nbme 16
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 - ANSW
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 - ANSW
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? - ANSW
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? - ANSW streptococcus pneumoniae is the mcc of sepsis in sickle cell patients
and splenectomy!
bulimia nervosa patient treatment? - ANSW 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? - ANSW 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? - ANSW 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? - ANSW 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 - ANSW 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, - ANSW Friedreich ataxia
dec frataxin, GAA repeats, similar to VIT E deficiency,child 5-15 yo - ANSW 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? - ANSW 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? - ANSW 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? - ANSW
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 - ANSW 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? - ANSW 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? - ANSW 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? - ANSW 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. - ANSW
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? - ANSW
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? - ANSW 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? - ANSW 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? -
ANSW 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? - ANSW 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. - ANSW 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? - ANSW VITAMIN E!!!!
poliovirus lacks 5"mCAP, yet is still translated? why? - ANSW no cap-->still translated
because of PRESENCE OF INTERNAL RIBOSOME ENTRY SITE--located in the
5'UTR (untranslated region).
