Question 12

(Source: Professor Yasser Metwally, 2008)

83 year old woman is brought to the clinic with abnormal movements of hand. She complains that she has difficulty in walking and doing things for some months. She denies any history of fever or neck stiffness. She has a past history of DM, HTN, Rheumatoid arthritis for several years. She is taking metformin, thiazide, aspirin and multivitamin daily. She lives with her son and daughter in law since her husband passed away 7 years ago and says that her kids are "very caring" and nice to her. During the interview, the physician notes that she shows no affect while talking, and her hands are constantly shaking. Her memory appears to be intact. When asked to walk she walks with a typical gait as shown above in the media. An appropriate diagnosis is made and treatment is begun. What is the pathophysiology of the disease under consideration?

A) Trinucleotide repeat
B) Degeneration of Substantia Nigra
C) Decreased Dopamine and increased Acetylcholine
D) Copper deposition
E) Iron deposition
F) Drug induced
G) Old age changes

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Question 11

Source: Professor Yasser Metwally, 2008)

An 85 year old male patient is brought to the clinic from the nursing home with symptoms of abnormal movement. He has recently completed a course for Tubeculous meningits for 9 months. He has no neck stiffness or fever. The neurological examination shown above in the media suggests a lesion in the brain which may be due to previous TB infection. Most likely, where should be the lesion located?

A) Occipital Lobe
B) Wernickes area
C) Brocas area
D) Subthalamic nuclei
E) Cerebeller tonsils
F) Cardiac vegetations
G) Trinucleotide repeat disorder in caudate

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Question 10

(Source: Professor Yasser Metwally, 2008)

51 year old woman is brought by neighbors with symptoms of abnormal movements since several days now. The woman stays alone and there are distant relatives who come to visit often. The woman's past medical file on record do not say about anything significant but there is a history about her father having some movement disorder at the age of 55 and that he died of aspiration pneumonia. The examination findings are given above in the video. The doctor suspects some neurological inherited disorder. Where is the neurological defect located in this patient?

A) Globus Pallidus, due to GAA repeat on short arm of chromosome 9
B) Caudate nucleus, due to GAA repeat on short arm of chromosome 9
C) Caudate nucleus, due to CAG repeat on short arm of chromosome 4
D) Caudate nucleus, due to CAG repeat on long arm of chromosome 4
D) Substantia nigral pathway
E) Mitral Valve vegetations
F) Caudate nucleus, due to CTG repeat on long arm of chromosome 19

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Question 9

6 year old Caucasian boy was brought to the ER with history of fever since 3 days, there is a rash on scalp since the advent of fever. The mother also complaints that he drinks a lot of water, and passes urine often, sometimes even 20 times a day. The mother is anxious and seems to be concerned about her son's bulging eyes. On examination, the boy looks lethargic, vitals are normal. Exophthalmus is present and Temperature is 99.6 F. X ray of the skull suggests cyctic lesions of the scalp. Urinary Na is low and serum Na is 154. On examination of ears, the physician finds a similar rash in the external canal. What is the most likely diagnosis in this case?

A) Benign Histiocytosis
B) Letterer Siwe disease
C) Hand-Schuller Chrsitian disease
D) Craniopharyngeoma
E) CNS lymphoma
F) Kawasaki disease
G) Meningitis
F) Acute lymphocytic leukemia

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Practice............ Practice............ & more Practice

Guys along with the questions we post here in the blog, I would also recommend you to go through the 350 questions posted on the Lippincott's website. You can give it a try after your first read and see where you stand before solving any Q: Bank.

Here is the Link:

http://www.lww.com/usmle/test/

http://www.lww.com/medstudent/usmle/

try one of these links above.

Regards & Luck

USMLE Challenger

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Question 8

Match the following:

1) G1 a) Vinca alkaloids
2) G2 b) Methotrexate
3) S c) Bleomycin
4) M d) 6 mercaptopurine
e) Busulfan

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Question 7

41 year old female is admitted for dyspnea on exertion, myalgias and fatigue since last 6 months. She has a past history of rheumatoid arthritis for which she is regularly taking aspirin and a DMARD. She also has history of HTN treated with hydrochlorthiazide and DM controlled by diet. She smokes 1 pack of cigerette daily for last 20 years and consumes alcohol on weekends. Her father was diagnosed with CML and succumbed to it at the age of 65 years, and her mother died of old age. Her elder brother has psoariasis and elder sister has hashimotos thyroiditis. She is sexually active with her husband and uses condoms regularly. She did not travel anywhere out of her town for the last 3 years after she was diagnosed with Rheumatoid arthritis. She is a homemaker, and loves to be with her two lovely children. On examination her BP is 128/76 mm Hg and pulse of 110/min. She appears to be pale. Her CBC shows Hb of 9.2, MCV 120, and the peripheral smear is shown (Image Source: Google). She has no tingling or numbness of extremities. What is the cause of low Hb?

A) Reversible Myelosuppression
B) CML
C) B12 deficiency
D) Dietary Folate deficiency
E) Chemotherapy
F) Iron deficiency anemia
G) Bone marrow fibrosis
H) Irreversible Myelosuppression
I) Pernicious Anemia

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