you have to know the definition of confidence interval. The CI = the odds (or likelihood) of finding the true average within a set range. Odds ratio is essentially comparing the odds between cases vs. control for both alcohol consumption and no-alcohol consumption. If one of the answer said, ' There is a 5% chance that the true average is not within the range between 1.8 - 6.6' that would be a legitimate answer

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trauma during mountain hiking + fever + calf swelling and tenderness + crepitus >>> this is a case of gas gangrene which is caused by c.perfringens

c.septicum can also cause gas gangrene so why not it ?

the answer is that c.septicum causes spontaneous gas gangrene with rapid onset and hemorrhagic bullae, BUT it is not associated with trauma (unlike c.perfringens)

in the question,it is mentioned that there was mountain hiking making having trauma more likely and hence c.perfringens is the answer

you should also know that c.septicum can cause colon cancer mostly in presence of IBD&immunosuppresion as risk factors

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myopathy&rhabdomyolysis are common side effects of statins particularly when given with fibrates

myoglobin released from damaged muscle cells may cause acute renal failure

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efficacy is defined as maximal effect regardless of dose (which determines potency)

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the graph shows that pressure in left atrium is rising during systole and there is systolic murmur,this indicates mitral valve incompetence

the only choice that can cause mitral valve incompetence is rupture of chordae tendineae

history of rheumatic valvular disease support diagnosis although it most commonly causes stenosis after many years

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sweet odor when changing diaber + increased isoleucine in urine >>> maple syrup urine disease,in which,degradation of branched amino acids (leucine - isoleucine - valine) is blocked due to ↓ branched-chain 𝞪-ketoacid dehydrogenase

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hyperresonance + absent breath sound >>> pneumothorax

in all other choices ,hyperresonance does not occur

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11- a
dorsal white matter of the upper thoracic spinal cord has only dorsal column tract which carries proprioception and 2 points discrimination -discriminative sensation- (differentiate if one finger is touching you or two fingers at the same time)
pain and temperature are carried my lateral spinothalamic tract
and motor activity are carried by corticospinal tract
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12- e
this patient has decreased bile absorption due to jejunoileal bypass as blie is absorbed from ileum,a decrease in bile absorption by turn will lead to decrease fat and fat soluble vitamins absorption (K,E,D,A) ,hence fecal fat is increased and fat soluble deficiency will develop
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13- a
bcl-2 is antiapoptotic , so when overexpressed , it will decrease cell death
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14- d
history of severe cramping pain in right flank that radiates to groin + pain not releived by position >>> stone
prophylaxis of stone formation is by drinking large amount of water in order not to let solutes concentrate and form stones
although calcium stones are the most common type kidney stones ,decreasing calcium in diet is not helpful as most cases of kidney stones occur in people with normal calcium level (normocalcemia & hypercalciuria) , and calcium absorption is regulated by vit d
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15- d
Chancre: charachterized by mononuclear cell infiltrate dominated by plasma cells with scattered histiocytes; also obliterative endarteritis with thickened small vessels due to proliferation of endothelial cells and fibroblasts
Condyloma lata: resembles condyloma acuminatum, and charachterized by prominent epidermal hyperplasia, more edema, chronic inflammatory infiltrate, but less keratinization, minimal if any koilocytosis

Gummas: have caseous necrosis, chronic inflammatory cell infiltrate, obliterative endarteritis
Healed gummas: become noncontractile scars with arching fibrosis

for more information :

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it is a case of CO poisoning

cherry red skin raises suspicion of either CO or cyanide poisoning

important key to know that headache is the most initial symptom on CO poisoning

in this case PCR is not done
Antibodies like IgG can pass through placenta can't tell if baby was infected or just they were passed

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unobtainable blood pressure indicates severe hypotension due to massive hemorrhage after accident,

decreased blood flow and ischemic injury can cause necrosis of tubular cells and their sloughing into tubular lumen obstructing it leading to oligouria

most affected sites are proximal convoluted tubules and thick ascending limb of loop of henle as they need high amount of energy

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This patient has Stanford A aortic dissection with bleeding into the pericardial space. This explains the chest pain and low blood pressure 80/40 mmhg. It acts like a cardiac tamponade mainly around the outflow tract of the left ventricles and causes backup of blood in the LV and LA. This increases LA pressure and reduces the pulmonary venous return to left side of the heart.
So pcwp ( an indirect measure of LA pressure) goes up. This pressures back up to the lungs and causes increased diastolic pulmonary pressure and that also backs up to increase RA pressure.
The body sensing decreased blood supply to the tissues ( due to the tamponade effect and low BP) fires reflexly to increase heart rate and vasoconstricts to maintain BP. This explains the increased systemic vascular resistance.
Finally cardiac index is a ratio of cardiac output to body surface area = CO/ BSA. In this case, BSA does not change but due to hypotension, CO reduces. Therefore, the cardiac index also drops.

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26- a
it is a new concept that you should know,but even if you do not know the answer ,you can answer correctly:
by exclusion,central thermoregulation is mediated by hypothalamus,skin graft and burns has no rule with this.
injured and inflammed skin may cause release of mediators that act as endogenous pyrogens but this would be acutely not continuous for years.
there is no large difference between normal skin and grafted or scar skin in sensitivity to heat or sunlight to the degreee that cause hyperthermia
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27- e
it is very very very high yield to know everything about metformin as it is highly used nowadays
it inhibits hepatic gluconeogenesis ,it also lead to inhibition of mitochondrial isoform of glycerol-3-phosphate dehydrogenase & complex 1 in electron transport chain in liver.
if you decided to know one single most important thing about metformin , it would be a side effect of LACTIC ACIDOSIS !!!!!!!!!!
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28- e
rifampin inhibits DNA dependent RNA polymerase in prokaryotes (this enzyme makes all three types of RNA in prokaryotes unlike eukaryotes that have 3 types of RNA polymerase)
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29- b
bilateral crackles on auscultation >> pulmonary edema >> left side heart failure (most commonly in USMLE)
S3 >> volume overload
pitting ankle edema >> right side heart failure
low blood pressure + peripheral cyanosis with these clues indicates systolic heart failure (diagnosis is supported by pre-eisting hypertension)
in systolic heart failure >> decrease cardiac output (CO)
right sided heart failure >> increased systemic venous pressure (SVP)
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30- b
after circumflex artery angioplasty, blood will increase to regions supplied by it ,which will be left ventricle
NOTE that this patient has a right dominant heart circulation so posterior descending artery arise from right coronary artery, if it was left dominant or codominant,circumflex artery would share in supply of PDA and hence regions supplied by PDA
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31- c
vegetarian for 12 years + macrocytic anemia + neurological manifestations >>> vit B 12 deficiency
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32- f
6-week-old + projectile vomiting - vomitus free of bile >>> pyloric stenosis
you should know that pyloric stenosis is not present at birth but develops later (within 2 weeks)
congenital megacolon presents in first 2 days of life by failure to pass meconium
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33- a
area postrema is found in medulla and is responsible of vomiting
note that it is one of areas that are not protected by blood brain barrier so it is easily stimulated to produce vomiting by different toxins circulating in the blood.
it is also the target of some antiemetic drugs
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34- d
question stem describes manifestations of parkinsonism disease
in parkinsonism: the lesion is in substantia nigra which is found in midbrain as indicated by the arrow
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35- e
tubular absorption is mostly by active transport using ATP , so high amount of oxygen is used (especially proximal convoluted tubules and thick ascending limb of loop of henle)
while glomerular filtration is a passive process
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36- c
ORS, Oral rehydration solution also contains glucose. This provides energy and helps the sodium–glucose cotransporter protein, which absorbs sodium into the cell much better if glucose is also present. The glucose in the oral rehydration solution ensures that the protein will bring as much sodium as possible into the cell. Bringing more sodium into the cell reduces its water potential, causing water to re-enter the cell from the lumen by osmosis.

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recurrent bacterial infections after birth indicates immunodefficiency disease

the only immunedeficiency disease in the choices that is associated with absence lymphoid tissue is Bruton agammaglobulinemia

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progressive dementia + major depressive disorder + movement disorder + autosomal dominant trait >>> Huntington disease

great variability in the symptom severity and age of onset support the diagnosis

this phenomenon is called anticipation,which means that disease severity increases with earlier onset of the disease with each generation

the more the number of triplet , the more the severity and the earlier is the onset.

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generalized tonic clonic seizures after 3 days of hospital admission with no access to alcohol indicates alcohol withdrawal

moreover,other choices do not cause seizres in withdrawal.

delta9-tetrahydrocannabinol (9THC) may cause tremors and ataxia but not tonic clonic seizures

it is very high yield to know manifestations of alcohol withdrawal:

3-36 hr : tremors (the first manifestation) and other minor symptoms similar to other depressants

12-48 hr : hallucinations (usually visual)

treatment for alcohol withdrawal is benzodiazepines

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under normal conditions, prolactin secreted by lactotrophs in anterior pituitary gland is suppressed by dopamine secreted from hypothalamus.

dopamine antagoinists as metoclopramide will lead to removal of this suppression ,and increase prolactin secretion from anterior pituitary (adenohypophysis) leading to galactorrhea.

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treatment and prevention of influenza A and B is oseltamivir ,a sialic acid analog that acts as neuraminidase inhibitor , decrease release of progony virus

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both hepatitis A and E are transmitted via feco-oral route,have no chronic state and usually self limited

but the main difference is that hepatitis E have a high mortality rate among pregnant women so they should be advised not to travel to any region that is know to be endemic with hepatitis E

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actually,the question asks about the normal histology of the lung

type 1 pneumocytes cover about 97% of alveolar surfaces and their function is gas diffusion

type 2 pneumocytes secrete surfactant and serve as precursors to type 1 cells,proliferate during lung damage

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decreasing to 5 mm will automatically include many cases that were left whose induration size was 5-9.9mm, hence prevalance will increase
incidence should also increase as the no. of new cases that will come are said positive if more than 5mm, earlier the limit was 10 mm. so comparatively no. of cases will increase compared to previous data
you should know that:
prevalence = incidence * duration
so when incidence increases,prevalence also increases

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severe combined immunodefficiency SCID is due to deficiency of IL-2R gamma chain (most common .X-linked) or adenosine deaminase deficiency (autosomal dominant,2nd most common cause)

adenosine deaminase deficiency will lead to accumulation of high amount of adenosine in lymphocytes which is toxic ,so they will not work well

patients with SCID present with recurrent bacterial and viral infections and may also opportunistic infections since birth .

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pattern of getting HLA from parents when you will do full square you will see that are 4 options (3 numbers from one parent are going always together to one gamet)

to make it simple .....
inheritance of HLA is like blood groups but no dominant effect like (A /B )
so a parent may have HLA-dr ( lets call it A) and HLA-dr2 (B) . other parent have HLA-dq4 (C) HLA-dq5(D )
so inheritance would be A B * C D

results would be :

AD

BD
each one of the 4 results would be different . so it is 1/4 chance of being the same

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Proteins Breakdown is done by 2 methods... an ATP independent process by Lysosomes...

other one is ATP dependent Ubiquitin proteosome system...

Cachexia mean muscle wasting.

Protein in the muscle is tagged for degradation with small protein called ubiquitin and the final complex is added to proteasome

So increase conjugation of ubiquitin causes breakdown of muscle

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It’s damage to internal urethral sphincter not external
And the internal urethral sphincter is innervated by parasympathetic (pelvic splanchnic)

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tetracycline as well as sulfonamides have a side effect of photosensitivity

it's marcus gunn pupil,you should know that it's decreased bilateral pupillary constriction when light is directed to affected eye.

the lesion is in the right optic nerve(afferent) as the question describes lesion when flash is directed to right eye.

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odds ratio equals a*d/b*c
it's a direct question,you should know the equation well
2*2 table is present in FA ,please know it by heart

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let's analyse keys:

alcoholic+foul smelling sputum(means bacterial infection ie.anaerobes)+episodes of unconsciousness

this is most probably aspiration pneumonia which may lead to lung abscess (the x-ray finding in the choice)

if you don't know how abscess looks like in x-ray,google search will help a lot.

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an easy question,remember that accumulation of lactate causes a decrease in ph and eventually fatigue .

lack or decrease in oxygen supply during heavy exercise will shift metabolism to anaerobic metabolism,which will lead to depletion of glycogen and accumulation of lactate

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factors determining risk of postmenopausal osteoporosis are:

ethnicity: african americans have low risk than caucasians

although socioeconomic history (choice f) may reflect diet and nourishment status , but choice b (dietary history) is more specific

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a typical case of rheumatoid arthritis

middle aged woman + affection of proximal interphalangeal joint with sparing of distal joints
biopsy of RA will show proliferative granulation tissue which is known as pannus (choice d)

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the x-ray in the question shows hyperlucent area in left chest most likely pneumothorax,

sudden left side sharp pain + dyspnea support diagnosis
in pneumothorax: air entry to pleura will lead to loss of negativity of intrapleural pressure (choice c)

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Exercise distends the vessels, reducing their resistance to blood flow. Thus, the base of the lung receives more blood flow than the apex. During exercise, vessels can be recruited, increasing the total cross-sectional area and reducing resistance. Lung volume also passively alters pulmonary vascular resistance

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pulmonary hypertension leads to increase right ventricle afterload

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very high beta human chorionic gonadotropin as well as large uterus is most likely a case of mole
in ectopic pregnancy this hormone is slightly increased

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of course it's vit D which is responsible of Ca absorption

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both warfarin and dicumarol are structurally related
they inhibit enzyme epoxide reductase which activate vit K ,inducing vit K deficiency like state

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metronidazole causes disulfiram like effect,which is shown in the question as vomiting , flushing and headache

metronidazole is the first choice to treat trichomonas vaginalis

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propranolol is a non selective beta antagonist:

beta 1 antagonism >>> decreases heart rate&contractility >>> decreases cardiac output

beta 2 antagonism >>> vasoconstriction >>> increases total peripheral resistance

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you should know mechanism of aspirin by heart and the step on diagram

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The patient will have shallow and rapid breathing to compensate for the decreased tidal volume..as deep breaths will cause pain.

nothing is wrong in the airways (obstructions) the airway resistance remains same !!

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blood-testes barrier are formed from tight junctions between sertoli cells

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age is the clue

before 18 >>> conduct disorder

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AMP stimulates glycogen phosphorylase via addition of the phosphate group on it ( remember it through glucagon pathway),this increases affinity of enzyme to substrate

And as you can clearly see from the enzyme substrate curve that it acts as an activator

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flutamide is a non selective inhibitor at androgen receptor while leuprolide is a GnRH agonist but it action varies with dose fashion:

it has activity of agonist when given pulsatile,but when given continuously,it acts as antagonist as it downregulates GnRH receptors on pituitary

when leuprolide is decided to be given continously,it causes surge at first which will lead to increase LH and androgens,so we use flutamide to block this initial increase

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the debate here is between NRTIs and protease inhibitors

- nearly all protease inhibitors cause lipodystrophy while only zidovudine and stavudine from group of NRTIs cause lipodystrophy so the choice of protease inhibitor is more likely the right answer

- protease inhibitors cause hyperglycemia and hypercholesterolemia which are present in the question

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all values indicate obstructive lung disease

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bruit over posterior flank > renal artery stenosis

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this is a case of SIADH as indicated by decreased plasma osmolality and increased urine osmolality

small cell lung cancer can secrete ADH as paraneoplastic syndrome causing SIADH

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the only drug from mentioned drugs that is known to cause osteoporosis is corticosteroid

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it is easy to answer this question as from question stem , it looks like an allergy case,in which histamine is released causing marked hypotension , but the very important concept you should know is that opioids cause IgE independent mast cell degranulation

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3rd pouch forms inferior parathyroids as well as thymus

4th pouch forms superior parathyroids as well as ultimoobrachial body

so if 3rd pouch is defective , there will be no thymus formation but there will be parathyroids (superior parathyroids formed from 4th pouch)

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dynein arm is know to be responsible of retrograde movement while kinesin is responsible of anterograde movement

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low back pain + osteoblastic lesions >>> prostate cancer >>> increased prostatic specific antigen PSA

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it is a case of acute rejection which is mediated by lymphocytes

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a retrograde study which is divided into two groups according to presence of disease

it would be cohort if the division was according to exposure status

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a case of androgen insensitivity syndrome

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serotonin is synthesized from tryptophan ,so increase tryptophan in food will lead to increase serotonin

note that niacin is also formed from tryptophan but giving niacin will slightly affect serotonin level because more tryptophan will be available to form serotonin

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from the scenario ,it is motor cortex affection

google cortical homunculus

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A site is empty...waiting for incoming of a charged aminoacid tRNA.

Only first amino acid comes to P site, the rest enter at A site, this is a growing chain hence amino acid enters at A site.

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at point X ,respiration stops

there are many mentioned drugs that can cause this,but from question,phrenic nerve activity is not affected,so the problem must be in neuromuscular junction

the only drug mentioned that can affect neuromuscular junction is tubocurarine,which act as ACh competitive antagonist

tetrodotoxin will affect the nerve itself not neuromuscular junction

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It is an easy question

it must received a marrow transplant from a male ,so progenitor cells will give XY daughter cells

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it is a serious systemic infection and must by treated with systemic antifungal (amphotericin B)

fluconazole can be given as maintenance therapy but amphotericin B must be given acutely first

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you should know that kidney also shares in gluconeogenesis

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Surfactant normally decreases the surface tension on the alveolar walls, thereby allowing them to expand easily. This neonate has decreased surfactant levels due to immaturity, because of which his alveoli will have higher surface tension, leading to higher collapsing pressures. This will lead to more alveoli being collapsed---> leading to less air in lungs ---> leading to decreased functional residual capacity.

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hemoptysis + hematuria + linear IgG deposition >>> GoodPasture syndrome >>> crescent formation

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1. Both parents must be carriers (Aa each) for the disease to be passed onto the brother.

2. For the parents to have a child that has this autosomal recessive disease, both must be carriers.

a. 2 Aa, 1 aa, 1 AA

b. The male must be either Aa or AA as he doesn't have the disease. We need to calculate the odds of the male being a carrier --> 2/3

4. For the 30yo female, the chance of having the disease is calculated via hardy-weinberg; you are looking for 2pq. q^2 = 1/40,000. q= 1/200 and p=199/200 (essentially 1). 2pq = 2*1*1/200 = 1/100 chance of being a carrier

5. The odds of the kid having the disease is the same punnet square from step 3. aa = disease, therefore the odds are 1/4.

Run the final calc:

(2/3) * (1/100) * (1/4) = 2/1200 --> 1/600

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its so straight forward
CD8 cells attack cells expressing MHC 1 which is seen in virally infected cells and hepB virus is a DNA virus that replicates in the hepatocytes....
Hence the hepatocytes express MHC1 with endogenous processing of viral proteins and attract CD8 t cells

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Because prinzmental is a neurological construction of coronary vessels (mostly idiopathic and responds to CCBs)

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epigastric pain + irritable&forgetful + distal motor weakness + impairment of consciousness

in lead poisoning there are :

sideroblasts in bone marrow

Be careful and read what he asked first ,in blood or bone marrow ?!

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all lab values indicate anemia

why not b,c,d,or e ? >>> as arterial Po2 &Pco2 are normal

venous Po2 and o2 content are decreased as tissues try to compensate anemia and decreased o2 amount by increasing percentage of o2 extraction

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coxsackievirus is the most common virus causing myocarditis and most commonly occurs after upper respiratory tract infection

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widening of hepatic venules + increased hepatic vein&wedge pressures with normal right atrial pressure >>> Budd Chiari syndrome

if right atrial pressure is also increased , it will be right sided heart failure