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None of the above enzymes are defective in either mutant strain P nor Q. Submit answer Correct Answer: C Explanation You should recognize that enzymes typically end with —ase and so you can see that the figure provided indicates the 3 enzymes that are catalysts for the three reactions as shown. This necessarily means that both P and Q have a functioning enzyme argininosuccinase see Figure 1. Going Deeper: More about the 1 gene, 1 enzyme hypothesis and the importance within a metabolic pathway. So, the gene that makes the enzyme for ornithine synthesis must have been mutated.

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Primary hyperaldosterone mineralocorticoid excess I. Renal artery stenosis, bilateral J. Renal artery stenosis, unilateral K. Renal parenchymal disease L. Sympathomimetics e. Transplant donor N. White coat hypertension O. None of the above 4. Harry Conroy, a year-old newspaper assistant editor, is seen in the office of his family physician complaining of blood in the urine over the past four days.

He states that he has had this on two previous occasions, both in relation to an upper respiratory tract infection. On both previous occasions the urine cleared spontaneously over a period of five to seven days. At the time of the present visit he states that he has been feeling lethargic with a sore throat for the past five days. He is a vegetarian and smokes a pack of cigarettes each day. Urine microscopy reveals oxalate crystals, dysmorphic red blood cells and red cell casts.

He has been hypertensive for the past four years and his blood pressure control has been erratic during this time. His only other medical problem is gout, which he experiences on average once every eighteen months. He continues to smoke two packages of cigarettes per day. He has a maternal family history of hypertension and cerebrovascular disease and a paternal family history of lung carcinoma.

His present antihypertensive medications are hydrochlorothiazide and adalat XL. Urine analysis at his last three visits has shown a trace of protein. Urine microscopy is unremarkable.

A 24 hour urine collection shows a normal creatinine clearance with excretion of mg of albumin during this time period. Serum liver enzymes are normal. She admits to stress at work and states that her father was diagnosed as hypertensive at the age of 60 but, thus far, has not required treatment. She has no symptoms with the exception of mild constipation for which she takes bran supplements. She is on no prescribed medication although she does admit to occasionally taking Vitamins C and E.

She denies taking any other medications. She does not smoke but takes alcohol socially. On physical examination she is not obese, has no signs of cardiovascular disease, and no hypertensive retinopathy. Hogan brings her daughter Natascha to the emergency room.

Natascha is a previously well, one-year-old girl who developed a fever two days ago. Her temperature, measured orally by her mother, was For the past two days Natascha has been listless and has eaten very little other than juice and milk. She has had neither diarrhea nor vomiting. Her mother thinks she may have had a bit of a runny nose earlier in the week.

Her mother has been treating her with Tylenol, and although Natascha appears flushed and ill when the fever is high, she is her usual self when the fever is down.

Her mother is concerned because Natascha has had a fever once before and it was an ear infection that required antibiotics. Her mother is wondering if she needs some today.

Natascha has otherwise been a healthy child and has received all her immunizations including MMR vaccine one week ago. She cries during the entire exam, but is comforted after by her mother and stops crying.

Her temperature is 40 degrees Celsius rectally. Her tympanic membranes are normal. Her throat is mildly erythematous, with no exudate. Abdomen is soft. She has a diaper rash. What causes of fever must you consider in this case?

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March 8, pm Hi, I highly recommend starting with Ultimate Review books for mccee and for mccqe1. They give you free questions to download and using those will give you a good start. I will add them to the post or write a new one. There is a chance if you go to Canada as a fellow you need to have a specialty from your country , work for years, they like you very much, and give you an opportunity to stay as a staff, even without taking any of the MCC exams. This is possible but the chance is very slim.

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Primary hyperaldosterone mineralocorticoid excess I. Renal artery stenosis, bilateral J. Renal artery stenosis, unilateral K. Renal parenchymal disease L. Sympathomimetics e. Transplant donor N. White coat hypertension O.

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