NBME 1 Flashcards
What is the most likely inflammatory/or immune response in the lungs to TB
Epithelioid cells, multi-nucleated giant cells, caseation necrosis
A bed ridden person that complains of sudden onset of dyspnea and chest pain and dies suddenly, Autopsy will show
Deep Venous Thrombosis
Burning pain in the epigastric area which ascends into the chest. Endoscopy show moderately severe inflammation in the distal 3cm of esophagus is most likely caused by
Inappropriate relaxation of the lower esophageal sphincter
Which metabolic event is most likely the cause of ischemia of regions after an acute coronary occlusion
ATP depletion
Which other abnormalities is most likely present in a person with progressive loss of facial expression, tremors, rigidity and slow voluntary movement and loss of pigmented cells in substantia nigra
Eosinophilic inclusion (Lewy bodies) in neurons of the substantia nigra
Hyperuricemia from gout which presents with overproduction of urate is most likely results from a lack of feedback inhibition by ADP or GDP at which enzyme
Phosphoribosylpyrophosphate synthetase
Episodic symptoms of hypoglycemia which shows decreased plasma glucose concentration, increased plasma insulin concentration and undetectable C-peptide concentration is caused by
Surreptitious use of insulin
Renaturation of DNA under conditions of high stringency has what effect
Mismatched DNA hybridization is prevented
Which fetal organ system is malfunctioning when there is an increased uterus size with a little fluid in amniotic sac
Renal
Which medication has the effects of mild constipation, inability to empty bladder leading to bladder distention and mild confusion
Diphenhydramine
Solitary thyroid nodule. Scan shows uptake of radioactive iodine by nodule. Diagnosis
Follicular adenoma
What is the causal organism in an AIDS patient that has progressive weakness of limbs, expressive aphasia and mild headache
Toxoplasma gondii
A person whose colonoscopy shows a mass and biopsy shows papillae composed of delicate fibrovascular cores covered by dysplastic columnar epithelium is most likely at risk of
Adenocarcinoma
What is the most likely cause of edema that results from the use of Venous occlusive tourniquet
Increased mean capillary hydrostatic pressure
A tender mass palpated in the right lower quadrant of a sexually active lady with fever, lower abdominal pain and purulent vaginal discharge. Which organ is it located in
Fallopian tube
What is the most likely cause of deficiency in a baby with history of Recurrent bacterial infection and decreased production of HOCl
Myeloperoxidase
Angina pain relived by nitroglycerin works by
Stimulating the formation of cyclic GMP
Prominent grasp and snout reflexes, progressively strange behavior, impulsive and distractible. Most likely cause of patients condition is
Pick’s Disease
The destruction of H2O2 is catalyzed by which enzyme
Catalase
Biopsy of tissue from patchy leukoplakia on the anterior floor of the mouth will show
Squamous cell carcinoma
What is likely to enhance the production of surfactant by type2 alveolar cells/pneumocytes
Corticosteroids
What laboratory findings will predict whether an operation that relieves obstruction will reduce blood pressure to normal is increased renin activity in the
Right renal vein vs Left renal vein
A neonate with ambiguous genitalia that feeds poorly and dehydrated in the first 48hours most likely has what deficiency
21-Hydroxylase deficiency
What renal finding is most likely to be seen in a kid whose peripheral blood smear shows erythrocyte fragmentation with history of fever, abdominal pain, nausea, vomiting and diarrhea
Narrowing of the capillary wall by fibrin deposition
A lady with type 1 diabetes mellitus that has increasing vulvar pruritus and vaginal discharge. A wet mount will most likely show which causal agent
Candida albicans
Supplementation with which amino acid is most likely to reverse the effect of competitive inhibitor of endothelial nitric oxide synthase
Arginine
What is the cause of a hemorrhage in the lower esophagus of an alcoholic person
Transmission of portal hypertension to the esophageal veins
Which drug is most likely to cause dizziness and ringing in the ear a week after onset
Aspirin
What procedure improves the immunogenicity of vaccines that use capsular polysaccharides as antigens
Protein conjugation
During the first four weeks after a vasectomy what is most likely to occur
Presence of viable sperm in ejaculate
Activation of T-lymphocyte results in the production of which component in signal transduction
Diacylglycerol
What is the diagnosis? Increasing weakness, weight loss, generalized lymph node enlargement and hepatosplenomegaly. Lab shows lymphocytosis, majority are CD5+.
Chronic lymphocytic leukemia
Which enzyme protects body tissues against highly reactive oxygen compounds
Superoxide dismutase
What cells help in the regeneration of alveolar epithelium
Type II pneumocytes
The most likely cause of anemia in Hodgkin disease, nodular sclerosing type is
Abnormal utilization of iron
What is the cause of sinus tachycardia, elevated BP and pulse in a drug addict
Blockage of neurotransmitter uptake at the presynaptic nerve terminal
Which DNA mechanism helps healthy children to mount diverse antibody responses to several thousands of different antigens
Recombination
Sulfonylureas exert their hypoglycemic effect by blocking which channels
K+ Channels
potassium channels
What receptor does insulin act through
Tyrosine kinase
Renal biopsy shows diffuse granular deposits of IgG and C3 in the glomerular basement membrane. Diagnosis
Membranous glomerulonephritis
Antibodies that can pass from the mother to the fetus are of which class
IgG
Latent infection with which virus is associated with B lymbhocytes
Epstein-Barr virus
Distant heart sound with no murmurs and distended head and neck veins in a hypotensive patient. Likely diagnosis
Cardiac Tamponade
What is the explanation of some patient with increased frequency on one HLA type inability to respond to immunization
Failure of T-lymphocytes to recognize the polypeptide
Use of what is most likely to prevent or reduce risk of melanoma
Sunscreen
What is the most likely consequence of impaired synthesis of interleukin-1 (IL-1)
Impaired function of T-lymphocytes
Fragile X is associated with which chromosomal abnormality
CGG repeat expansion
Which antihypertensive medication can lead to craniofacial deformity and pulmonary hypoplasia and abscene of urine
Enalapril
ACE inhibitor
Lung examination that shows focal nodular area of chronic pneumonitis with necrotizing arteritis and focal collection of epithelioid histiocytes is most likely
Wegener’s granulomatosis
What describes the most pathologic finding in the thyroid gland of a person with hypothyrodism
Heavy lymphocyte infiltrate with germinal center formation
What is the mechanism of intravenous heparin in treating deep venous thrombosis
Facilitation of inactivation of thrombin by antithrombin III
Anticodon of yeast serinyl-tRNA is 5’-AGC-3’. What is the serine codon
5’-GCU-3’
Which drug relaxes the skeletal muscle by directly working on action of excitation-contraction coupling
Dantrolene
Which cell share a common progenitor cell with microphages
Microglia
A clone of cancer resistance to vincristine, doxorubicin, and dactinomycin involves what mechanism
Inability to form polyglutamates
Which location of the bowl in mostly affected by atherosclerotic disease of the abdominal aorta that obstruct the ostia of the superior and inferior mesenteric arteries
Splenic flexure
What medication works on second messenger system activated by beta adrenergic receptor that is most effective in increasing heart rate in propranolol overdose
Glucagon
What is the greatest influence in determining the predictive value of a test for neural tube defect when a mother has increased levels of alpha fetoprotein concentration
Prevalence of neural tube defect in the population in question
The ability of endothelial cells to inhibit platelet aggregation in mediated in part by the metabolism of cell membrane-derived arachidonic acid by
Cyclooxygenase pathway
What is likely to reproduce pain in acute supraspinatus tendinitis
Abduction
Staying away from people because of negative criticism and difficulty socializing with people
Avoidant
Which human ell is 1N and haploid
Spermatid
Second messenger cascade directly responsible for release of intracellular stores of Ca2+ is
Inositol 1,4,5-triphosphate
Intravenous street drug user whose blood culture grows yeast. What is the organism
Candida albicans
What medication is given to a kid brought to the ER after ingestion of a drug that makes him sedated with normal respiration and and blood pressure
Flumazenil
Treatment of the sedation
A vegetarian diet that does not permit milk and eggs is most likely to cause
Vitamin B12 deficiency
cyanocobalamin
What helps extracellular binding proteins such as fibronectin and laminin to bind to cell membranes
Integrin
What is the likely beneficial effect of tamoxifen in a person with breast cancer
Competition with cytoplasmic estrogen receptors
Nausea vomiting and abdominal pain. Absent bowl sounds and involuntary guarding with rebound tenderness. Diagnosis
Peritonitis
History of shortness of breath without fever, chills or cough. Decreased breath sounds in the left lower lobe and decreased vocal and tactile fremitus, dullness to percussion in the area . Diagnosis
Pleural effusion
Which medication is likely to induce bronchodilation by activating adenylyl cyclase in a asthmatic patient
Albuterol
What is a mass in the posterior to the right sternocleidomastoid muscle. What is the origin of the mass
Brachial cyst
Mutation in cystic fibrosis transmembrane conductance regulator (CFTR) proteins alters which iron transport mechanism
Cyclic AMP (cAMP)- stimulated Cl- secretion
What is a person at an increased risk of after resection of the entire stomach
Vitamin B12 (cyanocobalamin) deficiency
A elderly lady that presents with left adnexal enlargement which was not present a year ago. Likely diagnosis
Ovarian tumor
Using POSTEROLATERAL approach in nephrectomy , which layer in most likely incised
Transversalis fascia
Fructose 2, 6-bisphosphate regulate the conversion of
Glucose-6-phosphate to pyruvate
Glyburide for type 2 diabetes and metformin increases a persons risk of
Lactic acidosis
In Benign prostatic hyperplasia biopsy of the prostate will show
Glandular hyperplasia
Which defect in the sphincter of Oddi explains recurrent episodes of biliary colic after a cholecystectomy for removal of gallstones
Loss of enteric inhibitory motor innervation
How is Retinoic acid able to induce remission in patients with Acute Promyelocytic Leukemia
Differentiation of leukemic cells
Vesicular rash involving the T-10 - T12 dermatomes is caused by which organism and characteristic
Shingles— Herpes Zoster
Double-stranded DNA
Sudden redrawal from which substance is most likely to produce life-threatening syndrome in a person dependent on the substance
Heroin
What type of tissue is most likely to be seen in surgically resected Meckel’s diverticulum
Gastric
Which condition on right posterior chest will cause a spoken “ee” to sound “ay”
Lower lobe consolidation
Fixed and dilated pupils, absent oculocephalic reflexes, no spontaneous respiration. EEG confirms electrocerebral inactivity. What is the level of neurologic functioning
Brain Death
What is the most likely effect of treatment with ACE inhibitors on circulating levels of ALDOSTERONE, RENIN, BRADYKININ
Decrease ALDOSTERONE, Increase RENIN and Increase Bradykinin
What medication is used in treating malathion poisoning after successful treatment of the cholinergic symptoms with atropine
PRALIDOXIME – form muscle weakness and breathing difficulty
Which band maintains constant length during muscle contraction
A - band
A friction rub over the precordium after an acute transmural anterior myocardial infarction is caused by
Autoimmune reaction
A person with travel history to Costa Rica experiencing seizures. CT of head shows numerous cortical lesions with calcification and edema. What is the life cycle of the parasite
Tinea solium–
Passage through pigs.
Which cytokines contribute the fever, dysuria and flank pain associated with E-coli infection
Tumor necrosis factor-alpha and IL-1
What is the cause of Rho(D) antibodies in an Rh negative mother after the birth of a second child
Intrauterine transplacental fetal-maternal hemorrhage during the second pregnancy
Proteins destined for the lysosomes are most likely to be found in what location in a patient with (mucolipidosis II) I-cell disease
Extracellular space
The most appropriate therapy for an elderly patient for Rheumatoid arthritis is
Aspirin
A person with pulmonary fibrosis is most likely to minimize the work of breathing by
Increasing Respiratory frequency and Decreasing Tidal volume
What component of a microbe is responsible for the shape of a Beta-hemolytic gram-positive coccus in chains that causes pharyngitis
Peptidoglycan
strep pyogenes)–> (group A strep
Blockade of which affarent pathway will prevent cough reflex from functioning
Vagal nerve
Long term administration of which drug causes osteoporosis
Prednisone
What is the cause of intermittent amenorrhea, thick and doughy skin, no energy and depression
Pituitary necrosis
An immigrant that develops fever, swelling of the neck and difficulty swallowing. Examination shows gray membrane across the pharynx. How does the pathogen acquire its virulence through which genetic even
Corynebacterium Diphtheria–> TRANSDUCTION
Because of inadequate diet (poor nutrition) administration of Trimethoprim-sulfamethoxazole will lead to
Megaloblastic anemia
Which medication used to treat anxiety and depression is most likely to cause Orthostatic hypotension
Amitriptyline
What is the most likely mechanism by which a drug enters the ell membrane when an (Ouabain) inhibitor of Na/K ATPase fails to inhibit the transport
Facilitated diffusion
The most likely consequence of ingestion of unknown quantity of Iron Sulfate tablets by a kid is
Gastric Bleeding
The effect of a drug that decreases cardiac preload and cardiac after-load and an increase if GFR is similar to the effect of
Atrial natriuretic peptide
What is the mechanism of 5-fluorouracil in the treatment of colon cancer
Inhibiting thymidylate synthetase activity
What is the most likely to be seen on biopsy of a patient that has suffered from type 1 diabetes mellitus for several years and microalbuminuria
Diffuse glomerulosclerosis
A young woman with 1 week history of increased urinary frequency, dysuria and intermittent suprapubic pain. Urine examination is most likely to show
Gram-negative bacilli
A virus that is no longer neurovirulent can be used in a vaccine because it has become
Attenuated
Which test is most useful in confirming the diagnosis of history of joint pain, photosensitive rash on face and other exposed parts
Antibodies against native DNA (double stranded DNA)
SLE
What will cause an increase in size of independent mutant plasmid by an approximate number
Insertion of a transposon
A stub wound in the 4th intercostal space on the left, immediately lateral to the sternum will injure
Right ventricle
What is the effect of a drug that prevents egress of Mg2+ from the N-methyl-D-aspartate (NMDA) receptor
Prevent Ca2+ entry into neuron and reduction of excitotoxin-mediated cell death
What microphage product is prevalent nine months after myocardial infarction of the left anterior ventricular wall
Fibroblast growth factor
A person with Tuberous sclerosis should be given what
Special education beginning in first grade
Which proteolytic enzyme is required to eliminate exudate and restore pleural anatomy in a person with pneumococcal pneumonia
Plasmin
Which agent when chronically ingested during pregnancy will decrease serum Thyroxine (T4) and increase serum Thyroid-stimulating hormone (TSH) concentration
Propylthiouracil
Which action will be most affected by nerve injury after fracture of the medial humeral epicondyle
Adduction of all digits
Which agent will decrease plasma VLDL and LDL concentration but cause cutaneous vasodilation that subsides with repeated dose
Niacin
In freeze-fracture image what is the function of the central aggregate of particles
Communication
The genotype of the cells of the chorionic villi that comprise the human placenta is
Fetal
- Cytotrophoblast__ inner layer of chorionic velli
- Syncytiotrophoblast__ outer layer secrets HCG
A ganglionic blocking agent administered before surgical procedure works by binding to which receptor
Nicotinic receptor
A person that develops cirrhosis after administration of multiple blood transfusion several years ago with no history of jaundice is most likely infected with
Hepatitis C
(common cause of post transfusion hepatitis and hepatitis among IV drug abusers
What is most likely to decrease risk of recurrent calcium-containing renal calculi
1, Administration of a thiazide diuretic
2. Increase H2O intake
What best describe the movement of Na+ and K+ during one cycle of the Na+-K+ pump (ATPase) in neurons
3 Na+ out and 2 K+ in
What is the cause of whitish discharge from both breast of a lady that had bilateral tubal ligation. Palpation of breast discloses no masses.
Pituitary adenoma
Where is the likely access site of an infection with staphylococcus aureus after abdominal operstion
Wound
The most likely diagnosis in a 10year old girl with fever, fatigue and easy bruising. Lab shows decrease hemoglobin, hematocrit and leukocyte count
Aplastic anemia
Pain reduction at the site of inflammation can be achieved by antagonizing
Bradykinin
A patient that develops fever and substernal chest pain days after being treated for gingivitis. Is most infected with
Strep viridian
Gram-positive cocci
The insertion of a single nucleotide in a codon can cause
Protein Truncation
The testis should be removed in cryptorchidism to decrease risk of
Malignancy
What medication is used to treat acetaminophen toxicity
N-acetylcysteine
Which cytoskeletal protein is involved in actively dividing fibroblasts
Tubulin
Which antimicrobial agent is most likely to be administered orally for the treatment of potentially serious systemic infections because of its predictable bioavailability
Ciprofloxacin
What organisms can cause hematuria and proteinuria secondary to superficial cellulitis
Streptococcus pyogenes (group A)
What medication can be used to treat recurrent peptic ulcer disease while awaiting operation for pancreatic neoplasm
Omeprazole
What is the cause of a patients inability to opsonize antigens
Defect in immunoglobulin isotype switching
In schizophrenia drug therapy involves which neurotransmitter systems
Dopamine
Damage to the anterior wall of the left ventricle is caused by occlusion of
Left anterior descending artery
A lesion in which part of the central nervous system ca cause generalized dystonic, hyperkinetic movements and depressive dementia
Atrophy of caudate nuclei
What medication is most appropriate for nasal congestion
Pseudoephidrine
Increase intracellular concentration of AMP in muscle after strenuous exercise can cause
Increased breakdown of glycogen
In hyperthyroidism (graves) circulating antibodies to what is most likely to be found
Thyrotropin receptor
In reversible hypoxic cell injury cellular swelling results from intracellular accumulation of
Sodium (NA+)
In a vertebral compression fracture with Bone Mineral Density BELOW reference range but serum concentration of calcium, phosphorous, albumin and creatinine and activity of alkaline phosphatase within reference range. Most likely diagnosis is
Osteoporosis
Which finding in serum will best support diagnosis of An ACQUIRED DEFICIENCY OF C1 ESTERASE INHIBITOR
Decreased concentration of C4
An early diastolic low frequency sound over the apex heard after S2 is
An S3 heart sound
A young woman with intermittent diarrhea for several years which occurs a couple of times in a year associated with stress. Stool is hard and “pellet-like”. Diagnosis
Irritable bowl syndrome
Tremulousness experienced after taking a medication to delay onset of preterm labor is working on which receptor
B2- Adrenergic receptor
Most common cause of a condition where an adult hemoglobin is 98% saturated with oxygen, but arterial oxygen is decreased is
Anemia
Which drug for maintenance therapy in patients with moderate to severe asthma also has positive cardiac inotropic effects, produces vasodilation, has diuretic action and stimulates diaphragmatic contraction
Theophyline
