After eating a Costco chicken, Anna begins studying how the body processes amino acids. She learns the alanine cycle is dependent on aspartate alanine aminotransferase (ALT) in the muscle and the liver. What vitamin deficiency would cause a disruption of this cycle?

Al presents to the ED with vomiting, confusion, slurred speech, and flapping tremors. He is found to have high levels of ammonia. Which compound is depleted in Al’s brain?

A 48-year-old homeless male presents with confusion and slurred speech. Physical examination reveals spider angiomas on the chest and flapping tremors on wrist extension. Labs reveal elevated AST and ALT levels. Where does the first step of this patient’s metabolic defect normally occur?

Calvin is wondering why amino acids must travel through a cell in order to get into the blood. What structure(s) in adjacent enterocytes prohibit passage of materials in the extracellular space?

A 32-year-old man presents with chronic diarrhea and weight loss. Laboratory studies reveal hypoalbuminemia and evidence of protein-energy malnutrition. Upper endoscopy with small bowel biopsy shows blunted villi and increased intraepithelial lymphocytes. Which of the following best describes the primary mechanism by which dietary protein is absorbed in the small intestine?

A professional basketball player collapsed to the ground during a game and was found to have an enlarging aortic dissection. History revealed that his father died very young with similar symptoms. His genetic and clinical testing is consistent with Marfan syndrome. Which of the following findings would be least likely in this patient?

Which of the following is seen in patients with Marfan’s syndrome but not Ehlers-Danlos syndrome?

Which of the following combinations is the correct gene mutation and inheritance pattern seen in Marfan’s syndrome?

What is represented by the first sound you hear when taking a manual blood pressure?

What sound would you expect to hear when percussing the liver?

You are examining a 47-year-old with cough and fever. You notice decreased breath sounds in the right lower lung field. You suspect pneumonia. Which of the following findings would you also expect to find during your examination?

What is the definition of malpractice?

What is the Fair Share Rule?

What is the purpose of compensatory damages?

Which of the following is NOT one of the 4 C’s of risk management?

Which of the following is NOT an area of focus of ACCESS Act of 2022?

Chad is a first-year medical student on his first ICE rotation, and is so excited to be rounding with a local neurologist. However, when discussing the case of an 80-year-old patient whose recent imaging revealed late-stage glioblastoma, the physician says he is just going to tell the patient that there’s nothing they can do and refuses to consider any requests for an oncology referral. Chad feels that the patient should be allowed to discuss this diagnosis with a specialist so he has all of the information, but doesn’t say anything because he is only a student and does not want to seem disrespectful. Repeated instances like these may lead to an increase of baseline distress called:

The healthcare hierarchy is the primary constraint that kept Chad from speaking up. What else would be considered an external constraint?

Chad goes to the AEC to tell Sarah and Jodi about this experience and his worries about future burnout due to situations like this. Which of these counts as an interpersonal factor of burnout?

Years later, Chad is an attending with his own practice. To mitigate empathetic decay, he implements a critical incident report program. Who benefits from programs like these?

Which of these is not considered a requirement for informed consent for genetic testing?

Your patient tells you that her mother was recently diagnosed with breast cancer. She’s curious about BRCA gene testing, but is nervous that this information will be used against her if she is positive. What should you tell her about GINA?

Your patient tests positive for the BRCA1 gene, which may indicate an up to 70% chance of developing breast cancer in her lifetime. She is understandably upset and decides that she will keep this information to herself, despite the fact that she has 3 adult daughters, all of which are your patient. You feel that her daughters deserve to know this information so that they can get tested themselves and understand their risk. You decide to speak to your ethics officer to decide whether or not you should tell them this information or not. What is the primary ethical principle utilized to justify contacting the daughters?

Which is not one of the main factors affecting the shape of a drug-concentration/time curve?

What route of administration is demonstrated by each line?

A patient with an autoimmune disease comes in for their regular infusion treatment. She tells you that she just came from her cycle class and had forgotten her water bottle at home, so she’s feeling quite light-headed. You’re concerned that she might be dehydrated. If this is the case, what dose adjustment should you consider?

You’re looking to start a continuous drug infusion on an emergency patient and need to calculate a loading dose to achieve immediate steady-state concentration of 75mg/L. Use the following drug values: 

T1/2 = 0.41 hrs Vd= 30 L

F = 0.89 k= 1.67

CL=50mg/hr

Calculate the maintenance dose if this were an oral drug  (goal mean steady-state concentration of 75mg/L).

T1/2 = 0.41 hrs Vd= 30 L

FPO = 0.89 k= 1.67

CL=50mg/hr

A 52-year-old man presents to the clinic with persistent joint pain and swelling in his right great toe, consistent with a diagnosis of gout. His symptoms began two weeks ago, and despite treatment with NSAIDs, his pain has not improved. Due to the ineffectiveness of the NSAIDs, his physician decides to prescribe a different medication to manage his condition. This new medication aims to reduce the production of uric acid by inhibiting a key enzyme in the purine metabolism pathway.​ Which enzyme is inhibited by the newly prescribed drug?​

A 1-year-old girl is brought to the physician for follow-up examination 1 week after admission to the hospital for bacterial pneumonia. She has had multiple episodes of purulent otitis media and infectious diarrhea since the age of 6 months. She underwent treatment for oral thrush 1 month ago. There is no family history of serious illness. Her height and weight are both below the 10th percentile. Physical examination shows no visible tonsils and slightly decreased breath sounds in the left lower lobe. Laboratory studies show increased deoxyadenosine concentration in both the serum and urine. An x-ray of the chest shows an absent thymic shadow. Which of the following additional findings is most likely in this patient?​

A 45-year-old woman comes to the physician because of a 2-week history of painful ulcers in her mouth. Over the past 2 months, she has had increasing fatigue and difficulties concentrating. She has a history of rheumatoid arthritis and was started on a new medication 4 months ago. Examination shows pallor of the mucosal membranes and three tender ulcerative lesions in her mouth. Her hemoglobin concentration is 8.7 g/dL and mean corpuscular volume is 109 μm3. A blood smear shows hypersegmented neutrophils. Which of the following is the most likely cause of this patient's findings?​

A 24-year-old woman comes to the emergency department because of hematuria and severe left-sided flank pain that started 12 hours ago and radiates to her left groin. Her father and sister often had similar episodes. Urinalysis reveals scattered RBCs and hexagonal crystals without leukocytes. CT of the abdomen is shown. Which of the following is the mechanism of this patient’s most likely diagnosis?

An 11-year-old boy is brought in by his parent to the clinic when she noticed a skin rash over his chest and arms over the past 2 weeks. The boy has noticed that the rash becomes pruritic and painful to touch when he goes outside during recess at school. He also complains of diarrhea over the past several weeks. His parent states his developmental history has been unremarkable except for similar rashes when he was 5 years old that resolved spontaneously. He takes no medications and has not received treatment for any condition in the past. Temperature is 37.0°C (98.6°F), pulse is 72/min, respirations are 18/min, and blood pressure is 115/72 mmHg. BMI is 19 kg/m2. Physical examination reveals well-defined, hyperpigmented, hyperkeratotic, symmetrical, thick scaly plaques surrounded by erythema on the dorsa of the hands, arms, feet, up to the knees, and along the sides of the neck. Urine studies are shown below. What is the disease mechanism?

Which of the following amino acids is essential?​

Based on this blot, who is the Dad of Kid 2?

A 55-year-old women comes to clinic because of recent weight loss and excess sweating. On physical examination, her thyroid is enlarged, smooth and nontender. Patellar tendon reflexes are brisk bilaterally. Ocular examination reveals the findings shown. Laboratory testing suggest primary hyperthyroidism. Eventually, your attending diagnoses her with an autoimmune disease, Graves disease. Which of the following tests will confirm the attendings diagnosis?​

What type of chromosomal abnormality is seen here?​

A 48 y/o female comes to your clinic over concerns of feeling a lump in her breast. She mentions she doesn’t know how long its been there but is worried she might have cancer because her neighbour recently died from breast cancer. She tests positive for breast cancer, so you want to start her on chemotherapy that is specific to tumor cells. What qualitative technique can be used to identify protein biomarker to help select appropriate therapy?​