nbme form 5 12: 29 1. av 2. bv Epidermal hematoma, can be rapid also but more risk factors point to subdural.

Subdural has the chronic slower presentation but we must not forget about the acute subdural hematoma. definition of extraaxial?
Extra-axial hemorrhage bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes: Epidural hematoma, subdural hematoma and subarachnoid hemorrhage
Pasted from <http://en.wikipedia.org/wiki/Intracranial_he morrhage>

unconsciousness occurs in what percent of EPH? bleedigng ofor vertex EPD can be

20-50% venous, probably from

superior sagittal sinus
Pasted from <http://emedicine.medscape.com/article/248 840-overview#a0104>

most important different between epidural and subdural but for subdural acute subdural hematoma can present very similar to epidural hematoma

age of patient and location of injury

to one-third of patients have a lucid interval lasting minutes to hours before coma supervenes, but most are drowsy or comatose from the moment of injury
Pasted from <http://accessmedicine.com/content.aspx?aID=2904549&searchStr=hemato ma%2c+subdural>

Chapter 373. Concussion and Other Head Injuries (Harrison Online)

Suspect acute subdural hematoma (SDH) whenever the patient has experienced a mechanism of moderately severe to severe blunt headtrauma. Patients generally lose consciousness, but this is not an absolute.
Pasted from <http://emedicine.medscape.com/article/828005-clinical>

Physical examination of patients with head trauma should emphasize assessment of neurologic status using the GCS. Search for any focal neurologic deficits or signs of increased ICP.
Pasted from <http://emedicine.medscape.com/article/828005clinical#a0217>

Acute traumatic subdural hematoma often results from falls, violence, or motor vehicle accidents. The clinical presentation depends on the location of the lesion and the rate at which it develops. Often, patients are rendered comatose at the time of the injury. A subset of patients remain conscious; others deteriorate in a delayed fashion as the hematoma expands. Chronic subdural hematomas are arbitrarily defined as those hematomas presenting 21 days or more after injury. Subacute subdural hematomas are defined arbitrarily as those that present between 4 and 21 days after injury
Pasted from <http://emedicine.medscape.com/article/1137207-clinical>

3. 4. 5. 6.

This is a prospective cohort study, so the BEST CONTROL group would be the one with no exposer i. e. one with NO EXPOSURE of colonic polyposis. SO IT WILL BE LIKE THIS... RR of Colonic Cancer for Cohort study where the RISK fastor is colonic polyposis ( 2 groups -- one with exposure and the other without exposure) one group -- 100 with colonic polyposis other group -- subjects without colonic polyposis.
Pasted from <http://www.usmleforum.com/files/forum/2010/1/550380.php>

ev av bv ev

7. bv glutamate caused what electrlyte mvt? 8. bv influx of ca

9. c.a x vDifference between ALS and polio vxvtrick for als 10. dv I got this wrong and put e x. answer is malignering, cataplexy is conscious in narcolepsy, patient is faking to get money after motor cycle. Nacrolepsy attacks after laughing invovlve vXxxv physical sign with Ob Sleep apnea? regulated by what nucdu? what neurons initial sleep is vattacks involve what sleep cycle conscious cataplexy pulmonary hypertension hypothatlamus MD; medial dorsal orexin and hypocretin neurons shorter rem rem only immediate sometimes after a little light non rem but polio only anterior motor neurons, ALS AMN and cortico spinal think of it as one pathways, since AMN connects to corticospinal

vdifference between cataplexy and sleep attacks? vcause of each 11. 12. 13. 14. bv bv bv bv I was wrong and put c x. somatosensory is where? motor premotor is

cataplexy person is conscious; sleep attack person is not strong emotion causes cataplexy; normal stuff causes sleep attacks.

d c b For this diagram, first locate precentral sulcus. which is thick line between d and e. Look for the boat structure.

next line to that is the central sulcus. The central sulcus is slightly more rostral to the splenium of the corpus collosum (see diagram below).

Once this is done c must be motor cortex and D somatosensory. A little more rostral you find the premotor cortex, the one involved in planning.

v6 is? v4 is

premotor somato motor

qwerqwer

15. 16. 17. 18. 19. 20.

av av bv av fv dv I put b and that was wrong x. vxvFlexor poliicis longus tendon inserts at base of distal pharynx this show picture of base of distal pharynx vXv adductor pollicis muscle inserts at

medial side of the base of the proximal phalanx of the thumb and the ulnar sesamoid
Pasted from <http://en.wikipedia.org/wiki/Adductor_pollicis_muscle>

vXv extensor pollicis longus tendon inserts

base of the distal phalanx of the thumb

Pasted from <http://en.wikipedia.org/wiki/Extensor_pollicis_longus_muscle>

there seems to be two right answers but d is the one coded for.

21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31.

bv dv bv cv av ev av dv ev bv ev Got wrong put e x . stupid do again, read question closer Read question closely, it says hemolysis, not hypotension vxfunctio nof properdin? vxvc5a causes release of indirectly cleaves c3 (by binding c3b) and allows for histamine Neurotransmitting not to be released to not be released k and NA only

32. Av I was wrong and put b x. vxvblocked ca channel influx cause what? Vx propagation of the action pot depends on 33. 34. 35. 36. 37. 38. 39. fv cv bv ev bv gv cv practice

vXv a is? b Vc Vd vXv e below SN, dark line is

red nucleus amygdala substantia nigra temperol cortex thalamus base of peduncle

40. Dv was wrnog x vfunctions of c3a in anaphylaxis? of c5a? 2 vc5a best role is? vdefinition of anaphylatoxin 41. 42. 43. 44. 45. 46. av av av cv cv bv vxThis is pic of lupus pernio cause edema and hypotension Chemotactic; causes histamine release acts at a chemoattrant for neutrophils complement by products, specifcally c3a and c5a>c4a

47. 48. 49. 50.

dv dv bv cv Section 2 1. ev 2. dcv 3. fv I was wrong and put d x 4. 5. 6. 7. dv dv bv dv labyrinthitis presents as? inner ear vertigo transposon dna that can reinsert in various places

8. vd I was wrong and put c x. vxvtransposition involves vxvwhich are 9. 10. 11. 12. bv cv ev ev Glycerol kinase found only in 13. av 14. bv

liver

within an intercalated discfascia adherens, macula adherens (aka desmosomes), and gap junctions. Fascia adherens are anchoring sites for actin, and connects to the closest sarcomere.

Macula adherens stop separation during contraction by binding intermediate filaments joining the cells together also called a desmosome. Gap junctions allow action potentials to spread between cardiac cells by permitting the passage of ions between cells, producing depolarization of the heart muscle
Pasted from <http://en.wikipedia.org/wiki/Intercalated_disc>

The clues are 1-Time duration=6 weeks ---CHOICE B is out 2-Being native american (Indian American)----choice A is IN 3-Loss of loved one=husband----CHOICE A IS IN 4-Repeated visit from the dead one---CHOICE A IS IN 5-Normal appetite and energy with no suicidal ideation ---CHOICES B ,d are out 6-Bruised arm and leg and normal NEURO AND CT SCAN-choice E is OUT explanation in my understanding

av

---Individual NATIVE AMERICAN tribes maintained their own death customs and adapted them to their regional environments into which they migrated, although such rituals and beliefs could pass from one group to the other through trade and intermarriage. Most Native American tribes believed that the souls of the dead passed into a spirit world and became part of the spiritual forces that influenced every aspect of their lives --Many tribes believed in two souls: one that died when the body died and one that might wander on and eventually die. ---And also it is common in some tribes talking to dead ones --hence my answer is AAA(schizophrenia is out ...due to short duration and alsom lack of other common symptoms)....
Pasted from <http://www.usmleforum.com/files/forum/2010/1/519693.php>

16. ev 17. fv 18. cv got wrong put f x.

if the brother got DMD because of a de novo mutation, the sister chance will only be as the general population not more.... so its not A

in mosaicism of germcell lineage some ova of the mother r normal others r abnormal. hence the higher chance of the daughter

definition of germcell lineage mosaic mutations: mutation that occurs early in development and affects only some germ cells..other germ cells r normal and all somatic cells r normal.

moreover, X-linked recessive diseases are diseases which if mother is a carrier transfer %age to the sons is 50% and they (male babies) will show da signs because they have only 1 x chromosome... whereas if a father is a carrier he will trasfer it to all his daughters who will be carriers. so in this case its the male baby who is manifesting the disease transferred from mother... so its C

if it would have been barr body inactivation, then sister would havebeen menifesting the disease but she is just a carrier so it cant be E
Pasted from <http://www.usmle-forums.com/usmle-step-1-forum/2068-duchene-muscular-dystrophy-geneticsquestion.html>

19. 20. 21. 22. 23. 24. 25.

Since hemagglutinin is the major surface protein of the influenza A virus and is essential to the entry process, it is the primary target of neutralizing antibodies
Pasted from <http://en.wikipedia.org/wiki/Hemagglutinin_(influenza)#Neutralizing_Antibodies>

cv av dv gv fv cv av

26. 27. 28. 29.

ev dv cv dv I thought this was b12 def and put e x, more likely folate. First thing to respond would be reticulocyte count. I could be wrong but for b12 the b12 could appear in the urine once that was restored. 30. ev 31. av 32. av Topisomerase 2 is similar to topisomerase 1 except that is uses atp bv ev av bv ev ev fv

33. 34. 35. 36. 37. 38. 39.

40. ev 41. av 42. av Discussion is still out, but some thought d.

genetic abnormality could occur even without any family history and most of abortions during first trimester are due to this. But question is specifically saying that lab studies are normal, and that the chance of finding abn. is low. So iam assuming that q is indirectly saying there is no beneficiance. (But D could be ans not certain) Autonomy is that we should respect the requests of competent patients.. like if a patient refuses treatment, we have to accept that though we know this is going to harm him.. likewise if a patient asks for an inappropriate treatment, we have to respect it and its our responsibility to explain her why its not appropriate.. so autonomy is definitely a point here.. Maleficiance is.. harming other people it could be a point here.. because the chance of harming here could be greater than beneficiance.. (? Invasive procedure +1 in 100 chance of abotions) Not utilitarianism because it means the greatest good for the greatest number (I browsed this.. (I never heard these words before..!! wikipedia) Deontology cant be right.. because.. its not moral.. focuses on the rightness or wrongness of actions themselves, as opposed to the rightness or wrongness of the consequences..(wikipedia) and I think that, anything thats not moral has nothing todo with our exam..
Pasted from <http://www.usmleforum.com/files/forum/2008/1/291662.php>

Examples of promoting autonomous behavior: Presenting all treatment options to a patient, explaining risks in terms that a patient understands, ensuring that a patient understands the risks and agrees to all procedures before going into surgery.
Pasted from <http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_auton_bene.htm>

43. av 44. ev 45. dv cocksakie virus 46. ev 47. dv 48. fv I was wrong and put c x, read question closer. 49. av 50. ev, I was wrong and put c x vReduced gluathione is unusable -----Secion 3 10 15 1. dv ans is d. I was wrong and put c x. half life is 4. first measuremeant is at 2 pm and that is 201. after 4 half lives serum will be 12.5; after 5 half lives it will be 6.025. 5 x 4 = 20 hours .

2. 3. 4. 5. 6. 7.

(anything below 4.3 half live or 4.3 x 4 = 17.2 hours would be acceptable. but 20 is the answer closest to 17.2). cv This patient is depressed. Part of SIGE CAPS is suicide. Always confront this issue to a patient because if not addressed he may take action on his life. dv av ev av a x vxvDrugs that PEAT are first order? vxv vcommon between thiopental and propofol phenytoin, ethanol, aspirin, thiopental both redistribute to adipose tissue

Thiopental is not used to maintain anesthesia in surgical procedures because, in infusion, it displays zero-order elimination kinetics, leading to a long period before consciousness is regained. Instead, anesthesia is usually maintained with an inhaled anesthetic (gas) agent. Inhaled anesthetics are eliminated relatively quickly, so that stopping the inhaled anesthetic will allow rapid return of consciousness. Thiopental would have to be given in large amounts to maintain an anesthetic plane, and because of its 11.526 hour half-life, consciousness would take a long time to return
Pasted from <http://en.wikipedia.org/wiki/Sodium_thiopental>

8. 9. 10. 11. 12. 13.

dv dv cv cv dv dv wrong and put a Vxv function of thymidate synthase? vXv blocked by methylates dUMP to dTMP 5 FU

14. 15. 16. 17.

cv cv av wrt up ev Got this wrong x. Patient has pneumo thorax management include diagnosis tools or treatment

diagnosis is clearly established, needle aspiration will solve problem 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. cv bv cv ev ev bv ev bv dv av cv cv Av I was wrong and put a.

Ans. should be A because heroin causes coma, miosis and cyanosis. However uticaria is also a symptom of opiods but it is felt at lower doses. In this question the person has overdose which means more than 30 mg of heroin. opiods act on u-receptors and cause CNS depression which leads to coma. CNS depression also causes respiratory depression which may lead to cyanosis and hypoxia. BP stays stable for a while but then drops at which point the pt goes into shock and vascular damage ensues. TX overdose with naloxone diluted to 0.4 mg IV slowly until patient's arousal improves.
Pasted from <http://www.usmleforum.com/files/forum/2011/1/572133.php>

31. Av

The use of tricyclics such asamitriptyline (1050 mg), nortriptyline (1075 mg), and doxepin (1025 mg) or a pharmacologically similar drug, cyclobenzaprine (1040 mg), 12 h before bedtime will give the patient restorative sleep (stage 4 sleep), resulting in clinical improvement.
Pasted from <http://accessmedicine.com/content.aspx?aID=2863215>

32. Bv 33. dv I was wrong and put c. Barium enema rules out Ulcerative colitis not meckels diverticulum. 34. 35. 36. 37. 38. 39. 40. 41. 42. ev ev cv bv cv dv ev dv Bv I believe it is B.

Benefits of mohs surgery

Mohs surgery Involves removal of the tumor followed by immediate frozen section histopathologic examination of margins with subsequent reexcision of tumor-positive areas and final closure of the defect Gives the highest cure rates (98%) and results in least tissue loss
Pasted from <http://accessmedicine.com/content.aspx?aID=3250525&searchStr=basal+cell+carcinoma>

Argument against surgery is: from Quick answers on access medicine

The technique of three cycles of curettage and electrodesiccation depends on the skill of the operator and is not recommended for head and neck lesions
Pasted from <http://accessmedicine.com/content.aspx?aID=3250525&searchStr=basal+cell+carcinoma>

From dermatology

cure rates for standard excisional surgery are inferior to those for MMS in cases of primary morpheaform BCCs, recurrent BCCs, and tumors located in high-risk anatomic sites
Pasted from <http://accessmedicine.com/content.aspx?aID=2954363>

I believe the neck is a high risk anatomic landsite Since mohs surgery is not option, then cryotherapy is the best bet Xxxv Best topical solution? v v 43. 44. 45. 46. 47. IMIQUIMOD, mech TLR 7 activator which causes Interferon release

graphs depict and increased EDV.ventricular dilation is aged related functional change are compensatory at a certain extent but will be no longer benificial when the dilation becomes too important -------) Franc Starling principle
Pasted from <http://www.usmleforum.com/files/forum/2009/1/418950.php>

bv av dv hv Ev I got this wrong and put d x. Evidence for e is this:

This is wrong because dilation decreases SV. So does extreme left ventricular hypertrophy

Left ventricular hypertrophy (LVH) is an increase in the thickness and mass of the myocardium. This could be a normal reversible response to cardiovascular conditioning (athletic heart) or an abnormal irreversible response to chronically increased volume load (preload) or increased pressure load (afterload). The thickening of the ventricular muscle results in decreased chamber compliance. As a result, LV pressures are elevated, the ESV is increased and the EDV is decreased, causing an overall reduction in cardiac output.
Pasted from <http://en.wikipedia.org/wiki/Pressure-volume_loop_analysis_in_cardiology#Left_ventricular_hypertrophy>

My argument against left ventricular hypertrophy If patient is old or has hypertrophic cardiomyopathy, elasticity of the heart increaese

Results Ees was reduced in dilated cardiomyopathy (1.320.10 mm Hg/ml) and increased in hypertensive cardiomyopathy (3.120.33 mm Hg/ml) patients compared to age-matched control subjects (1.960.26 mm Hg/ml; p<0.01 andp<0.05, respectively). More importantly, Ees was higher in the elderly (2.520.70 mm Hg/ml) than in the adult control group (p<0.05) and was linearly correlated with age (r2=0.639; p<0.0001).
Pasted from <http://eurjhf.oxfordjournals.org/content/7/5/829.full>

http://eurjhf.oxfordjournals.org/content/7/5/829.full Increase in heart elasticity causes a decrease in SV.

The increase in Ees is characterized by a significant reduction in stroke volume with little modification in afterload. Furthermore, an increased Ees may worsen diastolic dysfunction in the aging heart, throughfurther limited filling and raised diastolic pressur
Pasted from <http://eurjhf.oxfordjournals.org/content/7/5/829.full>

Thus left ventricular hypertrophy is likely not the answer because it would decrease stroke volume But this applies to pathological hypertrohpy, found in aortic stenosis

In athletic hearts hypertrophy occurs and diastolic volume increases

Figure 4 End-diastolic volume, end-diastolic volume index (enddiastolic volume divided by body surface area) and ratio of left ventricular (LV) to right ventricular (RV) end-diastolic volume (EDV) (ratio LV-EDV/RV-EDV) in endurance athletes (A) and untrained control subjects (C). Data are expressed as the mean value SD. Error bars represent 95% confidence intervals. ***p < 0.001 (paired t test).
Pasted from <http://content.onlinejacc.org/cgi/content/full/40/10/1856/FIG4>

Notice in the athetele (A) the EDV is increased. It is likley that this is occuring in this elderly man Left ventricular dilation would increase EDV but also decrease Answer is left ventricular hypertrophy, from medscape Stroke volume. The contraction of the ventricle is less effective.

Early studies indicated a decrease of cardiac output with aging at rest and with exercise.[13] However, these studies were done in a population with a high incidence of latent CAD. In a population with latent CAD capable of causing myocardial ischemia with exercise eliminated, studies using echocardiography and radionuclide angiography have shown that the cardiac output at rest is maintained by compensating for a slower heart rate by increasing the LV end-diastolic volume, therefore increasing the stroke volume. Wall stress remains normal in spite of the increased LV diameter and increased systolic pressure because of the moderate LV hypertrophy.
Pasted from <http://www.medscape.com/viewarticle/450564_4>

Also from this diagram if you subtract EDV in cm from ESV in cm, you see that both hypertensie and elderly have in increase in stroke volume

http://eurjhf.oxfordjournals.org/content/7/5/829/T1.expansion.html

48. dv 49. ev 50. Cv -------section 4 1104 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. av Av ev cv dv Fv good question dv bv cv bv ev Ev I was wrong and put d x. vxvMost conclusive hormone that ovulation has occurred is 13. fv 14. Cv I was wrong and put b x. vExcess HCG causes v vx vWhat mimics prolactin during pregnancy Precocious purbery via tSH> LH> FSH like influences, Not necessary galactorea Human placental progesterone

lactogen vxvReleased during what trimester

E should be incorrect because "Suckling of the baby causes release of hormone oxytocin which stimulates contraction of the myoepithelial cells. In this way of combined control from ECM and systemic hormones, milk secretion can be reciprocally amplified so as to provide enough nutrition for the baby." For contraction of the myoepithelial cells, not differentiation of mammary gland alveolar cells
Pasted from <http://www.usmleforum.com/files/forum/2010/1/501521.php>

2nd

They seem to be oppsite of each other udrin preganncy (excet for 38 week burst of HCG)

HPL vs. bHCG?

15. cv 16. Bv I was wrong and put C x. vHeart mass in dilated vs hypertrophic vDifferent Both have increase in mass Heart chambers increase in size only in diltaed ; hyertrohpic can have increased size as long as it is not pathological (ie athelteic heart)

17. 18. 19. 20. 21. 22. 23. 24. 25.

S = Suprarenal glands (aka the adrenal glands) A = Aorta/IVC D = Duodenum (second and third segments [some also include the fourth segment] ) P = Pancreas (tail is intraperitoneal) U = Ureters C = Colon (only the ascending and descending parts) K = Kidneys E = Esophagus R = Rectum

Dv av bv dv av dv Dv Cv wrt up Av

Pasted from <http://en.wikipedia.org/wiki/Retroperitoneal_space>

Dv cv

30. 31. 32. 33.

fv dv That wa the one I was looking for av cv Bv Cv I was wrong and put d x. vxvGonorrhea ocmplication in males? Epididymitits , in men and in women PID

34. 35. 36. 37. 38. 39.

cv gv bv cv ev Bv I was wrong and put b x. IDENTIFY

Is a free form cell, probably a phagocyte macrophage

A is b c d Trick Type 2 is Rbc in capilllary Type 2 pneumocyte Type 1 1 is a flat looking number Round and part of epithelium

type I pneumocyte, also known as the small alveolar cell (arrow).

Pasted from <http://accessmedicine.com/popup.aspx?aID=403417>

erythrocytes (arrowhead

Phagocytic alveolar macrophages (curved

Pasted from <http://accessmedicine.com/popup.aspx?aID=403417>

40. av 41. Ev 42. D v B seems to a be another name for gilbert, though less popular 43. dv 44. dv 45. cv 46. dv 47. Av good q wrt up 48. dv 49. ev 50. cv . X Select your answer more carefully
NBME 5 BLOCK 1: 1-5 ABEAB 6-10 EBBAD 11-15 BBBBA 16-20 ABAFD 21-25 BDBCA 26-30 EADEB 31-35 BDFCB 36-40 EBGCB 41-45 AAACC 46-50 BDDBC NBME 5 BLOCK 2:

1-5 EDFDD 6-10 BDDBC 11-15 EEABA 16-20 EFCCA 21-25 DGFCA 26-30 EDCDE 31-35 AABEA 36-40 BEEFE 41-45 AAAED 46-50 EDFAE NBME 5 BLOCK 3: 1-5 DCDAE 6-10 AEDDC 11-15 CDDCC 16-20 AECBC 21-25 EEBEB 26-30 DACCA 31-35 ABDEE 36-40 CBCDE 41-45 DEBAD (Note #42 is either B or E, so u find out) 46-50 HEDEC NBME 5 BLOCK 4: 1-5 AAECD 6-10 FDBCB 11-15 EEFCC 16-20 BDABD 21-25 ADDCA 26-30 DCFDA 31-35 CBCCG 36-40 BCECA 41-45 EDDDC 46-50 DADEC
Pasted from <http://www.usmleforum.com/files/forum/2010/1/510937.php>