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Usmle

Cod. A01112007

United State Medical Licensing Examination

Autopsy of a 70-year-old woman reveals a papillary growth within the left ventricular chamber. The growth consists of a small mass of finger-like projections attached to the mitral valve, without associated valvular or other cardiac abnormalities. Histologically, each papillary structure is composed of a core of fibrous tissue lined by thickened endothelium. The patient did not have any history of cardiac disease or evidence of thromboembolism.
Which of the following is the most likely diagnosis?

A. Acute mural thrombus
B. Cardiac myxoma
C. Infective endocarditis
D. Nonbacterial thrombotic endocarditis
E. Papillary fibroelastoma

Interesante pse nuk e vure tek tema "Diagnoze"

Gjithsesi mendoj qe kemi te bejme me nje FIBROELASTOM PAPILARE

Kjo per dy arsye qe me vijne ndermend tani :

 1. Ndertimi histologjik perkon me te.

2.Ka probabilitetin me te madh,nder ato semundje te renditura aty, qe te kaloje pa u vene re gjate jetes dhe te zbulohet rastesisht ne nje autopsi.

 

Cod. A05112007

yes sir!

tjetra...

45-year-old man presents to his physician with hematuria. Renal biopsy demonstrates a focal necrotizing glomerulitis with crescent formation. The patient has a history of intermittent hemoptysis and intermittent chest pain of moderate intensity. A previous chest x-ray had demonstrated multiple opacities, some of which were cavitated. The patient also has chronic cold-like nasal symptoms. Which of the following is the most likely diagnosis?

A. Aspergillosis
B. Polyarteritis nodosa
C. Renal carcinoma metastatic to the lung
D. Tuberculosis
E. Wegener's granulomatosis

  shume e lehte

Granulomatoza Wegener

Cod. A06112007

shume mire...

tjetra...

A chronic alcoholic develops severe memory loss with marked confabulation. Deficiency of which of the following vitamins would be most likely to contribute to the neurologic damage underlying these symptoms?

A. Folic acid
B. Niacin
C. Riboflavin
D. Thiamine
E. Vitamin B12

A ose E  
po zgjedh A 

Citim:

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Po citoj ato që tha Aljohin
shume mire...

tjetra...

A chronic alcoholic develops severe memory loss with marked confabulation. Deficiency of which of the following vitamins would be most likely to contribute to the neurologic damage underlying these symptoms?

A. Folic acid
B. Niacin
C. Riboflavin
D. Thiamine
E. Vitamin B12

---

Perfundimisht TIAMINE

Cod. B06112007

hahaha shume mire...dhe klasifikimi paraprak:

1) MARSMED...... 3 pike
2) Ns6................... 2 pike
3) Enigme........ -0,25 pike (c'do pergjigje e gabuar vlen -0,25 pike muhahaha )...

mundesia per revansh:

A 55-year-old man presents to a physician with jaundice. Ultrasonography demonstrates a 5 cm mass in the head of the pancreas. Endoscopic retrograde cholangiopancreatography with cytologic sampling demonstrates cells with large hyperchromatic nuclei and a high nuclear/cytoplasmic ratio. A few small glands composed of these cells are also seen in the cytologic preparation. The overall prognosis for this man will be most similar to that of a patient with which of the following malignancies?

A. Adenocarcinoma of the breast
B. Adenocarcinoma of the colon
C. Adenocarcinoma of the esophagus
D. Adenocarcinoma of the prostate
E. Primary gastric lymphoma

:(

ooo pyetje e besdisshmemu desh te hapja librat me e gjet se skisha asnje ide... dhe prap se di a eshte pergjigja e duhur sepse kur vjen puna tek shifrat nuk e lodh shume trurinKeto librat e mi nxirrnin si te perafert :

Adenocarcinomen e esofagut

 

 

Citim:

---

Po citoj ato që tha Aljohin
hahaha shume mire...dhe klasifikimi paraprak:
3) Enigme........ -0,25 pike (c'do pergjigje e gabuar vlen -0,25 pike muhahaha )...  

---

Citim:

---

Po citoj ato që tha Aljohin
hahaha shume mire...dhe klasifikimi paraprak:

1) MARSMED...... 3 pike
2) Ns6................... 2 pike
3) Enigme........ -0,25 pike (c'do pergjigje e gabuar vlen -0,25 pike muhahaha )...

mundesia per revansh:

A 55-year-old man presents to a physician with jaundice. Ultrasonography demonstrates a 5 cm mass in the head of the pancreas. Endoscopic retrograde cholangiopancreatography with cytologic sampling demonstrates cells with large hyperchromatic nuclei and a high nuclear/cytoplasmic ratio. A few small glands composed of these cells are also seen in the cytologic preparation. The overall prognosis for this man will be most similar to that of a patient with which of the following malignancies?

A. Adenocarcinoma of the breast
B. Adenocarcinoma of the colon
C. Adenocarcinoma of the esophagus
D. Adenocarcinoma of the prostate
E. Primary gastric lymphoma

---

Cod. A08112007

yes

Biopsy of a persistent exophytic area on the vulva of a 60-year-old woman demonstrates a squamous epithelial lesion. No koilocytes are seen. The lesions show papillary projections composed of disordered, squamous epithelium with well-differentiated cells. The basement membrane at the dermal-epidermal junction is focally disrupted by squamous cell groups extending deep into the dermis. Which of the following diagnoses is most accurate?

A. Condyloma acuminatum
B. Extramammary Paget's disease
C. Vulvar intraepithelial neoplasia
D. Vulvar melanoma
E. Vulvar squamous cell carcinoma

Hem... do perjashtoja D dhe E menjehere.. Pastaj Condyloma acum. do kishte prezencen e koilociteve (qeliza te medha me berthame piknotike)qe ketu nuk jane.Neoplasia vulvare intraepiteliale duhej te limitohej vetem brenda epiteliumit pa kaluar membr. basale.Mbetet E, karcinoma squamose vulvare,po prap kjo nuk ka qeliza mire te diferencuara ?!Hem.. nuk ka variant G :asnjera prej tyre

Po hidhem dhe une e po them opcioni E, Vulvar squamous cell carcinoma

Cod. A09112007

yesss...

The correct answer is E. The disruption of the basement membrane with cell groups extending deep into the dermis indicates that this is invasive squamous cell carcinoma of the vulva, which may arise in vulvar intraepithelial neoplasia, in condyloma, or spontaneously. The latter type (which is likely here) tends to be well differentiated, while the former two are often poorly differentiated.
Condyloma acuminatum (choice A) would contain koilocytes and would not cross the basement membrane.
Extramammary Paget's disease (choice B) would probably contain individual tumor cells that stain for mucin.
The lesion of vulvar intraepithelial neoplasia (choice C) does not cross the basement membrane.
Vulvar melanoma (choice D) is composed of melanocytes that would mark with S100 or HMB-45.

ok tjetra....

Which of the following conditions is associated with overexpression of bcl-2?
A. Acute lymphoblastic leukemia
B. Burkitt lymphoma
C. Follicular lymphoma
D. Multiple myeloma
E. Small lymphocytic lymphoma

Follicular lymphoma per shkak te nje shkembimi copash kromozomesh mes kromozomit 14 dhe 18.

pikes i ke rene

Cod. A10112007

ok

A 10-year-old boy with history of epilepsy and mental retardation is brought to a specialty clinic for evaluation.
Physical examination is remarkable for several ovoid hypopigmented areas on the trunk and large numbers of red and yellow papules on the face, particularly near the mouth. Biopsy of the papules demonstrates angiofibromata.
This patient is most likely to have which of the following central nervous system pathologies?

A. Acoustic neuromas
B. Capillary hemangioblastomas
C. Herniation of cerebellar tonsils into foramen magnum
D. Large cortical hamartomas
E. Leptomeningeal angiomatosis

Hem...
epilepsi+deficite mendore+ zona te hypopingmentuara+lezione kutane te tipit angiofibromatose kryesisht ne fytyre ..... do thoja qe kemi te bejme me sklerozen tuberoze (Bourneville's disease)

nuk e kuptova kush germe ishte zgjedhja jote? 

Po jam e pavendosur mo Aljohin se tani nga ato  alternativa qe ke dhene ti aty kshu duke u nis apriori do thoja ose B ose E ... po mendoj qe eshte skleroza tuberoza diagnoza ... dhe me sa di une sdi te emertohet ndryshe me ndonje nga ato emrat aty

nuk e ke kuptuar pyetjen...lexoje edhe nje here me mire...neser dua pergjigjen..."thuaje troc kjo jam une ky je ti...po jo keshtu se na plase"

hahahahha o Aljohin une sjam mesuar tia fus kshu kot gjerave qe si kam te qarta.. me mire nuk prononcohem.... por per kenaqesine tende po e bej ksaj rradhe....hajt qesh po deshe ..una po them B

         The correct answer is D. The disease is tuberous sclerosis. The facial angiofibromata are also called adenoma

         sebaceum, and the hypopigmented patches on the trunk are called ash-leaf spots. This disease is one of the

         neurocutaneous disorders called phacomatoses. Tuberous sclerosis is inherited as an autosomal dominant

         trait, and epilepsy and mental retardation are commonly seen in this disorder. Large, firm, white hamartomatous

         nodules (tubers) are seen in the cortex and in subependymal sites. The tubers consist of aberrantly arranged

         neurons and/or glia. Patients may also have pancreatic cysts, renal angiomyolipomas, and cardiac

         rhabdomyomas. Rarely, an astrocytoma will arise in a tuber.

         Acoustic neuromas (choice A) are a feature of neurofibromatosis Type II.

         Capillary hemangioblastomas (choice B) are a feature of Von Hippel-Lindau syndrome.

         Herniation of cerebellar tonsils (choice C) is a feature of Arnold-Chiari malformation.

         Leptomeningeal angiomatosis (choice E) is a feature of Sturge-Weber disease.

ooooooooooo kjo osht me bo lojra fjaleshpo una e gjeta ((

jooooooooo ata te bordit qe kane organizuar pyetjet nuk e mendojne qe ti e ke gjetur...ti duhet te gjesh per cilen semundje behet fjale normalisht por ata duan qe te shkosh nje hap me tej dhe te gjesh cfare eshte karakteristike per ate semundje....nejse

tjetra:

A 30-year-old African American woman has a chest x-ray that shows hilar lymphadenopathy and diffuse

        abnormalities of the lung parenchyma. Biopsy reveals non-caseating granulomas. Acid fast, silver, and PAS

        stains on the granulomas are negative. Which of the following is the most likely diagnosis?

                A. Coccidioidomycosis

                B. Histoplasmosis

                C. Leprosy

                D. Sarcoidosis

                E. Tuberculosis

 

 

Sarcoidosis! karakterizohet nga granuloma jo kazeoze dhe paraqet interesim te linfonodeve ilare!

shume mire...

tjetra:

A patient presents with a severe form of atopic asthma. Which of the following changes would most likely be

         found in this patient's blood?

                 A. Basophilic leukocytosis

                 B. Eosinophilic leukocytosis

                 C. Lymphocytosis

                 D. Monocytosis

                 E. Neutrophilic leukocytosis

A patient with long term severe hypertension develops progressive dementia. CT scan of the head demonstrates a diffuse loss of deep hemispheric white matter. Which of the following terms best describes the pathological process that is occurring?

A. Anemic infarcts
B. Hemorrhagic infarcts
C. Hypertensive encephalopathy
D. Lacunae
E. Subcortical leukoencephalopathy

kesaj sdi ti pergjigjem por nese do zgjidhja nder mundesite do zgjidhja ose C ose E...

duhet te zgjedhesh nje plako...mbyll syte dhe hidhu

poplli ka thon "qyli osh nona e gjithe te keqijave po si none qe osh duhet respektu" ...se di pse po alternativa C me duket shume e thjeshte per te qene pergjigja...kshu qe mbyll syte ene zgjedh E kete rradhe

hahaha nena s'te le kurre ne balte...

         Explanation:

         The correct answer is E. This patient has subcortical leukoencephalopathy (Binswanger's disease), which is one

         of the neurologic syndromes associated with hypertension. It is uncommon, but obviously devastating. The

         histologic findings are diffuse, irregular loss of axons and myelin accompanied by widespread gliosis. Small

         infarcts may be seen in the frontal lobes. The pathologic mechanism may be damage caused by severe

         arteriolosclerosis. None of the other choices would produce diffuse subcortical white matter involvement.

         Anemic infarcts (choice A) can be seen in hypertensive patients as a consequence of atherosclerotic

         thromboembolic events.

         Hemorrhagic infarcts (choice B) can also be seen in hypertensive patients as a consequence of atherosclerotic

         thromboembolic events followed by reperfusion. They tend to occur in gray matter or at the gray-white junction.

         Hypertensive encephalopathy (choice C) is an acute generalized dysfunction of the brain that can occur in

         malignant hypertension or other very severe hypertensive processes. The primary pathology is seen in cerebral

         vessels, although cerebral edema may be present.

         Lacunae (choice D) are small necrotic foci in deep gray matter (especially basal ganglia and thalamus) seen in

         some hypertensive patients.

 

What percentage of Down's syndrome patients also have congenital cardiovascular disease?

                 A. 0.1%

                 B. 3%

                 C. 20%

                 D. 50%

                 E. 90%

50%? ne fakt ne kete semundje jane goxha te perhapura semundjet kardiovaskulare kongjene, sidomos ato te valvulave te zemres!

          Explanation:

          The correct answer is C. This fact is worth remembering: one-fifth of Down's syndrome patients have

          congenital cardiovascular disease, most commonly an ostium primum type of ASD and/or a ventricular septal

          defect. This is a sufficiently high incidence to justify at least one echocardiogram in each of these children's

          lives. Affected children are also particularly vulnerable to seizures, and as adults may develop an

          Alzheimer-like dementia in their mid 40s.

tjetra:

A 50-year-old man presents with renal colic and an intravenous pyelogram demonstrates "clumps" of contrast

         medium limited to the medulla. Multiple small stones are also seen. Blood chemistries are all within normal limits.

         What is the most likely explanation for these findings?

                 A. Adult polycystic renal disease

                 B. Horseshoe kidney

                 C. Infantile polycystic renal disease

                 D. Medullary sponge kidney

                 E. Renal dysplasia

do pergjigja D duke marre parasysh ceshtjen e analizave te gjakut qe jane normale!

yessss

 

tjetra:

 

A 75-year-old female presents to the doctor with a chief complaint of vaginal spotting. She has been

        post-menopausal for 25 years and does not take hormones. An ultrasound is performed, and shows a mass in

        the uterine fundus. A hysterectomy is performed, and pathologic examination of the removed uterus reveals a

        malignant tumor of the endometrial glands and stroma. Which of the following is the most likely diagnosis?

                A. Endolymphatic stromal myosis

                B. Endometrial carcinoma

                C. Endometrial stromal sarcoma

                D. Leiomyosarcoma

                E. Malignant mixed müllerian tumor

 

E.

Tjeter?

shpresoja qe te pergjigjej nenjoni per kete pyetje sepse nuk jam i sigurte ne pergjigje!gjithsesi perjashtoj alternativen C sepse kemi te bejme si me "endometrial glands and stroma". alternativa E me duket se nuk i pershtatet shume moshes keshtu qe edhe kete e perjashtoj. alternativa A me ben te mendoj nje proces beninj nga fjala myosis prandaj do ta perjashtoja edhe kete (ishallah jam ne rregull me kete arsyetim)
keshtu qe nese do zgjidhja per kete pyetje do zgjidhja mes B dhe D!
alternativen B do ta vija ne dyshim sepse gjithsesi kanceri i endometrozes kerkon nje stimulim hormonal qe te coje ne nje shkallezim pastaj! kshu qe pergjigjem D edhe pse nuk jam komplet i sigurte por perderisa nuk duhet ta le bosh...

         Explanation:

         The correct answer is E. Malignant mixed müllerian tumor is a tumor with 2 components, stromal and epithelial

         (endometrial glands), both of which are malignant. This is a rare and highly aggressive tumor that has a 25%

         5-year survival rate. It usually affects older patients and presents with post-menopausal bleeding. The stromal

         component can contain metaplastic components such as cartilage and bone. Interestingly, usually only the

         epithelial component metastasizes.

         Endolymphatic stromal myosis (choice A) is a type of endometrial stromal tumor of intermediate malignancy. It

         appears as small pieces of stroma between myometrial bundles that infiltrate lymph channels. Patients may

         have pain or bleeding, or may be asymptomatic. Recurrences happen late in the course of the disease (years)

         in half of patients and metastasis occurs in 15%. There is no epithelial component, so this is an incorrect

         choice.

         Endometrial carcinoma (choice B) is a malignancy of the epithelial glandular component of the endometrium.

         Abnormal bleeding is the usual presentation. High estrogen states cause this tissue to proliferate. There is no

         stromal component of this tumor, so this is an incorrect choice.

         Endometrial stromal sarcoma (choice C) is a true sarcoma arising from the endometrial stroma that infiltrates

         the myometrium and invades vessels. There is no epithelial component.

         Leiomyosarcoma (choice D) is a true sarcoma arising from the uterine smooth muscle. It commonly has satellite

         lesions within the uterus. Leiomyosarcomas usually recur after removal; survival is greater with well

         differentiated lesions. Poorly differentiated lesions have a 10 to 15% 5-year survival rate. Distant metastasis is         via blood vessels. There is no epithelial component.

tjeter

 

An 80-year-old man has low back pain. An x-ray of the lower back and pelvis shows sclerotic changes in the lower

        vertebrae and in focal areas throughout the pelvis. The radiologist's report states that the sclerotic changes may

        represent osteoarthritis; however, metastatic prostate cancer cannot be excluded. Which of the following is most

        cost-effective in the initial work-up of this patient?

                A. Bone marrow aspirate and biopsy

                B. Digital rectal exam

                C. Prostate-specific antigen

                D. Radionuclide bone scan

                E. Serum alkaline phosphatase

 

Amor ku je ne kete foton, ne sarande?

Citim:

---

Po citoj ato që tha Aljohin
Amor ku je ne kete foton, ne sarande?

---

ku i bi kjo gjeja?

po them C.... edhe pse me e lira do ishte B :p

Citim:

---

Po citoj ato që tha Aljohin
ku i bi kjo gjeja?

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Citim:

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Po citoj ato që tha MARSMED
po them C.... edhe pse me e lira do ishte B :p

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A 40-year-old woman presents to the emergency department with severe abdominal pain localized to the right

         upper quadrant. A urine sample is taken for rapid dipstick reagent strip analysis. A positive result for which of the

         following substances would most strongly suggest gallstone disease as a possible cause of her abdominal pain?

                 A. Bilirubin

                 B. Glucose

                 C. Nitrite

                 D. Protein