04-08-2012, 12:46 PM
I've given NBME13 online, have some wrong answers.
If anyone can help in finding the right answer that will be great.
1.40yr man brought ER:1 hr h/o sudden severe pain while playing tennis.found ruptured left Achilis tendon
&undergo repair & long cast immobilization.6m later, left calf 2cm dec,most likely cause?
a. dec glycogen synth
b. dec myosin light chain Phosphatase activity
c. inc phosphatidyl degradation
d. inc prot degradation
e. mitochondrial damage
f. necrosis of muscle fiber
2. An otherwise healthy 23 yr old woman comes to the physician becasue she has not had a menstrual period for 2 months. Menarche occurred at the age of 14 yrs and menses had occurred at regular 28 days intervals. Pelvic exam shows blue tinged varginal mucosa. The uterus is somewhat soft in the lower segment and is about the size of an orange. The adnexa are nontender with normal-sized ovaries. Which of the following is the most appropriate next step to establish the diagnosis
A) Measurement of serum follicle-stimulating hormone concentration
b) Measurement of serum thyroid-stimulating hormone concentration
c) Measurement of urine B(Beta)-human chorionic gonadotropin concentration
d) Ultrasonography of the pelvis
e) Endometrial biopsy
3. A 63 yr old comes to ER 30 min after the sudden onset of right sided chest pain and shortness of breath that began after a 10 hr drive in his truck. The pain is more severe with inspiration. He does not smoke cigarettes. His pulse is 110/min and respirations are 32/min. The lungs are clear to auscultation. Which of the following findings is most likely on ventilation-perfusion lung scans ?
a) Absence of perfusion is some areas that are ventilated
b) Absence of ventilation in some areas that are perfused
c) Absence of ventilation-perfusion mismatching
d) Decreased perfusion gradient from the apices to the bases of the lungs
e) Increased ventilation-perfusion ratios at lung bases compared with those at the apices
4. A 3 yr old boy with a history of unexplained fever, lack of perspiration, absense of response to noxious stimuli, and self-multilating behavior is diagnosed with congenital insensitivity to pain with anhidrosis. Genetic analysis shows a missense mutation of the tyrosine kinase domain of the TrkA gene. Assuming this is the only signaling defect in this patient, which of the the following processes has most likely been disrupted?
a) Binding of nerve growth factor to its receptor.
b) Formation of TrkA homodimer in response to nerve growth factor
c) Phosphorylation of downstream molecules in response to nerve growth factor
d) Retrograde transport of nerve growth factor from nerve terminals
e) Synthesis of nerve growth factor
5. A 22 year old woman comes to physician 3 months after she noticed a painless, showly enlarging mass on the left side of her neck. Physical exam shows a freely mobile, soft, cystic mass with a cutaneous surface opening. The physician explains that it is from incomplete fusion during embryonic development. Which of the following is the most likely location of the opening of the duct leading to the mass on this patient
a) Anterior to the stermocleidomastoid muscle
b) midline on the neck
c) postauricular
d) posterior to the parotid gland
e) Submental
6. A 42 yr old man has an autoimmune disorder resulting in proximal muscle weakness of the lower extremities. Arrows in the photomicrograph shown indicated membranes that contain high concentrations of channels that are targeted by this condition. Which of the following is the most likely diagnosis?
a) A multiple sclerosis
b) myasthenia gravis
c) Myasthenic (Lambert-Eaton) syndrome
d) Periodic paralysis
e) Tetany
7. A 15 tr boy is broght to the physician because of painless swelling in his left breast for 1 month. There is no family history of breast cancer. He is at the 65th percentile for height and 70th percentile for weight. His pulse is 65/min and blood pressure is 118/76 mm Hg. Physical exam shows mild facial acne, thickening of mustache hair on the face and the presence of axillary hair. The is no adenopathy. The left breast appears mildly enlarged with a palpable breast bud; the right breast is normal with no gynecomastia. His genitalia are Tanner stage 3. Which of the following is the most appropriate initial statement by the physician regarding this patient's breast finding ?
a) Have you tried smoking marijuana recently. That has been known to cause breast enlargement
b) Some teenagers experiment with their parents prescription drugs, even birth control pill. Are you?
c) This is a common condition for teenage boys and should resolve in time
d) this may be a sign of a chromosomal problem. We need to do some genetic testing.
e) This may be a sign of a more serious condition. We will have to do more tests to be sure.
If anyone can help in finding the right answer that will be great.
1.40yr man brought ER:1 hr h/o sudden severe pain while playing tennis.found ruptured left Achilis tendon
&undergo repair & long cast immobilization.6m later, left calf 2cm dec,most likely cause?
a. dec glycogen synth
b. dec myosin light chain Phosphatase activity
c. inc phosphatidyl degradation
d. inc prot degradation
e. mitochondrial damage
f. necrosis of muscle fiber
2. An otherwise healthy 23 yr old woman comes to the physician becasue she has not had a menstrual period for 2 months. Menarche occurred at the age of 14 yrs and menses had occurred at regular 28 days intervals. Pelvic exam shows blue tinged varginal mucosa. The uterus is somewhat soft in the lower segment and is about the size of an orange. The adnexa are nontender with normal-sized ovaries. Which of the following is the most appropriate next step to establish the diagnosis
A) Measurement of serum follicle-stimulating hormone concentration
b) Measurement of serum thyroid-stimulating hormone concentration
c) Measurement of urine B(Beta)-human chorionic gonadotropin concentration
d) Ultrasonography of the pelvis
e) Endometrial biopsy
3. A 63 yr old comes to ER 30 min after the sudden onset of right sided chest pain and shortness of breath that began after a 10 hr drive in his truck. The pain is more severe with inspiration. He does not smoke cigarettes. His pulse is 110/min and respirations are 32/min. The lungs are clear to auscultation. Which of the following findings is most likely on ventilation-perfusion lung scans ?
a) Absence of perfusion is some areas that are ventilated
b) Absence of ventilation in some areas that are perfused
c) Absence of ventilation-perfusion mismatching
d) Decreased perfusion gradient from the apices to the bases of the lungs
e) Increased ventilation-perfusion ratios at lung bases compared with those at the apices
4. A 3 yr old boy with a history of unexplained fever, lack of perspiration, absense of response to noxious stimuli, and self-multilating behavior is diagnosed with congenital insensitivity to pain with anhidrosis. Genetic analysis shows a missense mutation of the tyrosine kinase domain of the TrkA gene. Assuming this is the only signaling defect in this patient, which of the the following processes has most likely been disrupted?
a) Binding of nerve growth factor to its receptor.
b) Formation of TrkA homodimer in response to nerve growth factor
c) Phosphorylation of downstream molecules in response to nerve growth factor
d) Retrograde transport of nerve growth factor from nerve terminals
e) Synthesis of nerve growth factor
5. A 22 year old woman comes to physician 3 months after she noticed a painless, showly enlarging mass on the left side of her neck. Physical exam shows a freely mobile, soft, cystic mass with a cutaneous surface opening. The physician explains that it is from incomplete fusion during embryonic development. Which of the following is the most likely location of the opening of the duct leading to the mass on this patient
a) Anterior to the stermocleidomastoid muscle
b) midline on the neck
c) postauricular
d) posterior to the parotid gland
e) Submental
6. A 42 yr old man has an autoimmune disorder resulting in proximal muscle weakness of the lower extremities. Arrows in the photomicrograph shown indicated membranes that contain high concentrations of channels that are targeted by this condition. Which of the following is the most likely diagnosis?
a) A multiple sclerosis
b) myasthenia gravis
c) Myasthenic (Lambert-Eaton) syndrome
d) Periodic paralysis
e) Tetany
7. A 15 tr boy is broght to the physician because of painless swelling in his left breast for 1 month. There is no family history of breast cancer. He is at the 65th percentile for height and 70th percentile for weight. His pulse is 65/min and blood pressure is 118/76 mm Hg. Physical exam shows mild facial acne, thickening of mustache hair on the face and the presence of axillary hair. The is no adenopathy. The left breast appears mildly enlarged with a palpable breast bud; the right breast is normal with no gynecomastia. His genitalia are Tanner stage 3. Which of the following is the most appropriate initial statement by the physician regarding this patient's breast finding ?
a) Have you tried smoking marijuana recently. That has been known to cause breast enlargement
b) Some teenagers experiment with their parents prescription drugs, even birth control pill. Are you?
c) This is a common condition for teenage boys and should resolve in time
d) this may be a sign of a chromosomal problem. We need to do some genetic testing.
e) This may be a sign of a more serious condition. We will have to do more tests to be sure.
