INFORMAZIONI

10 quiz di Basic Sciences. 

Provate a rispondere ai seguenti quiz che sono stati selezionati perche' sono molto rappresentativi sia come grado di difficolta' che come argomenti trattati. 
In bocca al lupo! Break a leg!

Questi quiz  sono presi per la maggior parte  dal volume: Practice Tests, USMLE Step 1- Practice tests (ed. Appleton & Lange, Joel Goldberg, ISBN 0-07-137739-5), consigliabile per le ottime spiegazioni delle risposte. 
 Si puo ordinare da www.amazon.com, o www.Barnes&Noble.com 

  1. A 72 year old hypertensive man presents with acute onset of expressive apahsia and right     hemiparesis affecting face and arm more than leg. Which of the  following cerebral blood vessels is likely to be occluded?

        a) left anterior cerebral artery
        b) left middle cerebral artery
        c) left superior cerebral artery
        d) right vertebral  artery
        e) basilar artery

 

  1. A new sedative-hypnotic drug is released for use as a continous infusion for patients on a mechanical ventilator. Its half life is approximately 30 minutes. If no loading dose is given, how long will a continous intravenous infusion of this medication take to reach 90% of its final steady- state level

a)15 minutes
b)30 minutes
c) 60 minutes
d) 100 minutes
e) 150 minutes

  1.  A newborn female has ambiguous genitalia. Blood studies reveal elevated dehydroepiandrosterone acetate sulfate (DHEAS) and 17a -hydroxyprogesterone levels. 11- Deoxycorticosterone levels are not elevated.  Which is the likely enzyme deficiency involved?

a) p450c21 (21b- hydroxolase)
b) p450c11b-( 11b- hydroxolase)
c) p450scc (side chain cleavage enzyme)
d) 3b-hydroxysteroid dehydrogenase
e) p45017 (17a-hydroxelase)

  1. A 23 year old heterosexual male, during his first meeting with a female psychiatrist, suddendly states: "All women are whores and I am wasting my time talking to you" . The patient gives a history of having had long term sexual relationships with 2 women over the last 4 years which he says were good. He describes normal feelings of intimacy with his present partner. The doctor's best response is as follows:

        a) You are expressing latent homosexual impulses
        b) The feelings are Oedipal in nature
        c) Your feelings of hostility make it impossible for me to help you
        d) Why do you have these feelings?
        e) You are bringing on feelings of fear in me

  1. A 60 year- old patient in the burn ward of  a hospital develops an infection of the burned tissue. Initial treatment with chloramphenicol and tetracycline was unsuccessful. Cultures of an infected site reveal gram-negative rods that grew on blood agar, EMB and trypticase soy agar. On the latter medium they produced a bluish - green pigmentation and aromatic odor. The organism is susceptible to carbenicillin, gentamicin, amikacin and polymyxin 
    This organism is most likely:

        a) Acinetobacter calcoaceticus
        b) Alcaligenesis faecalis
        c) Pseudomonas aeroginosa
        d) Flavobacterium sp.
        e) Citrobacter sp.

  1. A 65 year-old man presents to your office with a chief complaint of hoarseness. He also describes waking up  frequently at night with water brash and regurgitation of gastric contents he senses in his throat. He states that his symptoms improve transiently with antacids. he patient has no history of smoking or alcohol use.
    Which of the following is the most likely diagnosis?

        a) Laringeal cancer
        b) GERD with associated laringitis
        c) peptic ulcer disease
        d) pulmonary asthma
        e) laringitis

 

  1. A 25 year-old man is brought to a trauma center following a severe motor vehicle accident. He is hypotensive and unresposnsive. There is a large area of ecchymoses on his abdomen with gross distension. Intraperiteonal hemorrhage is suspected. If a pulmonary artery catherer is utilized, which of the choices is likely to be found in this patient? (refer to table below)  
  Cardiac Output Systemic 
Vascular Resistance		 Pulmonary Artery
Occlusion Pressure
A i h i
B h i ior no change
C i h h
D h i ior normal

a) A
b) B
c) C
d) D

  1. In a woman with amenorrhea and high LH and FSH levels what is the most likely diagnosis?

        a) Pituary insufficiency
        b) Pregnancy
        c) Primary ovarian failure
        d) abnormal gonadotropin-releasing hormone (GnRH) secretion
        e) ovarian cysts

  1. The neural tube has completly closed by gestational age

 a) 4 weeks
 b) 8 weeks
 c) 13 weeks
 d) 28 weeks
 e) 38 weeks

  1. Which of the following agents can cause peripheral neuropathy?

        a) Lead and acrylamide
        b) Vitamin C (high dose)
        c) Benzene
        d) Propane
        e) Erythromycin

 

RISULTATI:

 

   


 

        

        
        


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RISPOSTE 

  1. The correct answer is:
         d. (right vertebral  artery) The patient has suffered a lateral medulla stroke producing the multiple symptoms described. Basilar artery occlusions typically produce more widespread damage. 
    Questo e' un tipico quiz di neuroanatomia, con una presentazione clinica.      

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  1.  The correct answer is:
     d. Understanding pharmacokinetics of drugs is critical in evaluating new medications and implementing its use in clinical situations. A continuous infusion of any drug at a fixed rate will reach its steady state in an exponential fashion. The half-life is the time it takes to achieve 50% of the steady-state concentration. 75%
    of the steady -state concentration is achieved in 2 half-lives. (60 minutes for example) 90% of the steady-state is achieved in 3.3. half-lives. (99 minutes for example) Similarly, discontinuation of the drug will affect
    the  concentration also in an exponentional fashion.
    Questo (per fortuna) non e' un tipico quiz di farmacologia, ma  quasi sempre ci sara' una sua versione sia  nelle Basic che nelle Clinical Sciences, quindi e' molto importante saper fare questo tipo di calcolo rapidamente

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3.

The correct answer is: 
a. Deficiency of  p450c21 results in the accumulation of 17a - hydroxyprogesterone  and an increase in its conversion to adrenal andorgens such as DHEA, DHEAS and androstenedion Deficiency of  p450c11b- leads to accumulation of 11- Deoxycorticosterone.  3b-hydroxysteroid dehydrogenase deficiency results in decreased  17a -hydroxyprogesterone  levels. p450c17 deficiency is associated with decreased 17a -hydroxyprogesterone levels and decreased adrenal androgen production.
Questo e' un tipico quiz di Biochimica con una presentazione clinica. Molti di questi quiz sono su malattie metaboliche e genetiche

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  1. The correct answer is: 
     d. The doctor should encourage the patient to express his feelings in order to understand the causes of  his hostility. That will allow the physician to plan a treatment program. Telling the patient he has homosexual latent feelings or an Oedipal conflict is not only premature but it also could be inaccurate.
    Telling the patient that she cannot interact with him provides the ultimate therapeutic rejection and only further reinforces the patients problems. It is totally inappropriate to discuss fears of countertranference (answer e) with the patient. 
    Molti quiz di Behavioral Sciences riguardono il rapporto "medico-paziente". Quasi sempre la risposta corretta e' in forma interrogativa (risposta d). Questo permette al paziente di esprimersi.

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  1. The correct answer is: 
    c.     Pseudomonas aeroginosa is among the most common nosocomial pathogens and most difficult to treat due to its broad range of antibiotic resistance. Burn patients are among those at high risk for this pathogen. Growth properties on EMB, colony pigmentation and the aromatic compounds they produce make them easy to identify.
    Questa e' una tipica domanda di Microbiologia (facile). Spesso i candidati hanno riportato che
    sull'esame  venivano descritti terreni di coltura.

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  1. The correct answer is:
     b.     This patient has a diagnosis of GERD with associated laryngitis. The main symptom complex of nighttime heartburn and regurgitation predisposes the larynx and hypopharynx  to acid induced injury.  Laringeal cancer would generally be considered if hoarseness was not associated with reflux.
    Peptic ulcer and asthma would not result in the episodes of regurgitation.
    Questa domanda di patologia potrebbe causare dei problemi per i termini "hoarseness" (raucedine) e "heartburn" (bruciore di stomaco)
    Per questa ragione e' importantissimo fare piu' quiz possibili dove vengono descritti i sintomi dei
    pazienti con termini usati dai pazienti.

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  1. The correct answer is a. Shock is characterized by a state in which tissue perfusion is significantly reduced. There are several types of shock, but three general classes most commonly referred to are hypovolemic, cardiogenic, and distributive shock. Hypovolemic shock can arise from hemorrhage or fluid losses. Specific causes include trauma, vomiting, diarrhea, burns, insensible losses, gastrointestinal bleeding, or aortic rupture. In these states, the preload is reduced, and on a pulmonary artery (PA) catherer, the preload to the left ventricle can be estimated by the PA occlusion (or wedge) pressure (PAOP). Therefore, in cases of hypovolimic shock, the PAOP should be reduced with a concomitant drop in  the cardiac output. The systemic vascular resistance (SVR) is increased in response to the hypovolemia and fall in cardiac output.
          Vi sono moltissimi grafici soprattutto nei quiz di fisiologia. Bisogna essere esperti e non farsi intimorire.

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  1. The answer is:
     c.     In the absence of the ovarian production of estrogen and progesterone, as in primary ovarian  failure, there is no feedback inihibition of pituary gonadotropin secretion, and therefore LH and FSH levels are elevated. In amenorrhea caused by pituary insuficiency LH and FSH levels are diminished. In pregnancy estrogen and progesterone both inihibit the release of LH and FSH. If hypothalamic GnRH is not secreted normally, LH and FSH cannot be secreted  adequately from the pituary gland.
    Sia le Basic Sciences che le Clinical Sciences insistono molto sulla conoscenza dei meccanismi di azione degli ormoni

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  1. The answer is:
     a.     The neural tube and neural plate form by 21 days with closure of the anterior and caudal  neurospores by 26 to 28 days. By this time there is no longer comunication betwen the central canal and the amniotic fluid. A leakage of alpha-fetoprotein from the fetal blood supply to amniotic fluid  may be found in as many as 80% of fetuses with neural tube defects. The neural tube may have an inductive influence on mesodermal components to form the skull; anancephaly, partial or complete absence of the brain; and meningomyelocele, protrusion of meningis and neural tissue through an enclosed posterior vertebral arc. (Spina bifida) 
    Le domande di embriologia sono quasi tutte sul tubo neurale, quindi conviene studiarlo benissimo.

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  1. The answer is:
     a.     Lead toxicity produces a predominantly motor neuronopathy while acryamide is        associated with  distal axonal neuropathy.
    Attenzione! Sono molto "fissati" con la tossicita' di sostanze come il piombo.

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PASS con voto superiore  200: 8 corrette su  10

    PASS: 6 risposte corrette su 10   

Bibliography:
Appleton & Lange- Practice Tests, USMLE Step 1- Practice tests, Joel Goldberg, ISBN 0-07-137739-5
1) question 2 page 1,9,
2) question 25, pag 18,24
3) question 20, pag 32, 39
6) question 30, pag 106,107,113
7) question 26, pag 33, 39
8) question 30, pag. 64, 71
9) question 13, pag. 60, 69 
10) question 34, page 48, 55