nbme 16 questions and answers graded A+
20 yo woman with 8 yr hx of intermittent HA's, flashing lights in right visual field, f/by unilateral THROBBING headache with NAUSEA, vomiting, with menses - answer MIGRAINE HA-rmbr "POUND"--Pulsatile, One-day duration, Unilateral, Nausea, Disabling. pulsating pain with N/photophobia/phonophobia/aura. Avoid TYRAMINE-
containing products
intense periorbital pain, tears, rhinorrhea, smoker, for 15 mins-3 hours - answer Repetitive brief HA',s Excruciating periorbital pain with lacrimation and rhinorrhia. may induce Horner syndrome, mc in males/smoker, band around head. Tx" inhaled Oxygen, sumatriptan
80 yo old woman fracture of femur given morphine, soon her resp's are 6/min, has PINPOINT pupils, serum Cr is 1.8mg/dL, best explan of intoxication in pt? - answer morphine is metabolized to active metabolites that accumulate, she is having renal failure possibly, PINPOINt suggests intoxication.
child, with infection that has sickle cell anemia, given prophylaxis with PCN, what is the mcc? - answer streptococcus pneumoniae is the mcc of sepsis in sickle cell patients and splenectomy!
bulimia nervosa patient treatment? - answer cognitive behavioral therapy + FLUOXETINE (ssri)
stabbing pain noticed after shaving, pain is reproduced upon touching lateral nasal ala, nerve supplying this region exits where in the skull? - answer FORAMEN ROTUNDUM--V2--trigeminal neuralgia
chemotherapy regimen for 55 yr old w non hodgkin lymphoma is vinblastine. normal function of which cells and tissues resistant to this agent? - answer VENTRICULAR CARDIAC MUSCLE CELLS---vinblastine attacks rapidly dividing cells so since heart cells don't divide, and is a PERMANENT CELL 9neurons, skeletal, cardiac m, Rbc's). all
other cells divide.
child with 6 month history of difficulty walking and leg pain, has mild atrophy of LE''s, hammer toes, high stepping gait, cause? - answer absence of MYELIN SHEATHS, this is charcot-marie tooth dx. hereditary MOTOR & SENSORY neuropathy, also see foot drop/scoliosis/high or flat arches. defective prodcution of proteins involved in stx/fxn
of periph nerves or myelin sheath
HCM, spinocerebellar degeneration specifically DC's (spinal ataxia), kyphoscoliosis, DM, hammer toes - answer Friedreich ataxia--initial loss of sensory (DRG), with accompanying gait ataxia, hammer toes, AR, HCM(mc of death and bulbar dyxfunction, unable to protect airway), impairment of mit functioning
loss of DTR's, vibratory sense, proprioception, staggering gait, freq falling, nystagmus, dysarthria, pes cavus, HCM, - answer Friedreich ataxia
dec frataxin, GAA repeats, similar to VIT E deficiency,child 5-15 yo - answer friederich ataxia
16 yo boy dives into shallow pool that is 3 feet deep, unable to move RIGHT upper and lower extremities, where is the lesion? - answer lesion is at the lateral corticospinal tract (CST), if lesion in the SC--always motor deficit--IPSIlateral. so here, RT sided paresis due to right side lesion.
19 yr old girl withdrawn and isolated, uninterest, very anxious and depressed by listening to radio that only she can hear. thinks about a government scheme to control the psychic pain people feel. she's disheveled and malodorous. normal vital signs no abnormalities. mentally she's distracted. she has sad mood and anxious, sad, blunted affect. best therapy? - answer patient has Schizophrenia--treat with antipsychotic--
risperidone
previously healthy 52 yo F, 2 mo hx of progressive difficulty swallowing, double vision, and slurred speech., ptosis of the eyelids and waddling gait. muscle strength shows fatigable weakness of the neck, arms, hands, and fingers. Repetitive nerve stimulation shows a 25% decrease in muscle action potentials in several muscles. Which of the following mechanisms is the most likely cause of this patients disease? - answer BINDING OF AUTOAb to ACH receptor BY AN ANTIBODY--myasthenia gravis
PREV HEALTHY, young adult male, hears voices in head for 2 men for the past 2 weeks, is afraid of physician when seen - answer BRIEF, PSCYHOTOIC DISORDER, usually lasts <1 month, SUDDEN onset,
woman with progressive m. wkness and difficulty walking for 3 months, loss of Patella and achilles tendon reflexes, wkness and DECREASED muscle bulk, sensations of joint/position/pain/temp are normal. cause? - answer DEGENERATION OF MOTORNEURONS OF LUMBAR CORD---either ALS or poliomyelitis, patient is presenting with LMN lesion, desruction of Anterior horn
sudden onset severe headache, right pupil is 6mm, nonreactive to light, impaired adduction, nuchal rigidity, aneurysm to what artery? - answer Pcom---posterior communicating artery rupture--The aneurysm pressed on the oculomotor nerve and Trochlear Nerve. The eye is blow bc the right thing to be lost on oculomotor compression is parasympathetics then the motor. The eye can't adduct bc Superior oblique helps with adduction thats why its difficult for people with this paralysis to go down stairs they can't look medial and down. 21 yr old, 2 week hx of refractory back pain from MVA, asks for more opiods to manage pain, phys exam shows no abnormilites, correct response? - answer Determine which drugs have been prescribed for the patient in the past, want to give a nonjudgmental response.
65-yo F, 3mo hx of HA, wknss of her arms, and left flank pain; wt loss, Physical examination shows weakness of the proximal upper and lower extremity muscles. There
is augmentation of strength with repetitive testing of the deltoid muscles. An MRI of the brain shows a single well-demarcated mass surrounded by edema in the right frontal lobe. A stereotactic biopsy specimen of the lesion shows a malignant, small blue cell neoplasm that expresses citokeratin, chromogranin, and synaptophysin. - answer Pulmonary small cell carcinoma metastatic to the brain--50% of adult brain cancers are mets, and the augmentation of muscle strength with repeated testing suggests lambert eaton, so small cell lung cancer metastasis
female, motor vehicle accident, symptoms of meningitis , spleen removed? - answer Older asplenic person with meningitis --> knee jerk streptococcus pneumoniae
breast cancer patient, develops increased numbness and tingling of hands and feet during chemotherapy intervals, which drug caused it? - answer Vincristine--
mechanism--microtubules for axonal transport
79 year old sustained hip fracture, gardener, wine with dinner every night, what would help to decrease risk for additional fractures? - answer WALK DAILY
76 year old lives in california, takes beta blocker for HTN, painful swelling of right big toe, drinks homemade distilled liquor, textile factory, what is the most likely cause? - answer drinking from home-distilled liquor.--CHRONIC ALCOHOL ABUSE--is a risk factor for 2nd gout
8 year old with breast bud development and few pubic hairs, mothers asks about this, appropriate response? - answer this is NORMAL development--tanner stage II (pubarche--pubic hair appears),
70 yo man, wife recently died, difficulty sleeping/cries, enjoys grandchildren visits/bowling. No other depressive sx/suicidal ideation. - answer schedule appts to monitor patient;
CF patient with weakness, numbness and tingling for 3 wks, and difficulty walking, not adherent to medication for past 6 mo's, bilat wkness and dec tendon reflexes in UE and LE, ataxic gait, which vitamin is the cause? - answer VITAMIN E!!!!
poliovirus lacks 5"mCAP, yet is still translated? why? - answer no cap-->still translated because of PRESENCE OF INTERNAL RIBOSOME ENTRY SITE--located in the 5'UTR (untranslated region).
