NBME-3 Flashcards
Which is the most likely mediator released from macrophages that initated the process of septic shock?
Tumor necrosis factor
Pt has biopsy that shows small cell, neuroendocrine lung carcinoma. Which of the following abnormalities is most likely to develop in this patient?
- Hypocalcemia
- Hypoglycemia
- Hyponatremia
- Polycythmeia
- Hypocalcemia
- Hypoglycemia
- Hyponatremia
- Polycythmeia
Epidermal growth factor receptor and the platelet derived growth factor receptor are both classifered as which?
Receptor tyrosine kinases
HIV pt taking 2 different reverse transcriptase inhibitors and protease inhibtor, whats the point of the protease inhibtor?
blocking the cleavage step in active virion production.
Which of teh following contaminants will be removed from a fluid passed through a 0.45 u filter?
- Herpes Simplex virus
- HIV protease
- Lipopolysaccharide
- Mycoplasma hominis
- S. aureus
- Herpes Simplex virus
- HIV protease
- Lipopolysaccharide
- Mycoplasma hominis
- S. aureus
malignant neoplasm in the wall of the sigmoid colon, which group of lymph nodes is the neoplasm most likely to metastasize initially?
inferior mesenteric
what agent will most specifically complement antibiotic therapy (gave a specific pt)?
G-CSF (granulocyte-colony stimulating factor)
an acute extensive bilateral lesion in the rectiular formation of the tegmentum of the midbrain is most likely to result in which of the following?
loss of consciousness
- loss of abduction
- lateral roation
- flexion of arm
- loss of flexion at the elbow
- loss of supination of the forearm
What division is the lesion located at?
division containing C5 & C6
which substances will most likely cause blindness?
formic acid
for treatment of a psychotic episode which drug will cause:
- fever and muscle rigidity
- increase serum creatine kinase
Haloperidol
Viremia is an essential feature of which infection?
Primary varicella infection
injury to the common perineal nerve will result in lack of what motion?
dorsiflexion of the foot
pt has asthma and decreasing the severity of the episodes is done by inhibition of which enzyme?
5-Lipoxygenase
What will you find 3 months later, after someone (with dysphagia and odynophagia) ingests a drain cleaner containing sodium hydroxide?
Esophageal stricture
Pressure within the bladder increases in respose to what nervous system input?
Parasympathetic outflow from the sacral spinal cord.
an alcoholic man is found unresponsive after he drank large amounts of alcohol w/o eating any food over a 3 day period. His serum glucose concentration is 30 mg/dL.
This lab finding is most likely due to increased hepatic concentrations of which enzyme?
NADH
cultured cells are treated with an experimental agent that leads to rapid increases in cytoplasmic calcium concentrations and an increase in cellular diacylglyceral concentration. this experiement agent most likely stimulates which of the following?
- Adenylyl cyclase
- GTPase-activating protein
- Phospholipase C
- Protein Kinase A
- Protein Kinase C
- Adenylyl cyclase
- GTPase-activating protein
- Phospholipase C
- Protein Kinase A
- Protein Kinase C
A gel pattern obtain that is seen in southern blotting ( which is used to distinguish maternal and paternal copies of chromosome 7 in a single person).
Restriction fragment length polymorphism
A neoplasm in the colon invades through the basement membrane into the lamina propria. Which of the following proteins is most likely to be directly invovled in the process of invasion?
- APC gene product
- p53 protein
- ras gene product
- Rb gene product
- Type IV collagenase
- APC gene product
- p53 protein
- ras gene product
- Rb gene product
- Type IV collagenase
what is the rationale for advising a decrease in dietary intake of sodium chloride in patients with hepatict disease who develop edema?
Secondary hyperaldosteronism is present
What is the medication fro a pt that presents with 1 day of restlessness, irritability, and intense perirectal itching.
PHx: attends a lg day care facility, PE: perirectal region shows small worms that glow under bright light.
What is MOA and interaction
- Mebendazole
- MOA: inhibits the synthesis of microtubules in parasites and inhibits uptake of nutrients.
- Interactions: Carbamazapine and **phenytoin **lower levels of Mebendazole
A 40-yo man has evidence of chronic heart failure, clinical signs of both R and L heart failure are present. his heart is dilated.
when he was a child, his family settled newly cleared land in the brazilian amazon forest, and he lived in a primitive shelter built of mud, wood, and stone for 12 years.
What is the most likely organism?
Trypanosoma cruzi
A 58-yo man has had progressive weakness over the past 8 months.
PE: examination shows weakness and muscle atrophy in the upper and lower extremities. Muscle stretch reflexes are decreased in the upper extremities and increased in the lower extrimities. No sensory deficits noted.
is the what most likely cause for these findings?
Loss of myelin in the lateral column white matter and loss of ventral horn motoneurons.
A newborn with strabismus. what is the rationale for surgically correcting this problem during early childhood?
Normal binocular vision will not develop.
A 37 yo man is brought to the emergency department after falling down a flight of stairs.
PE shows acute alcohol intoxication, a bruise over the left temple and a swollen, painful wrist. Over the next 30 min, his level of consciousness deteriorates, and the L pupil become dilated.
Which of the following is the most likely cause of the neurologic findings?
Laceration of the middle meningeal artery
dysplastic nevus syndrome
define
familial atypical multiple mole
Neurofibromatosis
type I
type II
- Neurofibromatosis type I:
- nerve tissue that grows tumor that may be begin or cause serious damage by compressing other nervous tissue.
- Neurofibromatosis type II:
- bilateral acoustic neuromas often develop CN 8, which often leads to hearing loss
Osler-Weber-Rendu disease
- a auto dominante disease
- leads to abnormal blood vessel formation
- in the skin and mucous membrane
- & often in organs such as lungs, liver, and brain
Tuberous sclerosis
- multi system genetic disease
- causes bengin tumor in eyes, skin, heart, lungs, kidneys
Von Hippel Lindau disease
- rare autosomal dominate disease that predisposes pt to several benign and maligant tumors
- brain, eyes, adrenal glands, kidneys, pancreas, lymph nodes, testis.
- CNS, retinal hemangioblastomas, clear cell renal carcinoma, pheochromatcytomas, pancreatic neuroendocrime tumors, pancreatic cysts, endolympathic sac tumors, epidydimal papillary cystadenomas.
What stage of the sleep cycle does sleep walking occur?
slow-wave (delta)
delta = dreaming
Overdose of dopamine agonist results in what?
psychosis
Coronary blood flow is studied in an animal model of ischemic heart disease.
In this model, coronary blood flow is normal when the animal is at rest, but when the animal becomes active coronary vasoconstriction occurs and coronary blood flow decreases.
What is responsible for the action on the vascular smooth muscle.
Norepinephrine
Hydrochlorothiazide
MOA
Inhibits the Na-Cl symporter
What technique is used to show two bacteria’s DNA are identical
Nucleotide sequencing
Which of the type of RNA molecules present in a eukaryotic cell is the most abundant?
Ribosomal RNA
A 45 yo women remebers being sexually abused as a child by her older brother. She draws on her childhood experience to express intense emotions in her work as an actress.
This use of her childhood experiences is most illustrative of which of the following coping mechanisms?
Sublimation
What is teh antidote for morphine?
what does it do to the curve?
- naloxone
- shifts it to the right
A 3 yo infant has a severe LRT infection. A virus isolated from the respiratory tract causes the development of multinucleated cells in tissue culture.
Which of the following types of drugs is most likely to be effective in resolving the infants infection?
Ribavirin
Calcium chnanel blockers are effective antiarrhythmic agents b/c they inhibit Ca influx into which structure?
Atrioventricular node
A 60 yo postmenopausal woman comes to the physician b/c of back pain for 3 mo. Her mother and her sister both had breast CA.
PE: shows mild tenderness over the lumbar vertebrae.
To avoid a stimulatory effect on the breast or endometrium, treatment of this condition with which drug is most appropriate?
Raloxifene
the AP in excitable cells is a result of changes in _________?
Membrane ionic conductances
What is the chemotactic for neutrophils, monocytes, eosinophils, and basophils?
C5a
A 21 yo man has the sudden onset of fever, sweating, cyanosis, tachycardia, tachypnea, unstable blood pressure and muscle ridigity after administration of halothane and succinylcholine for an appendectomy.
Abnormality is seen in ________.
Ca2+ releasing channels
A 45 yo woman
- Abnormal
- weakness: anterior thigh
- unable to extend her leg (at knee)
- sensation is absent: medial side of leg
- Normal: flexion of the hip and knee
Which nerve is most likely injured?
Femoral n
a 45 yo man has generalized jerking movements in his extremities, progressive dementia and psychotic behavior for the past yr.
PHx: mother died of a similiar illness when she was 50 yrs
Atrophy in the which area of the brain would be seen on CT scan?
Caudate nucleus
This is huntington’s disease
overdose of diazepam will result in what complication?
Respiratory depression
A 48 yo man with chronic pancreatic insufficiency develops greasy, foul-smelling stools. He has lost 12 kg over the past 6 mo.
What would most likely be decreased in this man?
Urinary excretion of hydroxyproline.
Which hormone (produced by the duodenal and proximal jejunal mucosa) stimulates the release of pancreatic juice rich in digestive enzymes?
CCK (Cholecstokinin)
Which procedure is most likely to increase serum aldosterone concentrations in an experimental subject?
restriction of water intake
Urinalysis of numerous hexagonally shaped crystals. Urine concentration of several aa (ornithine, arginine, lysine) are increased.
What is the most predominant component of the crystals?
Cystine
Post menopause increase in which hormones is seen?
FSH and LH
A 1 yo has unilateral cryptorchidism. even if the problem is surgically corrected, the pt is at increased risk for development of which of the following cryptorchid testis?
Germ Cell neoplasm
a curettage shows a fibrous nodule of placental tissue that is firmly adherent to the uterine wall.
Placenta accreta
terazosin
- Indication
- MOA
- changes to its second messenger levels
- **Indication: **BPH & HBP
- MOA: alpha-1 antagonist
- changes to its second messenger levels: decrease in IP3
After undergoing a minro surgical procedure, a 71 yo man has difficulty voiding. What is a short term pharmacotherapy to give to the pt?
Bethanechol
