Medical 135

A 26-year-old woman and her 29-year-old husband have been trying to have a child for the past 3 years. During this time the woman has had five spontaneous abortions. The karyotypes of the mother, father, and the most recendy aborted fetus all contained 46 chromosomes, and all pairs were normal except for the pairs shown below. The event that led to the abnormal karyotype in the fetus was (D) a recombination event within a paracentric inversion (E) a recombination event within a pericentric...

Info

Administration of an experimental drug that acts on peripheral nervous system (PNS) myelin is shown to increase the space constant of an axon in a peripheral nerve. Action potentials traveling down the axon would be predicted to be 7. A patient undergoes a total gastrectomy because of a proximally located gastric cancer. After the surgery, which of the following digestive enzymes will be produced in inadequate amounts 8. What is the normal myeloid to erythroid ratio in bone marrow

Medical

An 8-month-old infant presents to the emergency department with a 1-day history of poor feeding and generalized weakness. The mother states that she often feeds the infant honey to pacify her. The toxin responsible for this presentation works by which of the following mechanisms (A) It blocks the release of acetylcholine from the nerve terminal (B) It blocks the release of inhibitory neurotransmitters such as glycine and GABA (C) It has a subunit that inactivates an elongation factor by...

Bait and Switch Questions Misdirected Attention

Sometimes what you first think the question is about is not what the question is really asking. Ever begin reading a question thinking that the core focus is Physiology and discover at the end of the question that the real issue is Pharmacology Ever read a clinical case collecting evidence for a diagnosis and discover that at the end of the question they give you the diagnosis, but want to know something about treatment options If you have had these experiences, then you have run into the...

C

Pericarditis is inflammation of the pericardium. Fibrinous pericarditis is the most frequent form of pericarditis associated with myocardial infarction. Clinically, it may present as a loud pericardial friction rub with chest pain, fever, and, occasionally, symptoms of congestive heart failure (CHF). Caseous pericarditis (choice A) is usually caused by tuberculosis. Hemorrhagic pericarditis (choice C) is usually associated with tuberculosis or a malignant neoplasm....

Clinical Case Questions Basic Science in Clinical Clothing

Clinical case questions are distinguished by a fairly lengthy presentation of a patient's history, physical exam findings, and maybe even lab results. Your task is to read through this voluminous information and arrive at the best answer to the question being asked. The most important part of the clinical case question is the last sentence. This is the sentence that actually poses the question. Until this point, you cannot be sure exactly what you will be asked. Many students are tempted to...

D

During the contraction cycle, ATP binds to myosin, causing the dissociation of myosin from actin. Actin (choice A) forms cross-bridges with myosin but does not bind to ATP. The sarcoplasmic reticulum (choice C) is involved in storing and releasing Ca2+ for muscle contraction. Tropomyosin (choice D) is a thin filament that runs alongside actin. In the absence of calcium, tropomyosin lies in the groove of the actin filament and blocks actin's myosin-binding sites....

Wight For Medical Exam

(A) Glucose-6-phosphate dehydrogenase deficiency (B) Leber hereditary optic neuropathy A mother is informed that her daughter has an inherited disorder in which the administration of a sugar-free product that contains aspartame could be detrimental to her health. This patient most likely has which of the following genetic disorders 49. Which of the following amino acids would most likely be found on the surface of a protein molecule 50. Retinoblastoma is associated with an abnormality in which...

Il12

A baby born at 32 weeks' gestation with Apgar scores of 2 and 7 was placed in the neonatal intensive care unit. She developed a fever and leukocytosis lumbar puncture revealed pleocytosis with increased protein, decreased glucose, and gram-positive rods. Which of the following organisms was most likely isolated from the CSF 17. A young mother takes her infant to the pediatrician for the first time. The pediatrician notices the infant's teeth are yellow. The antibiotic this mother most...

Pathology and Pathophysiology

Following an upper respiratory infection, a 5-year-old develops large purpuric lesions on the buttocks and extensor surfaces of the arms and legs. The patient also has abdominal pain, vomiting, and arthralgias. Dipstick analysis of the urine shows microscopic hematuria. Renal biopsy would probably show which of the following distinctive features (A) IgA in the mesangial region (B) Marked interstitial nephritis (C) Subepithelial electron-dense deposits 2. A 29-year-old man presents with...

Medical 7i

What is the primary function of the cell indicated in the figure below (A) It produces low-molecular weight polypeptides (B) It secretes bactericidal enzymes 24. An elderly woman with osteoporosis is taken to the emergency department following a fall. One of her legs appears shortened and is externally rotated. A fracture of which part of the femur is suggested by these findings 25. An otherwise healthy first-year medical student visits the student health office for a physical examination....

184 medical

A 54-year-old man with chronic renal failure receives a kidney transplant and is given immunosuppressive therapy with cyclosporine. Over the next 6 months, the patient's creatinine levels progressively rise, and a needle biopsy of the kidney is performed. What is the biopsy most likely to show (A) Intimal fibrosis, interstitial fibrosis, and tubular atrophy (B) Linear deposition of immunoglobulin and complement in glomeruli (C) Neutrophils, immunoglobulin, and complement in vessel walls (D)...

Qbook Practice Tests

Anatomy (Gross Anatomy, Neuroanatomy, Embryology, 1. A 75-year-old man with a 40-pack-year history of smoking and hypercholesterolemia is diagnosed with severe atherosclerosis. Atherosclerotic occlusion of which of the following arteries would result in insufficient perfusion of the urinary bladder 2. A 36-year-old woman is hospitalized for treatment of a stomach ulcer that has been getting progressively worse over several months. Radiographic studies reveal the site of involvement to be along...

Sglt1

Na+ cotransport system driven by the Na K ATPase Only one that works against a concentration gradient Uptake of glucose from the intestinal lumen and in the kidney proximal tubule During fasting, much of the GLUT4 in skeletal muscle and adipose resides in the membranes of cytoplasmic vesicles. Increased insulin following a meal induces the translocation of these vesicles to the cell membrane, thus increasing glucose uptake (and lowering the peripheral blood glucose). In skeletal muscle, GLUT4...

Table of Contents

Test-Taking and Study Strategies Guide Chapter 1. The USMLE Step 1 Examination 5 Chapter 2. Study Techniques Chapter 3. Tackling the Exam Chapter 4. Physical and Mental Preparation 39 Chapter 5. Summary Pointers Anatomy (Gross Anatomy, Neuroanatomy, Embryology, and Histology) Test 1 Test l Answers and Test 2 Test 2 Answers and Test 1 Test l Answers and Test 2 Test 2 Answers and Test 1 Test 1 Answers and Test 2 Test 2 Answers and Test 1 Test 1 Answers and Test 2 Test 2 Answers and...

Preparation Materials

Be careful when selecting review books to help you prepare. Review books are often a. Of uneven quality, covering some subjects in detail while slighting others. b. Out of date. Although the test has changed dramatically, many books have not changed appreciably in the past 5 to 10 years. Some review books consist of question types that were used in the old National Boards exam, but are not currently used in the USMLE. Avoid books that feature a large number of except questions or other...

X

In clinical trials, an experimental drug is found to cause impotence in a large percentage of male patients. Inhibition of which of the following could be responsible for this side effect (A) Conversion of DHT to testosterone (C) Nitric oxide synthase (NOS) 15. A healthy 22-year-old female medical student has an exercise stress test at a local health club. Which of the following is most likely to decrease in her skeletal muscles during exercise (B) Carbon dioxide concentration (D)...

Answers and Explanations

Pyruvate dehydrogenase (PDH) catalyzes the irreversible conversion of pyruvate to acetyl-CoA. If PDH is absent, pyruvate will be used in other pathways instead. Pyruvate will be converted to alanine via alanine aminotransferase (choice A) and to lactate via lactate dehydrogenase (choice C). Glutamate dehydrogenase (choice B) is involved in oxidative deamination, releasing ammonium ion for urea synthesis. Deficiency of this enzyme would not cause the symptoms described....

Medical si

A 19-year-old woman comes to the emergency department after falling while on roller-blades. There is a 3-cm laceration over the lateral aspect of the knee penetrating so deep that the head of the fibula is apparent. A radiograph of the leg is negative for any fractures. A noticeable foot-drop occurs while the patient walks. Further examination reveals inability to dorsiflex or evert the foot. Which of the following best explains her injury (A) The common peroneal nerve was severed (B) The...

Physiology

A 42-year-old woman complains of a burning pain in the upper middle region of her abdomen. The pain usually occurs about 2 hours after a meal and frequently awakens her at night. Antacids can usually relieve the pain within a few minutes. An x-ray film reveals a typical duodenal ulcer identified as a discrete crater in the proximal portion of the duodenal bulb. Because the woman does not have a history of chronic use of aspirin or other nonsteroidal antiinflammatory drugs (NSAlDs), the...

Usmle Step 1 Question Types

This Study Guide contains examples of each of the types of questions discussed below. As you practice and review these questions, pay attention to the way the questions are constructed, as well as to the content issues tested. All of the questions presented on the Step 1 exam are of the Single Best Answer Type. Matching questions were eliminated when the CBT was introduced. This means that your job is to select the one answer from the given set of options that is clearly better than all of the...

Step 1 Format

As of May 1999, the USMLE Step 1 exam is a computer-based exam (CBT). The exam is no longer being offered in its previous paper-and-pencil format. This means, among other things, that not all students will take the exam on the same day, or even in the same month. Pay careful attention to the instructions sent to you by the National Board of Medical Examiners (NBME) or the Educational Commission for Foreign Medical Graduates (ECFMG) on scheduling your time and location to take the exam. The...

The Usmle Step 1 Examination Dos And Donts

DO remember the content of the computer-based exam (CBT) will be similar to previous exams as will the amount of time per question (just over one minute). DO take advantage of the CD-ROM computer-based testing practice disk that will be sent with your Step 1 application confirmation. You also will have the option of practicing at a Kaplan Center near your home. DO be organized. Set up an organized study schedule and adhere to it. Plan your work and work the plan. DO be sure to make up questions...

Biochemistry

A 3-year-old girl who is small for her age has had multiple hypoglycemic episodes associated with moderate fasting during periods of illness. In her most recent episode associated with influenza, her parents slept late, and at 10 am were unable to rouse the child from sleep. Blood and urine samples collected at the emergency department reveal marked hypoglycemia, ketonuria, and ketonemia along with an appropriately low insulin level. The blood alanine level is abnormally low however, infusion...

Ivb

A 60-year-old man complains of difficulty arising from a chair and initiating new movements. On examination, the physician notices a resting hand tremor and cogwheel rigidity. Which of the following amino acids is the precursor for the neurotransmitter that is deficient in the brain of this patient 7. A patient with a history of easy bruising is diagnosed vvith Bernard-Soulier syndrome. Which of the following would you expect to find in this patient (A) Decreased circulating von Willebrand...

Microbiology Immunology

A 19-year-old man presents to the emergency department with pneumonia. Since the age of 6 months, he has had recurrent pneumonia and sinusitis due to Streptococcus pneumoniae and Haemophilus influenzae. Careful assessment of his immune function would likely reveal abnormal function of the 2. A 20-year-old woman presents with a 2-day history of dysuria and increased urinary frequency. She states that she was recentiy married and was not sexually active prior to the marriage. Physical examination...

Step 1 Content

The Step 1 exam features questions drawn from the content areas of seven core subjects Anatomy, Behavioral Sciences, Biochemistry, Microbiology Immunology, Pathology, Pharmacology, and Physiology. On most exams, a bit more emphasis is placed on second year courses, which are typically Pathology, Pathophysiology (not a specifically designated board subject), Pharmacology, and, often, Microbiology. This does not mean you should neglect the other disciplines in your studying, however. Doing well...

Test

Which of the following embryonic structures gives rise 4. to the adrenal cortex 2. A gastric biopsy is performed on a 42-year-old man. As the pathologist inspects the specimen, he observes numerous, normal cuboidal-to-columnar cells with apical membrane-bound secretion granules in the gastric glands. From which area of the stomach was the biopsy specimen most likely taken 3. During a football game, a player sustains a powerful blow to the lateral side of his weight-bearing leg. He experiences...

Two Step Double Jump Questions

Two-Step (also called double-jump questions) require several cognitive choices to arrive at a correct answer. Consider this two-step question where a correct answer requires you formulate a proper diagnosis and then select the most appropriate pharmacologic treatment. Note that you get no credit for the intermediate step of diagnosis. The correct answer is found only by reasoning all the way through to the treatment. 46-year-old bright, energetic, overweight man loves to talk and to give his...

Positively Worded Questions The Most Common Question Type

Positively worded questions ask you to select the answer that is most likely to be true. These are, by far, the most common type of questions on recent exams. Note that all of the options given maybe somewhat likely. Your job is to select the one that is most likely. An example of this type of question is as follows An 85-year-old man has had urinary frequency, difficulty initiating stream and dysuria for the last two months. A rectal exam reveals an enlarged prostate. Prostate-specific antigen...

Medical bi

Two basic things about cerebellar circuitry that are well-worth knowing are that Purkinje cells of the cerebellar cortex project to the deep cerebellar nuclei and that these nuclei project out of the cerebellum. Purkinje cells are located in the second (Purkinje) cell layer of the cerebellar cortex and project to the deep cerebellar nuclei, on which they form inhibitory synapses. Climbing fibers (choice A) are afferents to the cerebellum. Specifically, they...

H

Which of the following regulates the frequency of gastrointestinal slow waves C Intrinsic pacemaker regions within the smooth muscle D Local levels of cholecystokinin secretion E Systemic levels of catecholamines and corticosteroids 31. Which of the following points on the left ventricular pressure-volume loop above represents the mitral valve opening 32. A 65-year-old woman receives 3 liters of 0.9 saline following a minor surgical procedure. This results in increased right atrial filling...

E

In the citric acid cycle, succinate thiokinase succinyl-CoA synthetase catalyzes the cleavage of the succinyl-CoA thioester bond with formation of a high-energy compound. This compound can then be used by the body in which of the following biochemical pathways B Elongation of the polypeptide chain C Epinephrine synthesis from tyrosine D Isopentyl pyrophosphate synthesis 28. Which of the following amino acids is most responsible for the buffering capacity of hemoglobin and other proteins 29....