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NBME 19 Block 1 discussion - martini11
#41
Q1
A 10 yo girl is brought to the physician because of a 1day history of pain and swelling of her right index finger. Her tenperature 37.5℃,. Examination of the right hand show a tender, erythematous, edematous index finger with an intact wooden splinter embedded in the soft tissue. A white exudate is found in the lesion during removal of the splinter. This material is predominantly composed of which of the following type of cells?
a) Basophilis
b) Eosinophils
c) Lymphocyte
d) Monocyte
e) Meutrophils c) was wrong

Q2
2 member of a hiking club that recently returned from a 5days hike in Arizona develop an infection and require hospitalization. The infection is characterized by the sudden onsest of fever, chills, weakness, and headache, followed by the development of unilateral intensely tender lymphadenopathy in the groin. A gram stain of fluid taken fron a lympho node show gram(-) cocobacill. Which of folllowing is the most causal organism?
a) Cryptococcus neoformas
b) Flavivirus
c)Plasmodium falciparum
d) Vivrio cholerae
e) Yersinia pestis c) was wrong

Q3
During a period of 24 hours, a 25yo mad has an upper respiratory infection with feature of common cold. Which of the following viral or host factor is most critical in the initial establishment of the infection?
a) Activation of latent virus within epithelial cells.
b) Inhibition of inflammatory mediators.
c) Inhibition of synthesis of IgA antibody
d) Lysis of CD8 T lymphocyte
e) Presence of viral receptor molecules on epithelial cells. a) was wrong
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#42
Q4
In the diagram of proximal renal tubular epithelium, the labeled arrow denote pathway and mechanism of net movement of water or soluters, Which of the following letters of the pathway best describe the transepithelial transpoter of water?
c) no carrier, free passing
d) require both carriers not requiring energy and carrier requireing energy
e) require carriers not requiring energy

Q5
A 62-year-old woman comes to the physician for follow-up care of cramping abdominal pain and constipation for 3 months. Treatment with simethicone has provided some relief of symptoms She also has had a 9kg (20-lb) weight loss increasing fatigabilty and a need for more sleep. Endoscopy, colonoscopy, and a CT scan of the abdomen showed no abnormalities 1 month ago She believes her difficulty sleeping is due to worries about her son who has been using drugs during the past few months. Over the past 3 weeks, she began to􀀁 that she has cancer and will never get better. Vital signs are stable. Physical examination shows mild, diffuse abdominal tenderness. She is not anemic, and all other laboratory findings are within reference􀀁ranges. Which of the following initial actions by the physician is most appropriate?
A) Evaluation of the patient for major depressive disorder
B) Increase in the amount of dietary fiber
C) Barium enema
D) Repeat CT scan
E) Repeat colonoscopy E) was wrhong

Q6
A 2-year-old boy is brought to the physician because of fever and cough for 2 days. He has had two episodes of Streptococcus pneumoniae bacteremia and multiple ear and sinus infections since birth. His temperature is 38.4° C (101.1 °F}. Physical examination shows no tonsillar tissue. Crackles are heard in the right lower lobe of the lung Which of the following is the most likely immunodeficiency syndrome in this patient?
A} Bruton agammaglobulinemia
B} Chediak-Higashi syndrome
C} Chronic granulomatous disease
D} DiGeorge syndrome
E} lgG2 deficiency
F} Isolated lgA deficiency D) was wrong

Q7
A 22-year-old man gets separated from a group of friends while hiking He becomes lost and it is several days before he is rescued. He survives by eating plants; however, one of the plants causes him to develop nause and vomiting. The mechanism that precipitate his yomitting most likely involves signaling in which of the following structures?
A) Area postrema
B) Median eminence
C) Organ um vasculosum of the lamina terminalis
D) Pineal gland
E) Subcommissural organ B) was wrong

Q8
Oral fluid therapy is commonly used in developing countries to treat diarrhea caused by Vibrio cholerae. These fluids benefit patients with cholera primarily by stimulating activity of which of the following labeled membrane transport mechanisms?
a) K+
b) Na+
c) Na+ and Glucose
d) Na+, H+ exchange
e) Cl-, HCO3+ exchange
f) Cl-
g) Na+, H2O b) was wrong
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#43
Q9
A man with a fair complexion develops an ulcerated nodule on his face after prolonged exposure to sunlight. Examination of tissue obtained on excision of the nodule shows invasive squamous carcinoma. Which of the following type of DNA damage is most likely responsible for this lesion?
• A) Base sequence rearrangements
B) Double-strand breaks
C) lnterstrand cross-links
D) Pyrimidine dimers
E) Single-strand breaks

Q10
A 65-year-old woman in the terminal stage of breast cancer needs an analgesic for severe pain Dose-response curves of Drugs A-E are shown in the graph Which of the following labeled analgesics would be most efficacious in alleviating this patient`s pain?

picture

Q11
An 11-Y-old boy has ha:a pain in his right mid-thigh for 2 weeks. Physical examination shows an area of warmth and tenderness around an ill-defined mass. X-ray of the femur shows a solitary mid-diaphyseal osteolytic lesion with permeative margins The lesion is surrounded by concentric layers of reactive bone. Tissue obtained on biopsy of the mass is composed of poorly differentiated sheets of small, uniform. hyperchromatic cells with a very_ high nuclear cytoplasmic ratio, scant stroma, and no visible matrix. Which of the following is the most likely diagnosis?
A) Chondrosarcoma
B) Eosinophilic granuloma
C) Ewing sarcoma
D) Multiple myeloma
E) Nephroblastoma (Wilms tumor)
• F) Osteosarcoma
G) Small lymphocytic lymphoma

Q12
A 20-year-old man is brought to the emergency department 30 minutes after being involved in a motorcycle collision. Physical examination shows severe contusions on the chest and abd. He has an unsteady gait and slurred speech. The patient is admitted to the hospital for observation for possible damage to the spleen By the third night, he becomes.restless and begins having generalized tonic-clonic seizures. The diagnosis of substance withdrawal ls made. Which of the following best describes the patient's substance withdrawal and the immediate treatmerit required?
Withdrawal/Medication
A) Buspirone /lorazepam
B) Cocaine / haloperidol
C) Ethanol /diazepam
D) Heroin /naloxone
E) t.9-THC/phenytoin
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#44
Q13
A sedentary 50-year-old woman comes to the physician because of decreased energy for several months. She states that she has not seen a physician in years because she does not trust doctors. She says, "But I just turned 50, so I thought I'd get myself checked out" She has smoked one-half pack of cigarettes daily for 33 years. She is 163 cm (5 ft 4 in) tall and weighs 86 kg (189 lb); BMI is 33 kg/m2 Her blood pressure is 148/92 mm Hg. Breath sounds are decreased and mildly tubular on auscultation. Cardiac examination shows a laterally displaced point of maximal impulse There is trace pedal edema. Serum studies show a fasting glucose concentration of 122 mg/dl, total cholesterol concentration of 238 mg/dl, and HDL-cholesterol concentration of 31 mg/dL An ECG suggests left ventricular hypertrophy. It is most appropriate for the physician to primary focus on which of the following for the first several visits?
A) Control of her hypertension
B) Establishing a therapeutic alliance with the patient
C) Evaluation and treatment of chronic obstructive pulmonary disease
• D) Recommendation of smoking cessation
E) Treatment of her hyperlipidemia

Q14
A patient in the early stages of hemorrhagic shock is most likely to have which of the following?
A) Decreased ventilatory rate due to inhibition of the respiratory center
B) Flushing due to cutaneous vasodilation that occurs secondary to sweating
• C) Increased renal blood flow due to sympathetic activation
D) Sweating due to parasympathetic stimulation of sweat glands
E) A weak pulse due to decreased stroke volume

Q15
A 40-year-old woman who had pneumonia due to Streptococcus pneumoniae 6 montlhs ago comes to the physician for a follow-up examination. X-rays of the chest show no abnormalities. Which of the following is produced by the cell type most likely responsible for the restitution of near-normal lung structure?
A) Factor VI II (antihemophilic factor)
B) Histamine
• C) P-selectin
D) Surfactant
E) Type I collagen

Q16
An investigator is developing a new drug that is designed to stimulate epithelial cell turnover in the small intestine. To be successful, this drug must target which of the following structures?
A) Crypt cells
B) Folds of Kerckring
C) Goblet cells
• D) Mature enterocytes
E) Microvilli
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#45
Q17
33. A 60-year-old man with congestive heart failure develops bacterial bronchopneumonia while in the intensive care unit He responds to appropriate antibiotic therapy, but 3 days after the initiation of treatment, he develops a maculopappular rash over the extremities, with central vesicles and bullae having a targetoid appearance. A biopsy specimen of the rash shows subepidennal blisters and degeneration of the basal cell layer, keratinocyte necrosis, and lymphocytic infiltration at the dermal/epidermal junction. Which of the following is the most likely diagnosis?
A) Contact dermatitis
B) Erythema multiforme
C) Impetigo
• D) Stapflylococcus aureus infection
E) Urticaria

Q18
A 41-year-old woman at 34 weeks' gestatign, undergoes an amniocentesis because of uncontrolled hypertension. Amniotic fluid shows a decreased lecithin-to-sphingomyelin ratip of 1.5:1 (N=3:1). If the newborn is born at this time, which of the following pulmonary findings is most likely to develop in the newborn during thefirst 48 hours after delivery?
A) Decreased airway resistance
B) Decreased functional residual capacity
C) Decreased respiratory rate
• D) Increased static lung compliance
E) Increased total lung capacity

Q19
The following bloodgas' values are measured in a resting patient. These values are most consistent with which of the following?

Arterial Po, 96 mm Hg
Arterial Pco, 40 mm Hg
Arterial O2 content, 12.0 vol% (N=20)
Mixed venous PO2 ,36 mm Hg (N=40)
Mixed venous O2􀀁conten, 8.0 vol% (N=15)

A) Anemia
B) Drug-induced alveolar hypoventilation
• C) Residence at high altitude
D) Severe regional mismatching of alveolar ventilation and pulmonary capillary perfusion
E) Voluntary hyperventilation

Q20
An investigator studying spermatogenesis introduces a chemical that disrupts tight junctions between adjacent cells into the testes of experimental animals. The animals later develop an autoimmune response to products of germ cell divjsion that have entered the circulation. Tight junction have been disrupted between which of the following cells in these animals?
A) Capillary endothelium
• B) Early spermatids
C) Fibroblasts
D) Leydig
E) Sertoli
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#46
Q21
A newborn is delivered at term to a 40-year-old primigravid woman. Chorionic villus sampling at 15 weeks' gestation was done, and results of chromosomal analysis showed a male fetus. Physical examination shows femal external genitalia and absent internal genitalia. Further tests are most likely to determine that this child has a mutation preventing responses to which of the following hormones?
A) Estrogen
B) Follicle-stimulating hormone
C) Luteinizing hormone
• D) Mlillerian-inhibiting hormone
E) Testosterone2

Q22
One year ago, a,15-year-old girl received a bone marrow transplant following a relapse of acute myelogenous leukemia. She now has a karyotype of 46 XY The results of the karyotyping are most likely due to which of the following?
• A) Male pseudohermaphroditism
B) Nonautologous donor
C) Relapse of acute myelogenous leukemia
D) Total body irradiation-induced aberration
E) Underlying myelodysplasia

Q23
The graph shows the rate of breakdown of skeletal muscle glycogen by phosphorylase in the presence and absence of AMP. Based on the data, which of the following best describes the action of AMP?
A) Allosteric activator
B) Allosteric inhibitor
• C) Catabolite activator
D) Catabolite repressor
E) Covalent modifier of the enzyme
F) Covalent modifier of phosphorylase kinase

Q24
A schematic representation of eukaryotic translation is shown in the diagram. Only a portion of the mRNA is shown, and each separately colored segment represents a sense codon. Which of the following processes is the most likely next step in this reaction?
A) Binding of aminoacyl-tRNA to the A site
B) Hydrolysis of the peptide chain from the P site
C) Interaction of elF-4e with the A site
D) Peptidyl transfer to the E site
• E) Translocation of the peptidyl-tRNA from the P site to the A site
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#47
@mimimi
1 e
2 e
3 e
4 c
5 a
6 a
7 a
8 c
9 d
10 it would be the tallest curve
11 c
12c
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#48
13 b
14 don't know
15 d
16 a
17 b
18 b
19 a
20 e
21 e
22 b
23 a
24 a
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#49
Thank you, robin584
would you explain more ditail in
Q1, 7, 18, 20,23, 24? thanks.
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#50
@mimimi
1 white exudate = pus, which contains dead neutrophil

7 area postrema no BBB see fa 2017 p466

18 dec L:S ratio -> dec surfactant -> more tendency to collapse -> dec frc ( i reasoned this way, may have different explanation.)

20 fa 2017 p594

23 so with the AMP the km value goes down meaning AMP is an activator of the enzyme then i excluded other options such as catabolite activator which is involved in gene transcription and covalent modifier doesn't tell whether its an activator or inhibitor. ( it was a lucky guess)

24 the a site was empty so to continued prot synth aminoacyl t rna must come to a site.
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