NBME 26

Question 1

acute tubular necrosis from ischemic or nephrotoxic..if rhabodymylosis, what is nephrotoxic

Answer 1

myoglobin and nonprotein heme pigments are toxic

Question 2

hemolytic uremic syndrome

Answer 2

infectino from e.coli 0157:h7, gram negative rod

Question 3

intersitial nephritis

Answer 3

hsn rxn offending drugs (nsaids, diruectics, sulfonamieds, - eopsinohiluria)

Question 4

what are anchoring fibrils made of?

Answer 4

type 6 collagen- component of hemidesmosome. hemidesmosome function - anchor basal keratinocytes of epidermis to dermis at dermal-epidermal junction. any impairment of hemidesmome- blister will form. (tense blister)

bullous pemphigoid - another dz with desmisome

Question 5

pemphis vulgaris

Answer 5

Ab to desmoseomes- maintains cell to cell adhesion in epidermis - more fragile and flaccid

Question 6

vitamin c - scurvy

Answer 6

necessary to make collage, cofactor in hydroxylation of prolice and lysine residues

Question 7

constrictive pericarditis vs. cirrhosis

Answer 7

constrictive pericarditis has clinical evidence of right heart failure so it has increased JVP distention. other right heart failure such as edema of lower extremities, Cirrhosis - portal hypertension results in systemic vasodilation and decreased effective circulating volume.

Question 8

why does jejunum look feathery

Answer 8

plicae ciruclares are more prominent and numerous in jejunum, so increased overall surface are and associated increased number of mucosal villi - as compared to ileum.

Question 9

what is mannitol

Answer 9

osmotically active carbohydrate monomer- raises seroum osmolality when given as infusion

Question 10

vibrio vulnificus vs. hep A

Answer 10

both can happen from consumption of raw shellfish. hep A known for oysters. v. vulnificus is. water born bacteria that causes sepsis, schock, bullous skin lesions, Gi hemorrhage, DIC, way more severe and absence of jaundice

Question 11

what does hypoventiliation do to A-a gradient

Answer 11

nothing, it’s normal, just there will be decreasaed gas exhange. but if no disruption of diffusion or perfusion, like fibrosis etc, a normal gradient is expectedwith hypoventilation. high aterital co2 an dlow o2

Question 12

RA - antibodies against

Answer 12

against cyclic citrullinated peptides - affects MCP and PIP

Question 13

osteoarthiritis - x ray finidings, atrhrocentesis values

Answer 13

global degneration of joint, thickening of subchondral plate with sclerotic bone, subchondral cysts (due to infiltration of synovial fluid into bone). athrocentesis - few leukocytes, normal appearance, normal glucose

Question 14

gram negative organism that cuses STD chancroid (painful genital ulcertaion and inguinal lymphadenopathy)

Answer 14

haemophilus ducreyi

Question 15

prostacyclin role on platelets

Answer 15

prostacyclin aka PGI2 - produced through cycloxygenalse pathway - inhibits activation of platelets and helps with vasodilation. Epoprostenol - synthetic prostacyclin - used in tx of pulmonary atertial HTN

Question 16

abornal attACHEMNT OF placentat direclty to mymoetriym

Answer 16

placenta accreta, presents as postpartum hemorrahage, esp after hx of csection

Question 17

vaginal blleding, severe uterine pain, trauma, smoking cocaine use, prsents in 3rd trimeester

Answer 17

abruptio placentae

Question 18

what disease that is a parmyxovirus can cause giant cell pmenunoia (inclusion bodies) in immunocomprimed - more common in children

Answer 18

measles (rubeola)

Question 19

parasympathetic and sympathetic to peeee

Answer 19

pelvic parasympathetic nerves excite and contra detrusor muscle of bladder via muscarinic Ach receptor. Sympathetic nerves mediate relaxation of internal urethral spinchter via alpha 1 adrenergic receptors - leads to normal urination.

Question 20

process of peeing- what is external urinary spinchter innervated by?

Answer 20

pudendal nerve - supplies sensory nerons to external genital and carries skeletal muscle vbers. when ach, nictone, contraction and urinary retention. damage - loss of voluntary control.

Question 21

four diseases with trinucleotide repeat expanisons

Answer 21

fragile x syndrome, huntingotn disease, friederic ataxia, and mytonic dystrophy

Question 22

doxycylcine moA and side effects

Answer 22

prevents attachment of aminoacyl-tRNA to ribosomes. side effects- discoloration of teeth and inhibiton of bone grown, photosensitivty, (fetal bones and teeth- contraindicated in pregnancy), GI

Question 23

lyme’s - early and late state treated with what

Answer 23

early - doxycycline. later (heart and CNS - parenteral ceftriaxone)

Question 24

what drug stops folate synthesis

Answer 24

trimethoprim- bacteriostatic. blocks this enzyme used in sythesis of pyrines and thymidine. avoided in first trimester of pregnancy.

Question 25

what drug group inhibits prokaryotic dna gyrase

first, what is dna gyrase

Answer 25

dna gyrase- relaxes supercoilds during replacation and transcription. flouroqunilones inhibit dna gyrase aka topoisomerase (ex- levaquin, ciprofloxacin)

Question 26

what really is CRP

Answer 26

acute pahase reactant synthesiszed in liver in response to pro-inflammatory cytokine 6. improatnt for innate immune response. fx as opsonin and aids in targeting cells for phagocygtosis and fixation of compeltement.

Question 27

which side does varicocele occur most likely? why

Answer 27

the left side. because right gonadal vein drains directly into IVC. but left side , left gonadal vein drains into left renal vein. (increased resistance to venous flow)

Question 28

what;s a skin finding associated with glucanoma

Answer 28

necrolytic migratory erythema

Question 29

what is needed for conversion of homocysteine to methionine.

what is needed for conversion of methlymalnonyl coa to succinyl coa

Answer 29

b 9 and b12

b 12 so if b12 deficiency, would see incrawsed methylmalonic acid levels. if b9 def, would see increased homocysteine levels.

Question 30

anemia of chornic dz. hepcidin levels ? iron storage?

Answer 30

common in autoimmune and inflammatory dz, chornic infections and malizgnay. increased hepcidin levels decrease intestinal iron absorption and increae iron storerage in bone marrow and RES (prventing use of iron by erythcoyte precurors ) - leads to anemia. will be microcytic , iron studieds will normal or low. normal or increased ferritin. bone marrow will show blue prussian staining.

Question 31

what is baclofen ? what does itw ork on

Answer 31

GABA analogue, metatrobic gpcr , increase efflux of patassium, hyperpolarize, less AP. first line treatment for muscle spasiticty - gaba receptors also in cns, so it can cause sedation, esp with other cns depressants

Question 32

superior laryngeal nerve innervates ?

recurrent larygneal nerve innervates?

Answer 32

superior laryngeal - cricothryoid ms. - pitch of voice

recurrent - motor to the rest of all intrincic largyneal ms. sensory to all structures bwloe vocal cords.

Question 33

case series study

vs case control

vs cross sectional

Answer 33

case series- small number of pts to describe course of dz and treatment.

case control - asosciation between exposure and outcome . need control

cross sectional - identifu risk factor and measure outcomes at tsame time. so all informatoin is collected at same point

Question 34

organism

intraerythrocytic ring, tetrad formation, east coast

Answer 34

babesia microti, northeast us, ixodes tick, presents siliarl to malaria, hemolytic anemia

Question 35

what are two primary cells responsible for granuloma formation (for ex- like in TB?)

what two things activate these cells

Answer 35

granuloma formed by NK cells and cytotoxic T lymphoctyes. NK cells and cytotoxic T lymohocytes are activated by Interleukin 12.

Question 36

after cerebral infarction )stroke) - neurons - liquefactive necrosis - replaced by glial scar consist of what cells

Answer 36

astroctyes - dense neuroglial cells , takes a few months, kind alike fibrosis - akA GLIAL SCAR

Question 37

deviation of tongue to right - what cranial nerve

Answer 37

loss of motor control from right cranial nerve

Question 38

what does precentral gyrus of frontal lobe contain ?
medial precentral gyrus?

esp lateral precentral gyrus

Answer 38

primary motor cortex - voluntary movement of contralateral body.

medial precentral gyrus - lower extremity

lateral precentral gyrus - contralateral face (lower face only if it’s UMN becuase remember facial nerve nucles controls forehead).

Question 39

what are two primary forms of genomic instability in pathogenesis of colon cancer ? M instablity and c instablity.

cell cycle - describe quick

Answer 39

microsatttelite instablity (15%) - failure of MISMATCH REPAIR PATHWAYS (MMR) from mutations in MLH1, MSH2, APC - propagation of aberrant DNA - (familial cancer syndromes such as Lynch syndrone and famly adenoamotus polypisis (FAP). 
chromosme instablity. (85%) - majority of sporadid colon cancers- oncgogenes or tumor supressor. so enters cell cycle, chromosome replication (s phase) messed up, fidelity checks in G2 phase messed up, separation of chromosmomes (M phase messed up). activating oncogene like KRAS and deactivaitn tumor suppresor like p53. 

g0 - cell cycle arrest. g1 - cellular contents replicated (except for chromosomes). S - chromomes replicated.m
G2 (fidelity of replication checked). M- division into two cells.

Question 40

LFA-1 role in neutrophil activity?

what are the 5 steps to neutrophil recruitment?

Answer 40

Margination of neutrophils to periphery of blood veseel
Rolling at vessel periphery
Adhesion: LFA1, integrin involved in neutrophil adhesion to endothelium.
Extravasation/Diapedesis through capillary wall - PECAM- neutrophils move from vascular comparetment into extracellular space
Chemotaxis/Migration (migration to site of injurty) mediated by IL-8, c5a, leukotriene B4, 5-HETE, and formyl-methionyl peptides.