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NBME > NBME 22 > Flashcards

NBME 22 Flashcards

1
Q

What electrolyte do u lose with diuertics?

A

HCO3- –> so u see met acidosis

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2
Q

What electrolyte u loose with laxatives?

A

K

H20 loss –> + RAAS –> K dec and H dec with Na inc

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3
Q

A 12-yr old cant walk for 5d + anxious but not concerned abt his symptoms. All motor and sensory normal. Cause?

Brief psychotic
Conversion
Depersonalization
Illness anxiety disorder
PTSD

A

Its conversion

Why?
cuz others don’t make sense with C/P
and being not concerned abt C/P is a sign of conversion

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4
Q

Pt with fracture now has RR 6 post morphine dose. Her Cr is 1.8. What causes deterioration of ppt?

A

Morphine PharmaK?

Morphine is metabolized to morphine-6-glucuronide - excreted by kidneys

Cr >1.2 meaning CKD - dec excretion - inc plasma conc - inc effects

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5
Q

Sensitivity v/s (1-spp.) graph

A

The more sensitive - the more u can Rule out - means True positive

The more spp the lesser 1-spp!
Spp = True negative

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6
Q

Alpha and beta error is what? Inc sample size will cause what change?

A

Alpha = accuse innocent - false +ve
Beta is opp - false negative
1-beta is power inc with inc sample size so obv beta dec with inc sample size.

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7
Q

HIV 1 vs HIV 2?

A

HIV 1 - has higher viral load along with high CD4 TCs

HIV 2 is opp

any C/P goes along the way of Immunodef look at the HIV viral load mainly

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8
Q

Post MI changes in Na, K and Ca?

A

Na/K ATPase pump fails soooo

now we have no K being pumped in - dec K

Na is not being pumped out - Na inc

Ca rushed out of Sarcoplasmic reticulum so Ca inc

U can also think of it like he PM broke so K inc dec and Na in inc

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9
Q

Ant leg muscles and nerves?

A

Common fibular nerve (L4-S2)

PED - eversion and dorsiflexion at foot + motor to fibularis longus and brevis + sensory to lat leg + dorsum of foot (sup peroneal nerve)
Deep peroneal nerve - motor to tibialis ant and sensory to hallux + 2nd webspace

Tibial nerve (L4-S3)
sensory to foot sole
TIPs motor
motor to biceps fimoris, plantaris, popliteus and foot flexors

Tibial + fibular mixed injury = sciatica

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10
Q

If dad has a genetic Hx of AR disease + mom who might be a carrier (q=1/40000). What the probability of kid having the disease?

A

2/3 chances of dada being a carrier * 1/2 chances of him passing it on * mom being a carrier (1/100 = 2pq) * mom passing it on is 1/2

2/3 X 1/2 X 1/100 X1/2 = 1/600

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11
Q

during an explorative laparotomy, hemorrhage when surgeon put his hand behind the liver. What artery affected?

A

Hepatic vein from IVC

Hepatic art + portal vein safe in hepatoduodenal ligament
IVC and aorta are retroperitoneal and can’t cause intraperitoneal bleed
Celiac trunk is in front of liver so yeah

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12
Q

If pt has Hburia right after transfusion?

A

ABO incompatibility

Aba and complement driven process

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13
Q

Neisseria gonorrhea infection - has pillus in nasopharyngeal infection but no pillus in CSF infection. Cause?

A

phase variation - way of dealing with difft env with no random mutation acquisition

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14
Q

CL/P affects?

A

Maxillary and medial nasal prominences

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15
Q

Post partum thyroiditis Bx?

A

Ls infiltrate the gland and we have inc T3/T4 release

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16
Q

if it has been 10 weeks post a scar, its what?

granulation tissue
granuloma

A

Granuloma

(epitheloid + giant cells seen on Bx)

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17
Q

Adenosine deaminase def that causes inc dATP in T-Cells. Inc dATP inhibits what enzyme?

A

Ribonucleotide reductase

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18
Q

I- Cell disease?

A

problem in Golgi (Mannose-6-P) and cant go to target lysosome

thus has to go to ultimately as substance secreted from cells via clathrin

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19
Q

Some1 is opoids. Next best step by physician?

Monitor doing for seeing pain control
Check for Resp DPN

A

PRIORITY IS PAIN NOT RESP DPN!!

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20
Q

Lumbar levels and injuries.

L1-L2?

A

Femoral nerve issues (L2-L4)

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21
Q

Lumbar levels and injuries.

L3-L4?

A

Knee and 1st toe

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22
Q

Lumbar levels and injuries.

L4-L5?

A

5th toe issues

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23
Q

L5-S1?

A

Sciatica

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24
Q

flow rate formulae?

A

Q=vA
v - vel (cm/sec ko convert into L/min via multiplying by 60 and dividing by 1000)
A - Cross sectional area

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25
Q

Post MI some1 has natriuresis and Low serum Na conc. Cause?

A

Not inc ANP and BNP owing to HF yes they do have the same effect but not that significant - more imp for aldosterone escape mechanism to maintain Na conc

Ans: Inc ADH that dilutes the serum

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26
Q

Drugs that cause nephrogenic DI?

A

HCTZ
Amiloride
Democycline

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27
Q

repetitive infections in a bby with impaired resp burst pathway. Which bact?

A

NADPH oxidase def matlab catalase +ve bact

Strep
Psedomonas etc

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28
Q

Histamine effect on capillary and arteriole?

A

Inc Hydrostatic pr
Inc Filtration rate
Dec arteriolar resistance

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29
Q

How does breast cancer spread to the bone?

A

Intercostal –> azygos –> Via Batson venous plexus –> vertebral body

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30
Q

Transplant rxn is hyperacute?

A

Abs and complement mediated
Mins - hrs post transfusion

31
Q

Acute transplant rxn?

A

Ls (CD4 and CD8 cells)
weeks - mnths

32
Q

Chronic Transplant rxn?

A

TYPE 4 HSR - atherosclerosis and mononuclear infiltrate
Months to years

33
Q

GVHD

A

Fibrosis widespread
GI bleed + N/V + diarrhea

34
Q

Tingling sensation in fingers + wrist extension issue?

A

Radial + median nerve
C7 root defect

35
Q

Glucosamine to Fructose-6-P?

A

Glutamine (Urea cycle)

36
Q

Old man has problems with erection. 3m ago had cerebral infarction. Fatigue + insomnia. Effect on libido and nocturnal erections?

A

Libido dec (low Tz as u grow old)
Nl nocturnal erections

37
Q

How much time does it take for CO poisoning to wash off from the body?

A

120 days
(RBC life span)

38
Q

All HPT Hs like GnRH, TRH, ADH, Oxytocin are?

A

Gq - IP3 + DAG

+ HAV 1 or 3 MnM (H1, M1, A1,V1 and M1 n M3)

Additionally Gastrin and AT-2

39
Q

Insulin and GFs use what R?

A

TK-R

40
Q

cGMP pathway used by?

A

NO
ANP, BNP

41
Q

Sirolimus MOA?

A

Sirolimus/Cyclosporine + FKBP in cytosol inhibits mTOR –> dec IL2 -R expression

Tacrolimus - lower IL-2 pdtn

42
Q

Lambert-Eaton Synd v/s Myasthenia gravis?

A

LES - gets better with movmt like RA - Ca2+ Channels autoimmune destruction - Small cell lung Ca

MG - Worsens with movmt like OA - Ach R issue - Thymoma

43
Q

If some1 has high BMI with no physical Ex abnl cause?

A

Not leptin dec but inc calorie intake

44
Q

Interhemispheric ring enhancing lesion is?

Lymphoma
Meningioma

A

Meningioma cuz its only interhemispheric baaki sab are peripherally located

45
Q

Gustatory and olfaction ka Cx is what part of brain?

A

Temporal Lobe

46
Q

DVT pt has been prescribed a drug. MOA?

A

Warfarin - Carboxylation of 2,9,7,10

47
Q

prostectomy affects?

A

Pelvic Splanchnic nerves

48
Q

Osteoblastic Ca?

A

Prostate Ca
Small cell Lung Ca
Hodkin’s Lymphoma

49
Q

Mixed (OB + OC) Ca?

A

GI and breast

50
Q

Osteoclastic Ca?

A

MM
Non-Hodgkins
Non-small cell lung Ca
RCC
Melanoma

51
Q

no TATA box promotor via mutation?

A

No RNA polymerase binding

52
Q

If some1 is emersed in cold H20?

A

VC occurs
Inc Blood vol - Inc ANP/BNP and dec ADH

53
Q

Fever + mild abdominal discomfort + IVDA + RHF + high BP + Hepatomegaly. Cause?

A

Tricuspid insuff

(RHF + IVDA khallas yahi)

54
Q

Open-label Clinical trial?

A

Patient + Drs know the drug being given - cohort study

55
Q

Lytic lesions in vertebrae + LBP. Cause?

Chondrosarcoma
Ewing
Metastatic
Pagets
Osteosarcoma

A

its metastatic (MCC&raquo_space; 1’ tumors)

rest choose karne ke liye no enough info

56
Q

Eversion v/s inversion fractures?

A

Inversion fractures - Fracture with ligament rupture also tibial tuberosity + fibula proximally effected

Evulsion fractures - Fracture with ligament SPRAIN + both tuberosities effected

57
Q

Which pharmaK eqn has nothing to do with cleaance?

A

Loading dose

58
Q

Hemorrhagic shock pt will have dec CO and inc SVR to maintain?

A

MAP

all in all dec CO will dec SV

59
Q

How to get to Renal art via femoral art?

A

Testicular art (Femoral is branch of ext iliac art)

60
Q

Poison ivy, Nickel and some similar metals cause?

A

Type 4 HSR - CD8+ T-cells

61
Q

VDJ recombination funda?

A

B-cells and T-cells both undergo it to become Plasma cells and Mature T-cells.

Now for a cell to have undergone VDJ recombination it has to have the J-region of 1.5kB. Any grted J-region matlab not undergone VDJ recombination

62
Q

Hyperbilirubinemia in kids (UCB inc)

A

UDP-glucTase activity issue!

63
Q

Which med for cough wud not cause constipation?

Codeine
Dextromethorphan
Diphenhydramine
Morphine
Tiotropium

A

B) dextramethorphan as its not an opoid

64
Q

which nerve if compressed by an direct hernia outside sup inguinal ring cause?

A

dec sensation to scrotum - genitofemoral nerve

ilioinguinal nerve is inside the ring

65
Q

NF1 vs TSC?

A

Hyperpigmented spots + eye issues - NF1

Spots + Heart + Brain - TSCM

66
Q

Man with multiple injuries post MVA. Fibrinogen inc. What is the cause?

DIC
Acute phase reactant

A

B) Acute phase reactant

Fibrinogen
Amyloid A
Ferritin
CRP

66
Q

All MSK autoimmune issues like Sjoren’s, SLE etc are inherited via?

A

Multifactorial inheritance

67
Q

Niacin MOA?

A

Inhibits HSL to dec VLDL and dec LDL the best!!!

68
Q

Within a placenta what indicated that an embryo is formed?

Syncytiotrophoblast
Hematopoietic SCs
Cytotrophoblast
1’ stem villus

A

B) Hematopoitic SCs

rest all come from extraembryonic tissue!

69
Q

All viruses except that are ss RNA virus +ve sense except Reovirus/Rotavirus (a ds linear RNA virus) have what special ppy?

A

RNA dependent DNA polymerase

70
Q

Horseshoe kidney special ppy?

A

Anomalous origin of many renal art

71
Q

Pancreas embryonic derivative of?

A

Endodermal

72
Q

Non-oral vaccine have less efficacy that Parenteral vaccine cause?

A

Can’t cause secretion of Ab at epi surface

73
Q
A

NBME (11 decks)

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