8/11/2019 NBME 13 Review 2

1/29

Esophageal peristalsis

and lower esophageal

sphincter tone in

scleroderma

both decreased

Tx of hepatic

encephalopathylactulose

Ursodiol

reduces cholesterol

absorption and can

dissolve cholesterol

gallstones

Lactulose

decreases NH3

production by bacteria

and acts as a laxative for

hepatic encephalopathy

Bisacodyl stimulant laxative

8/11/2019 NBME 13 Review 2

2/29

12 hours after birth baby begins sucking

frantically and crying inconsolably, also

overreacts to stimuli around him and has

a marked startle response, symptoms

resolve in 2-3 weeks, what was the

mother using

heroin

cause of hypercalcemia

in multiple myelomaIL-1, TNF

structure that attaches

to the cervical region

and extends posteriorly

uterosacral ligament

a mutation in 50% of material

mitochondrial DNA present in

100% of her children is

explained by

heteroplasmy

painless blood-tingued

uring and hx of smoking

in 55 YO

bladder cancer

8/11/2019 NBME 13 Review 2

3/29

problem in brothers who

die of mycobacterial

infection

IFN-gamma receptor

deficiency

Cardiac tumor with

scattered mesenchymal

cells in an abundant

extracellular matrix

myxoma

Molecular problem if

trismus and

opisthotonos

blockade of inhibitory

NT release

Micafungin targets fungal cell wall

Megaloblastic anemia,

increased methylmalonic acid

and total homocysteine

suggest a deficiency in

B12

8/11/2019 NBME 13 Review 2

4/29

Histological sign of

diffuse alveolar damage

alveolar hyaline

membrane

Virulence factor of E.

coli causing

pyelonephritis

adhesins

Major risk with too

much metformin

consumption

lactic acidosis

We can administer

bevacizumab even

though it is a foreign

protein because

it is a humanized

antibody

Cancer type and tumor

antigen with high

antibody titer

cervical cancer and HPV

16, E6 protein

8/11/2019 NBME 13 Review 2

5/29

Osteoporosis is

associated with an

increase in what

cytokine

IL-1

Tyrosine kinases do

what

phosphorylate targets by

taking a phosphate from

ATP

Defective protein if glucagon

does not correct hypoglycemia

in a strain of mice but

epinephrine does

glucagon receptor

Erythromycin

mechanism

interferes with amino-

acyl translocation

Metabolic process

impaired if rapid red

fibers

oxidative

phosphorylation

8/11/2019 NBME 13 Review 2

6/29

Best diet for obese

person wanting to avoid

diabetes

low calorie

Staghorn caliculus think Proteus mirabilis

AATAAA at 3' end

encodes

cleavage and

polyadenation

Muddy brown cast of

ATN is a type ofgranular cast

Two weeks after

granular cast seen and

none since then, we

expect to see

regenerating tubular

epithelium

8/11/2019 NBME 13 Review 2

7/29

Greatest risk for death a few

weeks after strep infection and

PE that reveals pericardial

friction rub and quiet heart

sounds, but not pathogens

myocarditis

Seminal vesicles secrete fructose, glandins all the

other stuff

Cause of hyperglycemia

in a type I diabetic

activation of hepatic

adenylyl cyclase

ANP function opposite of aldosterone

(inhibits renin)

Where do the adductors

of the hip attachfemur and ischium

8/11/2019 NBME 13 Review 2

8/29

Cough suppressant treatment

that does not cause

constipation and has a low

potential for substance abuse

dextromethorphan

Aspirin induced asthma

is due toleukotrienes

Watery diarrhea,

hypokalemia,

achlorhydria

VIPoma

Tx of fetal pulmonary

hypertension

nitric oxide (monitor for

methemoglobinemia)

Receptor causing

uterine relaxationB2

8/11/2019 NBME 13 Review 2

9/29

Receptor causing

increased myocardial

contractility

B1

Receptor causing

internal urethral

sphincter contraction

A1

Receptor causing

lipolysisB1, B2

Receptor causing

pilomotor contractionA

Receptor causing

pupillary dilationA1

8/11/2019 NBME 13 Review 2

10/29

Hypochondriasis

requires

disproportionate fear of

serious illness

Laryngeal neoplasm in a

smokersquamous cell

Decreased MCV, red,

swollen, tender tongue,

angular stomatitis,

spoon-shaped nails

iron deficiency

Neutropenia, giant

granules in neutrophils,

white hair, pale skin,

blue irises, red pupils

Chediak Higashi (defect

on phagolysosome

fusion)

Neuraminidase inhibitor

mechanism of action

prevents release of virus

from infected epithelial

cells

8/11/2019 NBME 13 Review 2

11/29

8/11/2019 NBME 13 Review 2

12/29

Everything has been normal

for a woman but she cannot

conceive, what should we give

her next

clomiphene

Trisomy 21 associated

with increased risk of

which cancers?

ALL and AML

Hydronephrosis causes?Increased tubular

hydrostatic pressure

from blockage

Chronic HTN, heavy

heart?Hypertrophy of heart

Valproic Acid MOA

inhibits HISTONE

ACETYLASE - Histones

were in DNA -

transcription error

8/11/2019 NBME 13 Review 2

13/29

Chloroquine,

primaquine MOA

Chloroquie kills

malaria/ Primaquine

kills hypnozoites

Pain with thumbs down,

shoulders up

Arm up Thumbs down

sign... supraspinatus...

Left Axillary line

holosytolic murmur

Mitral Regurg - Left

Axillary line holosystolic

murmur

Oculomotor palsy from

aneurysm?

Posterior

Communicating Artery

Anuerysm

Dental procedure, bug? Strep Mitis - alpha

hemolytic

8/11/2019 NBME 13 Review 2

14/29

HDL with age in

woman?

HDL of a 25 year old vs.

55 year old, high in 25,

low in 55 (estrogen)

Organophosphate

poisoning- first antidote

Atropine

first/Pralidoxime second

Partial vs complete mole

Partial 1 egg two sperm

69XXY vs paternal

complete 46XX 2 sperm

no egg

EPO doping = ? EPO will increase RBC's

erythroid precursors

Ammonia source in

ammonioagenesis

Aspartate &

GLUTAMINE donate

NH4 ( amonia ) in renal

ammoniaagenesis

8/11/2019 NBME 13 Review 2

15/29

long-chain-fatty-acids? LCFA - peroxisomes

Salmonella post

antibiotic?

prolonged fecal

excretement post

antibiotic

Hypokinesis of Posterior

Left Ventricle?

Stenosis of the right

coronary artery

Pain upper abdomen,

refered to shoulder

Diaphram ulceration

phrenic nerve

Oligomenorrhea increased estrogen in

adipose tissue

8/11/2019 NBME 13 Review 2

16/29

8/11/2019 NBME 13 Review 2

17/29

Diabetic neuropathy

pain?burning pain

pinpoint pupils,

unconsciousheroin OD

Why deoxyHB can carry

CO2 better than

OxyHB?

DeoxyHB = better buffer

Recurrent severe

mycobacterial diseases

INF-gamma receptor

defect

Insulin increases? glucokinase activity

8/11/2019 NBME 13 Review 2

18/29

8/11/2019 NBME 13 Review 2

19/29

Low blood solubility =

slow or fast induction?

141) low blood solubility

--> rapid induction, low

potency

Screening for CD

markers?Immunohistochemistry

acute ischemic injury =

kidney findings?

Acute Tubular Necrosis -

Muddy Brown Casts

with epithelial cells

cyt a/a3 blocked by CO poisoning (requires

oxygen)

capillary hemangioma

embryological originendothelial

8/11/2019 NBME 13 Review 2

20/29

8/11/2019 NBME 13 Review 2

21/29

relative risk under/over

1

under one = decreased

risk, over one =

increased risk

pulmonary vs bronchial

circulation

pulmonary circulation =

larger percentage of CO

(=CO vs. bronchial circ

is much less of CO)

muscle misuseincreased protein

degradation not myosin

activity

MPO deficiency

decreased production of

bleach aka hydroxy-halide

radicals = susceptibility to

yeast infections

features of apoptosis

cell shrinkage,

eosinophilia, condensed

cytoplasm, apoptotic

bodies

8/11/2019 NBME 13 Review 2

22/29

amphetamine intoxpupillary dilation,

diaphoresis, agitation,

confusion

heroin intoxeuphoria, resp, CNS

depression, pupillary

constriction, seizures

seminal vesicle

secretions

fructose (bulbourethral

gland/Cowper =

mucous, prostate =acid

phosphate and PSA )

mitochondrial

inheritance expression

heteroplasmy = variable

expression

treatment for hepatic

encephalopathylactulose

8/11/2019 NBME 13 Review 2

23/29

location of bone that

heals fracture

periosteum (includes

osteoblasts)

CREST achalsia dysmotility and

decreased LES pressure

Hypercalcemia in MM

vs Sarcoid

MM = IL1 (osteoclast

activating factor),

Sarcoid = elevated 1,25

vit D

ab pain, nausea,

vomiting after party,

normal temp, low BP

enterotoxin ingestion (S.

aureus, usually rapid

onset in 1-8 hours)

cerebellar vermis

damage

truncal ataxia,

dysarthria (vermis is tree

like)

8/11/2019 NBME 13 Review 2

24/29

cerebellar hemisphere

intention tremor, limb

ataxia, loss of balance,

fall towards side of

lesion

hyochondriasis fear of serious disease

aspirin induced asthma

mediated by? Treat

with?

leukotrienes

(montelukast, zirlukast)

Nephrogenic DI (PCT,

DCT, CT)

PCT = always isotonic, DCT

and CT = hypotonic because

ADH acts here and action is

blocked in DI

nitric oxide

reduces pulmonary

vascular resistance

(watch for

metglobinemia)

8/11/2019 NBME 13 Review 2

25/29

Beta2 agonists decrease uterine tone

bupivicaina MOAamide local anesthetic =

decreased permeability

of Na

blood supply of

esophagusbranches off aorta

cough suppressant

without constipation

and low addiction

dextrometorphan

suspensory ligamentconnects ovaries to

lateral pelvic wall,

contains ovarian vessels

8/11/2019 NBME 13 Review 2

26/29

carcinoid tumors (3

most common sites)

appendix, ileum, rectum

(once mets outside GI

tract = carcinoid

syndrome)

Hunter's syndrome

accumulation

iduronate sullfatase deficiency

= heparan sulfate, dermatan

sulfate (mild developmental

delay, gargoylism, airway

obstruction + aggression)

protease inhibitor MOA

inhibits cutting up of long

enzyme chain into smaller

pieces = no new viruses, lack

mature core

Excess IL1 in elderly

womanosteoporosis

diabetes lipid levels low HDL, high TG, high

free fatty acids

8/11/2019 NBME 13 Review 2

27/29

8/11/2019 NBME 13 Review 2

28/29

thoracentesis location above the 9th rib,

midscapular line

micafungin/caspofungin

MOA

cell wall inhibitor,

blocks B-glucan

synthesis

staghorn calciulus bugs urease-positive (Proteus,

Staph, Klebsiella)

praziquantel MOA increased cell

membrane permeability

partial beta agonists pindolol, acebutolol

(PAPA)

8/11/2019 NBME 13 Review 2

29/29