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NBME > NBME 26 > Flashcards

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
Q

Murmur left midclavicular 2nd ICS - which aortic arch is defective?

A

Murmur is PDA - 6th arch

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26
Q

STM memory loass + anxiety. What brain area affected?

A

Limbic system - choose lat temporal area!

27
Q

Fundoscopic exam shows pale white retina + RA narrow and RV dec filling. Hx of HTN too. Dx?

malignant HTN
RA atherosclerosis
RV thrombus

A

Malignant HTN - nahh - pt with edema + hemorrhages

RV thrombus - RV dilation + tortous

thus ans is RA atherosc

28
Q

Periareolar mass in postmenopausal F + Bx showing cystic dilatations and Ls + PCs infiltrate + lipid laden Ms and amorphous debri. Dx?

A

Mammary duct ectasia

(not fibrocystic change - preMenopausal F + Hs sensitive)

29
Q

32/1000 pt have drug resistant Tb last yr and now isolated. Risk of incidence next yr?

A

32/1000 = 3.2%

3.2% of (1000-32) = 31

30
Q

Mask anesthesia ppy?

A

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
Q

Homeless male + never been to hospi + 45 yr old + Xray shows narrowing of disc space btw T10-T11. Cause?

MM or TB

A

Tb! (osteitis derformans)
Disc/Osteomyelitis inf caused by Tb
No high Ca signs and just Vertebral pt makes MM out

32
Q

inc urge to defecate post multiple fractures in a male. Anal wink on PEx. Intact anal sphicter also. Nerves effected?

A

U see control = voluntary = Not hypogastric but Pudental.

Conus medularis - urinary incontinence, saddle anesthesia and paralysis. bilat!

33
Q

2 day Hx of lethargy and cognitive impairment. 1 yr on chemo. Speaks with blunt affect.
MMSE (20/30). Cause?

Delirium
Dementia (AD)

A

Acute – AD nhi
Only cognitive dysfn + blunt affect with Hx of chemo - Delirium.

AD - insidious cognitive dysfn

34
Q

N.gonorrhea vaccine given nasally in rats. Later say Abs in in vaginal swab secretions. What Immune response?

A

Trafficking of IgA producing Ls to all mucosal sites

(best option as mucosal surfaces)

35
Q

Iodine iodinates what AA to help Thyroid H synthesis?

A

Tyrosine is present in Thyroid Hormone!

36
Q

Transjuugular shunt portosystemic shunt being placed for some1 to undergo Liver transplant. 1 branch in Portal vein and other where?

A

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&raquo_space; portal) helps bypass BS to liver

36
Q

Age related respiratory changes?

A

Inc RV (muscles weak isliye), dec PaO2 (dec responsiveness of the center) and inc A-a gradient (loss of alveolar SA)

37
Q

New Dx:

Low PO4, Low K, NAGMA + urine pH is 5 (AA in urine) + Glucosuria. Cause?

A

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
Q

Isotretinoin MOA for antiaging + teratogenecity?

A

Activation of nuclear transcription

39
Q

Look at qn 28 pg 30.

A

Answer is clear.

40
Q

A stop codon in H.pylori isolated protein. Which mechanism is defective?

qn 29 pg 30 see img

A

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
Q

All fn of Ns nl except chemotaxis?

A

LAD

42
Q

Chi sqaure?

A

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
Q

Azetazolamide for inc CSF. MOA?

A

Dec CSF pdtn by choroid

44
Q

Seee qn 39 on NBME pg 33

A

Cant post it here img based

45
Q

AA with side chain as - glycine, alanine, valine, leucine, isoleucine, methionine, phenylalanine, proline and tryptophan - nonpolar grp

A

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
Q

1st month mei what’s developing?

A

Week 4 mei neural tube forms!

47
Q

Qn 49 on pg 34

A

SEE SCENARIO!

48
Q

qn 5 pg 38 is an ECG

A

see qn

49
Q

A painter who spilled paint is now having HAGMA, dilated pupils with hyperemia and retinal edema. Which enzyme to inhibit?

Alcohol DH
Formaldehyde HD

A

Alcohol DH - 1st step of DH for methanol and ethanol is same!!!!

Fomepizole yaha kaam karta h

50
Q

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?

A

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
Q

Attributable risk?

A

a/(a+b) - (c/c+d)

A,b - case
c,d - control

51
Q

Transplant rxns?

A

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
Q

Muscle fibers injured. Healing via FB and myoFB but why are LL scar better than UL?

A

LL have passive stretching that makes the scar smaller.

51
Q

A cat scratched a bby and now she has painful linear marks with pain but no blood. Mechanism?

A

Its inf

1)VD via Hz and inc PCV permeability via Hz!

52
Q

Medication ind abortion?

A

Mifepristone (Pg antagonist) - help separate placenta from uterus
also help with Cervix dilation.

later u administer misoprostol - PG synthetic - contractions

53
Q

HIV drugs?

Integrase inhibitors -
NRTI/NNTIs -
Protease inhibitors -

A

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
Q

Left sided Horners synd?

A

Damage to left side ciliospinal center of Budge (Has SNS fibers for that side of the face)

55
Q

Overdose of AchE inhibitor (Pyridostigmine) causes severe muscle weakness and Resp DPN. Why?

A

Desensitization of Nicotinic R

56
Q

Qn 45 pg 47 - kidney with dilated renal pelvis and calyces. Compression atrophy of parechyme. Cause?

A

Hydronephrosis!!!

57
Q

Oxytocin MOA?

A

Works on Ligand-gated Ca channels
cAMP activation in sm muscle is its MOA

58
Q

A drug dose given, we are at 8mg peak with trough of 2.5microg. How to dec SEs and trough?

A

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
Q

Neutrophils have a bacteriacidal effect via what enzyme?

A

Hypochlorite (HOCl)

NBME (11 decks)

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