NMBE 13 practice test

Question 1

Scleroderma in regards to esophagus and LES tone (increase/decrease)?

Answer 1

Decreased esophageal peristalsis Decreased lower esophageal sphincter tone

Question 2

Warfarin overdose treatment (both mild and severe)

Answer 2

In mild cases, can be treated with Vitamin K (delayed response, need to generate more. In severe cases, can be treated with fresh frozen plasma (much more rapid)

Question 3

Chronic transplant rejection mediated by CD8+ T cells is due to….

Answer 3

Direct cytotoxicity to graft cells

Question 4

clostridium tetani mechanism

Answer 4

A protease that cleaves SNARE –>inhibits inhibitory neurotransmitter (glycine, GABA) release from Renshaw cells in spinal cord leading to spasticity (opisthotonos, trismus)

Question 5

The presence of _____ aids the bacteria in adhering to the urinary tract epithelium and withstanding the urine flow

Answer 5

adhesions (pilli)

Question 6

Heteroplasmy

Answer 6

A cell can have some mitochondria that have a mutation in the mtDNA and some that do not (variable expression in mitochondrial inherited diseases) I.E. mother has 50% mutation and then daughters and sons have 100% mutation

Question 7

Placenta Accreta

Answer 7

all or part of the placenta adheres abnormally to the myometrium Accreta – chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis. Leads to an increase in heavy bleeding when vaginal birth is attempted

Question 8

Schizoid

Answer 8

does not like being with people, prefers individual activities, indifferent to sexual behavior SchizoiD=Distant

Key in diagnosis is that it causes social or occupational dysfunction (lots of people can be weird, but it needs to interfere with daily life to be diagnosed)

Question 9

avoidant personality

Answer 9

Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid)

-biggest difference from schitzoid is that avoidant pts WANT to interact with people

Question 10

Celiac disease is associated with what condition

Answer 10

Dermatitis Herpetiformis -Pruritic papules, vesicles, and bullae (often found on elbows

Question 11

Pemphigus vulgaris

Answer 11

Potentially fatal autoimmune skin disorder with IgG antibody against desmoglein 1 and desmoglein 2 (component of desmosomes that link together squamous cells of the epidermis). Nikolsky sign + (separation of epidermis upon manual stroking of skin)

Question 12

Lesch Nyhan Syndrome (what is absent, what are pathways affected, what is produced more, what are sx)

Answer 12

Defective purine salvage, owing to absence of HGPRT

Hypoxanthine –> IMP

Guanine –> GMP

Results in excessive uric acid production and de novo purine synthesis -self mutilation behavior, hyperuricemia, gout, aggression

tx: allopurinol (xanthine oxidase inhibitor), which makes sense since cannot recycle the purines, produce more urea down the line.

Question 13

Crescendo-Decrecendo heart murmur

Answer 13

Aortic Stenosis Systolic murmur following ejection click Often due to aggravated calcific aortic stenosis or bicuspid aortic valve Can lead to: syncope, angina, dyspnea on exertion (SAD)

Question 14

Acute intermittent porphyria

Answer 14

AD Porphobilinogen deaminase is defective enzyme Symptoms (5 P’s):

1. Painful abdomen
2. Port wine–colored urine
3. Polyneuropathy
4. Psychological disturbances
5. Precipitated by drugs (e.g., cytochrome P-450 inducers), alcohol, starvation

Question 15

Ventricular Septal Defect murmur

Answer 15

holosystolic harsh sounding murmur. Loudest at tricuspid area most common congenital cardiac defect

Question 16

Lambert Eaton = Myasthinic Syndrome

Answer 16

Antibodies to calcium channels at presynaptic terminal Results in proximal muscle weakness when less ACh released improves with muscle use because Calcium eventually work its way into presynaptic terminal Associated with small cell lung cancer

Question 17

Hunter Syndrome

Answer 17

Mild Hurler + aggressive behavior, no corneal clouding. Iduronate sulfatase deficiency XLR (boys hunt, eyes are clear to hunt)

Question 18

Hurler Syndrome

Answer 18

Autosomal Recessive developmental delay, gargoylism, airway obstruction, corneal clouding, hepatosplenomegaly

-α-l-iduronidase deficiency

NOT X-Linked!

Question 19

Interleukin 1 (secreted by macrophages)

Answer 19

Also called osteoclast activating factor endogenous pyrogen, causes fever and acute inflammation. Activates endothelium to express adhesion molecules

Question 20

Gilbert Syndrome

Answer 20

caused by UDP gluconyl transferase deficiency (converting UCB –> CB in liver) increased unconjugated bilirubin without overt hemolysis. Bilirubin with fasting and stress VERY common and usually asymptomatic

Question 21

Type 2 error (beta)

Answer 21

Says there is not an effect or difference when in fact there is. =false negative error power and type 2 errors are inversely proportional (increase sample size, precision of measurement, decrease chance for type 2 error)

Question 22

Japanese food leads to increased risk of what and why?

Answer 22

gastric cancer due to increased nitrosamines in smoked foods

Question 23

elbow flexion done by what muscles and innervated by what nerve?

Answer 23

biceps and brachialis both innervated by musculocutaneous nerve

Question 24

Minimal Change Disease

Answer 24

most common form of nephrotic syndrome characterized by 2+ protein in urine, puffy eyes, no red cell casts -Usually found in children Often 1° (idiopathic) and may be triggered by recent infection, immunization, immune stimulus. Rarely, may be 2° to lymphoma See effacement of the foot processes and loss of negative glomerular charge (changes seen on EM, normal on Light microscope)

In children 1-10 years who do not have hypertension, gross hematuria, renal failure, extra-renal symptoms such as rashes or purpura, or low complement levels it is reasonable to start therapy with prednisone without obtaining a renal biopsy

Question 25

Atrophy mechanism (2)

Answer 25

1. decreased protein synthesis 2. increased protein degradation