Astrovirus

Which of the following is a common cause of epidemic gastroenteritis,
particularly aboard cruise ships and in summer camps? It may be
detected by ELISA methods or electron microscopy.
a. Rotavirus
b. Adenovirus 40/41
c. Norwalk virus
d. Astrovirus
e. Hepatitis A virus





Which of the following is a cause of mild gastroenteritis? It can be
transmitted by the fecal-oral route but not by food consumption.
a. Rotavirus
b. Adenovirus 40/41
c. Norwalk virus
d. Astrovirus
e. Hepatitis A virus
Reply With Quote

q

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numerous human genes contain a highly conserved 180-nucleotide motif called a HOMEOBOX. most homeobox containing genes code for which of the following protein types. 1)cytoplasmic enzymes 2)transport proteins 3)DNA replication enzymes 4)cell surface receptors 5)structural proteins 6)tRNA proteins Read more at www.usmle-forums.com

 

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New test is 95% negative on patients who do not have the disease. If test is used in 8 healthy volunteers, what is the probability of getting at least one positive result?

a) 1- 0.05 X 8
b) 0.05 X 8
c) 0.05 ^ 8
d) 0.95 ^ 8
e) 1 - 0.95 ^ 8

^ means degree (like 2^3=8)

The answer is E) 1 - 0.95 ^ 8

Explanation:

Short version

P(+) = p = 0.05
P(-) = q = 0.95
n = 8

The probability of getting AT LEAST one positive = P(X>=1)
This is the same as:

1 - P(X=0) = 1 - 0.95^8

P(X=0) = always p^n

------------
Long version

This follows a Binomial distribution, where:

P(X=0) = nCr * p^r * (q)^(n-r)
P(X=0) = (n combinations r) * p^r * (q)^(n-r)
P(X=0) = 8C0 * 0.05^0 * (0.95)^(8-0)
P(X=0) = 1 * 0.95^8 = 0.95^8

CS method

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CS method and 17 Tips for you

OK since I had just finished my CS a few weeks ago I will put in my input, hopefully it will help you prepare for the CS. CS Preparation Method Used FA for CS, Go through the mini cases every chance you have, that will be the basis of your physical as well as the history questions you are going to ask (like associated symptoms). Have a study partner and practice the long cases make sure you are not just reading, you have to actually act out each part ie knock on a wall, walk towards the desk, say hello introduce yourself, mimic placing a drape over the pt, ask questions like u would in the real exam not too fast not too slow. Do the actual physical like u would for real. It gives u a sense of how much time an action can really take. I personally didn't use Uworld but some people did and if your one of them, well more better for you. MNEMONICS ARE A MUST !! I REPEAT MNEMONICS ARE A MUST!!! use whatever mnemonics you are comfortable with but try to have a mnemonic for everything for ur present history, past history, ur physical, for what DDs you will write for a specific symptom , The more mnemonics you have the better off you will be as u wont miss something. 17 Tips for the actual CS encounter (NOTE- all phrases are just suggestion say whatever u feel comfortable with ) 1) YOU MUST BE CONFIDENT!!!!!! - this is one of the most important parts , don't go "uhhh, umm, errr" ...etc 2) Personally I would write a quick differential diagnosis list on the scrap paper upon seeing the symptom on the door chart to help me focus also I would write the name and the age and vitals. The name because I tend to forget so its there in front of me, Age and vitals were for my actual pt note so I wont have to get back up and look at the chart while writing my note. Also I would write my mnemonic (for example, SIQORAAA and PAM HUGS HITS FOSS or whatever mnemonic you use for your history) then I would just cross a letter out if the pt answered nothing to it or write down the answer to the question. This was to make sure I didn't skip over parts by mistake as I could glance at it and see what I asked and what I didn't. 3) BE POLITE- smile at them, If they are in pain give them the "I feel your pain" look, if they are sad give the serious but helpful look etc 4) Actually listen to the patient because they will be telling you important information don't ask a question then start thinking about ur next question while they are talking, u will miss something important that way 5) I found in almost every case I had after asking a few relevant associated symptoms I was able to ask "anything else?" and they would usually answer me with some other symptom that i missed and it would give me a hint on more things I should ask 6) And I would keep asking anything else until they said "No nothing else". 7) Make sure u extend the foot rest when pt is lying down and also retie the gown after exam (a very easy to forget item ) 8) On walking in and after introducing yourself drape the pt to make sure u don't forget it. 9) Distance should be an arms length and a half to 2 lengths (ie not too far or too close) also don't stand directly in front of the pt stand slightly to the side. NOTE- If pt has problem with vision or hearing in one side stand to the opposite side so they can see or hear u better. If they are lying on their side sit down on the stool with them facing you. A pt I had had a neck injury so she couldn't turn her head, I stood directly in front of her to make it easier to see me. What I'm trying to say is keep the pt happy and as comfortable as possible. 10) After u finish ur history questions (and b4 ur physical) ask them one more time "Anything else? "( if they are nice they might give u that bit of info u didnt get by urself) 11) Physical make sure u tell them whenever u plan on touching them and always say out loud when ur looking at an area for example " I'm just looking at ur stomach" or "I'm looking at ur hands" etc etc 12) If ur trying to elicit a specific sign u can manipulate a painful area again otherwise never repeat an action on a painful area . Also if you do make sure u say something like "I know that hurt but i needed to do it so i can get some more information to help me reach a better diagnosis" 13) Ask about anything you see it moles, scars, injuries, varicose veins, bandages, red marker (that's supposed to mean erythema), discolorations, everything real and fake, If it's relevant they will tell u about it if not they will say "don't worry about it" or "Its nothing important". 14) After physical make sure u give a short summery of history and relevant findings ( 4-5 pieces of info is enough i usually chose the chief complaint and its duration and an associated symptom or 2 and maybe a physical finding if there was one)+ diagnosis (in medical terms and its layman explanation)+ testing needed ( in layman terms). 15) Ask them if they have any questions. Answer them and then ask again if any questions( repeat until they say no nothing else) 16) Then counsel them on something ( drugs, smoking, sexual activity's, exercise, diet , taking their medication properly ) anything that u can think of that us relevant to their health. 17) Then give a conclusion like " OK Mr. Pearson I'm going to go write up for the tests u need to do and get back to you as soon as we get your results , good bye and see you soon" and walk out and your done with your encounter Read more at www.usmle-forums.com

 

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Gingival Hyperplasia

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The most high yield drugs that cause Gingival hyperplasia are: Calcium channel blockers; specifically Nifedipine and Verapamil Anticonvulsants; sepcifically Phenytoin but also others Cyclosporine

M5 AML may also cause gingival enlargement Read more at www.usmle-forums.com

 

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Drugs of Abuse

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Drugs of Abuse 2009 FA page 428 The Depressants: All Of Barbie's Benz are depressants Alcohol Opioids Barbiturate Benzodiazepines The stimulants: Amie Can Stimulate Cock Nicely Amphetamines Caffein Cocaine Nicotine Read more at www.usmle-forums.com

 

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QUOTE

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"First they came for the communists, and I didn't speak out because I wasn't a communist. Then they came for the trade unionists, and I didn't speak out because I wasn't a trade unionist. Then they came for the Jews, and I didn't speak out because I wasn't a Jew. Then they came for me and there was no one left to speak out for me." ~Martin Niemöller (German pastor and theologian) Read more at dancingfractals.blogspot.com

 

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Q

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A 25-year-old man is admitted to the hospital after coming to the doctor carrying a bottle containing bloody urine. All tests were negative, and he was observed stealing a test tube of blood from the laboratory technician's cart. Which of the following is the most likely diagnosis? (A) antisocial personality disorder (B) factitious disorder (C) malingering (D) schizophrenia (E) somatization disorder

sadly the answer is factitious disorder. The qbank said that the patient manipulates the test but it is not written why he did it, so that is why it is factitious disorder cos nobody knows the reason why he did it. But if it is written that the patient manipulated the test for secondary gain for example so as not to be deployed to a war zone, then it is malingering Read more at www.usmle-forums.com

 

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Q

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A 12-year-old boy is brought to his pediatrician by his mother with a two-day history of tea-colored urine. He recently completed a five-day course of penicillin for Streptococcal pharyngitis. His blood pressure is elevated. He has periorbital edema. Which of the following is the most likely microscopic renal lesion? A. Basement membrane immune complex deposition B. Basement membrane thickening C. Foot process effacement D. Mesangial proliferation E. Subepithelial immune complex deposition

This is a case of post-strep Glomurelonephritis, so the answer is E. PSGN is usually characterised by granular deposits of IgG/M and C3 in the glomerulus. Characteristic is "Sub-epithelial Humps" Read more at www.usmle-forums.com

 

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Q

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This is a very fascinating symptom where patients complaint about passing air and bubbles while they urinate. All we need to know for the purpose of the USMLE is the differential diagnosis: Vesicocolic fistula is the number one cause where fistula develops between the colon and the bladder and the most common cause of that is diverticular disease of the sigmoid colon. Therefore, a CT abdomen is a good idea to find the diverticular mass. Other causes of such a fistula development is Crohn's disease and cancers of the colon or the bladder. Read more at www.usmle-forums.com

 

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Q

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Remember PP is the difference between systolic pressure and diastolic pressure, since Cardiac output is related to systolic pressure, any time CO is increased pulse pressure will increase, and TPR is related to diastolic pressure, any time TPR is decreased pulse pressure will also increase. For example, in anemia, resistance is diminished because of reduced viscosity (R=Vl/r4), so TPR is decreased. In order to compensate anemic patients increase their cardiac output(increase both heart rate and stroke volume). So MAP= CO (systolic pressure)increased x TPR (diastolic pressure) decreased Pulse pressure= Systolic Pressure(increased) - Diastolic pressure (decreased) The result would be a wide or high pulse pressure. Other changes in pulse pressure include: Increased pulse pressure: Aortic regurgitation, Aortic sclerosis Decreased pulse pressure: Aortic stenosis, Mitral stenosis Increased diastolic pressure: Mitral stenosis Decreased diastolic pressure: Aortic regurgitation, Patent ductus arteriosus Read more at www.usmle-forums.com

 

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Q

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A 35 year old man was diagnosed with DIC. His coagulation panel test(PT, PTT, BT, Platelet count) would look like? A)Congenital afibrinogenemia B)Thrombocytopenic thrombotic purpura C)End stage liver disease D)Hemophilia B E)von Willebrand disease

again: GOOD QUESTION!!!! A)Congenital afibrinogenemia = normal Platelet B)Thrombocytopenic thrombotic purpura = normal PT & PTT C)End stage liver disease = the correct answer D)Hemophilia B = PTT prolonged E)von Willebrand disease = PTT & BT prolonged with low or normal platelet count Read more at www.usmle-forums.com

 

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Preparation for Tests

Study habits and skills contribute to success on tests:

There must be a total commitment to becoming a physician. The commitment to a 60+ hour work week will never go away. The workload increases over time, and you learn to do more work faster.

Deal with non-academic issues now. It is difficult to run a race carrying a large amount of baggage.

Create a daily and hourly study plan; don't leave scheduling to the moment.

Study multiple subjects per day. Devote some time to each subject. Learning is rate-limited by neurochemistry. Hence, cramming cannot work. Consolidation of short-term to long-term memory occurs over time.

Make use of facilities designed to enhance learning: library, study rooms, practice settings.

Make use of expert help: faculty

Attend all scheduled contact hours and be attentive. Inattention wastes time. You can't do it on your own, off by yourself. Most students who fail have poor attendance patterns.

Concentrate on understanding, not just memorization. The facts must fit together. Build conceptual frameworks for the facts.

Concentrate on problem-solving, not just recall. Physicians must make diagnoses and develop treatment plans. Learn how to use the information you are given.

Learn how to effectively read and absorb information from textbooks. Prioritize and filter.

Participate in active learning: ask questions, answer questions, discuss, write or type notes as you go. Non-participators become marginalized.

Both individual and group study are important. Group study helps keep group members accountable, attentive, and on track and helps share knowledge quickly.

Study the subject material BEFORE you self-assess. Working backwards from review resources and exams leaves you with a patchwork knowledge base.

Break up intense study periods into 20 minute segments, when attention span begins to decay. Begin again by reviewing a key concept you studied 20 minutes ago.

Schedule time for review. The learn-forget cycle may be repeated multiple times for difficult concepts. There can be daily, weekly, and end-of-term review.

The curfew is 10 pm on the night before the exam. Better yet, take the evening or day off before the exam. Performance is tied to long-term knowledge acquisition. Stresses from last-minute preparation diminish performance.

Resist the temptations offered by all the distractions in your environment: electronic devices including TV, computer games, web surfing, MP3's, cell phone, instant messaging, etc. This is an enormous time sink. (e.g., "You Gotta Put Down the Duckie if you Wanna Play the Saxophone")

Renal physiology - tricky question

When compared with antidiuresis, the effect of drinking 1 L pure water can result in which of the following findings?

 A. Clearance H2O > 0.0 mL/min
 B. Clearance urea < Clearance urea for antidiuresis control
 C. Filtered load Na+ > filtered load Na+ for antidiuresis control
 D. Glomerular filtration rate (GFR) > 125 mL/min
 E. Urine osmolarity > Plasma osmolarity




The correct answer is A)

 Clearance is the flow rate at which a substance is removed from the blood. In the kidney, it represents a balance between glomerular filtration/secretion and reabsorption. Several mechanisms are in place to promote antidiuresis (i.e., to promote the reabsorption of water from the tubular fluid to prevent dehydration; urine concentration). The water clearance rate (CH2O) is usually negative, as more water is reabsorbed than is filtered (i.e., urine concentration) during any given period of time. As a result, the body normally produces a highly concentrated, low-volume urine. Drinking large quantities of pure water raises the value of CH2O considerably to a positive number. This reflects water diuresis where there is a reduced rate of water reabsorption accompanied by the production of a large volume of dilute urine. This protects body fluids against dilution, and thus prevents electrolyte imbalances and their attendant complications.

 B) Urea is passively processed by the kidney. With increased urine flow in water diuresis, more urea is washed out, causing its clearance to be increased.

 C) The filtered sodium load (GFR × PNa+) is unaffected by water loading.

 D) GFR remains remarkably stable regardless of water loading.

 E) Uosm falls precipitously during water diuresis, producing a large-volume, low-concentration urine.

A 72-year-old woman has had increasing fatigue with a 3 kg weight loss over the past 7 months. Her hands become purple and painful upon exposure to cold. On physical examination she has a palpable spleen tip. Laboratory studies show Hgb 10.5 g/dL, Hct 31.7%, MCV 99 fL, platelet count 193,600/microliter, and WBC count 5390/microliter. The direct Coombs test is positive at 4 C and negative at 37 C. Which of the following underlying diseases is this woman most likely to have?

 A Non-Hodgkin lymphoma
 B Systemic lupus erythematosus
 C Pernicious anemia
 D Scleroderma
 E Thalassemia minor

Ans D

Ans D

Que

A 32-year-old man has had worsening headaches for the past 2 months. On physical examination he is afebrile. He has no lymphadenopathy or hepatosplenomegaly. A head CT scan reveals a 3 cm mass lesion to the right of midline next to the lateral ventricle. A stereotaxic brain biopsy is performed and microscopic examination shows diffuse large B cell lymphoma. A bone marrow biopsy is performed and on microscopic examination shows slightly decreased cellularity of all cell lines. Which of the following laboratory test findings is this patient most likely to have?

 A Elevated terminal deoxyribonucleodidyl transferase
 B Bence-Jones proteinuria
 C Elevated serum IgM
 D HIV-1 RNA of 8000 copies/mL
 E Lymphoma positive for tartrate-resistant acid phosphatase

Answer is C. Elevated serum IgM.

  E. is hairy cell leukemia
 B. Is multiple Myeloma
 A. is ALL
 D. Primary CNS lymphoma

Hey!!!!!

Hey guys, wass up???!!!  
GOOOOD Morning!!!!!
Mornings are always nice and full of energy , isn't it?? 
Today I want share something that has changed my life in a really positive way. 

Usually We all start our day by daily routine stuff and in kind of hurry because of our busy life style or actually we don't have time to think what is our plan today?? Now here's the thing blindly starting the day without set goals will really make a day blunt and ineffective. So please if you guys can spend only 5 minutes in the morning to think in mind what you gonna do today, or you may even write down if you are forgetful as I am than it will be really worth a shot. And I bet you there is nothing to loose but all is to gain. As a student it is really being helpful to me and sure it will help you all. 

Okie dokie,,, thanks for reading and see you next time!!!!!!

Q1

A 53-year-old with a history of chronic alcohol abuse presents with a productive cough and fever. His symptoms started one week ago. On examination, he has diffuse rales in all lung fields. A CXR reveals patchy infiltrates in all lung fields and a 5 cm area of consolidation in the lower right lobe that has an air-fluid level. Which of the following infectious agents is likely to be the cause of his pulmonary disease?

A. Mycobacterium tuberculosis
B. Mycoplasma pneumoniae
C. Candida species
D. Staphylococcus aureus
E. Influenza A virus

D) Staph aureus since it causes bronchopneumonia (patchy infiltrates) and abscess (air-fluid level) since he is an alcoholic he probably aspirated the organism.

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