DrUSMLE

1070 )A patient was thrown from a tractor, which partially ran over him and caused injury to the base of the skull. The origin of the internal jugular vein at the jugular foramen was compromised. Which of the following cranial nerves courses through the jugular foramen? # dr.Usmle

1069 ) A 60-year-old woman is admitted to the hospital with a fever and severe diarrhea for the last 24 hours. Cultures of blood, cerebrospinal fluid,urine, and stool are all negative for pathogens. The profile of gut hormones reveals elevatedlevels of VIP. An analogue of which of the following would most likely lower her VIP levels? # dr. USMLE

1069) (D) VIP is a neurotransmitter in the brain andin the parasympathetic nerves of the digestive tract. It also acts as a hormone. VIP has a secretin-like effect on the pancreas. It increasesthe volume of water and bicarbonate outputand affects GI blood flow and motility. All this contributes to severe secretory diarrhea in the case of VIP overproduction. Somatostatin is thebest choice because it has a broad range of inhibitory effects, inhibiting GI secretions, slowing GI motility, and reducing splanchnic blood flow. An analogue of somatostatin, called octreotide, was found useful for treatment of syndromes related with VIP overproduction.Octreotide has a longer half-life than physiologic somatostatin. Erythromycin (choice A) isknown to have antibiotic features. This is not the best choice, since no pathogens were found.Histamine (choice B) is a physiologic stimulant of gastric hydrochloric acid secretion, potentiating the effects of acetylcholine and gastrin.Motilin (choice C) stimulates gastric motility,which is contraindicated for diarrhea. Trypsin(choice E) is a protease released by pancreaticcells, breaking peptide bonds as well as converting many other proteolytic enzymes to their active form. All of the negative choices will not affect, and in fact may even worsen the VIPrelated symptoms. For More questions join @drusmle

1068 ) (D) Children frequently insert foreign bodies into the nose. Initial symptoms are local obstruction, sneezing, and pain. Subsequently, there is swelling and infection leading to a purulent, malodorous, and often bloody discharge. The infection clears after removal of the foreign body. Nasal polyps cause obstruction of the nasal passages, hyponasal speech,and mouth breathing; gray, grape-like masses can be visualized on nasal examination. Anupper respiratory infection is usually suggested by a careful history. Initial symptoms include a scratchy throat, followed by development of thin nasal discharge and sneezing. Myalgia, low-grade fever, headache, malaise, and decreased appetite may be present. By the 2nd or 3rd day, the discharge becomes thicker and more purulent. Cough iscommon. Symptoms usually resolve by 7–10 days. Adolescents with sinusitis may have classic symptoms of headache and sinus tenderness. In children, cough and nasal discharge are common; the cough is worse when supine. If upper respiratory infection symptoms persist without improvement for >10 days, sinusitis should be considered. A more acute form mayoccur, with a shorter duration and more severe symptoms such as fever >39°C, purulent nasaldischarge, headache, and eye swelling. Children with allergic rhinitis present with sneezing,clear watery, rhinorrhea, and itching of the nose,palate, pharynx, and eyes. Itching, redness, and tearing of the eyes may be present. This occurs in response to exposure to an allergen such as pollen, mold spores, and animal or mite antigens.For More questions join @drusmle

1068 ) A 2-year-old boy has had a purulent drainage from the right nostril for a week. He is afebrile and has had no associated symptoms, such as.cough. Which of the following is the most likely diagnosis? # dr.Usmle

1067 )(A) In a patient with GSI, a retropubic approachoffers the best long-term cure of the incontinence. The Burch procedure and the Marshall-Marchetti-Krantz procedure are the most common retropubic procedures. With an anterior colporrhaphy, plication sutures are placed at the UVJ in an effort to support and elevate it. Long-term results are not as good as a retropubic urethropexy or a suburethral sling. A suburethral sling procedure is used when urethral closing pressure is low, less than 20 cmH2O. Aneedle suspension procedure is most often done when there is associated genital prolapse with potential incontinence. Collagen injections at the UVJ have been attempted to obstruct the urethra partially. Incontinent patients who may benefit the most from collagen injections are those with intrinsic sphincter deficiency and a fixed bladder neck. For More questions join @drusmle

1067 ) A 48-year-old G5P5 woman has genuine stressincontinence (GSI). Kegel exercises have nothelped, and her incontinence is gradually worsening. Her urethrovesical junction (UVJ) is prolapsed into the vagina, and her urethral closure pressure is normal. Which of the following procedures will most likely cure her incontinence? # dr.Usmle

1066 ) (C) The nucleus raphe magnus receives inputfrom the periaqueductal gray and gives rise to descending serotonergic fibers of the raphespinal projection. The latter fibers activate enkephalinergic spinal cord interneurons thatpresynaptically inhibit incoming pain fibers at their initial synapse in the spinal corddorsal horn. The neurotransmitter dopamine(choice A) has not been shown to be involved in the descending systems that modulate paintransmission. The MLF (choice B) is an ascending fiber system in the brainstem that is primarily involved in the control of eye movements.The rubrospinal system (choice D) is a descending fiber tract involved with the control of limb musculature. The ventral lateral nucleus of the thalamus (choice E) is primarily involved with motor function and does not contribute to descending pathways that influence pain transmission. For More questions join @drusmle

1065) (C) Centroacinar cells are components of theexocrine pancreas and they contain zymogengranules, which are released under the action of cholecystokinin from the duodenum. The zymogen granules contain inactive proenzymesthat normally become activated within the duodenum. Premature activation of the pancreaticenzymes, such as trypsin, leads to autodigestionof the centroacinar cells of the pancreatic acini, which secrete these enzymes. This results in acute hemorrhagic pancreatitis which can becaused by excessive alcohol ingestion. All theother choices are cells of the endocrine pancreas, which secrete hormones. Alpha cells(choice A) secrete glucagon whereas beta cells(choice B) produce insulin. Delta cells For More questions join @drusmle

1065) A member of a college fraternity, who had consumed a large amount of alcohol on a dare, is brought to the emergency room with vomitingand severe abdominal pain. Blood tests reveal that he has elevated serum levels of amylaseand lipase. A tentative diagnosis of acute hemorrhagic pancreatitis is formulated. Which cellsof the pancreas are directly involved in this condition? # dr.Usmle

1064 ) (A) Intravenous solutions are distributed in thevarious body fluid compartments based onosmolality and their ability to penetrate the vascular wall and the cell membrane. The proteins in blood plasma will remain within the vascular compartment because of their low permeability across the vessel wall. Thus, 500 mL of bloodplasma will remain in the vascular compartment. Water (choice B) passes across the cellmembrane and the vascular wall easily. Hence distilled water will distribute itself between cellular and extracellular spaces, meaning only a small portion will actually contribute to bloodvolume, the other choices (C, D, and E) cross the vascular barrier and distribute partially tothe extravascular space and thus are less effective intravascular volume expanders. For More questions join @drusmle

1064 ) An adult male becomes hypotensive duringsurgery because of blood loss. Intravenous administration of 500 ml of which of the following solutions will have the greatest effect in restoring blood volume, and thus bloodpressure to normal? # dr.Usmle

1063 ) (B) Malclosure of the rostral neuropore duringthe fourth week of development results in anencephaly and is lethal in the affected newborn.The condition is better termed meroanencephalybecause of the presence of the rudimentary brainstem with some functioning nervous tissues. Defects in the closure of the caudal neuropore (choice A) result in varying conditions of spina bifida at the lower end of the spinal cord.The first branchial arch (choice C) and the somites (choice D) do not play any role in the formation of the brain. Fusion of the metopon or forehead (choice E) occurs after birth and also does not play a role in brain formation. For More questions join @drusmle