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NBME 26 Flashcards

1
Q

Someone hanging by the bar and now has ulnar nerve injury. What can he not do?

A

He cant abduct his finder (interrossei are supplied by ulnar nerve)

Opposotion/Abductor/Flexor - thenar - by median nerve (except the flexor sup head by ulnar)

Opposotion/Abductor/Flexor hypothenar- ulnar nerve

Extension is done by radial nerve for fingers and thumb

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2
Q

Initially IC pt developed rash and now has giant cell pneumonia?

A

Measles (Paramyxovirus) - others are parainfluenza, mumps and RSV

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3
Q

Inc growth in an-post diameter of skull in a baby?

A

Craniosynostosis - premature ossification of plates - TGF and FGF defects - keep in mind if Ant-post inc we have sagital suture issue (basically skull couldn’t grow normally in one so it choose to grow extra in another)

Inc AP diameter = dist btw frontal and occipital bone

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4
Q

Someone with bact infections different kinds since birth - what Igs pattern seen?

A

See pg 4 NBME qn 15

All in a complete flat out of Gamma globulin cuz its X-gammaglobinemia!

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5
Q

Tetracycline MOA?

A

Attachment of tRNA to ribosomes inhibited - protein synthesis ruk jaa!

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6
Q

A-a O2 kya h?

A

Inc - abv 14 - basically alveolar/diffusion issue!

4-15 - nl - hypoventilation causes soocho

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7
Q

Vibrio Vulnificus v/s Hep A - pt has N/V, abdominal pain, scleral icterus, liver enlarged and had raw oyesters?

A

Hep A not Vibrio!!

Vibrio - sepsis and bacteremia in pts that consume shellfish - + u see bullous skin lesions, GI hemorrhage.

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8
Q

Shortest SV in qn 22 pg 5 NBME?

A

Why B? see shortst ST interval in the ECG - ryt b4 abnormal wave (PVC) so B!

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9
Q

Baclofen MOA?

A

GABA R agonist - muscle relaxant

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10
Q

Mutated HIV produces less viral replication in infected T-Ls in an experiment. How?

A

Integration of provirus into host genome is defective!

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11
Q

Mass in lateral aspect of precentral gyrus?

A

Face affected or LL

Face!! LL is more in the mid (medial precentral gyrus in the paracentral lobe)

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12
Q

Mutations in intradermal and dermoepidermal adhesion complex?

A

Epidermolysis bullosa
(bullae, erosions and ulcers)

Bx: Intraepidermal cleavage MC

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13
Q

SOB for 2 weeks in yg F + high RR. NAGMA with resp compensation. Whats the Dx?
RTA
Salicylate posioning?

A

RTA

Salicylate poisoning does lead to HAGMA but 1st causes Resp Alkalosis.

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14
Q

CLL + RTC>8% + Inc UCB

Peripheral smear shows - spherocytes! Dx of type of anemia?

A

Its autoimmune hemolysis as RTC is high

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15
Q

20-months is all okay except wants to play alone and strikes any1 who plays with her stuff?

A

Normal h

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16
Q

X vs Y (Jejunum is more speculated than ileum). Why?

see img pg 11 qn 45

A

Jejunum has more SA cause of more prominent plicae circularis.

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17
Q

Lesch Neyhan synd - decet in salvage of what base pairs?

A

Guanine and Hypoxanthine

not Xanthine and hypoxanthine - HGPRT defects - Excessive pdtn of Xanthine np in its salvage!

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18
Q

Bulimia nervosa pt, PEx shows?

A

Dental caries - why?

vomitting is the cause!

why not dec body hair - MC in anorexia as protein use inc for energy supply to body

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19
Q

Bx shows intact spiral art (not extended) + straight glands + no secretions (not tortous glands with inc secretions). What phase of mensus cycle?

A

Proliferative phase! Ez mediated.

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20
Q

Hypoglycemic + dec KBs + Muscle symptoms. Issue in?

A

CAT

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21
Q

MOA of PGE2 to cause VD or sm muscle relaxation?

A

Inc cAMP.

Ach, Sub P and stress - activate guanyl cyclase - inc NOS

PGs activate - Gs pathway - inc NOS

(Closed K channels is wrong - memb depolarization - VC)

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22
Q

How is ChemoTx via proteosome inhibitor useful for MM?

A

Inc apoptosis via dec ubiquintination - protein build up and thus apoptosis

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23
Q

15 yr old + abd pain. Sx scheduled for an ectopic mass. Discovers a tissue in ileal region a few inches away from ileocecal valve. Dx?

A

Meckel’s diverticula hai!!!

Why? can ppt with vague pain later in life (not necessary it pt <2 years)
Not Appendicitis - RLQ pain not in ileum!

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24
Q

What disturbs Hardy-Weinburg eqlbm?

A

Defination: allelic freq remain the same in absence of evolutionary change.

random mating is required - nonrandom mating inc selection of certain alleles

Large popln is needed too for this principle

Immigration can also disrupt this eqlbm!

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25
Murmur left midclavicular 2nd ICS - which aortic arch is defective?
Murmur is PDA - 6th arch
26
STM memory loass + anxiety. What brain area affected?
Limbic system - choose lat temporal area!
27
Fundoscopic exam shows pale white retina + RA narrow and RV dec filling. Hx of HTN too. Dx? malignant HTN RA atherosclerosis RV thrombus
Malignant HTN - nahh - pt with edema + hemorrhages RV thrombus - RV dilation + tortous thus ans is RA atherosc
28
Periareolar mass in postmenopausal F + Bx showing cystic dilatations and Ls + PCs infiltrate + lipid laden Ms and amorphous debri. Dx?
Mammary duct ectasia (not fibrocystic change - preMenopausal F + Hs sensitive)
29
32/1000 pt have drug resistant Tb last yr and now isolated. Risk of incidence next yr?
32/1000 = 3.2% 3.2% of (1000-32) = 31
30
Mask anesthesia ppy?
Low blood solubility - Low MAC - high potency Inhaled anesthesia has to have Alveolar conc = Blood anesthesia conc to get to brain so yessss Others: High CO (dec blood to alveoli thus making diffusion useless) Inc minute ventilation inc Alveolar conc High blood sol - dec the eqlm btw blood and airway High CSF solubility - inc flow to brain yaani dec in blood and thus to muscles. High lipid solubility matlab goes into tissues and metabolize rather than acting to paralyze muscles.
31
Homeless male + never been to hospi + 45 yr old + Xray shows narrowing of disc space btw T10-T11. Cause? MM or TB
Tb! (osteitis derformans) Disc/Osteomyelitis inf caused by Tb No high Ca signs and just Vertebral pt makes MM out
32
inc urge to defecate post multiple fractures in a male. Anal wink on PEx. Intact anal sphicter also. Nerves effected?
U see control = voluntary = Not hypogastric but Pudental. Conus medularis - urinary incontinence, saddle anesthesia and paralysis. bilat!
33
2 day Hx of lethargy and cognitive impairment. 1 yr on chemo. Speaks with blunt affect. MMSE (20/30). Cause? Delirium Dementia (AD)
Acute -- AD nhi Only cognitive dysfn + blunt affect with Hx of chemo - Delirium. AD - insidious cognitive dysfn
34
N.gonorrhea vaccine given nasally in rats. Later say Abs in in vaginal swab secretions. What Immune response?
Trafficking of IgA producing Ls to all mucosal sites (best option as mucosal surfaces)
35
Iodine iodinates what AA to help Thyroid H synthesis?
Tyrosine is present in Thyroid Hormone!
36
Transjuugular shunt portosystemic shunt being placed for some1 to undergo Liver transplant. 1 branch in Portal vein and other where?
Has to be systemic circulation lekin kaha? Waha where we have no connection to portal circulation. Any gut Vein no but answer is Hepatic vein (systemic >> portal) helps bypass BS to liver
36
Age related respiratory changes?
Inc RV (muscles weak isliye), dec PaO2 (dec responsiveness of the center) and inc A-a gradient (loss of alveolar SA)
37
New Dx: Low PO4, Low K, NAGMA + urine pH is 5 (AA in urine) + Glucosuria. Cause?
PCT is effected for sure as low PO4. But AA in urine suggest a congenital defect and not Fanconi. Cystinosis is a LSD inc Cysteine, Arginine, Lysine, Ornithine defective reabsorption.
38
Isotretinoin MOA for antiaging + teratogenecity?
Activation of nuclear transcription
39
Look at qn 28 pg 30.
Answer is clear.
40
A stop codon in H.pylori isolated protein. Which mechanism is defective? qn 29 pg 30 see img
Slipped strand mispairing (Frame shift mutation - DNA polymerase in too many Cysteine region slipped and inserted another cysteine) (DNA excision repair is removal of bps and genes, not insertion/deletion)
41
All fn of Ns nl except chemotaxis?
LAD
42
Chi sqaure?
Assess statistical significance amogst 2 grp for >2 or 2 variables. Analysis of variance - mean comparison of 3 or more Linear regression - relationship btw dependent and independent variables (has to be linear) Non-parametric regression - relationship btw dependent and independent variables (no presumption - data shows +ve/-ve/ linear or sigmoid) T-test - means of 2 grp compared
43
Azetazolamide for inc CSF. MOA?
Dec CSF pdtn by choroid
44
Seee qn 39 on NBME pg 33
Cant post it here img based
45
AA with side chain as - glycine, alanine, valine, leucine, isoleucine, methionine, phenylalanine, proline and tryptophan - nonpolar grp
Seen in all Receptors and transmemb proteins. extra? Serine, threonine, tyrosine, asparagine, cysteine and glutamine are polar His, Lys, Arg is basic Asp, Glu are acidic
46
1st month mei what's developing?
Week 4 mei neural tube forms!
47
Qn 49 on pg 34
SEE SCENARIO!
48
qn 5 pg 38 is an ECG
see qn
49
A painter who spilled paint is now having HAGMA, dilated pupils with hyperemia and retinal edema. Which enzyme to inhibit? Alcohol DH Formaldehyde HD
Alcohol DH - 1st step of DH for methanol and ethanol is same!!!! Fomepizole yaha kaam karta h
50
7 day hx of rashes all of over buttocks and back. Emoillients and steroids dont help. IgA and IgE raised. Malignant transformation of what cell line?
Mycosis fungoides. Cutaneous T-cell lymphoma - initially scaly eczematous rashes in areas protected from sun - Bx inconclusive T-Ls in epidermis IHC using T-cell markers is ideal.
51
Attributable risk?
a/(a+b) - (c/c+d) A,b - case c,d - control
51
Transplant rxns?
Acute - <6m - T-cell mediated Hyperacute - few mins after transplant - Abs + cytokines mediated Serum sickness - Ag-Ab --> 1-2 weeks after initial exposure - fever, rash and arthralgias GVHD - rash, abd pain, diarrhea, jaundice (seen in non HLA matched ppl)
51
Muscle fibers injured. Healing via FB and myoFB but why are LL scar better than UL?
LL have passive stretching that makes the scar smaller.
51
A cat scratched a bby and now she has painful linear marks with pain but no blood. Mechanism?
Its inf 1)VD via Hz and inc PCV permeability via Hz!
52
Medication ind abortion?
Mifepristone (Pg antagonist) - help separate placenta from uterus also help with Cervix dilation. later u administer misoprostol - PG synthetic - contractions
53
HIV drugs? Integrase inhibitors - NRTI/NNTIs - Protease inhibitors -
Integrase inhibitors - do not allow the integration of proDNA into DNA genome NRTI/NNTIs - blocks conversion of RNA --> DNA Protease inhibitors -protein cleavage of the HIV core protein so it can mature and can't replicate
54
Left sided Horners synd?
Damage to left side ciliospinal center of Budge (Has SNS fibers for that side of the face)
55
Overdose of AchE inhibitor (Pyridostigmine) causes severe muscle weakness and Resp DPN. Why?
Desensitization of Nicotinic R
56
Qn 45 pg 47 - kidney with dilated renal pelvis and calyces. Compression atrophy of parechyme. Cause?
Hydronephrosis!!!
57
Oxytocin MOA?
Works on Ligand-gated Ca channels cAMP activation in sm muscle is its MOA
58
A drug dose given, we are at 8mg peak with trough of 2.5microg. How to dec SEs and trough?
best way to dec trough and maintain peak is inc dose-interval! Peak dose - dose given and t1/2 trough is metabolism and distribution 80mg given - at t=0, peak is 8.8 --> 1st t1/2 4.4 --> 2nd t1/2 2.2 --> 3rd t1/2 will be 1.1. And trough shud be <2.5 so! T1/2 is arnd 4 hrs. Steady state requires 4-5 t1/2s If we give drug every 4x3 = 12 same dose per 12 hrs!
59
Neutrophils have a bacteriacidal effect via what enzyme?
Hypochlorite (HOCl)

NBME (11 decks)

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