NBME 17

Question 1

what innervates uvula

Answer 1

vagus. deviates away

Question 2

painless menometrahia

Answer 2

endometrial hyperplasia

nuclear atypia. post menopause vaginal bleeding.

Question 3

pt with rhabdo, what actually causes nephrotic syndrome

Answer 3

myoglobin (not CK, just a marker of rhabdo)

Question 4

anticoag used in PE that causes thrombocytopenia

Answer 4

heparin

Question 5

What type of stone causes staghorn caliculi

Answer 5

Struvite. caused by infection of urease + bugs (proteus, staph saphophyticus, klebsiella)

made up of ammonium, magnesium, phosphate

radiopaque

look like coffin lid

Question 6

which hemroids are painful

Answer 6

external

Question 7

what nerve causes rectum motility (and internal urethral function and erections)

Answer 7

pelvic splanchnic

Question 8

string of beads appearance of artery (renal)?

Answer 8

fibromuscular dysplasia seen in polyarteritis nodosa

Question 9

what could cause abd structures in the thorax in a newborn?

Answer 9

failure of pleuroperitoneal membrane

Question 10

why does leprocy (myobacterium leprae) prefer extremities?

Answer 10

cooler temperatures

gives glove and stocking loss of sensation

tx: dapsone, rifampin, clofazimine

Question 11

TNF-alpha

Answer 11

cause fever and hypotension (vascular leak) secreted by macrophages in response to Lipid A of endotoxin

ALSO causes cachexia in malignancy

ALSO causes WBC recruitment

Question 12

Breath sounds dull to percussion with decreased tactile fremitus, decreased breath sounds

Answer 12

Pleural effusion, excess fluid between the pleural layers

Question 13

LH stimulates (male)

FSH stimulates

Answer 13

–> Leydig cells –> testosterone

–> Sertoli cells –> androgen binding protein, mullerian inhibiting factor

Question 15

Pincer grasps by how many months?

Answer 15

by 10 months

Question 16

Pull to stand at how many months

Answer 16

10 months

Question 17

synthesis of compounds in the skin that are subject to excitation by light. What pathway is defective

Answer 17

Porphyria cutanea tarda (defective heme synthesis, see photosensitivity, common porphyria)

Question 18

where does gluconeogenesis occur?

Answer 18

primarily in the liver but also in the kidney and intestinal epithelium

Question 19

Loratadine

Answer 19

2nd gen h1 antagonist that does not enter CNS

Question 20

Neural tube defect if neuropores fail to close by?

Answer 20

4th week

increased AFP, AChE increased in CSF

Question 21

osteogenesis imperfect

Answer 21

PROBLEM FORMING TRIPLE helix of collagen. decreased production of otherwise normal collagen

Question 22

Molluscum contagiosum— flesh-colored papule with

central umbilication

Answer 22

Poxvirus, DS linear enveloped. Also cause of smallpox and cowpox. often seen in kids sharing towel (fomite)

Question 23

ibutilide

Answer 23

class III antiarrhythmic

prolong phase 3, K channels of AP

predispose to long QT –> torsades

Tx for AFIB

Question 24

1-3 days post MI

Answer 24

fibrinous pericarditis with pericardial rub

extensive coagulative necrosis with neutrophils present

Question 25

3-14 days post MI

Answer 25

free wall rupture, causing tamponade. Due to macrophages coming in and eating up dead debris and make wall weakest point. Also can get papillary muscle rupture getting mitral regurgitation

Question 26

cyclophosphamide

Answer 26

crosslink DNA at guanine N-7 An alkalating agent that **inhibits DNA replication** Can cause hemorrhagic cystitis (need to give mesna

Question 27

cyclosporine

Answer 27

**calcineurin inhibitor, blocks T-cell activation** prevent IL-2 transcription **NEPHROTOXICITY** used for transplant rejection, PAIR

Question 28

rosacea

Answer 28

In inflammatory facial skin disorder characterized by erythematous papules and pustules but no comedones. May be associated with facial flushing in response to external stimuli (**eg, alcohol, heat)**. **Phymatous rosacea** can cause rhinophyma (bulbous deformation of nose).

Question 29

Pityriasis rosea

Answer 29

“Herald patch” followed days later by other scaly erythematous plaques, often in a “Christmas tree” distribution on trunk J . Multiple plaques with collarette scale. Self-resolving in 6–8 weeks

Question 30

Peutz-Jeghers syndrome

Answer 30

Autosomal dominant syndrome featuring numerous hamartomas throughout GI tract, along with hyperpigmented mouth, lips, hands, genitalia. Associated with risk of breast and GI cancers (eg, colorectal, stomach, small bowel, pancreatic).

Question 31

upper motor neuron lesion cause what to reflexes?

Answer 31

hyperreflexia

Question 32

MLF lesions are contra/ipsilateral?

Answer 32

ipsilateral. Right affects Right inability to tract pass midline in affected eye

Question 33

schizotypal

Answer 33

eccentric appearance, odd beliefs or magical thinking. Interpersonal awkward = magical thinking

Question 34

antisocial

Answer 34

sociopath

Question 35

sulfasalizine

Answer 35

A combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-in ammatory). Activated by colonic bacteria. ## Footnote Ulcerative colitis, Crohn disease (colitis component).

Question 36

IL-2

Answer 36

activate T-lymphocytes (blocked by cyclosporine--\> calcineurin inhibitor) IL-2 activate mTOR pathway

Question 37

adalimumab, infliximab

Answer 37

IBD treatment. (PAIR) TNF-Alpha monoclonal antibody

Question 38

tx ADHD

Answer 38

methylphenidate (increase DA and NE) can cause wt loss, insomnia

Question 39

Sarcoidosis

Answer 39

Characterized by immune-mediated, widespread noncaseating granulomas A , elevated serum ACE levels, and elevated CD4+/CD8+ ratio in bronchoalveolar lavage uid. More common in African-American females. Often asymptomatic except for enlarged lymph nodes. Findings on CXR of bilateral adenopathy and coarse reticular opacities B ; CT of the chest better demonstrates the extensive hilar and mediastinal adenopathy. Associated with restrictive lung disease (interstitial brosis), erythema nodosum, lupus pernio (skin lesions on face resembling lupus), Bell palsy, epithelioid granulomas containing microscopic Schaumann and asteroid bodies, uveitis, hypercalcemia (due to 1α-hydroxylase–mediated vitamin D activation in macrophages).

Question 40

caause of menopause

Answer 40

decreased estrogen release from ovaries (failure of ovaries to secrete 17b estradiol)

Question 41

ezetimibe

Answer 41

stops cholesterol absorption from brush border can make statin myopathy worse