Repeated USMLE Questions Step 1- Review- 54

Q- Which one of the following conditions is the most likely complication of Paget disease of bone in elderly patients?

A- Acute renal failure

B- Congestive heart failure

C- Dementia

D- Hepatic failure

B- Congestive heart failure- Paget disease of bone causes increased blood flow into the affected areas of bone which leads to high output congestive heart failure. This complication is common in elderly patients with less cardiac reserve.

Q- The upper limit of normal cholesterol for diagnosing hypercholesterolemia in patients with diabetes has been lowered from 90 mg/dL to 70 mg/dL. Which of the following is the effect of this change on diagnosing hypercholesterolemia in patients with diabetes?

A- Decreases the sensitivity of the test

B- Increases the Specificity of the test

C- Increases the negative predictive value of the test

D- Increases the positive predictive value of the test

C- Increases the negative predictive value of the test-Lowering the cutoff point of a test increases the sensitivity and decreases the specificity of the test. It also increases NPV and decreases PPV. To remember it Lower=negative. Sensitivity is for screening a test so, when you lower the cutoff then, I lot of people will be diagnosed of a disease which make it high. Specificity is the opposite to this.

Q- Echinocytes are type of erythrocytes characterized by abnormal cell membrane with small, spaced thorny projections. The presence of these cells in blood is characteristic of which one of the following enzyme deficiencies?

A- Citrate synthase

B- Glycogen reductase

C- Glycogen synthase

D- Pyruvate kinase

D- Pyruvate kinase- It is an inherited metabolic disorder leads to hemolytic anemia in young children due to impairment of glycolysis and decreased ATP caused by pyruvate kinase deficiency.

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