NBME 24 Flashcards
A pt came in with exacerbation of SOB has a dog, unclean room, stress and now her roommate smokes. What to do to control symptoms?
Stop roommate from smoking - apparently most imp RF so
If OR/RR is a number that falls within the CI 95% we know that the result is insignificant. Qn is what to choose, p>1 or 0.05<p<1?
p>1 is not possible, 100% chance of null hypothesis being right doesn’t exist.
But p being more than 0.05 but less than 1 is a more feasible way of saying that results are insignificant.
Which HIV drug causes high lactate?
NRTIs (also cause BM suppression, peripheral neuropathy)
didanosine - pancreaDIDis
Zidovudine - gets ZID of anemia
Post MVA, on bed rest. What physiological change seen?
Dec BV
Dec Na plasma
dec Aldosterone
dec Plasma vol
inc SNS activity
Dec BV
Why?
Fluid overload causes inc ANP/BNP - natriuresis + dec GFR
Overall dec BV
Patient has Low G + KBs in urine + HAGMA. Serum G inc on administration of galactose. Issue in?
FA oxidation
Gluconeogenesis
Glycogenolysis
Glycogen synthesis
Glycolysis
Gluconeogenesis
Galactose bcums glucose via glycogenolysis!
Blood loss causes BM to make what enzyme?
EPO
d-ALA
d-ALA - Succinyl CoA + Glycine + Fe –> Heme!!!
EPO inn kidney!
1m Abdominal pain + diarrhea with recent travel Hx. Asthma exacerbation + PEx shows “cutaneous larva currens” + Eosinophilia + Bilat alveolar infiltrates!
Tx???
“cutaneous larva currens” - Pathognomy for strongyloidiasis - Tx is bendazoles/Azoles
Praziquantels for Liver flukes only
Fibrous proteins in the inner surface of nuclear memb?
Lamins
low Tz + PG adenoma done. Tx?
Injection of GnRH
Injection of gonadotropins
Clomiphene citrate
Pg oral
Tz patch
PG adenoma matlab GnRH cant stimulate LH and FSH
Giving gonadotropins (LH)
HOX gene fn?
Reg of transcription
Pt has fever + cough. Experiment with virus causes plaques to form on laryngeal cells but can’t form plaques when pH<5. Cause:
Coronavirus
Coxsackie
EBV
Confusion is btw corona and EBV cuz they infect the larynx
EBV is unenveloped but coronavirus is soooooo
when some1 has spasms + requires cont. ventilatory supprt. Antitoxin to what shud be given?
AchE
Synaptobrevin
Spasms = Tetanus so Synaptobrevin
if no DUMBELLS cant be AchE!
Atypical Ls? B-cells or T-cells?
In case of old IC Female –> B-cells
In EBV/HHV4 (LNs + sore throat + positive sheep agglutination test) - any viral cause –> Its CD8+ T-cells
Cardiogenic shock?
SVR - Inc
PCWP - Inc
CO - dec
Pulm vascular resistance - dec - but HOW?? apparently its autoreg - when Heart is failing it releases VDs metabolites - causes Pulm BV to dilate!!
Touched hot surface and now has blister. Microscopy shows?
Eosinophils perivascular is wrong!! Why? No not perivascular but generally inc in the body yes
Intraendo gap venules - cause inf happens that causes PCV to dilate!
SCZ is most similar to what disorder in terms of inheritance?
T1DM
Overdose of levothyroxine?
Levothyroxine is T4 –> T3 so both inc
Whereas Liothyronine is T3 only soooo dec T4 here!
FT3 - Inc
FT4 - Inc
Thyroid I2 uptake - dec obv
Parotid gland Stenson duct passes through what muscle?
Buccinator (Not massetter)
7-yr old Pt has HypoG + low C-peptide by mum and unstable. IV dextrose resolves symptoms. Looks like Type1DM but had multiple ED visits for same reason (hmmmm):
Cause?
Factitious disorder by proxy
Report her!!
Very high G >500. Why is pt altered LOC?
dec G transport across BBB
Inc FFAs in CSF
Neurons cant perform glycolysis
IC +EC dehydration
IC + EC dehydration
Ciprofloxacin resistance?
Acquisition of plasmid encoding for acetylase
Acquisition of plasmid encoding for 23S ribosomal RNA methylase
Altered DNA gyrase
Altered PCN-BP
Altered 30S Ribosomal RNA
Altered RNA polymerase
Cipro MOA? Inhibits Topo 1 n 4 - thats DNA gyrase so answer is that
Acquisition of plasmid encoding for acetylase –> happens if culture shows more than 1 bact
Acquisition of plasmid encoding for 23S ribosomal RNA - Macrolides ke case mei
Altered 30S Ribosomal RNA - Aminoglycosides
Pt has great despair and binge drinking post break-up. She is depressed, unstable and angry. Trusts Dr totally and sees every1 as a jerk.
Borderline
Dependent
Paranoid
Apparently most imp here is her despair and anger - Borderline - Cluster B
AML pt undergoes chemo. Has L<12000 and Ns<475. What is best to administer?
Bcr-Abl TK inhibitor
GM-CSF
GM-CSF is the answer
CML - trtmt is Bcr-Abl TK inhibitor
AML trtmt is VitA + arsenic –> induces differentiation!
Ectopic thyroid?
Foramen cecum obv!!
Pro-opiomelanocortin gene –? mRNA –> ACTH, Beta-endorphins and MSH. How?
Alternative splicing
post-translational modification
post-translational modification
If some1 has high BP + sever headache + Metanephrines in urine. CT shows 2cm adrenal gland tumor. Cause of high BP?
Unoppsed Alpha-R activation
T1HSR. Results of action due to?
Mast cells
Eosinophils
The action is = MC degranulation
The result of action = Eosinophils inc
Hand muscles?
Flexor digitorum profundus - Median nerve - DIP
Flexor digitorum superficialis - Median nerve - PIP
Lumbricals flex at MCP and extend at DIP n PIP –> medial and ulnar nerve distribution is followed
Pt with Hx of T1DM has burning sensation + allodynia inc pain sensitivity). Cause?
Allodynia = peripheral nerve/nociR issue
S3 gallop + pulm edema and pleural effusions bilat. Cause which drug?
Bleomycin
Doxorubicin
HF like C/P - DCM - Doxorubicin
Bleomycin is more for pulm fibrosis!
Man has heterozygous null mutation and Female has 50% dec fn heterozygous mutation. How many kids require transfusion?
BB0
BB+
Punnet square banao
BB
BB0(50%)
BB+(75%)
B0B+(25%)
1 will require transfusions - 255 fn waala
Antibiotic resistance transfer amongst 2 bacteria?
Conjugation
Restenosis post stent placement cause?
Neointima formation in that art
C8 damage will have erection via what stimulus?
Erotica
Penile stimulation
Tz injections
A) Penile stimulation
lesions abv T9 matlab cerebral erection lost
Now PSNS S2-S4 will help - stimulated via penile stimulation
Tz nhi NO helps in erections
MTX + what adjunct?
MTX + leucovorin
Not folic acid as u inhibit synthesis of Folic acid already, Hada mushkila in rxn eqlbm if u give both
Pt has T1DM. Can’t eat as parents stress and argue on table. Low on G. What is next best advice to pt’s parents?
Discuss and alleviate stress in parents abt the Daughter’s illness
Niacin def meaning what synthesis is affected?
NAD - Adenine!
Polyneuropathy v/s Syringomyelia?
Rmmbr Syringomylia is loss of pain + temp in cape
If weakness + sensory issue - not ALS but polyneuropathy
Cognitive decline + Fam Hx - Bsically fam Hx of AD. Protein acc (neurofibrillary tangles + tau). Which protein?
Amyloid A
Preselin
Preselin in familial AD
Pt has no movement, no EEG and no response. B.stem reflex intact. Will said DNI. What is next best step?
Keep the pt extubates
No CPR to be performed too as brain dead even if Cardiac and Respiratory response noted.
Perfusion pr to kidney dec but we have
maintained RBF and GFR. How?
If both GFR and RPF are maintained we have myogenic mechanism and auto regulation via adenosine on AA acting .
In this case dec pr but both maintained meaning dec AA resistance is the response
Inc resistance is a wrong choice as that alters GFR and RBF.
Arterial supply of testis?
Testicular art and ductus deferans art. So if 1 is blocked other supplies
Venous is pampiniform plexus mainly
Odds ratio interpretation
If OR = 1, no coorelation amongst the 2 variables.
If OR > 1, then exposure causes outcome.
Foul black skin nodules + no other relevant C/P. Cause?
Black fly - onchocerca volvulus
Check out the peripheral blood smear of Megaloblastic anemia.
Pg 157
Question looks like LSD cuz of lipid-laden Ms in hepatocytes but high VLCFAs, cause?
Peroxisomal storage issue not LSD
Mitotic cyclins synthesis in what phase of cell cycle?
G2 - right b4 mitosis
Pt affected with CF but has analysis of 70 common genes shows only defective mutation in 1 allele. Why?
Cuz mutation in another allele wasn’t included in the analysis cuz uk AR
Opoid withdrawal (ex; heroin) C/P?
Flu like symptoms
Piloerection - most imp
Abdominal tenderness + diarrhea
Anxiety
1’ vs 2’ prevention?
1’ meaning lifestyle RF modulation
2’ meaning detecting disease earlier - screening
13 year old with gynecomastia. Best statement to say?
It will resolve in 12-18 months
Severe pneumonia + has chronic viral illness + low Ls. Test for?
HIV
Cud be pneumocystis jeruviciii
Hydroureters and hydronephrosis. What can be seen?
Inc Hydrostatic pr in CDs + Bowman capsule
Not in peritubular capillaries dumboooo
HIV virus?
-ve sense ssRNA
Recurrent resp infections + skin infections. Along with low MHC 1. Cause?
Peptide transporter called TAP
Not in FA, but affects cd8 TCs.
Constipation post vaginal delivery with no anatomical or bowel reflex related issues. Cause?
Damage to rectovaginal septum
Rectocele formed that pushes towards vagina - blocks stool passage
OSA pt + loud S2. What cause these findings?
Obv dec O2 sat not at all VR dec dumbooo
