NBME 17 Flashcards
Monoclonal antibody prepration for treatment of inflammatory bowel disease will target which cytokine?
Tumor necrosis factor
What are the components of the HELLP syndrome in pregnant women.
Hemolytic anemia, elevated liver enzymes, low platelet count
What does aflatoxin increase the risk of? What can you get it from.
Hepatocellular carcinoma, aspergillus fungus
Treatments for ADHD will focus on increasing which neurotransmittes.
NE and dopamine
What are the symptoms of iron overloadings
Liver damage, pancreatic damage, low insulin, sex hormones too low, skin bronzing ‘bronze diabetes’, small testes
Which enzyme converts dopamine to NE.
Dopamine B-hydroxylase
Which enzyme converts L-DOPA to dopamine
Dopamine decarboxylase
Which cranial hematoma will present with a lucid interval and a CNIII palsy.
Epidural hematoma
Which cranial hematoma is the only one to NOT cross suture lines.
Epidural hematoma
Describe everything about cyclosporine.
Immunosuppressive drug that inhibits IL2 transcription thereby inhibition lymphocyte proliferation. inhibits calcineurin by binding to cyclophilin. Used for Psoriasis and rheumatoid arthritis. Can cause nephrotoxicity
If a patient has involuntary muscle movements, hyperreflexia and pins and needles tingling sensation, which electrolyte is most likely messed up.
Calcium
Which cranial nerve causes soft palate elevation and uvula stationed in midline.
Vagus
What is the treatment for hereditary spherocytosis.
Splenectomy since spleen killing the cells causes the anemia
How do you distinguish cause of stable vs unstable angina.
Stable angina- stable stenosis greater than 70%
Unstable angina- unstable atherosclerotic plaque
What is the difference between thyroxine and triiodothyronine?
Thyroxine is T4, produced by thyroid. T4 converted to T3 in peripheral tissues. T3 is five times as active as T4.
Why does NSAID use sometime result in acute renal failure?
NSAIDs will inhibit prostaglandin production, so there will be no vasodilation at the affarent arteriole, decreasing GFR
How dantrolene reverse anesthetic induced hyperthemia?
Dantrolene is a ryanodine receptor antagonist so it will block calcium release from sacroplasmic reticulum
Describe the innervations of the internal anal sphincter.
Contraction- sympathetic hypogastric and superior rectal plexus
Release- parasympathetic pelvic splanchnic plexus
[review the plexuses]
What is the first objective sign of puberty in females.
breast bud development
What factor is important is causing mycobacterium leprae to infect skin rather than dermal organisms
Cool temperature
Why does heparin sometimes cause thrombocytopenia in patients.
development of IgG antibodies against heparin bound platelet factor 4
What are some hallmarks of patients presenting with pulmonary sarcoidosis?
African-American females, CXR shows bilateraly hilar adenopathy, increased calcium due to increased Vitamin D activation in macrophages by 1 alpha hydroxylase. erythema nodosum, bells palsy, elevated CD4/CD8 fluid ration in bronchoalveolar lavage
What does 1a-hydroxylase do in vitamin D activation. What is in regulated by?
Converts storage form, 25OH-vitamin D to 1, 25OH-Vitamin D [active form]. Positive feedback from PTH and if phosphate levels go too low.
In a patient with sarcoidosis, which form of vitamin D would increase?
1,25OH
Which hormone stimulated the hormone sensitive lipase in adipocytes?
Epinephrine
What is the mechanism of action of alendronate.
Bind hydroxyapetitie in bone and inhibit osteoclast activity
Pain in anterior thigh, medial leg and foot would involve which dermatomes?
L3-L4
What are the six stages of overcoming substance addiction?
Precontemplation- not acknoledging the problem
Contemplation- not yet willing to do anything about it
Preparation/determination
Action/willpower
Maintenance
Relapse
During which days post-conception does the neuropores fuse?
15-40 days or 4th week
An external anal hemorrhoid is formed due to a thrombosis in which vessel.
Inferior rectal VEIN
Hemorrhoids formed due to veins
What is the mechanism of action of the vibrio cholera bacteria?
Overactivation of Gs receptor causing increase in ADENYLYL cylase and cAMP
What are the sequences for recognizing RNA splice sites?
At the 5’ end- GU
At the 3’ end- AG
What is the male homolog of the labia majora?
Scrotum
Which immunodeficiency has the classical finding of delayed umbilical cord separation?
Leukocyte adhesion defect 1- LFA-1 [CD18] deficiency causing loss of neutrophil chemotaxis and migration and adhesion
how would you tell the difference between pyloric stenosis and immature LES in an infant?
Pyloric stenosis would have projectile vomiting, non-bilious while the immature LES would have vomiting several times a day but not projectile
how would neonates with tracheoesophageal fistulas present?
They would choke, drool and vomit with first feeding right away
where does gluconeogenesis occur?
Liver, kidneys, intestinal epithelium
which adrenal steroid enzyme deficiency would have normal BP with virilization?
11B hydroxylase deficiency
A young man presents with achilles xanthomas. What disease does he likely inherit?
Familial Hypercholestrolesmia– AD
defects or missing in LDL receptors of ApoB100
UMBILICATED papules on a kid in clusters.
Poxvirus
What is the defect in porphyria cutenia tarda?
Enzyme deficiency of uroporphyrinogen decarboxylase so that uroporphyrinogen accumulates. Blistering in sunlight, made worse with alcohol and associated with hep C
Why does Troponin I and CKMB rise after an MI?
lipid membrane breakdown and peroxidation
The inferior alveolar artery is a branch of which artery?
Maxillary artery off of the external carotid artery
A lower jaw break would disturb which nerve?
Inferior alveolar nerve
How do echinocandins or caspofungins work?
inhibit glycan polysaccaride synthesis in fungal cell wall causes inhibition of the beta 1,3 glucan
What is the mechanism of action of cyclophosphamide?
Cross-linking cell DNA by donating alkylating agents
Inspiration increased the intensity of which murmurs?
Right heart murmurs
What is the most commonly associated cancer with myasthenia gravis?
Thymoma
What is the pathology in myasthenia gravis?
Antibodies against post-synaptic Ach receptors at NMJ
Dysphagia can be attributed to enlargement of which heart structure?
Left atrium
Why do we see gynecomastia in liver disease?
Messed up testoterone synthesis or estrogen to testosterone ratio
How would a vitamin E deficiency present?
Acanthosis, hemolytic anemia and similar neurological symptoms to vitamin B12 deficiency but no megaloblastic anemia, no increase in methylmalonic acid
What is the structural defect in kartagener’s syndrome?
Dyeinin arms
What histological changes would you see in alcoholic hepatitis?
Mallory bodies [cytoplasmic inclusions of keratin filaments] with necrotic cells
what would be the changes in early septic shock?
decreased BP [that wont change] with increased cardiac output
what is the main cause of secondary hypertension due to renal issues?
fibromuscular dysplasia of the renal arteries showing string of bead appearance
what is lichen sclerosis?
thinning of epidermis of vulva with white plaques. fibrosis and sclerosis of dermis
