NBME 7

Question 1

fever, pyuria s/p prostatectomy w/catheter

Answer 1

p. aeruginosa

Question 2

anticentromere Ab

Answer 2

CREST

Question 3

which MHC is used to display antigens by macrophages?

Answer 3

MHC II

Question 4

MHC II peptide loading affected by metabolite concentration (inc. pH) in:

Answer 4

endosomes, liposomes, phagolysosomes

Question 5

deep brain stimulation for parkinson’s in the:

Answer 5

globus pallidus (also thalamus and subthalamic nucleus)

Question 6

placenta accreta

Answer 6

invasion of 75% of the myometrium

Question 7

placenta percreta

Answer 7

invasion of ENTIRE myometrium

Question 8

hot tub folliculitis

Answer 8

p. aeruginosa

Question 9

duchenne’s

Answer 9

X-linked recessive

Question 10

I cell disease (inclusion)

Answer 10

no urine mucopolysaccharide, skin fibroblasts w/dense inclusion bodies, defect in Golgi complex GlcNAc phosphotransferase (transfers P to mannose for lysosomal targeting)

Question 11

BUN/creat ratio > 15

Answer 11

prerenal azotemia: kidney hypoperfusion–> dec. GFR–> inc. ratio

Question 12

decreased BUN/creat ratio <10, FeNa 3%

Answer 12

intrarenal azotemia

Question 13

after some exhalation, air flow is limited by __________ and determined by elastic recoil and resistance upstream

Answer 13

airway compression

Question 14

restrictive disease

Answer 14

max flow decreases as total V expired; abnormally high flow in latter expiration b/c of inc. recoil

Question 15

oxidase positive, nonlactose-fermenting, gm neg bacillus, unipolar motility, pyocyanin (blue-green)

Answer 15

p. aeruginosa

Question 16

obstructive disease

Answer 16

low flow, scooped after point of max flow

Question 17

neuro sx similar to botulinum, small cell ca

Answer 17

lambert eaton myasthenic syndrome: dec. Ca–> dec. Ach in NMJ affects skeletal m., autonomics, cerebellum

Question 18

coarse facial features, hip dislocation, inguinal hernia, hypotonia

Answer 18

I cell disease

Question 19

incoordination, ataxia, loss of sensation of ipsi half of face, contra trunk/ext., loss of CN V, IX, X, XI

Answer 19

lateral medullary/PICA syndrome (Wallenberg’s)

Question 20

fever, catatonia, muscle rigidity, delirium, myoglobinemia, inc. CK w/hx of chlorpromazine

Answer 20

NMS

Question 21

chlorpromazine

Answer 21

typical antipsychotic; dopamine antagonist

Question 22

addison’s disease (primary adrenal insuff.)

Answer 22

dec. aldosterone and cortisol–> hypotension, skin pigmentation (POMC–> ACTH–> alpha-MSH), calcified pinna

Question 23

secondary or tertiary hypocortisolism

Answer 23

dec. CRH or ACTH; no skin pigmentation

Question 24

von gierke’s disease

Answer 24

glucose 6 phosphatase def.–> hypoglycemia; inc. glycogen in liver/kidneys; lactic acidosis, hyperlipidemia–> fat cheeks; inc. uric acid; tx: continuous feeds of carbs

Question 25

winter's formula for metabolic acidosis

Answer 25

expected pCO2 = (1.5 x HCO3) + 8 +/-2………. If actual pCO2 >, primary resp. acid.; if actual pCO2 <, primary resp. alk.

Question 26

intrarenal azotemia w/muddy casts and tubulorrhexis

Answer 26

ATN of PCT

Question 27

how does alcohol kill bacteria?

Answer 27

disintegrates cell membrane (making lipids water soluble), then denatures proteins

Question 28

mutation in HbS

Answer 28

glutamate (hydrophilic) to valine (hydrophobic)

Question 29

why do RBCs sickle w/HBS?

Answer 29

to gain stabilizing hydrophobic interactions

Question 30

spinothalamic tract

Answer 30

decussates at spinal cord; P&T

Question 31

decussates at medulla

Answer 31

posterior column medial lemniscus, corticospinal tract

Question 32

lateral corticospinal tract

Answer 32

voluntary motor

Question 33

dorsal columns

Answer 33

pressure, vibration, fine touch, proprioception

Question 34

tophi locations

Answer 34

external ear, olecranon bursa, achilles tendon

Question 35

botulinum toxin

Answer 35

heavy chain (endocytosis); light chain (protease); toxin A degrades SNAP-25 protein (SNARE normally fuses vesicle for NT release) to inh. Release of Ach into synaptic cleft

Question 36

schizoid personality d/o

Answer 36

no interest in relationships, solitary, secretive, emotionally cord

Question 37

high SD = high variability = homo or hetero population?

Answer 37

heterogeneous

Question 38

cingulate gyrus herniation

Answer 38

limbic system; abnormal posturing and coma

Question 39

uncal herniation

Answer 39

ipsi pupillary dilation 1st (parasymp fibers on outside of CN III), eyes down and out; ipsi primary visual cortex (PCA) and contra homonymous hemianopia

Question 40

duret hemorrhages

Answer 40

midbrain, pons--> reticular formation

Question 41

decorticate posturing, respiratory depression, lethargy, dec. HR

Answer 41

uncal herniation

Question 42

adenylyl cyclase activation requires:

Answer 42

GTP binding

Question 43

dec. SV, inc. LAP and PVR

Answer 43

mitral regurgitation

Question 44

MR murmur increases with:

Answer 44

inc. TPR: squat, handgrip; inc. VR: expiration

Question 45

inc. preload and dec. afterload does what to SV?

Answer 45

increases SV

Question 46

S3

Answer 46

ischemia, MVP, LV dilation

Question 47

synchronized d/c (spike and wave) of thalamocortical neurons

Answer 47

absence seizures (similar to delta SWS in stage 3 and 4)

Question 48

MLF lesion

Answer 48

internuclear ophthalmoplegia- one eye won't cross midline; integrates CN III, IV, VI, VIII, FEF

Question 49

multiple sclerosis

Answer 49

internuclear opthalmoplegia w/contra nystagmus, diplopia

Question 50

dec. diffusing capactiy for CO (DLco)

Answer 50

ARDS

Question 51

inc. Na intake leads to:

Answer 51

inc. PV, wt, cardiac/SV index, kidney failure

Question 52

budding yeast, soil, pigeon droppings

Answer 52

cryptococcus

Question 53

india ink w/latex agg test for cryptococcus looks for:

Answer 53

polysaccharide capsular antigen

Question 54

hypotension w/gm neg rods

Answer 54

LPS stim. TNF-alpha and IL-1 via TLR-4 binding CD14 on monocytes/macrphages/PMNs

Question 55

vertebral mets w/pleomorphic epithelial cells forming duct-like structures

Answer 55

prostate adenocarcinoma

Question 56

asymmetric gluteal folds in newborn

Answer 56

hip dislocation

Question 57

congenital hip dislocation without tx

Answer 57

erosive arthropathy

Question 58

strongest hip ligament

Answer 58

iliofemoral

Question 59

generalized tonic-clonic seizure tx:

Answer 59

valproate: inh. VG Na and T-type Ca channels, inc. GABA; carbamazepine: stabilizes inactive Na channels, inc. GABA; phenytoin: stabilizes inactiv. Na channels