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Download DemoVendor: USMLE
Certifications: USMLE Certifications
Exam Code: USMLE-STEP-1
Exam Name: United States Medical Licensing Step 1
Updated: Nov 27, 2024
Q&As: 847
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After removal of cancerous lymph nodes from the lateral pelvic wall, a patient develops painful spasms of the adductor muscles and sensory deficits in the medial thigh region. The adductor muscles are innervated by which of the following nerves?
A. femoral
B. inferior gluteal
C. obturator
D. pudendal
E. sciatic
Correct Answer: C
Section: Anatomy The obturator nerve innervates the adductor muscles and the medial region of the thigh. The nerve originates from the lumbar plexus, runs on the lateral aspect of the pelvic wall, and exits through the obturator canal to reach the medial aspect of the thigh. Lying on the lateral pelvic wall, it may be injured by surgical mishap. The femoral nerve (choice A) innervates the anterior aspect of the thigh and the muscles contained within the sartorius and the quadriceps femoris. The inferior gluteal nerve (choice B) innervates the gluteus maximus muscle and is confined to the gluteal region. The pudendal nerve (choice D) is sensory to the genitalia, motor to the perineal muscles, the external urethral sphincter, and the external anal sphincter. The sciatic nerve (choice E) innervates the hamstring muscles in the posterior aspect of the thigh.
A 33-year-old man comes to see you because of several episodes of hemoptysis and dyspnea during the last 2 weeks. Physical examination reveals hypertension and edema. You order some laboratory tests and the results indicate an iron-deficiency anemia, hematuria, and proteinuria with RBC casts. At this point you strongly suspect that he has which of the following diseases?
A. fibrosing alveolitis
B. Goodpasture syndrome
C. Kartagener syndrome
D. systemic lupus erythematosus
E. Wegener granulomatosis
Correct Answer: B
Section: Pathology and Path physiology Goodpasture syndrome consists of antibodies against basement membrane material, recurrent pulmonary hemorrhage, and glomerulonephritis. The pathologic changes are due to a type II hypersensitivity reaction along the basement membranes of the lung and kidney. Steroids, plasmapheresis, and immunosuppressive medicines may help in a minority of cases. Fibrosing alveolitis (choice A) is a pulmonary disorder of unknown etiology. Glomerulonephritis and pulmonary hemorrhage are not observed clinically. Kartagener syndrome (choice C) is a hereditary disease of infancy due to a defect in respiratory ciliary action. Systemic lupus erythematosus (choice D) may present with renal insufficiency. Antibodies are directed against nuclear antigens. Wegener granulomatosis (choice E) may present clinically with pulmonary hemorrhages and renal insufficiency. There are antibodies against neutrophil components, not basement membrane material.
Additive and potentially dangerous sedative interactions may occur between sedativehypnotic drugs and which of the following herbal preparations?
A. Echinacea
B. gingko biloba
C. ginseng
D. kava
E. St John's wort
Correct Answer: D
Section: Pharmacology Unregulated herbal preparations are in heavy use by the public and several have been documented to interact with regularly prescribed drugs. Kava (choice D) has sedative actions and interacts additively with sedativehypnotics and sedative-antihistaminics. Echinacea (choice A) has no reported drug interactions to date but many preparations contain alcohol, which may increase sedation with alcohol- containing beverages. Gingko biloba (choice B) has antiplatelet activity and should not be used with aspirin or other antiplatelet drugs. Ginseng (choice C) may cause CNS stimulation and should not be used by patients with epilepsy and those taking psychoactive drugs. St John's wort (choice E) may inhibit metabolism of certain drugs.
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