ they ask for the appropriate
treatment in this condition? Ethosuxomide.
96) They ask which drug increases potassium levels “ Succinylcholine
97) A person comes in with pinpoint pupils and is unconscious “ treat w/ Naloxone.
98) Mechanism of methylphenidate = increases serotinin levels (alpha-1 not in choices)
Musculoskeletal
99) Mechanism of third-degree burns: they go down the dermis and decrease fibroblasts.
100) Mites are seen in scabies
101) They show a picture of a person with skin patches “ Kaposi™s Sarcoma
102) Squamous cell carcinoma is identified by cytokeratin
103) Sunscreen™s mechanism = does it œblock UV or does it have a œbarrier function?
104) You had to identify Gout in a photo, pathologically
105) You had to know in a separate question stem that uric acid crystals seen in Gout.
106) SLE is associated to diffuse proliferative glomerulonephritis
107) There is perifascicular fiber atrophy in dermatomositis
108) There is an osteoclast defect in osteopetrosis
109) You had to identify osteoclasts in a photo
110) There is increased levels of phosphate in osteomalacia
111) Pain is perceived by free nerve endings
112) Stem indicated shoulder dislocation, then showed a picture and pointed to a nerve “ they must have been pointing to the Axillary nerve since its assoc w/ it.
113) You had to identify CN6 on a picture
114) A person comes in with a broken elbow, you had to identify an artery on an xray and it turned out to be the Bracial Artery
115) If you had trouble with anterior and lateral leg sensation its due to common peroneal nerve
116) Person is hit on the side of the knee with no redness = lateral meniscus injury
117) What is the treatment of rheumatoid arthritis = aspirin or etanercept (both are in the answer choices).
118) Xanthine oxidase = associated to leukemia (asked this twice!)
BEHAVIORAL
119) Factitious disorder is associated to lower levels of C-peptide
120) Factitious disorder is the underlying cause of a patient™s hypoglycemia (in another question stem)
121) You had to know the structure of insulin, such as the œpeptide portion
122) A person has visual dreams before sleeping = indicates narcolepsy
123) Weird question: there is a twin boy and a twin girl. The boy is tanner stage 3 and below normal height. The girl is tanner stage 5 and of normal height. What should do as their physician? Choices: do tests on the boy, do tests on the girl, do tests on both of them, offer reassurance, or tell them to come back after 6 months?
124) Another weird one: there is a boy age 16 who is tanner stage 5. He likes playing with girls since age 5, he feels like he™s in the wrong body, and is otherwise a normal XY, what to do? Offer reassurance.
125) There is a female who displays a œsplitting personality
126) There is another female who displays a œborderline personality
127) There is a guy who works at the veterinary and lives in an old home. He has symptoms at work, is okay at home, is okay at vacation, and exercises 3 times a week. What™s the primary cause of his symptoms: animal tatter, exercise, or hold home?
128) A married sixteen year old needs no parental consent!
129) There is a question in which the answer aws œcohort study model
130) A female presents with fine hair on her neck and back “ indicates anorexia
131) A question which had the answer of agoraphobia
132) If you shift the well/diseased curve from epidemiology to the right, that indicates increased false negatives & decreased false positives.
133) Serotonin syndrome is due to SSRI.
134) Symptom of lithium overdose is tremors.
135) You had to calculate 4 years survival time = you multiply year 1 x 2 x 3 x 4, which equals the 4th year survival time. It™s similar to an NBME question.
136) There is a confidence interval question at 95% = 2.5 % on bottom end of
guassian distribution.
137) If P < 0.05 there is a 5% chance of error
138) Rephrased and asked again, if P < 0.05 there is a minute random chance of
error.
GASTROINTESTINAL
139) Achalasia = presents with decreased myenteric plexus
140) Cirrhosis is associated to esophageal varices
141) Duodenal ulcers are treated w/ antibiotic therapy!
142) Increased bilirubin indicates obstruction in biliary system
143) Anti-HAV IgM = indicates recent Hepatitis A infection
144) Anti-HbS antigen only = indicates immunity to Hepatitis B
145) Cirrhosis associated to portal hypertension (asked twice)
146) How is cirrhosis associated to gynecomastia?
147) Pancreatic carcinoma mechanism “ how does it spread and where does it
spread to on its way to the back?
148) Diabetics have a problem where in there kidneys? Glomerulus
149) Person presents with granulomas, fissures, ulcers at ileum “ has Crohn™s.
150) Kid has blood in his feces “ you would see œgastric mucosa
151) When is the first time to start worrying about a polyp , villous or tubularvillous?
152) What artery supplies the ileum? Superior mesenteric artery.
153) Weird one: how are sigma cells associated to antrum of the stomach?
154) Secretin increases CCK
155) Again asked later of its location, found in duodenum
156) Asked about identify symptoms of insulinoma
157) Person comes in with cold intolerance and weight gain “ hypothyroidism
158) Patient showed symptoms of chvotsek™s sign, be able to identify them
159) Growth hormone causes visual defects
160) There is increased aldosterone levels in Conn™s Syndrome
161) There is increased corticotropin if adrenal mass is presented in stem
162) Why are there higher levels of T3 than T4 in scenario of this question stem? Increased conversion to T3
163) Female pseudohermaphrodite associated to congenital adrenal hyperplasia
164) What is the best way to give birth control to someone who can™t make trips to the doctor because they live too far? Via injection.
165) Flutamide = increases free testosterone
166) Propothiouracil is OK to give to pregnant women
REPRODUCTIVE
167) A picture of PID is given, asked what organism involved? Gonorrhea
168) Why is there more chance of endometrial cancer in obese women? Fat will secrete more estrogen.
169) Classic symtpoms of abruptio placentae and asked to diagnose it
170) Once a hydatidiform mole is removed, what will the placenta lack? Fetal
vessals.
171) A person has high blood pressure and previous polyhydramnios, best answer choice is pre-eclampsia.
172) There is a guy with bilateral swelling underneath both nipples: one side is rigid and the other side is motile. Does he have gynecomastia or male breast cancer? These are the two answers I had it narrowed down to.
173) What does increased estradiol cause in males?
174) What is the location of nodular hyperplasia? Peri-urethral zone
175) Incomplete fusion of paramesonephric ducts associated w/ bicorneate uterus
176) MIH causes fallopian tube regression
177) They show an FSH graph (same as in First Aid but ONLY of FSH hormone) = have to ID proper graph of FSH out of 5 different looking ones.
178) DHT™s association to the penis?
179) If person suffers a urethral laceration, fluid leaks to anterior abdominal wall
180) If there is swelling in cells after MI/ischemia “ due to ATP depletion.
181) Why are elderly more affected by benzos than younger people are?
IMMUNOLOGY
182) IL-12, INF-Y, IL-2 involved in TB
183) ID Protease Inhibitor function on a diagram
184) Anaphylactic reaction involves mast cells
185) LPS is associated to TNF-alpha
186) What is the mechanism for IgA in mammary glands? Pinocytosis
187) Clathrin = this is what™s defective if improper endocytosis occurs
188) If there is decreased beta-2 microglobulin, then there is decreased MHC-1
189) NK cells use perforin as part of their mechanism
190) Decreased NADPH Oxidase results in defect in engulfing or killing?
191) Thymoma is associated to Ach defect
MICROBIOLOGY
192) What is an effect of Chlamydia? Conjuctival scarring
193) There was a comparison between Gram œ-œ bacteria causing diarrhea
194) Enterotoxigenic E Coli causes traveler™s diarrhea on a cruise
195) Person comes in with a cat bite = Pasteurella
196) Boy recurrently infected by Strep Pyogene, why? M-protein variant
197) Different types of Strep is distinguished how? Via hemolysis
198) Nasopharynx is most likely to show what bacteria? Strep Pneumonia
199) Child has white vesicles in mouth “ most likely Coxsackie virus
200) Silver stain = used to identify Pneumocystis Jerivicki
201) Person presents w/ Leishmania = treat w/ Stilbogluconate
202) ID a picture of Giardia Lamblia
203) If a person has a renal transplant, treat him for CMV virus
204) Scenario involving specialized transduction
205) Scenario involving conjugation via direct contact
206) Cholera toxin mechanism = increases camp
207) Diptheria toxin mechanism = inhibits protein synthesis
208) Neisseria vaccine is capsular
209) Scenario in which you had to diagnose patient w/ bacterial vaginosis
BIOCHEMISTRY
210) Patient presents with a bulky stool. The only fat vitamin option in the answer choices was Vitamin E deficiency.
211) Vitamin C deficiency causes decreased proline/hydroxylation
212) Fructose 2, 6 Bisphosphate allows formation of PFK
213) Valine deficiency in patient = causes maple syrup scent in child
214) You would take less sucrose if there is decreased fructose in the patient
215) Inhibiting ALA dehydrase will cause ALA accumulation
216) Asterixis will lead to ammonium problems
217) Asbestosis is associated to people who work in a shipyard
218) Dilated blood vellses + chromosome abnormality = lead to DNA repair problem
219) Degenerate codon = 2 amino acids for 1 codon
220) Question which asked the difference between prokaryotes and eukaryotes? Prokaryotes don™t have introns.
GENETICS
221) In cystic fibrosis, chloride epithelial transport is affected
222) Patient presents with low AFP levels, high beta-HCG levels, and endocardial cushion defect “ he has Down™s syndrome.
223) Imprinting is associated to chromosome 15
224) Female that constantly laughs, & male that is obese “ associated by imprinting 225) High levels of testosterone and LH, indicates polycystic ovarian disease
226) There is a diagram in which you have to figure out its œmitochondrial inheritance
EVERYTHING ELSE
227) There is a graph in which you have to figure out it™s a œcompetitive inhibitor
228) There is a graph in which you have to compare drugs via their VMAX
229) There is a scenario where a young boy is affected by lipofuschin granules
230) There is an acid-base graph indicating increased HCO3 excretion
231) Asks the mechanism of how Amphotericin B acts on fungi
232) Patient presents with symptoms of malaria, asks what another symptom may be: blackwater fever.
233) What would be another drug you could add after 3 drugs given already, in œdrug-resistance TB? Ethambutol
234) Aspirin acts at cyclo-oxygenase
235) When you lose K+/Cl- is person hypertonic or hypotonic? Had it between these two choices.
236) What causes complete blindness in diabetes?
237) Spinal cord section that causes loss of lower leg sensation?
238) There is a photo of the diencephalon, you are asked to ID the hypothalamus
239) Photo of spina cystica (you were asked to ID what the photo is)
240) Photo of maxillary sinus (you were simply asked to ID the photo again)
241) You were asked to ID a photo of pehmphigus vulgaris (clue was œnetted IgG)
242) Asked to compare two drugs (drugs A and drug B). You had to tell them if drug B had a higher/lower/equal half-life AND higher/lower/equal bioavailability in comparison to drug A.
243) Had to simply tell what is involved in elongation in protein syntehsis “ EF-1.
244) Site that™s not transcriptionally active in a photo “ heterochromatin
245) Scenario involving a virus, answer was œreverse transcriptase
246) Had to tell how edema flows to the lungs in CHF
247) Had to know albumin levels are decreased in a scenario of edema
248) The cause of a lump over the crycoid “ thyroglossal duct.
249) What is the underlying disease that causes dilation of arteries in head and neck only? Is it due to bronchogenic cancer, DVT, or some other choices “ don™t remember them all.
250) Photo of prion vacuolization, simply had to identify it.
251) Showed a shaded part of a spinal cord and had to know its associated to vitamin B12 deficiency.
252) Showed a shaded part of a spinal cord and had to know its associated to inability to discern pain and temperature.
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Page 1 of 1
* Step 1 * Re: 2008 remembered questions
0 - ArchivalUser - 09-21-2008
BS and ethics is my weakest link
it could contain some mistakes, any correction is welcome
MEDICAL ETHICS 137 cases:
1.A 25- year old mother refused immunization for her 2-month old son. The social worker spoke to the mother. (Important for Board examination)
Next step in management: immunization should be given for the benefit of the child.
Correction: IMMUNIZATION CAN BE WITH HELD FROM THE CHILD IF PARENTS ARE AGAINST IT.BECUZ LACK OF IMMUNIZATION POSES VERY LITTLE THREAT AND IT IS NEITHER LIFE OR LIMB SAVING.
HOWEVER IF GLOBAL CAMPAIGN ON IMMUNIZATION REFUSED APPROPRIATE HEALTH AUTHORITIES SHUD BE NOTIFIED {BREAK CONFIDENTIALETY BECAUSE POSING RISK TO OTHERS}
2. A 30-year old mother refused surgery for suspected appendicitis for her 6-year old daughter. The social worker spoke to the mother. (Important for Board examination)
Next step in management: surgical removal of the appendix should be preformed for the benefit of the child. (RULE: PARENTS CANNOT WITHHOLD LIMB OR LIFE SAVING PROCEDURE TO THEIR CHILD)
3. A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death is certain without surgery. (Important)
Next step in management: amputation should NOT be preformed.
Adolescent patients or adults who are competent in making decisions have an absolute right to determine what shall be done with their own bodies. However, most pediatric patients are not competent to make their own decisions. Please remember, children (15 years or older) are usually able to give a genuinely informed consent. Therefore physicians may respond to their request, except in a case of irreversible sterilization.
4. A 17-year old girl is a Jehovah™s Witness. She refuses a lifesaving blood transfusion. She is aware of the consequences. She spoke to the social worker. (Important)
Next step in management: blood transfusion should NOT be given because she is competent to make the decision.
5. A 5-year old girl is a Jehovah™s Witness. She requires emergency blood transfusion. Her mother refuses blood transfusion. A social worker along with two physicians spoke to the mother. (Important)
Next step in management: blood transfusion should be given because the patient is not competent. Mother cannot refuse her daughter™s treatment. (LIFE saving)
6. A 2-year old boy was brought to the ER by his parents for an injury. Physicians made the diagnosis of child abuse. There are three other children living in the same household. Both parents confess to child abuse but request the physician to keep it confidential. Social worker was involved. (Important)
Next step in management: the case should be reported to Child Welfare Agency (CWA). All children should be removed from the parents.
7. A 15-year old boy with STD (sexually transmitted disease) came to see a physician. He asked the physician not to tell his parents. (VERY IMPORTANT)
Next step in management: the physician should treat the patient and notify the appropriate health authority, but should not tell his parents.
8. A 16-year old boy wants to use a condom. He comes to the clinic for free samples. He requested the physician, however, not to tell his parents. (Important)
Next step in management: condom should be given and physician should not tell his parents.
9. A 30-year old male patient is recently diagnosed with HIV. He lives with his wife and two other children but is promiscuous. He requested the physician not to tell his wife. He lost his job recently. Social worker spoke to the patient. (Very Important)
Next step in management: physician should notify the appropriate authority (e.g. department of health) for the safety of other specific persons who are engaged in unsafe sexual practices. The physician however, should ask the patient to divulge the diagnosis to his wife and other sexual partners.
10. A very small premature infant was born in the delivery room by NSVD (normal spontaneous vaginal delivery). The attending physician decided not to resuscitate the newborn. Physician spoke to the mother. Mother started to cry. Newborn expired after 30 minutes. Is the physician liable for the newborn™s death?
Answer: NO. Please remember, no physician in the USA has ever been found liable for withholding or withdrawing any life sustaining treatment from any patient for any reason.
11. A physician picked up a car accident victim from the street and brought him to the ER in his car. He did not want to wait for an ambulance because the patient™s condition was critical. Physical examination in the ER reveals quadriplegia. Is the physician liable for this consequence? (Very Important)
Answer: YES, because the physician did not protect the neck of the patient resulting in quadriplegia.
12. A policeman brought an alcoholic patient to the ER. The policeman asked the physician to give him a sample of gastric contents by putting a nasogastric tube for laboratory study. The patient refused insertion of a nasogastric tube. (Very Important)
Next step in management: nasogastric tube should not be placed. Blood alcohol level however should be preformed. The policeman should not give orders to a physician.
13. A 60-year old man with a history of myocardial infarction (MI) suddenly develops ventricular tachycardia. A physician from another department was present. The patient needs resuscitation. (Very Important)
Next step in management: the physician must resuscitate that patient. Physician should not refuse treatment because he belongs to another department.
14. A 15-year old homosexual boy wanted to change his sexual orientation. He was not successful. He needed help. He requested the physician not to tell his parents. (Important)
Next step in management: physician should help him avoid homosexual activities. Physician should not tell his parents about his homosexual activities.
15. A 15-year old homosexual boy is brought by his parents to a physician. His parents do not accept their son™s sexual orientation. The boy refuses to change. (Important)
Next step in management: physician should tell his parent that homosexual activity is considered as an alternative life style. Parents should talk to his son but should not force him to change his homosexual activities.
16. A 16-year old girl becomes pregnant. Her mother wanted her to abort this pregnancy. The girl wanted to continue her pregnancy despite difficulties. Her boyfriend is a high school drop out. (Important)
Next step in management: physician should advise to continue this pregnancy because the girl is competent to make this decision.
17. A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the doctor not to tell her parents about this pregnancy. (Important)
Next step in management: abortion should be done and parents should not be notified. Please remember, strict requirements for parental consent may deter many adolescents from seeking health care.
18. Can a physician provide sterile needles for intravenous drug abusers? (Important)
Answer: YES. It reduces the risk of acquiring HIV or hepatitis. The patients should be referred to appropriate health facilities.
19. A 26-year old pregnant woman went for antenatal check up. Sonogram revealed a 27-week old fetus with erythroblastosis fetalis. Doctor recommended intrauterine fetal blood transfusion. She refused the procedure. Social worker discussed the case with the mother. (Important)
Next step in management: doctor should receive a court to do the procedure which will help the fetal condition.
(A HIGHLY DEBATABLE ASPECT.MOTHER IS LIABLE FOR WITH HOLDING LIVE SAVING PROCEDURE TO VIABLE FOETUS WHICH DOESNT PUT THE MOTHER AT RISK OF SERIOUS DAMAGE.HOWEVER AMERICAN OBSTETRIC ASSOCIATION MENTIONS NOT TO DO ANY OBS PROCEDURE ON REFUSAL OF MOTHER.MOTHER SHUD BE TOLD THAT SHE IS COMMITING AN ASSAULT AND THE CASE BE TAKEN IN COURT.COURTS ARE NOW RECOGNISING THE RIGHTS OF A VIABLE FOETUS)
20. A 20-year old man tells his doctor that he is going to kill girlfriend. She lives in the university dormitory. Doctor called the university and alerted them about the threat. However, university security people did not protect her. She was killed by her boyfriend. Who should be responsible for this killing? (Important)
Answer: the 20-year old man is responsible. Doctor did the right thing by notifying the university or the police. The university is also responsible because they did not take any preventive measures.
21. A 20-year old pregnant woman refuses cesarean section for complete placenta previa. Fetus is full-term and healthy. Social worker spoke to mother. (Important)
Next step in management: doctor can go to court to get permission for cesarean section for the benefit of the fetus.
22. A 30-year old pregnant woman ingested alcohol and illicit drugs (e.g., cocaine, crack) which are harmful to the fetus. What should a physician do? (Important)
Answer: the physician should be careful in reporting this case because the pregnant woman may not come back for prenatal care, which is important for both the mother and the fetus. However, if the baby™s urine toxicology test is positive for illicit drugs, case should be reported to CWA (child welfare agency). CWA suggests separate custody for the child.
23. A physician wants to study a group of children aging from 10-12 year old. Physician already got the consent from the parents. However, he didn™t discuss the study with the children. A child refused to participate. Should the physician force the child to participate? (Important)
Answer: no, because a child can refuse to participate in a research study.
24. A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with the patient who understood the procedure. Can the patient give consent? (Important)
Answer: yes. If a psychiatric patient understands the procedure, he or she can give the consent.
25. A 65-year old schizophrenic patient needs coronary angiography because of suspected myocardial infarction. Cardiologists explained the procedure to the patient who did not understand the procedure. Who can give the consent on behalf of the patient? (Important)
Answer: the patient™s relative can give the consent. If nobody is available to give the consent, court order should be obtained. If a psychiatric patient does not understand the procedure, he or she cannot give the consent.
26. A 25-year old woman developed postpartum psychosis. The newborn developed cyanosis due to congenital heart disease. The newborn needs cardiac surgery. Surgeon discussed the procedure with the mother. She understood the procedure. Can she give the consent? (Important)
Answer: yes, because she understood the procedure.
27. A newborn is diagnosed with either trisomy 18 or 13 with TE (tracheoesophageal) fistula which requires suregery. Mother request surgeon to repair the TE-fistula. What should a surgeon do? (Important)
Answer: surgeon should refuse to do the reparative surgery because these conditions (trisomy 18 or 13) are nonviable. If the patient survives, surgeon can put a gastrostomy feeding tube for nutrition. However, please remember that a patient with trisomy 21 (Down syndrome) with TE fistula should be operated on.
(LAW OF MEDICAL FUTILITY APPLIED HERE)
28. A 45-year old terminally ill patient wanted to die. He has pancreatic cancer and has been suffering from constant pain. He asked the physician to give him some medication which can expedite his death. What should a physician do? (Very Important)
Answer: physician cannot give any medication which will expedite the death. However, physician can prescribe medication to minimize the pain. The dose should be appropriate. Physician-assisted suicide is illegal everywhere (except in the state of Oregon).
29. A 47-year old man came to a doctor for chronic low back pain and dysuria. The diagnosis of metastatic prostate cancer was made after appropriate investigation. Should the doctor tell the bad news to the patient? (Important)
Answer: yes physician must tell the truth to the patient.
30. A surgeon wanted to perform cholecystectomy on a patient. The surgeon is not sure whether the patient has decision-making capacity. What is the next appropriate step? (Important)
Answer: consultation with a psychiatrist or neurologist may be helpful. Sometimes it is necessary to discuss the case with hospital attorneys, ethic committees, or ethic consultants. In a difficult case, the ultimate judge of a patient™s competency is a court.
31. A 45-year old widow was admitted to an ICU (intensive care unit) with ruptured intracranial aneurysm. She is comatose and is placed on a mechanical ventilator. She has a 20-year old son who did not keep any relation with his mother. However, he came to see his mother. His mother made a written proxy advance directive which indicates that her 50-year old female neighbor should make the substitute decision. Who is the right person to make the substitute decision in this situation? (Important)
Answer: 50-year old neighbor should make the substitute decision. Please remember, the most appropriate person to make the substitute decision is someone designated by the patient while still competent, either orally or through a written proxy advance directive. Other substitute decision makers, in their usual order of priority, include a spouse, adult child, parent, brother or sister, relative, or concerned friend. For a patient who has no other decision maker available, a phblic official may serve as a decision maker.
32. The right of patients to refuse medical intervention: patients can refuse dialysis, cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition and hydration, even if such a decision results in the patient™s death. A patient™s decision to withdraw (discontinue) or to withheld (not to initiate) life-sustaining treatment is not considered suicide and physician participation is not considered physician-assisted suicide. Physicians do not have any legal risk.
33. Can a medical student introduce himself or herself as a ˜doctor™ to the patient? (Important)
Answer: no. a patient can refuse a medical student from performing any procedure. However, medical students are allowed to perform a procedure under appropriate supervision If the patient agrees to that.
34. Should a bus driver hide history of epilepsy from his employer? (Important)
Answer: no. He has requested his physician not to mention his epilepsy to the employer because this would result in the loss of his job. The physician is obligated not only to his patient but to the community. The patient should notify his employer and try to find a non-driving job in the company. If the patient disagrees, physician may notify the appropriate authority for the safety of the patient and the community.
35. A 50-year old make is diagnosed with stomach cancer. He requested the physician not to tell his wife. The following day, the wife calls to inquire about her husband™s diagnosis. (Important)
Answer: the physician should not divulge the husband™s diagnosis. However, the physician should encourage the patient to reveal his diagnosis to his wife.
36. A 29-year old man is diagnosed with presymptomatic Huntington™s disease. This disease is an autosomal dominant (50% chance of having the disease in each pregnancy). He requested his physician not to tell the diagnosis to his wife. The wife wants to have children. (Important)
Answer: physician should ask the patient to seek genetic counseling and to urge him to discuss the matter with his wife. Since there is a risk of harm to the future children, physician can divulge the diagnosis to protect the future children.
37. A 18-year old man is diagnosed to have suspected bacterial meningitis. He refuses therapy and returns to the college dormitory. What should a physician do in this situation? (Very Important)
Answer: physician should report to the college authority and recommend that the suspected individual should be isolated during the course of his illness.
38. A 39-year old nurse is diagnosed with hepatitis B antigen-positive. She is working in a dialysis unit. She told her doctor. However, she did not tell the hospital authority because she is afraid to lose her job. (Very Important)
Answer: physician should ask the nurse to divulge her medical condition to the hospital authority. If she refuses, physician should notify the hospital authority for the protection of patients.
39. A 20-year old man with severe head injury was admitted to a small hospital. The patient needs neurosurgical intervention which is available in a nearby university hospital. Hospital refused to accept a patient who has no medical insurance.
Answer: university hospital must accept the patient.
40. A 30-year old man needs a second prosthetic valve. He is a drug addict. Surgeon does not want to perform surgery because the patient does not take care of himself. Is this the right decision? (Important)
Answer: no. Surgery should be performed if it is medically indicated.
41. A newborn male is diagnosed with anencephaly. His 1-year old sibling needs a kidney. His parents requested the physician to remove the kidney from the anencephalic child and to transplant that kidney in the 1-year old sibling. What should a physician do?
Answer: surgeon should perform the kidney transplant.
42. A 50-year old man is in a persistent vegetative state. Physician decided to discontinue nutrition and hydration for that patient. Is this the right decision?
Answer: yes. This is an acceptable practice in most states. Few states require clear evidence that the patient would have chosen this course.
43. A medical student requested his attending to perform a pelvic examination on a patient who is anaesthetized for appendectomy. Is this ethically acceptable?
Answer: no. The patient did not give consent to perform a pelvic examination.
44. A 20-year old woman slashed her wrists and wanted to die. She was unconscious and was brought to the ER. What should a physician do? (Important)
Answer: physician should take care of the patient. Psychiatric consultation and social worker evaluation are indicated. A suicide attempt is very often a ˜cry for help™.
45. A 90-year old man was diagnosed with having Alzheimer™s disease 10 years ago. It is difficult to feed him. He cannot recognize his family members. He developed recurrent aspiration pneumonia. What should a physician do?
Answer: physician should discuss this with the family and should respect their decision.
46. A 1-day-old infant was diagnosed with hypoplastic left heart syndrome. The patient is stabilized with the use of prostaglandin. Physician discussed this case in detail with the parents. What should the parents decide in this situation?
Answer: the parents can choose a staged surgical repair of the heart, a final heart transplantation if the organ is available, or allow the infant to die.
47. A 55-year old woman with severe developmental disability recently is diagnosed with breast cancer. Her mental age is estimated at a 2-year old level. Her family members do not want any more intervention. What should physician do?
Answer: physician should discuss this case with the hospital ethics committee members. The usual consensus is ˜not to do anything™ because of her severe mental disability. (NEVER, SHE IS COMPETENT, COMPETENT PATIENT APLLY BEST INTEREST STANDARAD)
48. A 49-year old woman with cervical cancer has a history of noncompliance. She had surgery a month ago. She missed several appointments. Can a physician force her for chemotherapy? (Important)
Answer: no. Physician can talk to her regarding the importance of chemotherapy. However, the patient must make the final decision.
49. An internist has been managing a diabetic patient for the last 10 years. The patient™s condition is progressively getting worse. The patient is also not happy with the physician™s management. What should a physician do in this situation?
Answer: physician should find another physician (e.g., endocrinologist) who might be more successful with the patient in this particular circumstance.
50. An internist recently refused to see a patient who he has been seeing for the last 5 years. Internist stated that the patient was rude to him. The patient went to see another physician who requested the patient™s medical record. What should the internist do in this situation?
Answer: internist should provide the medical records of the patient to the new physician.
51. An internist refused to see a complicated hypertensive patient who he has seen for the last 10 years. Internist did not give any notice to that patient. The patient was angry with the physician. The patient was recently admitted to a hospital with the diagnosis of stroke. Is the internist responsible for the patient™s condition?
Answer: yes. The legal charge of abandonment can arise when the physician without giving timely notice, ceases to provide care for a patient who is still in need of medical attention. Internist is not obligated to find him another physician. However, patient should have sufficient time to arrange for another physician.
52. A physician went to vacation for 2 weeks. He did not find another physician to cover him. He is very sincere. One of his patients with hypertension developed severe headache. The patient has an appointment with the doctor as soon as he comes back from vacation. The patient did not look for another physician and decided to wait. The patient suddenly collapses and was diagnosed to have intracranial hemorrhage. Is the physician responsible for this patient? (Important)
Answer: yes. The physician has a legal obligation to arrange for coverage by another physician.
53. An ophthalmologist performed a cataract surgery on a patient who went home after the operation. In the evening, the patient started vomiting and complained of severe headache. The ophthalmologist refused to accept that the symptoms were due to postoperative complications. The patient wanted to see the doctor immediately but he refused to see that patient. The patient went to the nearest ER and was diagnosed to have dislocation of the lens and partial retinal detachment. Is the physician responsible for the patient™s condition?
Answer: yes ophthalmologist failed to judge the patient™s condition seriously enough to warrant attention.
54. A 70-year old Chinese man is diagnosed to have severe osteoarthritis. He told his doctor that he is using Chinese herbal medicine. He is feeling better. However, he had two episodes of dizzy spells since he started that herbal product. What should a doctor suggest to this patient? (Important)
Answer: the doctor should suggest to discontinue the herbal product which may be causing the dizzy spells.
55. A 35-year old woman is diagnosed to have chronic throat infection. She is frustrated with the conventional medicine. She told her doctor that she is using an alternative homeopathic medicine. She is feeling much better and she has no other complications. What should a doctor suggest to this patient?
Answer: the patient can continue an alternative homeopathic medicine. Alternative medicine therapy is accepted in the society and is also used along with conventional therapy.
56. A 45 year old woman is diagnosed to have UTI (urinary tract infection). She told her doctor that she could not afford to purchase antibiotics. However, she is using herbal medicine that is cheaper. She is complaining of fever and dysuria. What should a doctor suggest to this patient? (Important)
Answer: the patient should discontinue the herbal medicine immediately and should start antibiotics as soon as possible.
57. A 13-year old boy with suspected meningitis refuses therapy. His parents also support that decision because they are supposed to go on vacation the following day. What should a physician do in this situation? (Important)
Answer: the patient should be admitted and treated in the hospital. If they refuse, legal action should be taken. (MENINGITIS TREATMENT IS LIFE SAVING)
58. A 2-year old girl is admitted with the diagnosis of intestinal obstruction. Her mother has a psychiatric problem. Her mother is not capable of giving the consent. Her father died one year ago. What should a surgeon do in this situation?
Answer: legal steps may be taken to provide a surrogate decision-maker.
(IN EMERGENCY LIKE THIS ONE USE IN LOCUM PARENTIS I.E PHYSICAIN DECIDES)
59. A 67-year old widow has been using hypnotics for the last 5 years. She is addicted. Her doctor wants to withdraw her from her present medication by trial on placebos. Is the physician making a right decision? (Important)
Answer: no. The physician cannot use placebos because his decision is deceptive. The problem of addiction should be discussed directly with the patient. The use of deceptive placebo is indicated in the following conditions:
(a) the patient insists on a prescription;
(b) the patient wishes to be treated;
© the alternative to placebo is either continue illness or the use of a drug with know toxicity;
(d) high response rates to placebo (e.g., postoperative pain, mild mental depression).
60. A 50-year old man is diagnosed to have multiple sclerosis. In the morning, the surgeon asked the man his opinion on the surgical procedure and he agreed. In the evening, the man refused to give consent for the same surgical procedure. He is also disoriented to place and time. Is the patient capable of making the decision?
Answer: no the patient has impaired capacity.
61. A 55-year old woman with diabetes is diagnosed to have gangrene on both feet. She was brought to the hospital. She told the doctor the she is feeling fine and she has no medical problems. Can she give consent for the amputation of both legs?
Answer: no. The appointment of a surrogate should be sought to get the consent for the surgery.
62. A 17-year old boy came to a surgeon for bilateral vasectomy. He is the father of one child and does not want to have any more children. He does not want to tell his girlfriend and parents. He lives with his parents. What should a surgeon do in this situation? (Important)
Answer: surgeon should not perform bilateral vasectomy and should offer him less radical alternatives. Please remember, a mature minor may not comprehend the implications of this procedure.
63. A 16-year old girl came to a doctor for bilateral tubal ligations. She is a mother of one child and does not want to have any more children. She does not want to tell her boyfriend and parents. She lives with her parents. What should a doctor do in this situation? (Important)
Answer: obgyn doctor should not perform bilateral tubal ligation and should offer her less radical alternatives.
64. A 16-year old boy wants to donate one of his kidneys to his friend who is suffering from ESRD (end stage renal disease). The boy™s parents did not agree with his decision. What should a physician do in this situation? (Important)
Answer: the physician cannot accept his kidney. However, he can donate one of his kidneys if his parents agree.
65. A 15-year old boy wants to participate in a research study. He told his parents who did not agree. He lives with his parents. Can this boy participate in the research study?
Answer: no the boy needs consent from his parents to participate in a research study.
66. A 17-year old boy lives independently. He is married and has one child. He wants to participate in a research study. Does he need his parents permission? (Important)
Answer: no. He is an emancipated minor who lives independently from his parents physically and financially.
67. A 70-year old man is diagnosed with terminal esophageal cancer and requires an insertion of a gastrostomy tube. He has signed a DNR (Do Not Resuscitate) order about a month ago. Should the preexisting DNR order stand or be suspended during the surgical procedure? (Very Important)
Answer: attending physician, surgeons, and the patient or surrogate should discuss the matter and either affirm or suspend the order in anticipation of surgery. If a patient is competent and wishes a preexisting DNR order to stand, resuscitation should not be performed in the event of an intrasurgical arrest.
(BAD ANSWER, DNR ONLY REFERS TO CPR AND NOTHING ELSE IF NOT CLEARLY
MENTIONED IN DNR ORDERS) MY ANSWER IF PT COMPETENT ASK SPECIFICALLY TO GASTROSTOMY.AND PROCEDE AS WISHED BY PT.IF PT INCOMPETENT ASK FAMILY FOR PTS WISH.IF CONFLICT AMONG FAMILY ON WISH OF THE PT GO TO ETHICS COMMITEE. (REMEMBER IF CONFLICT AMONG FAMILY IS NOT BASED ON WISH OF PT.GO FOR THE WISH WHOEVER TRULY REPRESENTS IT.)
68. An infant, born at 30 weeks gestation, appears to be SGA (small for gestational age) with multiple malformations. Amniocentesis study was not performed. Infant needs resuscitation at birth. What should a physician do in this situation? (Important)
Answer: physician must resuscitate the patient in the delivery room because the diagnosis is uncertain.
69. A 60-year old man is diagnosed with terminally ill colon cancer and needs resuscitation. He did not sign a DNR order. The physician has decided to perform a ˜slow code™ on his own. Is this the right decision? (Important)
Answer: no. Please remember, a performance of ˜slow code™ or ˜show code™ is not acceptable to the patient. This decision by the doctor represents the failure to come to a timely and clear decision about the patient™s resuscitation status.
SLOW CODES REFER TO WHEN FAMILY SAYS TO DO CPR BUT PHYSICAIN THINKS ITS FUTILE AND JUST TO SHOW FAMILY DOES CPR WITHOUT FULL PROTOCOL.
70. A 20-year old man is diagnosed with suspected bacteremia and meningitis. He refuses antibiotic therapy. He collapses and requires resuscitation. What should a physician do in this situation?
Answer: the physician should resuscitate the patient despite the patient™s refusal to antibiotic therapy. THOUGH ANTIBIOTICS STILL NOT USED.
71. A 50-year old woman is diagnosed with severe aortic stenosis. She collapsed in a doctor™s office and is required resuscitation. She is waiting for valve replacement surgery. What should a physician so in this situation?
Answer: this condition is called ˜physiological futility™. In severe aortic stenosis, vigorous resuscitation is highly unlikely to restore adequate cardiac output. Therefore, the physician might reasonably refrain from resuscitation.
PHYSIOLOGICAL FUTILITY IS WHEN CHANCES OF SURVIVAL WITH CPR LESS THAN 1%.
72. A 14-year old boy is diagnosed with terminally ill cancer. He is not responding to chemotherapy. His parents want to continue the treatment. However, the boy does not want to continue his suffering. The physician told the parents that chemotherapy will not be helpful. What is the appropriate decision at this point? (Important)
Answer: the boy™s decision should be respected because the treatment is futile.
(WRONG PT MINOR PARENTS REQUEST SHUD BE UPHELD)GIVING CHEMOTHERAPY DOESNT PUT PT ON LIFE AND DEATH SITUATION
73. A surrogate pregnant mother made a surrogacy contract with a couple in which she will give the baby to the couple. She developed complications in the first trimester and wanted to abort. Is she allowed to do that? (Important)
Answer: yes. If her life or health becomes threatened from continuing the pregnancy, she should retain her right to abortion.
74. A physician became sexually involved with a current patient who initiated or consented to the contact. Is it ethical for a physician to become sexually involved?
Answer: no. Sexual involvement between physicians and former patients raises concern. The physician should discuss with a college or other professional before becoming sexually involved with a former patient. The physician should terminate the physician-patient relationship before initiating a romantic or sexual relationship with a patient.
IDEALLY ON STEPS SHUD BE HER DOC BUT SUPRESS UR OWN FEELINGS
75. A physician decided to take care of his own family members and relatives. He is a very smart physician. Is this a right decision?
Answer: no. The physician should encourage all friends and family members to have their own personal physician.
76. A male patient wants to have a copy of his medical records. What should a physician do in this situation?
Answer: the physician should retain the original of the chart. Information should only be released with the written permission of the patient or the patient™s legally authorized representative (e.g., attorney).
77. A 30-year old female wants to have an abortion. Her physician objects to abortion on moral, religious, or ethical grounds. What should a physician do in this situation? (Important)
Answer: physician should not offer advice to the patient.
IF SHE IS NOT COMFORTABLE DOING ABORTION ON MORAL GROUNDS REFER THE PT TO SOMEONE ELSE.
78. A physician sees patients at a reduced fee. He spends very little time with each patient. Is the physician doing the right thing?
Answer: no. The physician is not providing optimal care.
79. A surrogate pregnant mother signed a surrogacy contract with a couple. Male partner gave sperms which were artificially inseminated to the surrogate mother. Surrogate mother has a genetic relation to the child. She wants to void the contract after the baby is born. Is she allowed to breach the contract? (Important)
Answer: yes. Surrogate contracts, while permissible, should grant the birth mother the right to void the contract within a reasonable period of time after the birth of the child.
80. A surrogate pregnant mother signed a surrogacy contract with a couple. Both male and female parents gave sperm and ovums respectively. The surrogate mother wants to void the contract and she has no genetic relation. Is she allowed to breach the contract? (Important)
Answer: no. Genetic parents have exclusive custody and parental rights.
81. A surrogate pregnant mother signed a surrogacy contract with a couple. The couple got divorced. Male partner gave sperms and the female partner gave ovums. They do not want to continue the surrogate pregnancy. What should be the decision at this point? (Important)
Answer: the couple is genetically related to the fetus. They have the right not to continue with this pregnancy.
82. A surrogate pregnant mother signed a surrogacy contract with a couple. The couple got divorced. Male partner gave sperms but the female partner could not give ovums. They do not want to continue the surrogate pregnancy. What should be the decision at this point? (Important)
Answer: female partner has no right to terminate this pregnancy because she has no genetic relation. Surrogate mother has genetic relation and she has the right to continue this pregnancy even if the male partner disagrees.
83. A 3-year old girl is diagnosed with blood cancer. She has been waiting for an umbilical cord transfusion. Her mother delivered a newborn baby girl. Umbilical cord blood was obtained and was transfused to the 3-year old sibling. What is the duty of the physician?
Answer: physician should obtain an informed consent of the risks of donation and he or she should follow the normal umbilical cord clamping protocol. Physician should protect both the children.
84. A 31-year old man has decided to donate one of his kidneys for a large amount of money. Is this the right decision?
Answer: no. However, the donor can receive some payment to cover his medical expenses. Only the potential donor not the donor™s family or another third party may accept financial incentive. Payment should occur only after the organs have been retrieved and judge medically suitable for transplantation.
85. A couple has decided to have a child through artificial insemination. They asked the physician for sex selection of the child. What should a physician advise in this situation? (Important)
Answer: physician should not participate for sex selection for reasons of gender preference. However, sex selection of sperm for the purpose of avoiding a sex-linked inheritable disease is appropriate.
86. A 30-year old man has donated his sperms which were kept frozen. He died in a car accident. He did not leave any specific instructions regarding sperm donations. His wife wants to make use of them. A woman requested her to donate his sperms. What is the appropriate decision? (Important)
Answer: the donor™s wife can use the semen for artificial insemination but not to donate it to someone else. The donor should give clear instructions at the time of donation. The donor has the power to override any decision.
87. The donor and recipient of sperms are not married. Who would be considered the sole parent of the child? (Important)
Answer: the recipient. Except in cases where both donor and recipient agree to recognize a paternity right.
88. The residents and medical students were asked by an attending to follow certain orders for a patient. The residents and medical students believe the orders reflect serious errors in clinical or ethical judgment. What is the appropriate way to handle the situation? (Important)
Answer: The residents and medical students should not follow those orders. They should discuss with the attending issuing those orders. They should also discuss the situation with a senior attending physician, a chief of staff, or a chief resident.
89. A physician used a newly prescribed drug to his patient. The patient got sick after the drug was ingested and required hospitalization. Should the physician report this drug™s side effect to FDA (Food and Drug Administration)? (Important)
Answer: yes. FDA should be notified only if the drug causes serious adverse events such as those resulting in death, hospitalization, or medical or surgical intervention.
90. A 39-year old female has been suffering from chronic cholecystitis. The surgeon advised cholecystectomy. The patient wants a second opinion. The surgeon agreed. The patient went to another surgeon and has decided to be operated by the second surgeon. What should the second surgeon do in this situation? (Important)
Answer: the second surgeon should accept the patient because the patient has the right to choose the surgeon. First surgeon should accept the patient™s decision.
91. A 45-year old male was admitted to the hospital with mild chest pain. He wants to leave the hospital before completion of therapy. How do you manage the patient? (Important)
Answer: The patient is asked to sign a statement that he is leaving against medical advice (AMA). The patient may however leave without signing that statement. This document is a legal evidence that the patient was warned by the physician about the risk of leaving. Please remember, discharge AMA does not apply to children.
92. A 55-year old man requested his physician to misrepresent his medical condition to receive disability or insurance payment. What is the appropriate response of the physician in this situation?
Answer: The physician must refuse that request.
93. What is the responsibility of a fellow physician who is aware of drug abuse, alcohol abuse, or psychiatric illness of his colleagues or of a medical condition that is harmful to patients? (Very Important)
Answer: the physician should protect the patients. The fellow physician should report to the appropriate authority (i.e., report to the hospital authority; report to the Dean for a medical student™s problem).
94. A 60-year old male has been suffering from severe pain due to terminal prostate cancer. The patient is receiving lower doses of narcotics and sedatives. How can a physician relieve his suffering? (Important)
Answer: The physician should increase the dosage of narcotics and sedatives up to the maximum recommended amount. Listening, spending more time with him, and reducing psychological distress can reduce the suffering.
95. A 25-year old female medical student or resident noticed a mistake made by a junior attending physician during rounds. She is afraid of that attending physician. What is the appropriate way to handle the situation? (Important)
Answer: She should discuss the situation with a more senior attending physician for appropriate interpretation, advice, and assistance.
96. A 26-year old male medical student or resident made a mistake during patient care. He is afraid of what might result. What is the appropriate way to handle the situation?
Answer: He should disclose the mistake to the attending physician and try to learn from that mistake. The patient should be notified as well.
97. A 63-year old female health care worker is concerned about taking care of patients with HIV infection or multidrug-resistant tuberculosis. What is the appropriate way to handle the situation? (Important)
Answer: The physician should provide appropriate care to patients despite personal risk. Institutions should reduce the risk of infection by appropriate equipment, supervision, and training. Her concern should be taken seriously.
98. A 30-year old male physician has an opportunity for financial incentive if he sees more patients and refers them unnecessarily. What is you opinion about this?
Answer: The physician should provide only care that is in the patient™s best interest.
99. Two physicians are discussing a case inside the elevator of a hospital. What is your opinion about this?
Answer: They should not do that because they have to maintain the patient™s confidentiality.
100. The patient™s confidentiality should be maintained except in the following situations:
Physicians should override third parties in case of domestic violence, child abuse, elderly abuse, gunshot wounds, syphilis, and tuberculosis. They should report these cases to appropriate governmental authorities.
101. A physician is experiencing a very difficult ethical issue regarding a complicated case. He is confused. What should be the next step?
Answer: he should discuss the matter with other faculty members in his health care team, colleagues, or hospital ethics committee.
102. What is the final plan of action in an ethical issue?
Answer: Both patient and physician should agree regarding final management. The patient should be well informed about the medical condition. The physician should be sympathetic and knowledgeable regarding the relevant medical condition.
103. DNR (do not resuscitate) order. This is appropriate if the patient or surrogate signed that order or if CPR (cardiopulmonary resuscitation) would be futile. Physicians should write DNR orders and the reason for them in the chart. Please remember, œslow or œshow codes are not acceptable. Foods and fluids are considered therapies that should be stopped. (Important)
104. (A) Brain death (adult): (Important)
(i) Definition by the President™s Committee:
Death is an irreversible cessation of circulation and respiratory functions or irreversible cessation of all functions of the entire brain and brain stem.
(ii) The criteria of brain death by the staff of Massachusetts General Hospital and the Harvard Committee:
Death occurs when there is absence of all signs of receptivity, responsivity, and all brainstem reflexes, and the EEG is isoelectric. Sometimes metabolic disorders and intoxications may mimic the above findings.
(iii) The guidelines of brain death:
(a) The diagnosis should be made also by another physician and confirmed by clinical findings and EEG.
(b) The family should be notified. They should not make the decision about discontinuing medical treatment except in a situation where the patient has directed the family to make the decision.
© The physician should discuss with another physician before removing supportive measures (e.g., ventilators).
(d) Family members may request organ donation, and in many states physicians may request the family to make an organ donation.
(B) Brain death (children):
(i) Definition: same as in adults.
(ii) Criteria: similar in children and adults, but the period of observation is longer in children.
Children 1wk-2mo of age: two separate examinations 48 hours apart
Children 2mo-1yr of age: two separate examinations 24 hours apart
Children more than 1 yr of age: two separate examinations 12 hours apart
Spontaneous movements must be absent, with the exception of spinal cord reflex withdrawal and myoclonus.
Generalized flaccidity should be present. The presence of clinical criteria for 2 days in term and 3 days in preterm infants indicates brain death in majority of asphyxiated newborns. The absence of cerebral blood flow on radionuclide scan and silence of electrical activity on EEG are not always observed in brain-dead newborns. There is no universal consensus about the definition of neonatal brain death. The decision is made after discussion with the family and health care team. If there is difference of opinion, the ethics committee should be consulted. The decision is made on the basis of what is in the best interest of the infants and children.
105. Practice guidelines for physicians:
(i) The best way to practice medicine is to select useful diagnostic techniques and therapeutic measures which are most appropriate to a particular patient and clinical condition.
(ii) Practice guidelines can reduce the health care costs, which improve health care to patients who even do not have adequate health care benefits.
(iii) Please remember, guidelines do not and should not be the only way of managing an individual patient.
106. Some important points about patients:
(i) For a patient with an incurable disease, the major goal of therapy should be the enhancement of the quality of life.
(ii) The patient care begins with a personal relationship between the patient and the physician. If a patient has confidence on the physician, reassurance may be the best therapy. The patient must understand that the physician is giving the best possible care available.
107. Patients who do not have decision-making capacity about their medical care:
The patients who do not have decision-making capacity usually arrange for surrogates who make decisions for them. Their choices depend on their values. Psychiatrists are helpful in mentally impaired patients. Family members are usually the surrogates, because they know the patients very well.
Advanced directives: statements made in advance in case patients lose their decision-making capacity in the future. These directives indicate the names of surrogates and which interventions are acceptable or not acceptable to them. These are achieved by oral conversation (most common form), living will, health care power of attorney, or physicians can ask the patient in advance.
Absence of advance directives and surrogates: physicians can make the decision using all information and should respect the patient™s values. Physicians must know the laws of the state in which they practice.
Patient preferences are known:
The decision is made with the patient™s best interest in mind.
Disagreements between potential surrogates or between the physician and surrogate: Physicians can consult with the hospital ethics committee or with other physicians. The courts should be only the last resort.
108. Down syndrome with different medical conditions: (Very Important)
(a) Duodenal atresia at birth: surgical repair is recommended as it is done regularly.
(b) VSD (ventricular septal defect) in newborn period: initial conservative medicals management is followed by surgical repair as it is done regularly.
© Cyanotic heart disease at birth: immediate medical management, which is followed by surgical repair, as it is required routinely.
(d) Cosmetic surgical condition (e.g., rhinophyma or big nose): there is no urgency to repair the underlying condition, but it can be done as it is performed regularly.
(e) Neural tube defects (e.g., meningomyelocele): surgical repair is recommended as it is done regularly.
Please remember, a patient™s management should be discussed with his/her parents and the decision made with the best interest of the patient in mind.
109. A healthy male patient with Down Syndrome lives independently. He went to a doctor for facial cosmetic surgery. Can he make his own decision? (Important)
Answer: yes. The patient can make his decision if he understands the procedure and the consequences. He lives independently which indicates that he is capable of making his own decision.
110. A patient went to the doctor due to throat pain. The doctor asked the patient what her problem was. The patient said that she woke up at six o™clock in the morning, went to the bathroom, ate breakfast, and went to drop her children at school. She then came back home, stared cooking and continues to talk about irrelevant things. What should the doctor do to stop the patient from rambling? (Important)
Answer: the doctor should ask the patient to tell him what problems she has related only to her throat.
111. A patient went to a doctor for abdominal pain but remained quiet throughout the visit. He did not tell the doctor enough about his symptoms. What should the doctor do? (Important)
Answer: the doctor must ask the patient detailed questions about his abdominal pain. It is the doctor™s obligation to find out as much as he can about the patient. Without enough information, the doctor will not be able to make an accurate diagnosis.
112. A patient walked into his doctor™s office with acute abdominal pain. He has been suffering from ulcerative colitis. The patient is noncompliant and did not visit for the past six months. What should the doctor do in this situation? (Very Important)
Answer: The doctor should find out more about the patient™s abdominal pain before making any other decision. The doctor should always be responsible with the patients.
113. A terminally ill pancreatic cancer patient with multiple metastases is admitted to the hospital.
He is in critical condition. The patient wants to know his prognosis. What should the doctor say?
Answer: the doctor should tell the patient politely that he will discuss his condition with him and his family. The doctor should never specify the longevity of the patient.? The doctor should tell the truth even when the patient is a child. The doctor should not hide any medical information from the patient.
114. A patient is recently diagnosed with cancer. He is nervous but is eager to know about his medical diagnosis. What should the doctor™s reply be? (Important)
Answer: the doctor should gently tell the patient his condition.
115. A patient is recently diagnosed with cancer. Previously, he had an episode of a nervous breakdown after hearing a family death and had to be admitted to a hospital. He loves his family members and tends to be very open with them on all issues. How should the doctor tell the patient about his current state? (Important)
Answer: the doctor should call his family members and discuss the patient™s medical condition openly and politely.
(WRONG IF DISCLOSING BAD NEWS CLEARLY PUTS PT IN NERVOUS BREAKDOWN CONDITION WAIT AND GRADUALLY TELL THE PT.NEVER BREAK CONFIDENTIALETY)
116. A male patient was admitted with severe myocardial infarction. He was admitted to the ICU and his condition is very critical. He does not know the reason for his admission. The patient is unstable. What should the doctor tell the patient? (Important)
Answer: the doctor should wait until the patient is stabilized and then gently tell him his medical condition.
(HIDING SOMETHING FROM THE PT MAKES HIM MORE SUSPICIOUS AND MAY LEAD TO ALL KIND OF MISCONCEPTION IN PTS MIND SO NEVER WAIT TO TELL PT UNLESS TELLING IS CLEARLY DETREMENTAL)
117. A mother gave birth to a premature baby who was admitted to the NICU (neonatal intensive care unit). The baby is on a mechanical ventilator. The mother wants to hold the baby. What should the doctor do in this situation? (Important)
Answer: the mother should be allowed to hold the baby.
118. A male patient is recently diagnosed with HIV. Should the doctor ask about his sexual orientation (i.e., male, female, or both)? (Important)
Answer: yes, the doctor should ask the patient directly but politely about his sexual orientation.
119. A homosexual male patient went to a doctor. The patient™s partner was recently diagnosed with HIV. Should the doctor ask the patient whether his partner is penetrating him or he penetrates his partner?
Answer: yes, because the person who is being penetrated has a higher incidence of HIV due to trauma in perianal area.
120. A 6-year old boy comes to the ER after drowning. He expired in the ER despite appropriate resuscitations. The family members became angry which is a reflection of a sense if guilt and helplessness. What is the appropriate way of giving information to the family members?
Answer: the physician should give the information clearly and compassionately when there is no hope for survival. Parents need to know that everything was done to save the child.
121. A pregnant woman who is Rh (-) ve became sensitized. She had H/O induced abortions. Her husband is not aware of his wife™s previous abortions. He wants to know from the physician how she became sensitized. (Very Important)
Answer: the physician should tell the man to ask his wife. The physician should not mention anything about the patient™s H/O abortions.
122. A mother brought her infant to the ER. The radiologist test reveals old fractures of the ribs. She did not know anything about that. (Very Important)
Answer: this is a case of child abuse. This case should be reported to child welfare agency.
123. A physician is examining a child with respiratory distress. The child™s mother became anxious during the physical examination. Please remember, a patient™s management should be discussed with his/her parents and the decision made with the best interest of the patient in mind. (Important)
Answer: child abuse.
124. A mentally retarded patient became pregnant. The patient does not want an abortion. Her mother and husband want an abortion. What should a physician do in this situation? (Important)
Answer: abortion should not be performed.
BCUZ SHE IS COMPETENT UNLESS PROVED OTHERWISE
125. A male physician is examining an adolescent or adult female patient. What should a physician do in this situation? (Important)
Answer: a chaperone should be present during the physical examination. The same rules apply when a physician is examining a patient who appears to be seductive. (Important)
126. A female physician is examining an adolescent or adult male patient. What should a physician do in this situation? (Important)
Answer: a chaperone should not be present during the physical exam.
127. A suspected HIV patient expired in a car accident. He signed for organ donations. What
should a physician do in this situation?
Answer: his HIV status is not certain. The organs can be preserved until the HIV status is confirmed. If the test for HIV is positive, organs should be discarded.
128. A patient who expired in a car accident signed in his license for organ donations. His license has expired. He always wanted to donate his organs. What should a physician do in this situation? (Important)
Answer: physician cannot accept organs because the signed consent has expired.
ASK FAMILY MEMBERS ABOUT WISHES OF THE PT IF HE WANTED TO DONATE ORGANS.JUST AHVING AN ORGAN DONOR CARD DOESNT TELL PT INTENT.MAY BE HE SHUD HAVE DONE TO SHOW OFF OR GET A BONUS OR FORCRD BY SOMEONE.EVEN IF DONOR CARD HAD NOT EXPIRED AND FAMILY UNANAMOUSLY SAID THAT PT DIDNT WANTED TO DONATE ORGANS DONOT ACCEPT ORGANS FOR TRANSPLANT
129. A male physician sexually harassed a female patient during the physical examination. The patient complained to a nurse. What should the nurse do in this situation?
Answer: the nurse should tell the patient to make an official report to the hospital authority or to an appropriate agency.
130. A chronic male smoker comes to the physician for his heart problems. The physician wanted his patient to quit smoking. What should the physician advise in this situation?
Answer: the physician should ask the patient to quit smoking immediately because patients are usually more responsive when they are ill. The physician should assist the smoker to move one step closer to quitting.
131. A terminally ill patient did not sign a DNR (do not resuscitate) order, however, he signed a DNI (do not intubate) order. What should the physician do in this situation?
Answer: the physician should follow his orders i.e., the patient should be resuscitated but should not be intubated, despite severe hypoxic condition of the patient.
132. A terminally ill patient signed a DNR order, however, he did not sign a DNI (do not intubate) order. He wants to be intubated but not resuscitated. What should a physician do in this situation?
Answer: the physician should follow his orders i.e., the patient should be intubated but should not be resuscitated.
133. An adolescent car accident victim was brought to the ER in an unconscious state. The patient needs immediate surgical interventions. The surgeon was unable to contact any family member to obtain consent. What should a surgeon do in this situation? (Important)
Answer: the surgeon should do the procedure without waiting to obtain consent for the benefit of the patient.
134. An obgyn doctor is recently diagnosed with HIV infection. He is receiving medication for HIV. His physical and mental conditions are normal. Should he tell his patients or fellow physicians about his HIV status?
Answer: no, however, the doctor should take appropriate precautions for infection control. He does not have to tell his fellow physicians about his HIV status including the physicians who are referring patients to him. The doctor is allowed to see patients if he takes appropriate precautions. However, he should notify the hospital authority.
135. A physician is scared of seeing an HIV patient with an open wound. Can a physician refuse to see a patient?
Answer: yes, however, a physician™s refusal to see a patient is unethical but is legal.
136. An elderly semi comatose patient may require surgical intervention. His family members are confused about the surgery. They asked the surgeon for his opinion. What should the surgeon™s response be?
Answer: the surgeon can give his opinion and act as a moral surrogate for the benefit of the patient. (Very Important)
137. A 12-year old boy is diagnosed with a terminal illness (e.g., malignancy). He asked the doctor about his prognosis. His parents requested the doctor not to tell him the bad news. What should the doctor do in this situation? (Very Important)
Answer: the doctor should tell the truth politely and compassionately to the patient.
YES TOTALYY CORRECT CHILD NEEDS TO BE BE TOLD OF HIS TERMINAL ILLNESS IF HE CAN UNDERSTAND THE SITUATION AND IRREVERSIBILTY OF DEATH.TRY TO CONVINCE PARENTS FIRST.
138. A 55-year old woman is recently diagnosed with right breast cancer. The doctor told the patient that she would require surgery for removal of the right breast. She started to cry. What should a doctor do in this situation?
Answer: first, the doctor should give her some tissue paper for wiping her tears. Then, the doctor should be sympathetic to her and console her. He might tell her that similar reactions are usually expected from other patients with breast cancer. Please do not mention that she will be fine with a breast implant or without a right breast because she is already 55-years old.
139. A mother is carrying a 500 gram premature fetus, which develops acute fetal distress. The physician wanted to perform a cesarean section. Mother refused cesarean section. What should the doctor do in this situation?
Answer: the physician should arrange a bedside conference with the mother along with other physicians, social worker, and administrator to discuss the matter.
0 - ArchivalUser - 09-21-2008
AUTOSOMAL RECESSIVE DIS
Mnemonic: Police Commissioner of STATe Had Problem Getting PR(Permanent Residence) for Pigmented Hypothyroid Dwarf uncle Wilson
P-Phenyl Ketonuria
C-Cystic fibrosis
S-Sickle cell anemia
T-Tay Sachs( & all other lysosomal storage disorders except hunter™s & Fabry™s which r XLR)
A-Albinism
T-thalassemia
H-Hemochromatosis
Hepatolenticular degeneration
P-Pyruvate kinase deficiency
G-Galactosemia
-Glycogen storage disorders (All)
P-Polycyctic Kidney (Juvenile)
-Premature senility
R-Retinitis pigmentosa
Pigmented-Xeroderma pigmentosum
Hypthyroidism
Dwarf-Dwarfism
Uncle Wilson-Wilson™s disease
Most of the enzyme def. disorders are AR..except for few like G6PD def,Fabry's,Hunter's , which are XLR
0 - ArchivalUser - 09-21-2008
#1356034
silva - 06/20/08 16:51
gojan audio
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