NBME 31 Flashcards
Inc range of motion in joints + pectus excavatum + new diastolic murmur (no location). Cause:
Mitral insufficiency
Aortic insufficiency
B. Diastolic matlab this
A - holosystolic
Too high HR causes what?
Short diastole and systole equally
Diastole< Systole
B
Methyl malonic acidemia - defect in methylmalonyl CoA mutase. Protein restriction + supplementation of what vitamin?
VitB12
In SVC synd, BS returns to heart via what to IVC?
Internal mammaries and intercostal veins
Generalized Tonic clonic seizure + stiffened left arm and spasms in left leg. Origin in what area of brain?
Motor deficits matlab Contralateral Frontal Cx
Trichophyton rubrum v/s Candida?
Tinea - scaling of lesions with formation of hyphae and arthrospores
Candida - no scaling and formation of psedohyphae
Post PID how to preserve infertility?
Hysterosalpingography
Condom use counselling
B. Cuz RF for infertility include - STDs, multiple partners and no use of barrier
A is to check for tubul patency and not indicated unless tubal dysfn indicated
Long standing T1DM + now has sudden onset double vision and weakness in abduction. Cause?
Cavernous sinus thrombosis
DM mononeuropathy
B.
A yes but post infection
Post acute inf MI has bradyarrthmia and hypoTN. Trtmt?
Atropine - Muscuranic antagonist
How can maxillary sinus be drained post sinusitis?
Via opening in nasopharynx, at hiatus semilunarism in the middle meatus
If diet calories dec by 1000/day, how much wt loss in a week?
1 pound = 3500 calories
7 d - 7000 calories
7000/3500 = 2 pounds/week
If US suggested features of Down synd and u sent further test. What to say to expecting parents?
The newborn has features of Downs and chromosomal analysis has been requested
The newborn has unusual features and a test has been ordered for Dx
A. Don’t withhold info abt diff dx
Androgenic alopecia cause?
DHT can’t bind to R right
Which sedative works via NMDA?
Ketamine
Laryngeal LNs drainage?
Cervical
Non-small cell lung Ca drains where and is imp to Bx this for prognosis?
Mediastinal LNs
Thalamic or internal capsule lesions are?
Full contralateral side
AFB stain takes how many days/weeks?
2-5 weeks
2-3d for PPD and <24 hrs for IFN gamma
CN3 injured on left. Shining light in right causes?
Constriction in right
No change in left
Murmur + chorea + yg pt. Cause:
Syndeham chorea
Huntington
A.
Huntington- fam hx (anticipation) + psychiatric + motor issues
Albendazole for pinworms MOA?
Altered binding of cytoskeleton to tubulin
Which is responsible for Esophageal peristalsis+ LES relaxation?
Eneteric ganglion
Pt with problems with dorsiflexion and planter flexion. Bx from ehat nerev to avoid motor dysfn?
(Find the sensory nerve in the qn stem)
Sural nerve
HbS allele has freq 1/20 in Africans and 1/200 in Americans. Cause?
Heterozygous advantage - balanced polymarphism
Autophagy v/s apoptosis?
Autophagy - fusion of memb (phagosome and lysosome)
Apoptosis - release of cyt c
Pt with HIv now has enlarges LNs. Bx will show?
EBV bro - malignant B-Ls
Post surgical repair inc amt of onlt Ns. Cause?
Pro inf state of post Sx stress causes release of Ns from post mitotic BM reserve
Old woman concerned abt post menopause lost of interest in sex and changed mood. Best thing to say?
As u age loosing interested in sex is nl
Most women go through menopause experience I disabling changes in emotions and sexual interests
B is the answer
NG acts where?
PM
Cytosol
Cytosol - inc cGMP via stimulating guanylate cyclase
Polycystic kidney disease in kid and adult shows variable severity of symptoms. Cause?
Variable expression
Why women have higher alcohol toxicity and conc?
Polymorphism is Alcohol DH - nopeeee
Dec Alcohol DN activity yessss
LK R antagonist work on?
Nucleus
PM
PM… GPCR
Pg 77 bilateral infiltrates case of pneumonia. What is seen on PM?
NAG-NAM
Glucans
Polyglutamic acud
Teichoic acid
A) bact CW
B in fungal CW (org is Histoplasma) - chitins and glycoproteins
C - in Bacillus
D - gram positive bacteria
Virus recognized by HLA DR to be presented on cell surface. Recognition happens in what space/organelle?
Cytososl
ER
Endosomes
Endosomes - endocytosed viral peptide interacts with HLA-DR there, if bound, ppt to CD4 TCs to cause killing
Influenza vaccine is against what component of the virus inorder to incite a T-Ls response and Abs pdtn?
Hemagglutinin
Neuraminidase
A. This allows viral entry and is targeted by vaccine to generate Abs agnst this
B is target of antiviral meds like oseltamivir - doesn’t allow virions to be released
Kidney transplant operation ongoing. Post anastomosis of renal vessels, the transplanted kidney is now cyanotic and mottled. Cause:
Fibrin thrombi in capillaries
Organizing thrombus in Renal art
T-Ls in tubules
A is the ans - hyperacute to circulating Abs and cytokines
B - post sx thrombosis is the mechanism - hypercoaguble post Sx
C - is acute not hyper acute
Lytic bone lesion in humerus+ bone pain+ hx of radiation therapy. Cause of lesion is what type of cell?
OC nopeeee its Plasma cells its
Someone with signs of depression at the moment. Had euphoric mood and cud not sleep 2 yrs ago. Dx?
Bipolar disorder
Someone addicted to heroin now on methadone. Its what?
Long acting opoid agonist
Someone addicted to heroin now on methadone. Its what?
Long acting opoid agonist
Left leg sensation issue. lesion at?
DC on the left at T8
Not right as DC fibers travel ipsilateral to decussate at medulla
Dec HR + dec Av conduction + force of contraction same.Drug?
BB
Muscuranic antagonist
Pg 86
F cuz BB dec all 3.
Post trauma has pinpoint pupil and decorticate posturing. Location of bleed?
Intraparenchymal
Inflamed carbuncles arises from?
Dermatome
Not myotome, neurotome, sclerome.
Dec CO while running but Cerebral perfusion same. Cause?
Myogenic art constriction (cerebral autoreg)
How to resect a PG tumor?
Via sphenoid sinus
Bronchial BVs effected. What is affected?
Delivery of nutrients to tracheal wall
All -osis under ILD have what in the granuloma?
Collagen
Hookworm infections that cause IDA examples?
Ancylostoma duodenale or Necator americanus - if exposure is contaminated soil
Schistosomiasa mansoni - contaminated water
Hookworm infections that cause IDA examples?
Ancylostoma duodenale or Necator americanus - if exposure is contaminated soil
Schistosomiasa mansoni - contaminated water
Murphy’s sign?
Inc pain and inspiration arrest
Aneurysm of proxima SMA effects?
Left renal vein right below it.
EA effects?
When VC - inc GFR + Inc FF and inc PCT absorption
When VD - opp - dec GFR and FF and dec PCT reabsorption
Proteinuria + hematuria post 3 weeks of an URTI. Bx shows mesangial proliferation IgA, C3 n few IgG. Cause:
Immune dysfn causes visceral epi injury and loss of Glomerular polyanions
Inc IgA synthesis - mesangial entrapment and Comp act
B thou 2-3 weeks post URTI but A is wrong as that goes with MCD
If pt has nephritic synd C/P 1-3 weeks post URTI with Bx showing IgA, C3 and few IgG deposits in the mesangial. Cause:
Immune dysfn that cause epi injury and loss of polyanions on the GBM
IgA synthesis inc - mesangial entrapment
B even if its 2-3 wks post URTI
A is MCD
Reticogranular densities in preterm infant NRDS. Cause at the level of alveoli for resp distress?
Atelectasis
1st line for prostate Ca?
GnRH R agonist - Leuprolide - cont infusion dec LH n FSH and thus downstream Hs
Others are Ketoconazole, Abieteranone - 17-alpha hydroxylase inhibitors that dec steroids synthesis
Flutamide - Androgen R antagonist
Img of pg 129 points towards a 3rd lobe apart from the 2 main lobes behind isthmus. Pt also has HyperTG symptoms (Graves MCC).
That lobe is pyramidal lobe
Its not adenoma as that will show variable areas of reuptake not diffuse reuptake (MC in Graves)
Organophosphate have chemical that cause the Inc Ach at the R by inhibition of AchE and cause Dumbells. What are the chemicals?
Parathion
Fenthoin
Malathoin
Organophosphate have chemical that cause the Inc Ach at the R by inhibition of AchE and cause Dumbells. What are the chemicals?
Parathion
Fenthoin
Malathoin
An intervention like dec sugar in all foods in order to dec rate of obesity is:
Community= primary prevention
Y
How to understand limitation of an exposure to outcome not being established, using a cross sectional study?
Cohort study study for exposure and outcome
If a cross sectional study does this, its measuring exposure and outcome at the same time not as a follow up so yes
Ans) temporap seq of events is the limitation
Inclusion body myositis?
In Males > 50
Insidious proximal or distal muscle weakness
Nl to slight raise in CK
Negative Ab screen
Bx: inc Ls and inclusion body (basophilic rimmed vacoules(
Fainting post svere coughings cause?
Dec CO due to inc intrathoracic pr
Infusion pump IV 20mg drug kept on steady state. Half life is 8 hrs. How much time will it take for the drug to be 18mg (90% of steady state)?
So basically at 8hrs, 20/2 =10
We infuse 20 more
30mg
Now post 16 hrs when its 15 we add 20 more - 35
Post 24 hrs when conc is 17.5 (88% of Steady state)
CT on pg 161 shows mass in sella turcica. Will effect what nerve?
Optic nerve (travels post to the optic chiasm decussation)
If there is mutation in gene encoding for cysteine-tRNA and there is substitution of cystein to tyrosine. Effect?
Disulfide bonds are not formed (tertiary struc is affected by cysteine being replaced)
Polyadenylation of mRNA causes?
Stabilization of the mRNA and permits transport out of nucleus
Trabsposons for AntiB resistance is inserted where?
At insertion seq in plasmids without being homologous with DNA
Pancreatitis+ HypoCa what type of necrosis?
Saponification of fat (Fat necrosis)
Why do 2 grps with all factors same have diff in CI?
No of pts (CI without 1 is significant - good p-value and to inc significance u need high no of participants)
Pt has HTN + edema + proteinuria. Paracentesis yields Strep pneumo. What dec in pt?
Neutrophil oxidative burst
Serum IgG conc
Serum IgG conc as nephrotic synd signs
(Oxidative burst inc)
Background of CKD. Dec Hb + nl everything ferritin and all + dec RTCs. Cause?
Dec EPO
If RTC wud be inc - hemolysis and inc erythrophagocytosis
