Form 25 Incorrects

Question 1

Answer 1

C:
Hepatocytes are critical for the synthesis of multiple coagulation factors. Increased PT/INR secondary to impaired synthesis of factor 7 and may result in prolonged bleeding.

Question 2

Answer 2

A:
Randomization is a way to minimize confounding variable bias.

Question 3

Answer 3

D;
Congenital syphilis is caused by the transmission of Treponema palladium in the second and third trimesters. Manifestation include syphilitic rhinitis, rhagades (linear cracks or fissures in the skin, especially around the mouth or anus), dental malformations, and organomegaly, but the time of presentation after birth is variable.

Question 4

Answer 4

F;
Centrally located primary lung cancers include squamous cell carcinoma of the lung and small cell carcinoma. Squamous cell carcinoma is the more common subtype and is associated with hypercalcemia because of paraneoplastic PTHrP.

Question 5

Answer 5

B:
The peripheral nerves of the leg are often sites of compression injury or entrapment causing sensory loss and mote weakness. The superficial fibular nerve everts the foot, while the deep fibular nerve dorsiflexes the foot, and the tibial nerve plantar flexes the foot.

Question 6

Answer 6

C;
Radiation pneumonitis is a potential sequela of radiotherapy for the treatment of malignancy. Fibrosis and contraction of lung tissue are characteristic of the later stages of radiation pneumonitis and can produce alveolar collapse and impaired gas exchange, a phenomenon known as atelectasis.

Question 7

Answer 7

E;
Meningiomas are benign CNS tumors arising from the meninges that may compress the brain or spinal cord and cause focal neurological deficits as well as seizures. MRI typically demonstrates a spherical and well-circumscribed mass that indents the parenchyma.

Question 8

Answer 8

B;
The contemplation stage of behavioral change refers to ambivalence about changing a behavior, in which the patient expresses knowledge of the consequences of their detrimental behavior but is not yet prepared to make plans to change. Motivational interviewing is a technique used by physicians to promote a patient’s readiness for change.

Question 9

Answer 9

F;
Tricuspid valve endocarditis is typically associated with IVDA. Damage to the valve can lead to regurgitation, which is a risk factor of right sided heart failure. Common organisms include Staph. Aereus, Pseudomonas aerugingsa, and Candida organisms.

Question 10

Answer 10

E;
Constriction of the SMA occurs in duodenal volvulus from intestinal malrotation; the SMA is embryologically related to the midgut and in turn shares a common mesentery with the duodenum which twists during the volvulus.

Question 11

Answer 11

D;
Physicians should acknowledge a sensitive topic, normalize the issue, and use direct, non-presymtive language to foster an effective discussion about a potentially embarrassing topic such as urinary continence. Physicians should avoid stigmatizing an presumptive language, as this could trigger defensiveness on the patient’s part and prevent effective discussion of the topic.

Question 12

Answer 12

D;
Anthax is a pathogenic bacterium, which uses a fpolyglutamic acid capsule to evade phagocytosis. Many other bacteria produce polysaccharide or glycosaminoglycan capsules that act in a similar fashion to protect the bacteria and increase virulence.
**LF leads to apoptosis of macrophages.
**EF alters cyclic adenosine monophosphate signaling pathways within the immune cells.

Question 13

Answer 13

A;
Acoustic neuromas, benign tumors of Schwann cells that arise from the vestibulaocochlear nerve, can compress the cerebellar peduncles. Acoustic neuromas can cause ipsilateral hearing loss and positional sissiness and, if compressing the cerebellar peduncles, can lead to ipsilateral dysmetria.

Question 14

Answer 14

B;
IgA deficiency can result can in anaphylaxis following the transfusion of plasma and other blood products containing IgA, as patients with this disease may have existing antibodies against IgA.

Question 15

Answer 15

C;
A Spigelian hernia occurs at the site of the Spigelian aponeurosis which lies between the rectus abdomens medially and the semilunar line laterally.

Question 16

Answer 16

A;
developing infants who form secure attachments with their caregiver will begin to make eye contact at age 2 months and illustrate delight when their caregiver is present and distress when their caregiver is absent.

Question 17

Answer 17

A;
Pyloric stenosis is caused by hypertrophy of the pyloric sphincter, resulting in gastric outlet obstruction, which typically first presents ar around 3 to 6 weeks of life. It is characterized by repeated vomitting after feeds, leading to dehydration and a hypochlorenic, hypokalemic metabolic alkalosis.

Question 18

Answer 18

E;
Alpha1-antitrypsin deficiency should be suspected in patients who present with emphysematous lung changes in the absence of a smoking history. Alpha1-Antitrypsin is a protease inhibitor responsible for regulating neutrophil elastase.

Question 19

Answer 19

D;
Common PE findings in acute congestive heart failure include increased jugular venous pressure, peripheral extremity edema, ascites, hepatojugular reflex, pulmonary crackles, and an S3 or S4 gallop.

Question 20

Answer 20

A;
Dipeptides and tripeptides are produced by the activity of trypsin and chymotrypsin within the lumen of the duodenum. Free amino acids are produced upon further digestion of these small peptides within the brush border of the intestinal mucosa.

Question 21

Answer 21

E;
Asthma exacerbations, secondary to a reversible obstruction to airflow, typically present with respiratory alkalosis because of hyperventilation when mild. If severe, symptoms of respiratory distress will remain present (eg, shortness of breath, tachycardia, tachypnea, hypoxia, poor air movement, biphasic wheezing, accessory muscle use, and the arterial blood gas analysis may appear within reference ranges or demonstrate developing or worsening respiratory acidosis.

Question 22

Answer 22

E;
The P-value is the probability that a type 1 error has been committed and the null hypothesis has been erroneously rejected. A P-value of 0.05 or less is generally considered statistically significant.

Question 23

Answer 23

B;
Cat-scratch disease is caused by infection with the gram-negative coccobacillus Bartonella henselae. Histologic examination of involved lymph nodes typically demonstrated necrotizing granulomas with stellate (star-shaped) micro abscesses. Multinucleated giant cells may or may not be present.

Question 24

Answer 24

A;
Upper motor neuron injuries lead to hyperreflexia and/or spasticity as the descending motor neurons no longer provide inhibitory inputs to the lower motor neurons of the reflex arcs. Lower sensory or motor neuron lesions interrupt the reflex arc, thereby causing hyporeflexia.

Question 25

Answer 25

D; The correct positioning for a thoracentesis is about the 9th rib on the affected side, along the midaxillary line if the patient is supine or the posterior mid scapular line if the patient is upright, which avoids damage to the lung parenchyma and adjacent structures.

Question 26

Answer 26

D; Increases in the ratio of ATP:ADP lead to islet cell depolarization by closing potassium-ATP channels. Calcium ions enter the cell, triggering the exocytosis of pre-formed insulin. Uncoupling protein prevents some of the proton gradient in a mitochondrion from being used in the synthesis of ATP. Blocking such a protein would theoretically increase the cell's ATP:ADP ratio.

Question 27

Answer 27

B

Question 28

Answer 28

C; Chronic pancreatitis impairs bicarbonate release form pancreatic acing cells, predisposing to pancreatic auto digestion and abnormally acidic duodenal contents, which commonly presents as recurrent abdominal pain.

Question 29

Answer 29

B; HCTZ acts at the DCT to inhibit sodium and chloride reabsorption and promote diuresis.

Question 30

Answer 30

E

Question 31

Answer 31

E; Heroin withdrawal demonstrates symptoms that are common to other CNS depressants such as restlessness, tachycardia and hypertension, tremors, and nausea and vomiting. However, lacrimation, rhinorrhea, piloerection, and yawning are much more typical for heroin withdrawal than for other CNS depressants.

Question 32

Answer 32

E; The symptoms of seasonal allergies are secondary to the vasodilation and increased capillary permeability caused by histamine.

Question 33

Answer 33

C; PAN is a necrotizing vasculitis involving medium sized arteries that generally affects the kidneys and visceral organs, sparing the lungs. It typically presents with systemic symptoms, HTN, kidney damage, kidney micro aneurysms, abdominal pain, and melon. Treatment involves suppression of the inflammation with corticosteroids and cyclophosphamide.

Question 34

Answer 34

A; Drug eruptions are a common cause of widespread rashes. Morbilliform, or maculopapular, due eruptions typically occur 7 to 10 days after medication initiation. Most common culprits include antibiotics, sulfa-containing drugs, and anti epileptics.

Question 35

Answer 35

A; Acute hepatic inflammation in the setting of viral hepatitis A or yellow fever may cause apoptosis of hepatocytes. Image shows ballooning hepatocytes and apoptotic bodies (Councilman bodies)

Question 36

Answer 36

D; Lesch-Nyhan syndrome. Important in the purine salvage pathway to make guanosine monophosphate and inosine monophosphate.

Question 37

Answer 37

E; The SYR gene is located on the located on the Y chromosome and is responsible for producing testis-determining factor, which results in male gonadal differentiation. In testis development, hormones secreted by Sertoli cells (MIF) and Leydig cells (testosterone and DHT) promotes the development of male internal and external genitalia and suppress the development of female structures. SRY gene translocation can occur during recombination in which the SRY gene on the Y chromosome becomes part of the X chromosome, leading to an XX embryo developing male characteristics.

Question 38

Answer 38

E; Pulsus paradoxus refers to the abnormal variation of systolic blood pressure between inspiration and expiration (greater than 10 mmHg), which is seen in conditions that restrict expansion of the heart, such as cardiac tamponade.

Question 39

Answer 39

B; Carbidopa cannot cross the BBB and therefore increases the bioavailability of levodopa without inhibiting the conversion of levodopa to dopamine in the brain. Carbidopa also decreases peripheral dopamine concentrations, reducing the likelihood of dopamine-related side effects such as nausea.

Question 40

Answer 40

D

Question 41

Answer 41

E

Question 42

Answer 42

G; The lower extremity is controlled by the medial aspects of the pre central (motor) and post central (sensory) gyro in the region referred to as the paracentral lobule. Strokes affecting this region result in the loss of motor and sensory function of the contralateral extremity.

Question 43

Answer 43

D; Chronic alcohol use disorder and associated malnutrition may result in significant vitamin B1 (thiamine) deficiency, which can cause Wernicke-Korsakoff syndrome. The syndrome is characterized by symptoms such as AMS, ophthalmoplegia, ataxia, and retrograde, and anterograde amnesia. The mammillary bodies are classically atrophied in Wernicke-Korsakoff syndrome.

Question 44

Answer 44

E; The cytoplasmic domain of the LDL receptor is responsible for signaling that leads to endocytosis, so mutations at this location allow for normal binding of LDL but an inability to transport it across the membrane. Mutations that cause dysfunction or absence of the LDL receptor result in familial hypercholesterolemia.

Question 45

Answer 45

E; Gram negative and gram positive bacteria have different modes of acquiring antibiotic resistance that lead to differing clinical patterns in virulence. Beta-lactamases inactivate beta-lactam antibiotics and are a common mode of resistance to the beta-lactam class among gram-negative bacteria.

Question 46

Answer 46

B;

Question 47

Answer 47

B;

Question 48

Answer 48

A;

Question 49

Answer 49

D

Question 50

Answer 50

C;

Question 51

Answer 51

E

Question 52

Answer 52

B;

Question 53

Answer 53

D;

Question 54

Answer 54

E;

Question 55

Answer 55

E;

Question 56

Answer 56

D;

Question 57

Answer 57

D;

Question 58

Answer 58

C;

Question 59

Answer 59

B;

Question 60

Answer 60

F;

Question 61

Answer 61

C;

Question 62

Answer 62

A;

Question 63

Answer 63

F;

Question 64

Answer 64

D;

Question 65

Answer 65

A;

Question 66

Answer 66

E;

Question 67

Answer 67

E;

Question 68

Answer 68

C;

Question 69

Answer 69

D;

Question 70

Answer 70

D;

Question 71

Answer 71

E;

Question 72

Answer 72

E;

Question 73

Answer 73

B;

Question 74

Answer 74

C;