Wrongs

Question 1

Person with Hashimotos, comes with megaloblastic anemia, raised methylmalonic acid and total homocysteine levels?
What is the cause?

Answer 1

Failure of Intrinsic Factor production because the symptoms are of Vitamin B12 deficiency.

Question 2

Which enzyme does Vitamin B12 serves as a co-factor, such that in Vitamin B12 deficiency Methylmalonic acid levels INCREASE in serum?

Answer 2

Methylmalonyl-CoA MUTASE

Question 3

Which enzyme does Vitamin B12 serves as a co-factor, such that in Vitamin B12 deficiency HOMOCYTEINE levels INCREASE in serum?

Answer 3

Methionine Synthase needs Vitamin B12 as co factor

Question 4

64 year old woman- NO wrinkles on face and neck, there’s synovial thickening of wrists B/L.
What will happen to the following:
Esophygeal Peristalsis: Increased/Decreased
Lower Esophygeal Sphincter Tone: Increased/Decreased.

Answer 4

Esophygeal Peristalsis: Decreased

Lower Esophygeal Sphincter Tone: Decreased.

(Esophygeal dysmotility can cause Barret’s esophagus and fibrous stricture formation in sceroderma patients)

Question 5

Uworld:

Name two pulmonary complications of systemic sclerosis?

Answer 5

Interstitial fibrosis

Pulmonary HTN-IMPORTANT TO REMEMBER.

Question 6

Uworld:
In diffused Scleroderma, there is Dermal layer (contraction/expansion) due to deposition of ___________.

There is atrophy/inflammation if intradermal adipose tissue and hair follicles.

Answer 6

Expansion, collagen

Atrophy

Question 7

Which antibodies are found in:

Diffuse scleroderma?

Limited Scleroderma?

Answer 7

Anti- Scl 70 (Anti-DNA Topoisomerase 1 ab) and Anti-RNA Polymerase 3 ab

Anti-Centromere Ab( Crest Syndrome)

Question 8

E.Coli causing pyelonephritis, what is the virulence factor?

Answer 8

P Pili ( In FA)
In NBME 13, the correct option was “ADHESINS”

Question 9

Looseness of Lateral Collateral Ligament, suggestive of a tear. Lack of which component in the ligament will most likely limit the healing of this injury?

Answer 9

Blood Vessels.

Question 10

6 year old girl has sever abdominal pain, vomiting, nausea. She are pastries and cake at a party.
What is the cause of these findings?

Answer 10

Enterotoxigenic ingestion

Question 11

For Transvaginal hysterectomy, the uterus must be seperated from all surrounding pelvic structures. Incision of which structure is important? The structure attaches to cervical region and extends posteriorely?

Answer 11

Uterosacral ligament

Question 12

What is the cause of Hypercalcemia in a patient of Multiple Myeloma?

Answer 12

Local IL-1 and TNF effects

Hence, IL-1 is also called osteoclast activating factor and causing lytic bone lesions in Multiple Myeloma

Question 13

2 treatment drugs used for Multiple Myeloma and also tell their MOA?

Answer 13

1. IL-6 inhibitor

2. BORTEZOMIB- 26S proteosome inhibitor so it facilitates apoptosis

Question 14

After administration of Desmopressin, what findings in the nephron best describes the tubular osmolality, compared with serum in the patient of Nephrogenic DI?
Proximal tubule:
JG Apparatus:
Medullary CD:

Answer 14

Isotonic
Hypotonic
Hypotonic

Question 15

Which artery’s stroke causes C/L paralysis and sensory loss in face and upper limbs? ( Also causes Aphasia and Hemineglect according to dominant and non-dominant hemisphere thingy?

And which artery’s stroke causes C/L paralysis and Sensory loss in LOWER limbs and urinary incontinence?

Answer 15

MIDDLE CEREBRAL ARTERY

ANTERIOR CEREBRAL ARTERY

Question 16

What happens if there is a stoke of Anterior Spinal Artery?

Also called Medial Medullary Syndrome- due to infarction of paramedian branches of ASA

Answer 16

C/L paralysis of upper and lower limbs.

Tongue deviates ipsilaterally ( Ipsilateral hypoglossal function)

Question 17

Cardiac arrest due to cocaine is due to?

Answer 17

Cocaine-induced INHIBITION OR NE REUPTAKE

Question 18

Blood Glucose Concentration increased after several hours of receiving insulin. What is the cause of patient’s hyperglycemia?

Answer 18

Activation of hepatic adenylyl cyclase

Question 19

Gram Negative rod that produces pyocanin?

Answer 19

Psuedomonas

Question 20

What the mechanism of persistent colonization of pseudomonas in a CF patient despite aggressive treatment with antibiotics?

Answer 20

Biofilm formation in the lower respiratory tract makes pseudomonas eradication really tough in CF patients

Question 21

MOA of Cisplatin drug?

Answer 21

Cytotoxic platinum analogs that bind to DNA and form intrastrand and interstrand cross-links.

Question 22

Pt of Myesthenia Gravis has increased her dose of Neostigmine because she has started experiencing INCREASED MUSCLE WEAKNESS LATELY?

Answer 22

Increased muscle weakness despite increasing Neostigmine’s dose means that DESENSITISATION OF NICOTINIC RECEPTORS has occurred in this patient due to use of neostigmine.

Question 23

MOA of Cephalexin?

Answer 23

Interference with bacterial cell wall synthesis.

Question 24

Pt has 
Hemoptysis
Hematuria
Hypochromic microcytic anemia
Weight loss

What is the renal disease that the patient has?

Answer 24

Good Pasture’s Syndrome.

Question 25

How does GoodPasture’s Syndrome look on LM, IF and EM?

Answer 25

LM: Glomerular Crescents
IF: LINEAR IgG and C3 deposition.
EM: No deposits.

Question 26

Decreased serum levels of which hormone is the cause of erectile Dysfunction in a patient of Alcoholic Liver Disease?

Answer 26

Testosterone

Question 27

Winging of scapula. Which nerve is damaged?

Answer 27

Long Thoracic nerve

Question 28

What is a special property of Pindolol?

Answer 28

Partial agonism

Question 29

Patient comes to you with 2-week history of heart murmur and hepatomegaly. She has a 3-month history of cutaneous flushing with hypotension and crampy diarrhea.
What is the most likely site of a primary neoplasm in this patient?

Answer 29

Small Intestine

Question 30

MOA of erythromycin?

Answer 30

Binds to 50S ribosomal unit and interferes with translocation.

Question 31

A researcher in a pharmaceutical company designs a new protease inhibitor that inhibits replication of HIV in T-lymphocytes in culture. In subsequent assays, which of the following findings is most likely to indicate that the compound is working specifically as a protease inhibitor?
A) the drug prevents integration of proviral DNA into host genome
B) the RNA is partially reverse transcribed into Proviral DNa
C) There is a lack of mature core

Answer 31

C) There is a lack of mature core

Question 32

Patient has infectious mononucleosis. Atypical cells with abundant lacey cytoplasm jn the peripheral blood smear are most likely derived from which cells?

Answer 32

Abundant lacey cytoplasms describe the presence of reactive lymphocytes. Reactive lymphocytes are a common occurence in a viral illness. These cells come from T-lymphocytes.

Question 33

Where is a pharyngeal cleft cyst located?

Answer 33

Anterior to sternocleidomastoid muscle

Question 34

MOA of ciprofloxacin?

Answer 34

Inhibits DNA gyrase

Question 35

Bupivacaine’s MOA?

Answer 35

Decreased permeability to Na+

Question 36

A 65y old man dies after complete occlusion of the left coronary artery. The left ventricle contains a large irregular area that is soft and pale. Which of the following processes is most likely responsible?

Answer 36

Coagulation necrosis

you did liquifactive necrosis which was wrong