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doubts!!!!!!!! - cs_78
#1
can anyone please tell me what the answers are and why they are the ans's....

(1) 2mnth old boy has 6wk h/o diarhea and vomiting esp. after formula feeds. he has a 113grams weight loss since birth and currently weighs 3.1kg and ht is 51cm. he appears irritable and o/e jaundice+, lungs-nrml, cvs-nrml. liver- is palpable 2-3cms below the costal margin and spleen 1-2 cms below the costal margin. serum glucose- 35mg/dl, bilirubin (total) is 2.3mg/dl. urine glucose- negative, urine reducing sub's 3+. MOST LIKELY MECHANISM?
A- DECREASED GLUCONEOGENESIS
B- INCREASED "
C- INCREASED GLUCAGON SECRETION
D- INCREASED INSULIN SECRETION
E- DECREASED "
F- INSULIN RESISTANCE

(2) 28 yr old female develops arthopnea and fatigue 3wks afetr normal delivery. BP and pulse normal. crackles heard at both lung bases. the point of max. impulse is laterally displaced and diffuse. S3+. there is 2+ pedal edema. chest x-ray- vascular cephalization of pulm vasculature and kerly b lines. most appropriate next step?
A- MEASURE CKMB AND LDH
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#2
sorry the choices for the second q are:

A- MEASURE CK-MB AND LDH
B- ECHO
C- DIPYRIDAMOLE THALLIUM SCAN
D- V/Q SCAN
E- MYOCARDIAL BIOPSY
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#3
http://usmleforum.com/forum/message.php?id=69658

2.D.?
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#4
these are q's from NBME-2. so i don't know the answers..... could anyone tell me the reason also why they consider an answer.
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#5
1. galactosemia.....increased gluconeogenesis????

2. echo
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#6
galactosemia will have hypoglycemia, how can the gluconeogenesis be the reason? Decrease gluconeogenesis should be.
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#7
i too thought of ECHO and INCREASED GLUCONEOGENESIS.... coz due to hypoglycemia... there will be increased glucagon and decreased insulin. when insulin/glucagon ratio decreases.. there will be gluconeogenesis.... that's what i thought. any suggestions?????
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#8
hey! i'm sorry..... just did a massive search. the gluconeogenesis in galactosemia ia actually reduced.... coz gluconeogenesis requires ATP and in galactosemia.... most of the inorganic phosphate gets trapped as galactose-1-p.... therefore decreased gluconeogenesis.
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