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Recent contributions!
... pgayed made a comment on nbme19#4 (66 yo man, 2 months no erection)

 +13  upvote downvote
submitted by pgayed

Inability to maintain an erection = erectile dysfunction. So now the question is "Why?"

Fatigue, difficulty sleeping, difficulty concentrating is starting to sound like depression. "Difficulty concentrating" might be interpreted as impaired executive function or the beginnings of vascular-related dementia (dementia related to small but numerous cerebral infarcts), but on Step 1 dementia will be blatant (i.e., "lost his way home," "wandering," etc.).

Depression is actually common after a debilitating event like stroke, as you might expect. With depression comes a loss of sexual interest and desire—that is decreased libido.

One can make the argument that a "vascular patient" might have some issues with his "pipes" (arteriosclerosis, parasympathetic/sympathetic dysfunction) and, for this reason, nocturnal erection should be decreased; but note that nothing is mentioned about long-standing vascular disease (no hx of hypertension).

As a result, the best answer choice here is C. (Libido decreased but nocturnal erections normal.) The big question I have is, how the heck does this guy know he's hard when he's asleep!!? :p

... mtthwgyd made a comment on nbme19#35 (5 yo boy, right eye pain 1 week)

 +4  upvote downvote
submitted by mtthwgyd

This is what is known as a somatic mutation: a mutation that occurs in non-germline cells and, therefore, only effects daughter cells derived from the parent cell with the mutation. So, a mutation occurred in a differentiated parent cell that gave rise to a set of daughter cells (which, in this case, were destined to become retinal tissue).

... ajguard26 made a comment on nbme19#1 (53 yo woman with GERD.)

 +1  upvote downvote
submitted by ajguard26

So although Misoprostol DOES increase mucus production and is gastro-protective (and in FA does state that it decreases acid production), thereby decreasing symptoms and aiding in healing, omeprazole is the "more correct" choice. This is because omeprazole is a proton-pump inhibitor, which will act directly on the proton pumps of the stomach and decrease the offending agent more than the misoprostol will. Therefore, it is the first line drug for GERD.

... ajguard26 made a comment on nbme19#42 (Advantage of randomized controlled studies)

 +1  upvote downvote
submitted by ajguard26

"Confounding variables" here means "confounding bias," essentially. And this is true because a prospective cohort looks at a specific exposure to a substance (environmental toxin, drug, etc.), and asks "Who will develop this disease if exposed?" PCS's look attempt to find a relative risk associated with an exposure. They do not take into account the affects other exposures. This is your confounding bias. FA gives the example of confounding bias as "Pulmonary disease is more common in workers in a coal mine; however, miners are more likely to smoke," and since smoking can also lead to pulmonary disease, you can't really say whether the smoking (first or second hand) or the coal dust causes the problem. A clinical trial, on the other hand, contains a test group and a control group, so variables such as the confounding variable mentioned above are limited.

... ajguard26 made a comment on nbme19#48 (62 yo man, decreased speech fluency after cerebral infarct)

 +1  upvote downvote
submitted by ajguard26

Obviously no picture here, but "A" in the picture represents Broca's area, which would cause the expressive aphasia this patient is experiencing.

However, the question also states the patient has weakness of the lower two-thirds of his face. This may cause you to think there is maybe a lesion in the pre-central motor area (thinking humonculus), but realize that the motor area travels all the way down to the bottom of the frontal lobe, RIGHT BEHIND THE BROCA'S AREA. In fact, Broca's area encompasses that part of the humonculus. And since the upper part of the face is controlled by the upper part of the facial motor cortex, and the lower part is controlled by the lower part of the facial motor cortex, you can have paralysis of the lower part of the face and have expressive aphasia if the lesion is in that specific area (does not need to be a lower motor lesion to spare the upper face/forehead).

... ajguard26 made a comment on nbme19#24 (62 yo woman sudden weakness of left leg)

 +1  upvote downvote
submitted by ajguard26

This patient presents with classic upper motor neuron lesion symptoms: weakness, hyperreflexia, and decreased sensation. However, the question states she "cannot tell whether her left great toe is raised or depressed" when her eyes are closed, which may make you reconsider and think there may be some proprioceptive issues they are trying to hint at. This is not the case. Especially once they mention there are no other abnormalities (i.e., no upper limb abnormalities or right sided abnormalities). If this is the case, there is no damage to the tracts at all (which are still considered UMN).

Therefore, the damage is purely motor and sensory in the left leg, which is on the medial aspect of the frontal and parietal lobes respectively. This area is supplied by the anterior cerebral artery.

... ajguard26 made a comment on nbme19#13 (25 yo man, exercise test. Most likely physiologic changes)

 +1  upvote downvote
submitted by ajguard26

As the muscle works and breaks down ATP, adenosine is produced, leading to an increase in the tissues. This increased adenosine causes vasodilation, which in turn increases vascular conductance (the flow of a volume of blood through the vasculature).

Although you may think muscle contraction may lead to a decrease in flow through the vessel(s) by squeezing down on them, this mechanism is overcome by the increased cardiac output from the heart.

... ajguard26 made a comment on nbme19#16 (40 yo woman, chorionic villus sampling)

 +1  upvote downvote
submitted by ajguard26

Chorionic villi sampling is the taking of genetic material within in the chorionic villi of the placenta. Chorionic sampling is done when a patient is at high risk for chromosomal abnormalities (previous pos. tests, 35yo or older, family hx.) during the 10-13 weeks of pregnancy.

Confined placental mosaicism results when the C.V.S. testing comes back back showing a trisomy, but all subsequent testing (and the fetus itself) have normal chromosomal counts. This may be due to either a trophoblastic mutation, or by "trisomic rescue," in which trisomic cells that were supposed to be in the fetus are confined to the placenta to prevent an abnormal fetus.


Block 1/Question#1
53 yo woman with GERD.

Block 1/Question#4
66 yo man, 2 months no erection
Libido: decreased; Noctural erections: normal

Block 1/Question#7
48 yo woman, 2 weeks fever and mucus in stool
Entamoeba histolytica

Block 1/Question#13
Mechanism of action of tumor suppressor genes
Inhibition of cell-cycle regulation

Block 1/Question#16
60 yo man, 2 weeks flank pain and blood in urine
Metastatic renal cell carcinoma

Block 1/Question#17
29 yo man untreated HIV
CD8+ T lymphocyte–mediated killing

Block 1/Question#24
62 yo woman sudden weakness of left leg
Right anterior cerebral artery

Block 1/Question#26
Decreased lysosomal hydrolase activity

Block 1/Question#28
13 yo girl with mother for routine visit
Ask mother to leave the room before asking the patient any questions.

Block 1/Question#31
32 yo man on primaquine
Enzyme deficiency in the erythrocytes

Block 1/Question#34
12 yo girl, 5 days unable to walk but unconcerned
Conversion disorder

Block 1/Question#35
5 yo boy, right eye pain 1 week
Retinal cells

Block 1/Question#36
36 yo woman believes she had a heart attack
Panic disorder

Block 1/Question#42
Advantage of randomized controlled studies
Better control for confounding variables

Block 1/Question#44
Best testing strategy when treatment has serious side effects
Test 3 followed by test 1 if test 3 is positive

Block 1/Question#48
62 yo man, decreased speech fluency after cerebral infarct
Area labeled by letter 'A'

Block 2/Question#5
38 yo woman, 6 months depressed mood, joint pain, weakness, memory problems + erythema migrans
Lyme disease

Block 2/Question#6
24 yo man, generalized tonic-clonic seizure; somnolent, hyponatremia; drinks 6 liters of water in 24 hours but says he's not thirsty
Psychogenic polydipsia

Block 2/Question#8
Retinoic acid receptors and HOX gene products bind specific DNA sequences; what is the function of these molecules?
Transcription factors

Block 2/Question#9
Lab findings expected after administration of insulin and saline
Potassium decreased; Bicarbonate increased; BUN decreased; Arterial pH increased; blood CO2 increased

Block 2/Question#13
25 yo man, exercise test. Most likely physiologic changes
Arteriolar diameter increased; Tissue adenosine concentration increased; Vascular conductance increased

Block 2/Question#16
40 yo woman, chorionic villus sampling
Confined placental mosaicism

Block 2/Question#17
Scurvy symptoms associated with decreased activity of which enzyme?
Prolyl hydroxylase

Block 2/Question#23
10 yo girl, slightly painful 2 mm subcutaneous nodule on chin

Block 2/Question#25
48 yo woman, 3 months fatigue; X-rays reveal generalized osteopenia
Paracrine stimulation of osteoclasts by osteoblasts

Block 2/Question#27
Case-control study; 95 percent confidence interval was [reported range]. Most appropriate interpretation?
The likelihood is 95% that the true value for the odds ratio is between [the reported range]

Block 2/Question#34
Mechanism by which action potentials permit currents to flow deep within skeletal muscle fibers
Transmission along T tubules

Block 2/Question#36
75 yo man with dementia; no advanced directives
Encourage the family to come to a consensus based on their perception of the patient's wishes

Block 2/Question#37
2 day old newborn with jaundice
Conjugation of bilirubin to glucuronic acid

Block 2/Question#43
45 yo woman undergoing vinblastine chemotherapy
Decreased number of neutrophils

Block 2/Question#45
Pathway of the transepithelial transport of water
Pathway denoted by letter 'C'

Block 2/Question#46
Decreased pulmonary artery pressure facilitated by increase in the intracellular concentration of which molecule?

Block 3/Question#5
30 yo woman, 1 week of visual difficulty
Right optic nerve

Block 3/Question#9
Cells most responsible for graft rejection?
T lymphocytes

Block 3/Question#12
23 yo woman engages in 30 minutes of strenuous exercise
Increased, as a result of distention and recruitment of microvessels

Block 3/Question#16
13 yo girl grows over the summer; what accounts for increased intestinal absorption of calcium?
Hormones derived from 7-dehydrocholesterol

Block 3/Question#17
45 yo patient, chronic alcohol dependence, foul-smelling brownish sputum
Chest radiograph labeled 'D'

Block 3/Question#19
30 yo man and 24 yo woman; best estimate that child will have oculocutaneous albinism?
1 in 600

Block 3/Question#22
Blood gas values: arterial O2 pressure: 96 mm Hg; Arterial O2 content: 12.0 vol%

Block 3/Question#27
74 yo man; continuous systolic-diastolic bruit over R posterior flank
Renal artery stenosis

Block 3/Question#28
40 yo man, 1 month increasing malaise, nausea, abdominal pain; CD8+ T lymphocytes resulting in liver injury

Block 3/Question#29
15 yo girl receives bone marrow transplant; karyotype reveals 46,XY
Nonautologous donor

Block 3/Question#33
19 yo man stabbed in abdomen; has been incarcerated for armed robbery
Antisocial personality disorder

Block 3/Question#34
52 yo man, 4 hours of severe headache, anxiety, sweating, palpitations; what happens after injection with propranolol?
Increased total peripheral resistance and decreased cardiac output

Block 3/Question#39
45 yo man, lost outdoors in the Rocky Mountains for 10 days

Block 3/Question#40
25 yo woman requests prenatal diagnosis at 12 weeks gestation
Chorionic villi sampling

Block 3/Question#41
41 yo woman, 34 weeks gestation; amniocentesis shows lecithin-to-sphingomyelin ratio of 1.5:1
Decreased functional residual capacity

Block 3/Question#42
Study conducted to determine effects of drug X on respiratory function

Block 3/Question#46
52 yo man, sudden onset of substernal chest pain

Block 3/Question#49
Schematic representation of eukaryotic translation
Binding of aminoacyl-tRNA to the A site

Block 3/Question#50
39 yo man, 6 months of headache, muscle aches, fatigue; distal motor weakness of extremities
Basophilic stippling

Block 4/Question#13
26 yo woman after jejunoileal bypass for morbid obesity; most likely deficiency?
Vitamin A

Block 4/Question#14
11 yo boy, right mid-thigh pain for 2 weeks; femur X-ray reveals single osteolytic lesion in mid-diaphysis
Ewing sarcoma

Block 4/Question#15
60 yo woman, 1 year of episodic involuntary rhythmic jerking of R leg and foot; brain MRI reveals 2 cm round enhancing lesion within interhemispheric fissure

Block 4/Question#17
60 yo man, 20-year history of hypertension; shortness of breath and fatigue for 3 months
Cardiac output: decreased; CVP: increased

Block 4/Question#23
30 yo woman with Marfan syndrome, sudden onset of tearing chest pain
Cardiac index: 2.0;
Right atrial pressure: 18;
Pulmonary capillary wedge pressure: 18;
Pulmonary diastolic arterial pressure: 20;
Systemic vascular resistance: 2,000

Block 4/Question#26
54 yo man, routine exam; given an angiotensin converting enzyme (ACE) inhibitor
Area labeled by letter 'F' (efferent arteriole)

Block 4/Question#27
52 yo woman prescribed cisplatin for non-small cell carcinoma of the lung

Block 4/Question#33
Oral fluid therapy for diarrhea caused by Vibrio cholerae
Membrane transport mechanism denoted by letter 'C' (Sodium-Glucose cotransporter)

Block 4/Question#46
24 yo woman; renal oxygen consumption found to be 20 mL per minute; which process consumes the most oxygen?
Tubular reabsorption

Block 4/Question#49
30 yo woman with high-grade intraepithelial lesion
Superficial to the basement membrane


Block 1/Question#3
5 yo boy, history of motion sickness
Antagonist at muscarinic-3 receptors

Block 1/Question#10
25 yo woman, polycystic kidneys
HCO3: decreased; inorganic PO4: increased; parathryroid hormone: increased

Block 1/Question#11
67 yo man, fine resting tremor in both hands

Block 1/Question#13
10 yo boy, nosebleeds and easy bruising
Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex

Block 1/Question#14
26 yo man with 27 yo wife, inability to conceive
Primary spermatocyte

Block 1/Question#15
experimental animal with defect in an innate gastrointestinal defence mechanism
Chronic gastritis

Block 1/Question#17
4 day old boy, vomited throughout night after breastfeeding

Block 1/Question#18
68 yo man, chronically increased hydrostatic pressure in Bowman space
Benign prostatic hyperplasia

Block 1/Question#19
70 yo woman, increasingly severe pain in right knee over 3 months
Pleomorphic neoplastic cells producing new woven bone

Block 1/Question#23
22 yo man, professional cyclist
Eccentric hypertrophy

Block 1/Question#26
50 yo woman, chronic obstructive pulmonary disease
Endothelial nitric oxide synthase production

Block 1/Question#28
Cholera toxin is a catalyst that results in the inhibition of GTPase activity of G-stimulator protein
Concentration of cAMP

Block 1/Question#30
29 yo woman irregular menstrual periods
Provide follow-up appointments to assess the patient's progress in attaining her goals

Block 1/Question#31
7 yo boy appendectomy
Low blood solubility

Block 1/Question#32
52 yo man with chest pain and shortness of breath
Proximal tubule: isotonic; Macula densa: hypotonic; Medullary collecting duct: hypertonic

Block 1/Question#33
35 yo woman with pain and swelling of breasts, pelvic discomfort
Have a chaperone join them for the remainder of the examination

Block 1/Question#34
60 yo man, 1 day of fever, chills, confusion and memory loss
Vibrio vulnificus

Block 1/Question#38
45 yo homeless man found unconscious
Methylmalonic Acid: normal; Homocysteine: increased

Block 1/Question#43
18 yo man cracked lips and sunburned skin

Block 1/Question#44
26 yo man skiing accident

Block 1/Question#45
55 yo man; father and brother died of myocardial infarct at early age
Increased transcription of HMG-CoA reductase

Block 1/Question#46
65 yo man, generalized tonic-clonic seizures
High-grade fibrillary astrocytoma

Block 2/Question#8
39 yo man, polycystic kidney disease
pH: 7.22; PCO2: 28; HCO2: 11

Block 2/Question#9
19 yo woman being treated for meningococcal meningitis
Adrenocorticotropic hormone stimulation test

Block 2/Question#15
38 yo man, 1 week history of shortness of breath with exertion
Aortic regurgitation

Block 2/Question#17
65 yo woman, 1 week of swollen, painful knee
Uric acid

Block 2/Question#18
Researcher testing new cancer drug
Neutrophil counts

Block 2/Question#21
66 yo woman, 2 days of fever, flank pain, pain with urination, nausea
Calcium carbonate

Block 2/Question#25
40 yo man, 1 year of orthostatic hypotension and loose stools
Motility disorder

Block 2/Question#27
58 yo man, 4 years of recurrent cough and sputum
Pseudostratified columnar epithelial cells

Block 2/Question#29
32 yo woman, new neurologic finding; imaging shows cavernous sinus thrombosis
Inability to abduct the eye

Block 2/Question#30
35 yo man, 4 weeks of severe midline back pain

Block 2/Question#32
Investigator studying vancomycin-resistant Enterococcus faecalis
Plasmid loss

Block 2/Question#34
25 yo woman, fatigue for 3 weeks
Greening reaction on blood agar

Block 2/Question#37
34 yo man, semiconscious and combative

Block 2/Question#41
35 yo woman, 3 days fever and sharp chest pain

Block 2/Question#44
35 yo woman, passed out while washing dishes
K+: decreased; HCO3: increased; Anion gap: normal; pH: increased

Block 3/Question#3
17 yo boy septic shock

Block 3/Question#5
82 yo woman, 24 hours of constant severe lower abdominal pain

Block 3/Question#6
32 yo woman, diagnosis of hyperparathyroidism
Abnormal migration of endoderm from the fourth pharyngeal pouch

Block 3/Question#9
35 yo woman with infertility
Spillage of contrast, which is normal

Block 3/Question#12
58 yo woman, 6 months shortness of breath, nonproductive cough
Pulmonary hypertension

Block 3/Question#13
35 yo woman, 2 days pain in left leg
Drug-related antibodies

Block 3/Question#14
2 yo boy, 2 days of fever, sore throat, rash
Erythrogenic toxin

Block 3/Question#17
46 yo woman, 1 week of fever and joint pain
Inflammatory infiltrates in the interstitium

Block 3/Question#21
48 yo woman, gradual onset of back pain over 2 weeks
Metastatic carcinoma of the breast

Block 3/Question#22
70 yo woman routine pelvic examination

Block 3/Question#25
63 yo man, 2 weeks of fullness in left upper quadrant of abdomen

Block 3/Question#26
33 yo man, diagnosed with epilepsy
He is medically qualified to drive

Block 3/Question#31
28 yo woman, 4 days of palpitations, severe neck pain, fatigue, malaise
Subacute granulomatous thyroiditis

Block 3/Question#32
25 yo woman, 2 years of intermittent, diffuse, cramping lower abdominal pain
Accentuation of mu-opioid myenteric plexus receptor

Block 3/Question#33
4 yo boy, clumsy gait for 1 year

Block 3/Question#34
52 yo woman with breast cancer

Block 3/Question#40
47 yo woman with irregular, raised, multicolored dark lesion
Subcutaneous tissue

Block 3/Question#41
24 yo man, 3 days of progressive numbness of both feet
Myelinated primary afferents

Block 3/Question#45
65 yo patient with lung region underventilated but well perfused
Physiologic shunt

Block 3/Question#46
45 yo man for annual health maintenance examination

Block 3/Question#47
19 yo woman, 2 days of pain in left index finger
Flexor digitorum profundus tendon

Block 3/Question#48
52 yo man, chronic pancreatitis

Block 4/Question#3
68 yo man, 3 days of increasingly severe deep chest pain
Aortic aneurysm

Block 4/Question#4
36 yo woman, 2 weeks of fatigue, bleeding gums, bone pain
Histone acetylase

Block 4/Question#14
18 yo woman ingests 100 aspirin tablets in suicide attempt
pH: 7.32; PCO2: 15; HCO3: 8

Block 4/Question#15
45 yo man follows up 1 week after appendectomy
Gilbert syndrome

Block 4/Question#27
54 yo man, normal renal function, receives heart transplant

Block 4/Question#29
65 yo man, cancer of the cecum
Ileocolic → superior mesenteric → portal → right hepatic branch of the portal

Block 4/Question#30
5 yo girl, 1 day severe leg pain after falling off sled
Intestinal calcium absorption

Block 4/Question#31
57 yo man with alcoholism

Block 4/Question#35
73 yo man, 4 months poor appetite and 25 pound weight loss
Cytokine effect

Block 4/Question#36
18 yo woman given general anesthesia for wisdom tooth extraction
Sarcoplasmic Ca2+ release

Block 4/Question#37
66 yo man, 1 month nonproductive cough, 6 months progressive shortness of breath
Idiopathic pulmonary fibrosis

Block 4/Question#42
4 month old boy, abnormal glycogen storage

Block 4/Question#45
35 yo man, prolonged QT interval
Outward (delayed) rectifying potassium channel


Block 1/Question#1
80 yo woman evaluated for suspected temporal arteritis
Additional testing to confirm the diagnosis of TA

Block 1/Question#6
55 yo man chronic bronchitis, found unresponsive in bed

Block 1/Question#8
6 week old girl, 6 days of vomiting a small amount of milk
Immature lower esophageal sphincter

Block 1/Question#14
21 yo man, excruciating anal pain for 4 hours
Inferior rectal vein

Block 1/Question#20
24 yo man, history of intravenous drug use, brought to ER 30 minutes after he could not be aroused

Block 1/Question#21
42 yo farmer, 7 mm red scaly plaque on ear
Actinic keratosis

Block 1/Question#28
12 yo boy, swimming in mountain stream; immersed in 60-degree water for 20 minutes
Central blood volume: increased; ADH (vasopressin): decreased; Atrial natriuretic peptide: increased

Block 1/Question#35
42 yo woman, 3 years of intermittent facial rash

Block 1/Question#38
Newborn with male genital ducts but female external genitalia

Block 1/Question#48
9 yo girl, poor growth over 1 year; below 3rd percentile for height; 10th percentile for weight
Diverticulum of the roof of the embryonic oral cavity

Block 2/Question#4
28 yo woman, 3 weeks of double vision
Area labeled with letter 'C'

Block 2/Question#5
56 yo man, sudden onset of uncontrollable irregular movements on left side of body for 4 hours
Right subthalamic

Block 2/Question#6
80 yo woman, 2 days of feeling funny

Block 2/Question#9
randomized clinical trial compares wound healing and cosmetic differences between two surgical procedures
Neither procedure is superior

Block 2/Question#11
13 yo girl, grade 2/6 holosystolic murmur over left fifth intercostal space

Block 2/Question#12
2 month old boy given vaccine which converts T-independent antigens to T-dependent forms
Haemophilus influenzae type b

Block 2/Question#13
28 yo woman, 18 weeks gestation and palpitations
Free T4

Block 2/Question#19
21 yo man, brought to ER 45 minutes after sustaining multiple injuries in motor vehicle collision
Streptococcus pneumoniae

Block 2/Question#20
38 yo woman, 2 years of pain and heavy flow with menses
Proliferative endometrial tissue

Block 2/Question#22
60 yo man, 1 month of progressive shortness of breath
Pleural effusion

Block 2/Question#24
65 yo woman, ovarian cancer treated with cyclophosphamide
DNA replication

Block 2/Question#27
Polymorphic marker with three alleles, 1, 2 and 3, tightly linked to gene for polycystic kidney disease

Block 2/Question#33
Study conducted to assess effectiveness of lidocaine injections
Placebo effect

Block 2/Question#34
40 yo man, skin extremely sensitive to sunlight
Heme synthesis

Block 2/Question#35
40 yo woman, 1 year of episodic crampy abdominal pain, intermittent diarrhea, rectal bleeding with passage of mucus

Block 2/Question#39
40 yo man, interstitial pulmonary fibrosis
Increased radial traction on airways

Block 2/Question#41
Seven hundred healthy women observed for 10 years

Block 2/Question#45
25 yo woman, 3 years of irregular menses

Block 2/Question#46
38 yo man, brought to ER 30 minutes after being found near his home, unsbale to stand upright
Metabolic acidosis

Block 3/Question#2
3 yo boy and 5 yo brother, bruise easily, recurrent hemarthroses
Factor VIII (antihemophilic factor)

Block 3/Question#9
40 yo African American woman, 2 weeks of fever, malaise, dyspnea

Block 3/Question#11
30 yo woman, 20 weeks gestation, fundal height greater than expected
Tracheoesophageal atresia

Block 3/Question#13
15 yo girl, 1 day of redness, painful skin after sunbathing
First-degree burn

Block 3/Question#14
16 yo boy, no signs of puberty
Luteinizing hormone

Block 3/Question#16
14 yo boy, daily headaches for 2 months
Inhaled glue

Block 3/Question#19
65 yo woman, surgical repair of aneurysm of right internal carotid artery
Area labeled with letter 'A'

Block 3/Question#24
10 yo girl, well-child examination
Breast bud development

Block 3/Question#25
Physician is sad because he must inform patient of recent test results
Yes, it is.

Block 3/Question#26
34 yo man, lightheaded after 12 miles of marathon
Sympathetic efferent activity: increased; parasympathetic efferent activity: decreased

Block 3/Question#27
44 yo woman, follow-up examination, two Pap smears revealed atypical squamous cells
Ubiquitin ligase

Block 3/Question#29
75 yo man, 2 years of decreased force of urinary stream
Increased hydrostatic pressure in Bowman space

Block 3/Question#31
20 yo man, 6 hours of difficulty breathing and vomitting

Block 3/Question#33
Female newborn delivered at 36 weeks, respiratory distress
Incomplete formation of pleuroperitoneal membrane

Block 3/Question#36
18 yo man, Crohn disease, admitted to hospital after 1 day of severe abdominal pain, intermittent bloody diarrhea
T-lymphocyte function

Block 3/Question#37
4 yo boy, two bacterial urinary tract infections over last year
Congenital ureteral obstruction

Block 3/Question#38
Ten healthy human subjects given new drug
Phase 1

Block 3/Question#41
27 yo woman, 12 hours of fever and abdominal pain

Block 3/Question#49
48 yo nulligravid woman, 3 months excessive uterine bleeding
Endometrial hyperplasia

Block 4/Question#1
83 yo man found bedridden and confused
Early septic shock

Block 4/Question#3
46 yo man, recevied cardiac transplant, treated with oral cyclosporine
Suppressing the early response of T lymphocytes to activation

Block 4/Question#4
54 yo woman, hypertension and bilateral renal artery stenosis
Vasodilating prostaglandins at the afferent arteriole

Block 4/Question#10
32 yo woman, gravida 2, para 1, 7 weeks gestation
Ectopic pregnancy

Block 4/Question#14
55 yo man, admitted to hospital for treatment of sepsis
0.9% Saline

Block 4/Question#16
32 yo man, 3 months of swelling, ternderness of breasts
Tissue: Testicle; Effect: Estradiol production

Block 4/Question#20
45 yo man, 4 days of yellow skin
Mallory hyaline

Block 4/Question#23
72 yo man, weakness and fatigue
Gastrointestinal blood loss

Block 4/Question#27
20 yo man, suspected appendicitis, periumbilical burning and discomfort

Block 4/Question#30
45 yo man, 1 month of intermittent bloody diarrhea and abdominal pain
Tumor necrosis factor

Block 4/Question#33
52 yo woman, hot flashes, 6 months of irregular menses
Failure of the ovaries to secrete 17β-estradiol

Block 4/Question#34
16 yo girl, 2 years of intermittent fainting while standing
Dopamine β-hydroxylase

Block 4/Question#36
41 yo woman, 6 weeks of increasingly severe headaches
Fibromuscular dysplasia

Block 4/Question#40
48 yo man, 3 months of increasing bronzing of skin, weakness, fatigue
Increased intestinal iron absorption

Block 4/Question#47
10 yo boy, anemia since birth; spleen is five times normal size
Hereditary spherocytosis


Block 1/Question#1
27 yo man, Hodgkin lymphoma, receives bone marrow transplant from cousin
Donor T lymphocytes reacting against host cells

Block 1/Question#2
18 month old boy, 3 hours lethargy, poor eating for past 24 hours
Long-chain acyl-CoA dehydrogenase

Block 1/Question#3
38 yo woman, 10 weeks epigastric pain, frequent stools
Serum calcium concentration

Block 1/Question#5
24 yo man, nasal congestion, watery nasal discharge, sneezing
α-Adrenergic agonist

Block 1/Question#7
2 yo boy, increased thirst, urinary frequency, failure to thrive
Amino acids: decreased; Glucose: decreased; Phosphate: decreased; HCO3: decreased

Block 1/Question#8
55 yo man, 2 weeks constipation after starting an over-the-counter medication

Block 1/Question#14
Lesch-Nyhan syndrome

Block 1/Question#16
40 yo woman, gunshot wound to abdomen
Decreased function of Na+–K+ ATPase

Block 1/Question#17
Investigator studying pulmonary lymphatic flow using animal model
Intravenous infusion of 0.9% saline for 5 minutes

Block 1/Question#18
Screening program for detection of vaginal Chlamydia

Block 1/Question#24
79 yo woman, right hip fracture after falling
Go for a long walk outside daily

Block 1/Question#26
16 yo boy, brought to ER after diving into 3-foot-deep swimming pool at night
Area labeled by the letter 'E'

Block 1/Question#30
5 yo boy, presents to ER after 16 hours of severe vomiting, increased sleepiness
Cerebral edema

Block 1/Question#37
54 yo man, aneurysm of distal abdominal aorta

Block 1/Question#39
28 yo woman, 1 month of pelvic pain, increasingly severe over the last week

Block 1/Question#41
18 yo man, acute lymphoblastic leukemia, 3 days intermittent fever and left-sided chest pain
Amphotericin B

Block 1/Question#46
55 yo woman, 3 months shortness of breath
Parathyroid hormone: decreased; 1,25-Dihydroxycholecalciferol: increased

Block 1/Question#47
24 yo African, 3 months red bumps on face and chin
Pseudofolliculitis barbae

Block 1/Question#48
12 yo boy, 6 months difficulty walking and leg pain
Abnormal myelin sheaths

Block 1/Question#49
In an experiment, glycolytic intermediates are measured in human endothelial cells
Glyceraldehyde-3-phosphate dehydrogenase

Block 2/Question#3
48 yo woman, 6 months irregular menstrual periods, hot flashes
Increased follicle-stimulating hormone

Block 2/Question#13
5 yo boy, 8 months of recurrent middle ear and upper respiratory tract infection

Block 2/Question#18
Animal study conducted to assess the effects of smoking on pulmonary defense
Mucus production and secretion: increased; Activity of airway cilia: decreased; Alveolar macrophage function: decreased

Block 2/Question#24
85 yo woman, fracture of the right femur, begins treatment with morphine
Morphine is metabolized to active metabolites that accumulate

Block 2/Question#37
33 yo man, 3 months muscle weakness and cramping
Glycogen phosphorylase

Block 2/Question#49
An experimental study of oxygen consumption in kidney
Proximal tubule

Block 2/Question#50
35 yo man, 3 years enlarging nose, coarsening facial features, muscle weakness, increased hand and foot size
Adenylyl cyclase

Block 3/Question#1
20 yo man, 4 hours abdominal pain, nausea, vomiting
Induction of cytochrome P450 enzymes that activate acetaminophen to a hepatotoxic metabolite

Block 3/Question#3
83 yo man, 3 days painful blisters on torso
Bullous pemphigoid antigen

Block 3/Question#5
45 yo man, congestive heart failure

Block 3/Question#7
15 yo girl, brought to ER 12 hours after ingesting 100 capsule vitamin D in suicide attempt
Increased absorption of calcium in the gastrointestinal tract

Block 3/Question#9
53 yo homeless man, alcoholism, found collapsed and coughing on park bench
Normal oral flora

Block 3/Question#12
18 yo woman, progressive fever, general malaise, blood in urine
Interstitial nephritis

Block 3/Question#17
Gram stain performed on sputum specimen
Outer membrane

Block 3/Question#20
Investigator studying strains of Streptococcus pneumoniae
Natural transformation

Block 3/Question#24
8 yo girl, well-child examination
“Your daughter’s development is normal.”

Block 3/Question#25
27 yo nulligravid woman, 2 years inability to conceive

Block 3/Question#26
Study designed to evaluate ambient noise and hearing loss in automobile manufacturing plant

Block 3/Question#30
54 yo woman, nurse, routine tuberculosis screening
Interferon gamma

Block 3/Question#32
65 yo woman, 3 months of headache, weakness of arms, left flank pain
Pulmonary small cell carcinoma metastatic to the brain

Block 3/Question#38
68 yo man, 2 hours loss of vision
Right ophthalmic

Block 3/Question#39
27 yo woman, concerned of sleep apnea

Block 3/Question#40
Female newborn delivered at term to 35 yo primigravid woman
Enlarged thyroid gland

Block 3/Question#41
70 yo man, 8 months difficulty sleeping since wife died
Schedule regular appointments to monitor the patient

Block 3/Question#45
25 yo woman, 6 months of irregular mentrual periods, progressive acne
Fasting insulin: increased; Testosterone: increased; Luteinizing hormone: increased

Block 3/Question#50
10 yo girl, fatigue and appears pale
Deficiency of erythrocyte spectrin

Block 4/Question#8
24 yo woman, follow-up examination; 8 years of seizure disorder refractory to treatment
Tuberous sclerosis

Block 4/Question#11
78 yo man, 1 month fever, chills, fatigue, 5.4 kg weight loss
Bacterial endocarditis

Block 4/Question#12
39 yo woman, rheumatoid arthritis, follow-up examination
Tumor necrosis factor-α

Block 4/Question#24
35 yo man, 6 months burning abdominal pain one to two hours after eating

Block 4/Question#26
42 yo woman, biopsy of suspicious calcifications on mammogram
High-grade, low-stage neoplasm

Block 4/Question#27
18 yo man, brought to ER by mother 45 minutes after finding him crouched in closet
Brief psychotic disorder

Block 4/Question#32
70 yo woman, persistent fever despite intravenous broad-spectrum antibiotic therapy
Candida albicans

Block 4/Question#34
43 yo woman, 3 months progressive difficulty walking
Degeneration of motoneurons of the lumbar cord

Block 4/Question#35
51 yo woman, 6 months burning abdominal pain one to two hours after eating
Area labeled by the letter 'B'

Block 4/Question#39
32 yo man, begins to laugh while eating dinner with friends
While swallowing: closed; Immediately after laryngeal irritation: closed; while coughing: open

Block 4/Question#40
New antiplatelet agent developed for prevention of recurrence of stroke

Block 4/Question#45
42 yo woman, brought to ER, 30 minutes after sudden onset of severe headache
Posterior communicating

Block 4/Question#48
32 yo woman, gravida 4, para 0, aborta 3, delivers female newborn at term with dysmorphic features, organ anomalies
Unbalanced chromosome rearrangement

Block 4/Question#49
40 yo woman, comes to ER, 1 week abdominal pain, watery and bloody diarrhea
Entamoeba histolytica

Block 4/Question#50
35 yo woman, participates in study of new diagnostic test of steroid hormones in saliva
Day 12


Block 1/Question#6
7 yo boy, 1 day fever, headache, nonproductive cough
Virion release

Block 1/Question#9
3 yo boy, cleft lip and palate, no other birth defects

Block 1/Question#10
When compared to oxygenated blood, deoxygenated blood carries more carbon dioxide for a given PCO2
Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin

Block 1/Question#11
9 yo boy, mild mental retardation, 4 years increasingly frequent major motor seizures
Tuberous sclerosis

Block 1/Question#15
48 yo woman, comes to ER, palpitations
Increased cardiac parasympathetic activity

Block 1/Question#19
65 yo man, ischemic heart disease, fatigue, pain and swelling in legs

Block 1/Question#24
3 yo girl, 2 weeks of diarrhea
Interferon-gamma receptor

Block 1/Question#32
4-day-old male newborn, brought to ER, respiratory distress and cyanosis

Block 1/Question#33
75 yo woman, 1 day fever and back pain
Releases NF-κB after undergoing phosphorylation

Block 1/Question#35
30 yo woman, uncomplicated vaginal delivery, delivers placenta but continued heavy blood loss

Block 1/Question#37
36 yo man, heterozygous for LDL-receptor deficiency
LDL receptor

Block 1/Question#38
23 yo woman, 3 days drooping right eyelid
Oculomotor nerve

Block 1/Question#39
Investigator study, new behavioral program for attention-deficit/hyperactivity disorder (ADHD)

Block 1/Question#44
59 yo man, 10 days shortness of breath, fatigue, cough

Block 1/Question#46
6 yo boy, severe mental retardation and choreoathetosis
0.2 to 0.5

Block 1/Question#48
22 yo man, brought to ER, 30 minutes after being hit by automobile
Deep fibular (peroneal)

Block 1/Question#49
23 yo woman, 3 weeks frequent thirst and urination

Block 1/Question#50
25 yo man participates in study of muscle function
epp Amplitude: 1; mepp Amplitude: 1; Response to Ach: 1

Block 2/Question#3
2 yo girl, brought to ER, 20 minutes after ingesting insecticide

Block 2/Question#4
32 yo man, annual company-sponsored health maintenance examination
Schizoid personality disorder

Block 2/Question#6
56 yo woman, 3 weeks progressive difficulty swallowing
Helicobacter pylori

Block 2/Question#9
67 yo man, 2 days double vision and drooping left eyelid
Aneurysm of the posterior communicating artery

Block 2/Question#11
48 yo man, brought to ER, 1 hour nausea, crushing chest pain
Degenerating epithelial cells and dirty brown granular casts

Block 2/Question#14
25 yo woman, rheumatic fever and mitral valve prolapse, 2 weeks of fever, fatigue
Streptococcus mitis

Block 2/Question#15
64 yo man, 2 months progressive shortness of breath
Increased fibrosis in the interstitium

Block 2/Question#20
30 yo man, 1 day irrational behavior, severe abdominal pain
Porphobilinogen deaminase

Block 2/Question#21
43 yo woman, 6 months altered consciousness
Complex partial

Block 2/Question#22
22 yo woman, HIV positive
Protein processing

Block 2/Question#23
26 yo woman, 2 weeks flank pain, palpitations, sweating, recurrent headaches
Area labeled by letter 'E'

Block 2/Question#26
47 yo man, admitted to hospital for myocardial infarction
Increased pulmonary capillary pressure

Block 2/Question#28
35 yo woman, gravida 1, para 1, 2 months generalized weakness and fatigability
Nicotinic acetylcholine receptor

Block 2/Question#29
2-month-old male infarct, brought to ER, 2 days generalized tonic-clonic seizures
Glycine receptor

Block 2/Question#31
24 yo woman, Marfan syndrome, positive home pregnancy test

Block 2/Question#32
25 yo primigravid woman, 25 weeks gestation, routine prenatal examination

Block 2/Question#36
72 yo woman, admitted to hospital for acute myocardial infarction
Left coronary, circumflex, posterior interventricular (posterior descending)

Block 2/Question#39
43 yo man, 10 years alcoholism, change in skin color
Decreased glutathione

Block 2/Question#40
4 yo boy, 2 months progressive weakness, loss of muscle function

Block 2/Question#41
45 yo man, has not been examined by a physician for 30 years
Mitral regurgitation

Block 2/Question#43
37 yo woman, brought to ER by husband after being found unconscious

Block 2/Question#45
3 yo girl, 1 year of short stature
Abnormal targeting of these enzymes to lysosomes

Block 2/Question#47
75 yo man, chronic obstructive pulmonary disease, admitted to hospital 6 hours after acute exacerbation

Block 2/Question#49
1950s study to determine the causes of lung cancer
Cohort study

Block 3/Question#3
56 yo woman, brought to ER, 2 hours fever and shortness of breath

Block 3/Question#6
50 yo man, routine health maintenance examination

Block 3/Question#7
1 yo boy, 4 weeks progressive generalized tonic-clonic seizures
RNA splice error

Block 3/Question#9
Newborn undergoes surgical repair of esophageal atresia

Block 3/Question#10
5 yo boy stung on foot by bee
Gap formation between endothelial cells

Block 3/Question#15
65 yo man, hypertension, participates in clinical trial of loop diuretic
Acid-base: Metabolic alkalosis; Volume contraction: yes

Block 3/Question#18
27 yo man, 3 hours nausea, cramping abdominal pain, diarrhea
Prolonged fecal excretion of the organism

Block 3/Question#24
28 yo African American man, 3 months mild fatigue, weakness, 4.5 kg weight loss

Block 3/Question#30
13 yo boy, receiving chemotherapy for leukemia
T-lymphocyte thymocytes localized to the thymic cortex

Block 3/Question#32
2-month-old girl, follow-up examination 2 days after abnormal complete blood count
Congenital neutropenia

Block 3/Question#39
42 yo woman, multiple sclerosis, double vision since yesterday morning
Medial longitudinal fasciculus

Block 3/Question#43
18 yo man, sports physical examination
Inquiry about a history of anabolic steroid use

Block 3/Question#45
30 yo woman, Hodgkin disease 10 years ago, treated with radiation and chemotherapy for 6 months
Therapy for Hodgkin disease causes mutations in hematopoietic stem cells, and one mutant cell progresses to leukemia

Block 3/Question#47
2-month-old boy, hypotonia and poor feeding since birth

Block 3/Question#48
A study finds a statistically significant difference between two groups when, in reality, there isn't one. What is the name of this statistical error?
5%, Type I error

Block 4/Question#3
51 yo man, Wegener granulomatosis, follow-up examination

Block 4/Question#5
Male newborn delivered at term with right-sided aortic arch
Third and fourth branchial pouches

Block 4/Question#7
17 yo boy, chronic renal insufficiency, undergoes unilateral nephrectomy

Block 4/Question#8
Newborn delivered at 28 weeks, severe respiratory distress
Lung elastic recoil

Block 4/Question#9
40 yo woman, breast cancer, 1 week progressive loss of left-sided peripheral vision in both eyes
Occipital lobe

Block 4/Question#11
45 yo man, follow-up examination, 2 weeks after starting hydrochlorothiazide
Venous return: decreased; Carotid sinus baroreceptor activity: decreased; Cerebral blood flow: decreased

Block 4/Question#17
18 yo woman, 3 days pain with urination, urinary frequency, urinary urgency
β-Lactamase production

Block 4/Question#20
52 yo man, 3 days after sudden onset of left eye blindness
No constriction because the retinal ganglion cells in the left eye have been destroyed

Block 4/Question#25
Couple has two children with osteogenesis imperfecta
Germline mosaicism

Block 4/Question#26
65 yo woman, follow-up examination, DEXA scan shows decreased bone density
Osteoblast activity: decreased; Osteoclast activity: increased; RANKL: increased

Block 4/Question#29
45 yo woman, routine health maintenance examination
Incomplete penetrance

Block 4/Question#30
25 yo woman, 5 months palpitations, insomnia, 5 kg weight loss
Nuclear/retinoid X binding to DNA

Block 4/Question#32
70 yo woman, found dead in skilled nursing care facility

Block 4/Question#33
During normal skeletal muscle twitching, ATP concentration does not fall significantly.
ATP is quickly regenerated from creatine phosphate

Block 4/Question#38
25 yo woman, 1 week general malaise, facial rash

Block 4/Question#40
18-month-old boy, severe combined immunodeficiency syndrome
Irradiated packed red blood cells

Block 4/Question#42
4 yo boy, karyotype 47,XY+21
Excess lymphoblasts

Block 4/Question#44
72 yo woman, 6 months diffuse muscle pain, weakness

Block 4/Question#47
31 yo woman, treated for Plasmodium vivax malaria
Primaquine kills hypnozoites

Block 4/Question#48
Study of effectiveness of cough medication in children
Lack of blinding between groups


Block 1/Question#1
77 yo woman, dies in hospital after long illness
Interleukin-1 (IL-1)

Block 1/Question#13
18-month-old boy, 6 months progressive facial abnormalities, slow growth
Iduronate sulfatase

Block 1/Question#19
22 yo woman, 3 months painless, slowly enlarging mass on left neck
Anterior to the sternocleidomastoid muscle

Block 1/Question#20
3 yo girl, grade 4/6, loud, harsh, high-pitched holosystolic murmur
Ventricular septal defect

Block 1/Question#25
32 yo woman, 1 month progressive shortness of breath and anxiety
Myasthenia gravis

Block 1/Question#26
4 yo boy, brought to ER, 1 hour headache, nausea, vomiting, dizziness
Reaction step labeled by the letter 'E'

Block 1/Question#27
12 yo African, brought to ER, 6 hours fever, severe rib pain
Polymerization of hemoglobin with hypoxic conditions due to amino acid substitution in the β chain

Block 1/Question#29
43 yo woman, metastatic colon cancer, taking bevacizumab
The agent being a humanized antibody

Block 1/Question#30
43 yo man, routine health maintenance examination

Block 1/Question#41
20 yo man, cramping periumbilical pain; pain shifts to right lower quadrant
Interleukin-1 (IL-1)

Block 1/Question#43
18 yo man, 8 days temperature of 38.3 C, sore throat, cervical lymph node enlargement
T lymphocytes

Block 1/Question#48
Male newborn at 34 weeks gestation delivered vaginally

Block 2/Question#1
15 yo boy, 2 months sneezing, coughing, watery eyes after mowing lawn
Type I (immediate) hypersensitivity

Block 2/Question#6
Female newborn, delivered at 34 weeks gestation, advanced-care setting
Nitric oxide

Block 2/Question#8
5-month-old boy, 5 days difficulty feeding
Thyroglossal duct

Block 2/Question#9
Study of coronary artery disease (CAD) risk factors, persons aged 30 and older
Observational cohort study

Block 2/Question#21
36 yo man, HIV seropositive, 2 weeks nonproductive cough
Pneumocystis jiroveci (formerly P. carinii)

Block 2/Question#30
47 yo woman, physical examination shows fine wrinkles in photodamaged skin on face
Activation of nuclear gene transcription

Block 2/Question#38
5 yo boy, 6 months progressive clumsiness and fatigue

Block 2/Question#41
23 yo woman, 3 weeks persistent cough worsened by cold air

Block 2/Question#45
54 yo man, squamous cell carcinoma of right lung
Loss of heterozygosity

Block 3/Question#5
42 yo Asian woman, brought to ER, 24 hours nausea, vomiting, progressive lethargy
Induction of cytochrome P450

Block 3/Question#6
Homologous pairing of chromosomes in prophase I
Crossing over

Block 3/Question#7
32 yo woman, 5 years inability to conceive

Block 3/Question#11
31 yo woman, brought to ER, 10 minutes difficulty breathing, severe muscle weakness
Desensitization of nicotinic receptors

Block 3/Question#14
40 yo man, brought to ER, 1 hour after sudden onset of severe pain in left leg
Increased protein degradation

Block 3/Question#15
33 yo woman, right-handed, 3 days progressive weakness, numbness of arms and legs
Voltage-gated Na+ channels

Block 3/Question#19
Study of onset and course of cardiovascular disease in African American men and women

Block 3/Question#21
Autopsy of 46 yo woman, adenocarcinoma of colon

Block 3/Question#30
Cluster of three cases of nosocomial pneumonia caused by Klebsiella pneumonia
Promote thorough hand cleansing before and after medical personnel visit each patient

Block 3/Question#31
23 yo woman, type 1 diabetes mellitus, follow-up examination
Inability to produce hydroxy-halide radicals

Block 3/Question#35
25 yo woman, radical mastectomy with removal of left axillary lymph nodes
Compression sleeve

Block 3/Question#39
Young adult couple, 2 years unable to conceive
Seminal vesicles

Block 3/Question#45
25 yo man, cystic fibrosis, 3 days fever, cough, progressive shortness of breath
Biofilm formation in the lower respiratory tract

Block 4/Question#2
18 yo woman, mild mental retardation, 3 days decreased ability to see in reduced light
Apo B

Block 4/Question#7
Mouse melanoma, B-16, highly metastatic

Block 4/Question#13
22 yo woman, follow-up examination, pulmonary embolism 1 year ago
Antiphospholipid antibody syndrome

Block 4/Question#20
32 yo man, brought to ER, 1 day intermittent flashing spots, blurred vision, vomiting, confusion, difficulty walking
Alcohol dehydrogenase

Block 4/Question#21
40 yo woman, brought to ER, 30 minutes after severe chest injuries in motor vehicle collision
Vascular malformation

Block 4/Question#34
33 yo woman, 16 kg weight gain over 6 months despite dieting
Cortical hyperplasia

Block 4/Question#35
55 yo man, hepatic encephalopathy, 24 hours of confusion and lethargy

Block 4/Question#36
25 yo man, admitted to hospital for viral pneumonia
Alveolar hyaline membrane

Block 4/Question#42
64 yo woman, 6 months heartburn, difficulty swallowing solid food and liquid
Esophageal peristalsis: decreased; Lower esophageal sphincter tone: decreased

Block 4/Question#46
62 yo man, brought to ER, 3 hours progressive difficulty breathing, mild left shoulder pain
Pulmonary edema