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SMART 2 > NBME 1 > Flashcards

NBME 1 Flashcards

1
Q

What is the most likely inflammatory/or immune response in the lungs to TB

A

Epithelioid cells, multi-nucleated giant cells, caseation necrosis

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2
Q

A bed ridden person that complains of sudden onset of dyspnea and chest pain and dies suddenly, Autopsy will show

A

Deep Venous Thrombosis

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3
Q

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

A

Inappropriate relaxation of the lower esophageal sphincter

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4
Q

Which metabolic event is most likely the cause of ischemia of regions after an acute coronary occlusion

A

ATP depletion

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5
Q

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

A

Eosinophilic inclusion (Lewy bodies) in neurons of the substantia nigra

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6
Q

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

A

Phosphoribosylpyrophosphate synthetase

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7
Q

Episodic symptoms of hypoglycemia which shows decreased plasma glucose concentration, increased plasma insulin concentration and undetectable C-peptide concentration is caused by

A

Surreptitious use of insulin

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8
Q

Renaturation of DNA under conditions of high stringency has what effect

A

Mismatched DNA hybridization is prevented

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9
Q

Which fetal organ system is malfunctioning when there is an increased uterus size with a little fluid in amniotic sac

A

Renal

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10
Q

Which medication has the effects of mild constipation, inability to empty bladder leading to bladder distention and mild confusion

A

Diphenhydramine

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11
Q

Solitary thyroid nodule. Scan shows uptake of radioactive iodine by nodule. Diagnosis

A

Follicular adenoma

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12
Q

What is the causal organism in an AIDS patient that has progressive weakness of limbs, expressive aphasia and mild headache

A

Toxoplasma gondii

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13
Q

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

A

Adenocarcinoma

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14
Q

What is the most likely cause of edema that results from the use of Venous occlusive tourniquet

A

Increased mean capillary hydrostatic pressure

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15
Q

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

A

Fallopian tube

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16
Q

What is the most likely cause of deficiency in a baby with history of Recurrent bacterial infection and decreased production of HOCl

A

Myeloperoxidase

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17
Q

Angina pain relived by nitroglycerin works by

A

Stimulating the formation of cyclic GMP

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18
Q

Prominent grasp and snout reflexes, progressively strange behavior, impulsive and distractible. Most likely cause of patients condition is

A

Pick’s Disease

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19
Q

The destruction of H2O2 is catalyzed by which enzyme

A

Catalase

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20
Q

Biopsy of tissue from patchy leukoplakia on the anterior floor of the mouth will show

A

Squamous cell carcinoma

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21
Q

What is likely to enhance the production of surfactant by type2 alveolar cells/pneumocytes

A

Corticosteroids

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22
Q

What laboratory findings will predict whether an operation that relieves obstruction will reduce blood pressure to normal is increased renin activity in the

A

Right renal vein vs Left renal vein

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23
Q

A neonate with ambiguous genitalia that feeds poorly and dehydrated in the first 48hours most likely has what deficiency

A

21-Hydroxylase deficiency

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24
Q

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

A

Narrowing of the capillary wall by fibrin deposition

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25
Q

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

A

Candida albicans

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26
Q

Supplementation with which amino acid is most likely to reverse the effect of competitive inhibitor of endothelial nitric oxide synthase

A

Arginine

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27
Q

What is the cause of a hemorrhage in the lower esophagus of an alcoholic person

A

Transmission of portal hypertension to the esophageal veins

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28
Q

Which drug is most likely to cause dizziness and ringing in the ear a week after onset

A

Aspirin

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29
Q

What procedure improves the immunogenicity of vaccines that use capsular polysaccharides as antigens

A

Protein conjugation

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30
Q

During the first four weeks after a vasectomy what is most likely to occur

A

Presence of viable sperm in ejaculate

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31
Q

Activation of T-lymphocyte results in the production of which component in signal transduction

A

Diacylglycerol

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32
Q

What is the diagnosis? Increasing weakness, weight loss, generalized lymph node enlargement and hepatosplenomegaly. Lab shows lymphocytosis, majority are CD5+.

A

Chronic lymphocytic leukemia

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33
Q

Which enzyme protects body tissues against highly reactive oxygen compounds

A

Superoxide dismutase

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34
Q

What cells help in the regeneration of alveolar epithelium

A

Type II pneumocytes

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35
Q

The most likely cause of anemia in Hodgkin disease, nodular sclerosing type is

A

Abnormal utilization of iron

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36
Q

What is the cause of sinus tachycardia, elevated BP and pulse in a drug addict

A

Blockage of neurotransmitter uptake at the presynaptic nerve terminal

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37
Q

Which DNA mechanism helps healthy children to mount diverse antibody responses to several thousands of different antigens

A

Recombination

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38
Q

Sulfonylureas exert their hypoglycemic effect by blocking which channels

A

K+ Channels

potassium channels

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39
Q

What receptor does insulin act through

A

Tyrosine kinase

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40
Q

Renal biopsy shows diffuse granular deposits of IgG and C3 in the glomerular basement membrane. Diagnosis

A

Membranous glomerulonephritis

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41
Q

Antibodies that can pass from the mother to the fetus are of which class

A

IgG

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42
Q

Latent infection with which virus is associated with B lymbhocytes

A

Epstein-Barr virus

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43
Q

Distant heart sound with no murmurs and distended head and neck veins in a hypotensive patient. Likely diagnosis

A

Cardiac Tamponade

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44
Q

What is the explanation of some patient with increased frequency on one HLA type inability to respond to immunization

A

Failure of T-lymphocytes to recognize the polypeptide

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45
Q

Use of what is most likely to prevent or reduce risk of melanoma

A

Sunscreen

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46
Q

What is the most likely consequence of impaired synthesis of interleukin-1 (IL-1)

A

Impaired function of T-lymphocytes

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47
Q

Fragile X is associated with which chromosomal abnormality

A

CGG repeat expansion

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48
Q

Which antihypertensive medication can lead to craniofacial deformity and pulmonary hypoplasia and abscene of urine

A

Enalapril

ACE inhibitor

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49
Q

Lung examination that shows focal nodular area of chronic pneumonitis with necrotizing arteritis and focal collection of epithelioid histiocytes is most likely

A

Wegener’s granulomatosis

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50
Q

What describes the most pathologic finding in the thyroid gland of a person with hypothyrodism

A

Heavy lymphocyte infiltrate with germinal center formation

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51
Q

What is the mechanism of intravenous heparin in treating deep venous thrombosis

A

Facilitation of inactivation of thrombin by antithrombin III

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52
Q

Anticodon of yeast serinyl-tRNA is 5’-AGC-3’. What is the serine codon

A

5’-GCU-3’

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53
Q

Which drug relaxes the skeletal muscle by directly working on action of excitation-contraction coupling

A

Dantrolene

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54
Q

Which cell share a common progenitor cell with microphages

A

Microglia

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55
Q

A clone of cancer resistance to vincristine, doxorubicin, and dactinomycin involves what mechanism

A

Inability to form polyglutamates

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56
Q

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

A

Splenic flexure

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57
Q

What medication works on second messenger system activated by beta adrenergic receptor that is most effective in increasing heart rate in propranolol overdose

A

Glucagon

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58
Q

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

A

Prevalence of neural tube defect in the population in question

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59
Q

The ability of endothelial cells to inhibit platelet aggregation in mediated in part by the metabolism of cell membrane-derived arachidonic acid by

A

Cyclooxygenase pathway

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60
Q

What is likely to reproduce pain in acute supraspinatus tendinitis

A

Abduction

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61
Q

Staying away from people because of negative criticism and difficulty socializing with people

A

Avoidant

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62
Q

Which human ell is 1N and haploid

A

Spermatid

63
Q

Second messenger cascade directly responsible for release of intracellular stores of Ca2+ is

A

Inositol 1,4,5-triphosphate

64
Q

Intravenous street drug user whose blood culture grows yeast. What is the organism

A

Candida albicans

65
Q

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

A

Flumazenil

Treatment of the sedation

66
Q

A vegetarian diet that does not permit milk and eggs is most likely to cause

A

Vitamin B12 deficiency

cyanocobalamin

67
Q

What helps extracellular binding proteins such as fibronectin and laminin to bind to cell membranes

A

Integrin

68
Q

What is the likely beneficial effect of tamoxifen in a person with breast cancer

A

Competition with cytoplasmic estrogen receptors

69
Q

Nausea vomiting and abdominal pain. Absent bowl sounds and involuntary guarding with rebound tenderness. Diagnosis

A

Peritonitis

70
Q

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

A

Pleural effusion

71
Q

Which medication is likely to induce bronchodilation by activating adenylyl cyclase in a asthmatic patient

A

Albuterol

72
Q

What is a mass in the posterior to the right sternocleidomastoid muscle. What is the origin of the mass

A

Brachial cyst

73
Q

Mutation in cystic fibrosis transmembrane conductance regulator (CFTR) proteins alters which iron transport mechanism

A

Cyclic AMP (cAMP)- stimulated Cl- secretion

74
Q

What is a person at an increased risk of after resection of the entire stomach

A

Vitamin B12 (cyanocobalamin) deficiency

75
Q

A elderly lady that presents with left adnexal enlargement which was not present a year ago. Likely diagnosis

A

Ovarian tumor

76
Q

Using POSTEROLATERAL approach in nephrectomy , which layer in most likely incised

A

Transversalis fascia

77
Q

Fructose 2, 6-bisphosphate regulate the conversion of

A

Glucose-6-phosphate to pyruvate

78
Q

Glyburide for type 2 diabetes and metformin increases a persons risk of

A

Lactic acidosis

79
Q

In Benign prostatic hyperplasia biopsy of the prostate will show

A

Glandular hyperplasia

80
Q

Which defect in the sphincter of Oddi explains recurrent episodes of biliary colic after a cholecystectomy for removal of gallstones

A

Loss of enteric inhibitory motor innervation

81
Q

How is Retinoic acid able to induce remission in patients with Acute Promyelocytic Leukemia

A

Differentiation of leukemic cells

82
Q

Vesicular rash involving the T-10 - T12 dermatomes is caused by which organism and characteristic

A

Shingles— Herpes Zoster

Double-stranded DNA

83
Q

Sudden redrawal from which substance is most likely to produce life-threatening syndrome in a person dependent on the substance

A

Heroin

84
Q

What type of tissue is most likely to be seen in surgically resected Meckel’s diverticulum

A

Gastric

85
Q

Which condition on right posterior chest will cause a spoken “ee” to sound “ay”

A

Lower lobe consolidation

86
Q

Fixed and dilated pupils, absent oculocephalic reflexes, no spontaneous respiration. EEG confirms electrocerebral inactivity. What is the level of neurologic functioning

A

Brain Death

87
Q

What is the most likely effect of treatment with ACE inhibitors on circulating levels of ALDOSTERONE, RENIN, BRADYKININ

A

Decrease ALDOSTERONE, Increase RENIN and Increase Bradykinin

88
Q

What medication is used in treating malathion poisoning after successful treatment of the cholinergic symptoms with atropine

A

PRALIDOXIME – form muscle weakness and breathing difficulty

89
Q

Which band maintains constant length during muscle contraction

A

A - band

90
Q

A friction rub over the precordium after an acute transmural anterior myocardial infarction is caused by

A

Autoimmune reaction

91
Q

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

A

Tinea solium–

Passage through pigs.

92
Q

Which cytokines contribute the fever, dysuria and flank pain associated with E-coli infection

A

Tumor necrosis factor-alpha and IL-1

93
Q

What is the cause of Rho(D) antibodies in an Rh negative mother after the birth of a second child

A

Intrauterine transplacental fetal-maternal hemorrhage during the second pregnancy

94
Q

Proteins destined for the lysosomes are most likely to be found in what location in a patient with (mucolipidosis II) I-cell disease

A

Extracellular space

95
Q

The most appropriate therapy for an elderly patient for Rheumatoid arthritis is

A

Aspirin

96
Q

A person with pulmonary fibrosis is most likely to minimize the work of breathing by

A

Increasing Respiratory frequency and Decreasing Tidal volume

97
Q

What component of a microbe is responsible for the shape of a Beta-hemolytic gram-positive coccus in chains that causes pharyngitis

A

Peptidoglycan

strep pyogenes)–> (group A strep

98
Q

Blockade of which affarent pathway will prevent cough reflex from functioning

A

Vagal nerve

99
Q

Long term administration of which drug causes osteoporosis

A

Prednisone

100
Q

What is the cause of intermittent amenorrhea, thick and doughy skin, no energy and depression

A

Pituitary necrosis

101
Q

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

A

Corynebacterium Diphtheria–> TRANSDUCTION

102
Q

Because of inadequate diet (poor nutrition) administration of Trimethoprim-sulfamethoxazole will lead to

A

Megaloblastic anemia

103
Q

Which medication used to treat anxiety and depression is most likely to cause Orthostatic hypotension

A

Amitriptyline

104
Q

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

A

Facilitated diffusion

105
Q

The most likely consequence of ingestion of unknown quantity of Iron Sulfate tablets by a kid is

A

Gastric Bleeding

106
Q

The effect of a drug that decreases cardiac preload and cardiac after-load and an increase if GFR is similar to the effect of

A

Atrial natriuretic peptide

107
Q

What is the mechanism of 5-fluorouracil in the treatment of colon cancer

A

Inhibiting thymidylate synthetase activity

108
Q

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

A

Diffuse glomerulosclerosis

109
Q

A young woman with 1 week history of increased urinary frequency, dysuria and intermittent suprapubic pain. Urine examination is most likely to show

A

Gram-negative bacilli

110
Q

A virus that is no longer neurovirulent can be used in a vaccine because it has become

A

Attenuated

111
Q

Which test is most useful in confirming the diagnosis of history of joint pain, photosensitive rash on face and other exposed parts

A

Antibodies against native DNA (double stranded DNA)

SLE

112
Q

What will cause an increase in size of independent mutant plasmid by an approximate number

A

Insertion of a transposon

113
Q

A stub wound in the 4th intercostal space on the left, immediately lateral to the sternum will injure

A

Right ventricle

114
Q

What is the effect of a drug that prevents egress of Mg2+ from the N-methyl-D-aspartate (NMDA) receptor

A

Prevent Ca2+ entry into neuron and reduction of excitotoxin-mediated cell death

115
Q

What microphage product is prevalent nine months after myocardial infarction of the left anterior ventricular wall

A

Fibroblast growth factor

116
Q

A person with Tuberous sclerosis should be given what

A

Special education beginning in first grade

117
Q

Which proteolytic enzyme is required to eliminate exudate and restore pleural anatomy in a person with pneumococcal pneumonia

A

Plasmin

118
Q

Which agent when chronically ingested during pregnancy will decrease serum Thyroxine (T4) and increase serum Thyroid-stimulating hormone (TSH) concentration

A

Propylthiouracil

119
Q

Which action will be most affected by nerve injury after fracture of the medial humeral epicondyle

A

Adduction of all digits

120
Q

Which agent will decrease plasma VLDL and LDL concentration but cause cutaneous vasodilation that subsides with repeated dose

A

Niacin

121
Q

In freeze-fracture image what is the function of the central aggregate of particles

A

Communication

122
Q

The genotype of the cells of the chorionic villi that comprise the human placenta is

A

Fetal

  1. Cytotrophoblast__ inner layer of chorionic velli
  2. Syncytiotrophoblast__ outer layer secrets HCG
123
Q

A ganglionic blocking agent administered before surgical procedure works by binding to which receptor

A

Nicotinic receptor

124
Q

A person that develops cirrhosis after administration of multiple blood transfusion several years ago with no history of jaundice is most likely infected with

A

Hepatitis C

(common cause of post transfusion hepatitis and hepatitis among IV drug abusers

125
Q

What is most likely to decrease risk of recurrent calcium-containing renal calculi

A

1, Administration of a thiazide diuretic

2. Increase H2O intake

126
Q

What best describe the movement of Na+ and K+ during one cycle of the Na+-K+ pump (ATPase) in neurons

A

3 Na+ out and 2 K+ in

127
Q

What is the cause of whitish discharge from both breast of a lady that had bilateral tubal ligation. Palpation of breast discloses no masses.

A

Pituitary adenoma

128
Q

Where is the likely access site of an infection with staphylococcus aureus after abdominal operstion

A

Wound

129
Q

The most likely diagnosis in a 10year old girl with fever, fatigue and easy bruising. Lab shows decrease hemoglobin, hematocrit and leukocyte count

A

Aplastic anemia

130
Q

Pain reduction at the site of inflammation can be achieved by antagonizing

A

Bradykinin

131
Q

A patient that develops fever and substernal chest pain days after being treated for gingivitis. Is most infected with

A

Strep viridian

Gram-positive cocci

132
Q

The insertion of a single nucleotide in a codon can cause

A

Protein Truncation

133
Q

The testis should be removed in cryptorchidism to decrease risk of

A

Malignancy

134
Q

What medication is used to treat acetaminophen toxicity

A

N-acetylcysteine

135
Q

Which cytoskeletal protein is involved in actively dividing fibroblasts

A

Tubulin

136
Q

Which antimicrobial agent is most likely to be administered orally for the treatment of potentially serious systemic infections because of its predictable bioavailability

A

Ciprofloxacin

137
Q

What organisms can cause hematuria and proteinuria secondary to superficial cellulitis

A

Streptococcus pyogenes (group A)

138
Q

What medication can be used to treat recurrent peptic ulcer disease while awaiting operation for pancreatic neoplasm

A

Omeprazole

139
Q

What is the cause of a patients inability to opsonize antigens

A

Defect in immunoglobulin isotype switching

140
Q

In schizophrenia drug therapy involves which neurotransmitter systems

A

Dopamine

141
Q

Damage to the anterior wall of the left ventricle is caused by occlusion of

A

Left anterior descending artery

142
Q

A lesion in which part of the central nervous system ca cause generalized dystonic, hyperkinetic movements and depressive dementia

A

Atrophy of caudate nuclei

143
Q

What medication is most appropriate for nasal congestion

A

Pseudoephidrine

144
Q

Increase intracellular concentration of AMP in muscle after strenuous exercise can cause

A

Increased breakdown of glycogen

145
Q

In hyperthyroidism (graves) circulating antibodies to what is most likely to be found

A

Thyrotropin receptor

146
Q

In reversible hypoxic cell injury cellular swelling results from intracellular accumulation of

A

Sodium (NA+)

147
Q

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

A

Osteoporosis

148
Q

Which finding in serum will best support diagnosis of An ACQUIRED DEFICIENCY OF C1 ESTERASE INHIBITOR

A

Decreased concentration of C4

149
Q

An early diastolic low frequency sound over the apex heard after S2 is

A

An S3 heart sound

150
Q

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

A

Irritable bowl syndrome

151
Q

Tremulousness experienced after taking a medication to delay onset of preterm labor is working on which receptor

A

B2- Adrenergic receptor

152
Q

Most common cause of a condition where an adult hemoglobin is 98% saturated with oxygen, but arterial oxygen is decreased is

A

Anemia

153
Q

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

A

Theophyline

SMART 2 (7 decks)

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