USMLE STEP 1

USMLE STEP 1 :: RE: Kaplan Coaching Cost for USMLE in India?

Anonymous — Fri, 20 Nov 2009 14:45:16 GMT

Author:
Posted: Fri Nov 20, 2009 8:15 pm (GMT 5.5)

HEY SAMI,,HAVE YOU JOINED OR ALREADY DONE WITH DELHI KAPLAN CENTRE PLZ GIVE ME SOMEINFORMATION ABOUT IT , MY ID IS KASH_VALLEY1999..............Y.C

USMLE STEP 1 :: RE: A 62 year old man presents with a right sided spastic hempar

changsu — Fri, 20 Nov 2009 08:09:44 GMT

Author: changsu
Posted: Fri Nov 20, 2009 1:39 pm (GMT 5.5)

d. myelencephalon

USMLE STEP 1 :: A 62 year old man presents with a right sided spastic hempar

changsu — Fri, 20 Nov 2009 08:08:51 GMT

Author: changsu
Subject: A 62 year old man presents with a right sided spastic hempar
Posted: Fri Nov 20, 2009 1:38 pm (GMT 5.5)

Arter suffering a stroke, a 62 year old man presents with a right sided spastic hemparesis. Neurologic testing reveals a loss of tactile and vibration sensation in the right extremities and right side of the trunk. His tongue deviates to the left when protruding. The patient's lesion is in a brain structrue that derives from which of the following embryonic structures.

a. Diencephalon
b. mesencephalon
c. metencephalon
d. myelencephalon
e. telencephalon.

USMLE STEP 1 :: RE: A 39 year old woman with carcinoid syndrome undergoes a CT s

changsu — Fri, 20 Nov 2009 08:08:10 GMT

Author: changsu
Posted: Fri Nov 20, 2009 1:38 pm (GMT 5.5)

Ans- B bronchus. Right sided valvular heart disease is more common in carcinoid syndrome and the primary is usually in the small intestine.Left sided valvular heart disease is seen either with a patent foramen ovale or a bronchial carcinoid.Heart is usually involved in small intestine carcinoids only after metastasis to the liver as the liver is thought to metabolise the serotonin

USMLE STEP 1 :: A 39 year old woman with carcinoid syndrome undergoes a CT s

changsu — Fri, 20 Nov 2009 08:07:40 GMT

Author: changsu
Subject: A 39 year old woman with carcinoid syndrome undergoes a CT s
Posted: Fri Nov 20, 2009 1:37 pm (GMT 5.5)

A 39 year old woman with carcinoid syndrome undergoes a CT scan that reveals a single tumor with no evidence of metastasis. She has a history of left-sided valvular heart dis. Where is the tumore most likely located.

A appendix
B bronchus
c pancreas
d. rectum
e. small bowe.

USMLE STEP 1 :: RE: A 23-year-old woman with no previous history of psychiatric

changsu — Fri, 20 Nov 2009 08:07:06 GMT

Author: changsu
Posted: Fri Nov 20, 2009 1:37 pm (GMT 5.5)

A use of trimethoprim/sulfamethoxazole +acute abdominal pain

USMLE STEP 1 :: A 23-year-old woman with no previous history of psychiatric

changsu — Fri, 20 Nov 2009 08:06:34 GMT

Author: changsu
Subject: A 23-year-old woman with no previous history of psychiatric
Posted: Fri Nov 20, 2009 1:36 pm (GMT 5.5)

A 23-year-old woman with no previous history of psychiatric illness or substance abuse is admitted for sudden onset of restlessness, visual and auditory hallucinations, and emotional lability. Her parents report that she had been treated with trimethoprim/sulfamethoxazole for a urinary infection 2 weeks ago. She has frequent abdominal pains and constipation. On examination, she looks pale, weak, diaphoretic, and is tachycardic. There is symmetric bilateral weakness of the lower extremities, with greatly diminished tendon reflexes. Which of the following is the most likely diagnosis?

Options:

A. Acute intermittent porphyria.

B. Addison disease.

C. Guillain-Barre syndrome.

D. Hyperthyroidism.

E. Systemic lupus erythematosus

USMLE STEP 1 :: RE: After amplification of exon 9 of the LDL receptor gene using

changsu — Fri, 20 Nov 2009 08:05:03 GMT

Author: changsu
Posted: Fri Nov 20, 2009 1:35 pm (GMT 5.5)

The answer is C. The point mutation has resulted in the introduction of the palindrome recognized by Nla III, GTAC. Enzymatic digestion of the amplified 222 bp mutated exon 9 should therefore result in two fragments, of combined mass 222. Digestion of the normal 222 bp amplified exon should not result in fragmentation, and it should remain a 222 bp fragment. A heterozygote individual has one normal allele of the LDL receptor gene and one mutated allele. Digestion of the PCR-amplified exon 9 should therefore result in 3 different restriction fragments: the 222 bp normal allele, and the fragmented mutant allele. Note that 126 and 96 add up to 222.

One thick band at 222 (choice A) would be expected in an homozygous normal individual, both alleles remaining intact after Nla III digestion. The thickness of the band only shows the abundance of the restriction fragment of that size.

Three bands of 180, 32 and 10 bp (choice B) would indeed indicate digestion by the restriction enzyme. However, the lack of 222 bp restriction fragment would rule out the presence of a normal allele. Also note that since the sum of the three fragments is 222, it would indicate the presence of 2 restriction sites for the enzyme, which is not compatible with the information given.

Two bands of 126 and 96 bp (choice D) would be the pattern expected from a homozygous individual for the mutated allele. The thickness of the band reflects the abundance of restriction fragment of that size.

Two bands of 444 and 222 bp (choice E) would be very difficult to interpret. A fragment that is larger than the original amplified material could not be created by enzyme digestion.

USMLE STEP 1 :: After amplification of exon 9 of the LDL receptor gene using

changsu — Fri, 20 Nov 2009 08:03:54 GMT

Author: changsu
Subject: After amplification of exon 9 of the LDL receptor gene using
Posted: Fri Nov 20, 2009 1:33 pm (GMT 5.5)

After amplification of exon 9 of the LDL receptor gene using PCR, a scientist employs RFLP analysis with Southern blotting to identify a point mutation in codon 408. This mutation has resulted in the missense mutation of GTG (Val) to GTA (Met):

Normal: CTGGTGCCA

Mutant: CTGGTACAA

Exon 9: 222bp

Nla III is a restriction enzyme recognizing the short palindrome GTAC, which is not present in the normal exon 9. The researcher digests the amplified exon 9 with this enzyme, then subjects it to Southern blotting with a probe directed against the entire amplified region. Which of the following banding patterns would most likely be found in an individual heterozygous for the mutation described?

Options:

A. One thick band of 222 bp

B. Three bands of 180, 32 and 10 bp

C. Three bands of 222, 126 and 96 bp

D. Two thick bands of 126 and 96 bp

E. Two bands of 444 and 222 bp

USMLE STEP 1 :: RE: A 37-year-old woman is abducted, beaten, and repeatedly rape

changsu — Fri, 20 Nov 2009 08:02:48 GMT

Author: changsu
Posted: Fri Nov 20, 2009 1:32 pm (GMT 5.5)

The answer is B. The reaction was precipitated by a stressful event that would cause anyone to experience a severe and intense emotional response. The symptoms occurred within 3 months of the event and lasted for less than 6 months after the trauma, all corresponding to the diagnosis of adjustment disorder with mixed anxiety and depressed mood.

Acute stress disorder (choice A) and post-traumatic stress disorder (choice E) both require that the person reexperience the traumatic event in wakeful or dream states and the presence of dissociative symptoms.

This is not a major depressive disorder (choice C) because her symptoms are not of psychotic proportion and there is a clear precipitating stimulus.

Panic disorder without agoraphobia (choice D) is incorrect because the panic episodes are uncued and not the response to an environmental stressor.

USMLE STEP 1 :: A 37-year-old woman is abducted, beaten, and repeatedly rape

changsu — Fri, 20 Nov 2009 08:01:35 GMT

Author: changsu
Subject: A 37-year-old woman is abducted, beaten, and repeatedly rape
Posted: Fri Nov 20, 2009 1:31 pm (GMT 5.5)

A 37-year-old woman is abducted, beaten, and repeatedly raped. For five months after the attack she is nervous, tearful, easily fatigued, and has difficulty concentrating. She also notes difficulty sleeping and lack of appetite, and is hyperreactive to unexpected or loud stimuli. By six months she has returned to her characteristic pre-attack behavioral patterns. Which of the following is the most likely diagnosis?

Options:

A. Acute stress disorder.

B. Adjustment disorder with mixed anxiety and depressed mood.

C. Major depressive disorder.

D. Panic disorder without agoraphobia.

E. Post-traumatic stress disorder

USMLE STEP 1 :: RE: A 78-year-old man has a murmur consistent with mitral stenos

changsu — Fri, 20 Nov 2009 07:59:15 GMT

Author: changsu
Posted: Fri Nov 20, 2009 1:29 pm (GMT 5.5)

The answer is D. Diltiazem is a calcium channel blocker that inhibits calcium influx into vascular smooth muscle and the myocardium. It is also an AV nodal blocking agent, and is often used intravenously to control rapid atrial fibrillation (shown above) and atrial flutter.

Amiodarone (choice A) can be used in the treatment of atrial fibrillation, but it is not used for the acute control of the heart rate. It may take one to three weeks of treatment before there is a response to amiodarone.

Heparin (choice B) and warfarin (choice E) are both anticoagulants, and are used in atrial fibrillation to prevent thrombus formation, but they play no role in controlling the arrhythmia.

Digoxin immune Fab (choice C) is an antibody directed against digoxin. It is used in digoxin toxicity

USMLE STEP 1 :: A 78-year-old man has a murmur consistent with mitral stenos

changsu — Fri, 20 Nov 2009 07:58:22 GMT

Author: changsu
Subject: A 78-year-old man has a murmur consistent with mitral stenos
Posted: Fri Nov 20, 2009 1:28 pm (GMT 5.5)

A 78-year-old man presents to the emergency department with palpitations. On physical examination, he has a murmur consistent with mitral stenosis. A cardiac rhythm reveals the strip shown above. Which of the following medications can be used to immediately control his palpitations?

Options:

A. Amiodarone

B. Heparin

C. Digoxin immune Fab

D. Diltiazem

E. Warfarin

USMLE STEP 1 :: RE: A 75-year-old woman comes to see her physician complaining o

akshay — Fri, 20 Nov 2009 07:56:45 GMT

Author: akshay
Posted: Fri Nov 20, 2009 1:26 pm (GMT 5.5)

The answer is B. The case presents a woman who is having a normal grief reaction to the loss of her husband. The grief response is likely exacerbated by the fact that she survived the accident and he did not, something we call "survivor" guilt. "The key to this question is that the physician must recognize that although some of the symptoms of depression are present, this is normal grief. The patient does not need diagnosis or drugs, but someone to talk to and someone to listen to her. When patients are in grief, the physician should take time to talk with them, let them know that grief is normal (many people begin to feel that it is not), and that grief takes time. Normal grief can last up to one year. Asking about her husband encourages her to talk about her reactions and her memories of the relationship. Both are a part of the healing process.

Choice A has key questions for the diagnosis of posttraumatic stress disorder (symptoms over one month) or acute stress disorder (symptoms under one month). However, focusing on diagnosis misses the mark here. The grieving patient needs support and an outlet for expression of feelings, not a diagnostic label.

The woman is having a normal grief response and does not need to be hospitalized (choice C). She is not unable to care for herself, nor is there any mention of suicidal ideation.

As a general rule, do not medicate grief (choice D). To work through the grief, the patient need to come to grips with reality, an unpleasant reality. The physician job is not to reduce her emotional reactions with pharmacology, but to allow her to come to psychological acceptance of that reality by helping her think about and talk about that reality.

There is no need to pass off this patient to someone else (choice E). The physician should recognize what is going on, and is perfectly able to provide support and comfort on his or her own.

Telling her to get on with her life (choice F) is premature and suggests that something is wrong with her for having the reactions that she is having. Grief takes time� up to one year for some people (although often resolved in 6 months).

This is not depression (choice G), but normal grief. Grief is about the loss of another. Depression is about the "loss" of one's self. Both can have similar symptoms with these key differences. Depression lingers for years. Grief resolves itself in time. Grieving people do not contemplate suicide. Over 60% of depressed people do have suicidal ideation. Medicate depression, but not grief.

USMLE STEP 1 :: A 75-year-old woman comes to see her physician complaining o

akshay — Fri, 20 Nov 2009 07:56:13 GMT

Author: akshay
Subject: A 75-year-old woman comes to see her physician complaining o
Posted: Fri Nov 20, 2009 1:26 pm (GMT 5.5)

A 75-year-old woman comes to see her physician complaining of fatigue and difficulty sleeping. "I just don't feel like doing anything anymore." she says. DSM IV, Axis IV is notable for the death of her spouse four months ago in an automobile accident in which she was a passenger. Physical examination reveals a weight loss of 11 pounds.
During more intensive questioning, she reports bouts of crying for no reason, and says she sometimes thinks she hears her husband calling to her from another part of her house. At this point what should the physician's say next?

Options:

A. "Do you have any nightmares or find yourself reliving the car crash in some way?"

B. "Do you think about your husband often?"

C. "I'm going to admit you to the hospital for overnight observation so we can run a few tests."

D. "I'm going to give you something to help you feel better and make it easier for you to sleep."

E. "I'm going to schedule you for an evaluation with a colleague of mine who can help us understand why you are feeling this way."

F. "It sounds like the loss of your husband was difficult for you, but it is time for you to think about your own life now."

G. "You have all of the symptoms of depression. Do you understand what that means?"

USMLE STEP 1 :: RE: A 21 year old man develops wristdrop after sustaining a comp

akshay — Fri, 20 Nov 2009 07:55:00 GMT

Author: akshay
Posted: Fri Nov 20, 2009 1:25 pm (GMT 5.5)

A is the answer. At the time of the fracture he sustained a compartment syndrome.This led to muscle atrophy. Now he is in the recovery phase. This is what is seen clinically.

USMLE STEP 1 :: A 21 year old man develops wristdrop after sustaining a comp

akshay — Fri, 20 Nov 2009 07:52:14 GMT

Author: akshay
Subject: A 21 year old man develops wristdrop after sustaining a comp
Posted: Fri Nov 20, 2009 1:22 pm (GMT 5.5)

A 21 year old man develops wristdrop after sustaining a complete fracture of the upper arm associated with extensive tissue damage. The fracture was reduced successfully, and the ends of vessles and nerves were rejoined surgically. Despite physical therapy, the extensor muscles have a decreased volume and can contract only weakly. Wound healing and flexor are good. The most likely cause of this condition is abnormal funtion of which of the following?

A:Circulation
B:Glucose Transporters
C:Lymphatic Drainage
D:Neurotrophic Input
E:Tender stretch receptors.

USMLE STEP 1 :: RE: Two individuals became infected with HIV at approximatively

akshay — Fri, 20 Nov 2009 07:51:21 GMT

Author: akshay
Posted: Fri Nov 20, 2009 1:21 pm (GMT 5.5)

Answer is C....products of TAT and REV genes INCREASE VIRAL MATURATION and act TO DECREASE LATENT PERIOD ,
VIF genes products affects viral infectivity and VPR gene products INCREASE the EFFICIENCY of BUDDING.
another possible difference between the 2 individuals( JT and AY) is that may be AY lack the invasion gene, which codes a cellular co receptor for HIV,
env codes for envelope, and pol codes for RT.

USMLE STEP 1 :: Two individuals became infected with HIV at approximatively

akshay — Fri, 20 Nov 2009 07:50:37 GMT

Author: akshay
Subject: Two individuals became infected with HIV at approximatively
Posted: Fri Nov 20, 2009 1:20 pm (GMT 5.5)

Two individuals became infected with HIV at approximatively the same time;
JT progresses to full blown AIDS and dies within 3 years.
AY is still asymptomatic after 10 years.
possible explanation is that the virus in JT is probably expressing a high amount of activity of which regulatory gene product?
A. VIF
B. vpr
C. tat
D. env
E. env

USMLE STEP 1 :: RE: Virology to design a vaccine against HIV infection a logical

akshay — Fri, 20 Nov 2009 07:49:48 GMT

Author: akshay
Posted: Fri Nov 20, 2009 1:19 pm (GMT 5.5)

Answer is B...Gp 120 is the surface antigen of HIV that mediates its attachment to CD4.
Gp41 is a transmembrane glycoprot and P17 P24 and nuceleocapsid prot are ALL INTERNAL MOLECULES; which WOULD RARELY BE ACCESSIBLE to the immune response.

USMLE STEP 1 :: Virology to design a vaccine against HIV infection a logical

akshay — Fri, 20 Nov 2009 07:48:55 GMT

Author: akshay
Subject: Virology to design a vaccine against HIV infection a logical
Posted: Fri Nov 20, 2009 1:18 pm (GMT 5.5)

Virology to design a vaccine against HIV infection a logical goal would be to alter some native molecule or product of the virion in order to make it highly immunogenic if U wished to prevent the attachement of the virus to helper T lymphocytes which molecule might best be targeted?
A. gp41
B. gp 120
C. nucleocapsid
D. P17
E. p24

USMLE STEP 1 :: RE: A 23 year old woman drinks several diet colas containing sev

akshay — Fri, 20 Nov 2009 07:48:11 GMT

Author: akshay
Posted: Fri Nov 20, 2009 1:18 pm (GMT 5.5)

Phosphate has a direct inhibitory action on 1alpha-hydroxylase in the kidney which converts 25OH vit D3 to 1,25(OH)2 VitD3. High levels of dietary phosphate also cause hypocalcaemia by precipitating calcium.

USMLE STEP 1 :: A 23 year old woman drinks several diet colas containing sev

akshay — Fri, 20 Nov 2009 07:47:05 GMT

Author: akshay
Subject: A 23 year old woman drinks several diet colas containing sev
Posted: Fri Nov 20, 2009 1:17 pm (GMT 5.5)

A 23 year old woman drinks several diet colas containing several hundred millligrams of phosphate but no calcium. Which of the following hormanl reposnse will most likely occur in response to this ingestion.

a. decreased 1,25(OH2)2D3 and decreased PTH

B. Dec 1,25(OH2)2D3 and increased PTH

c. Inc 1,25(OH2)2D3 alone

d. inc 1,25(OH2)2D3 and dec PTH

e. inc 1,25(OH2)2D3 and inc PTH

USMLE STEP 1 :: RE: A pateint with lymphoma has involved lymph node resected and

akshay — Fri, 20 Nov 2009 07:46:31 GMT

Author: akshay
Posted: Fri Nov 20, 2009 1:16 pm (GMT 5.5)

Answer is A
Mantle cell lymphoma or intermidiate differentiated lymphocytic lymphoma, accounts for 3% of all non-hodgkin lymphomas. This tumor arrises from the mantle zone B lymphocytes, and the tumor cells are positive for Cd19, CD20 and CD 5 and negative for CD23. Translocation 11;14 is characteristic, Chromosome 11 has bcl-1 and chromosome 14 has immunoglobulin heavy-chain genes.

USMLE STEP 1 :: A pateint with lymphoma has involved lymph node resected and

akshay — Fri, 20 Nov 2009 07:46:00 GMT

Author: akshay
Subject: A pateint with lymphoma has involved lymph node resected and
Posted: Fri Nov 20, 2009 1:16 pm (GMT 5.5)

A pateint with lymphoma has involved lymph node resected and examine pathologically. The lymph node shows a malignant proliferation of small cleaved cells that are most prominent in the areas immediately ouside the follicles. Immunohistochemical stains show the cells are positive for CD19, CD 20 CD5 and negative for CD 23. This type of lymphoma is associated with a characteristic translocation that involves which of the following.

a. bcl-1 and immunoglobulin heavy chain gene
b. bcl-2 and immunoglobulin heavy chain gene
c. c-abl and bcr
d. c-myc and immunoglobulin heavy chain gene
e. PML amd RAR-alpha