NBME 2 BLOCK 1-4 (With Answers)

7/25/2019 NBME 2 BLOCK 1-4 (With Answers)

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NBME 2 BLOCK 1-4

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*Lipopolysacharides(Bacteria)

LPS bind to "Toll-like receptor"(TL) (a sin!le Transebranereceptor)------# acti$ation o% Inhibitory kappa B kinase (IKBkinase)-------#

'ote: '-kB is a transcription actor that eist in cytoplas bond toInhibitory kappa B (IKB) protein in Inacti$e %or +'-kB,IKB

so continin! the abo$e se.ence //

LPS----# TL----#0IKB kinase-----#phosphorylation o% IKB o% thecople+'-kB,IKB and no1 this phosphorylated IKB !et de!radedand '-kB is released-----#'-kB o$e to 'cles 1here it pre!late!ene epression o% T'------#Sepsis


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The 2stachian tbe (or aditory tbe or pharyn!otypanic tbe)is a tbe that links the pharyn to the iddle ear/

'orally3 the 2stachian tbe is closed3 1hich helps pre$ent theinad$ertent containation o% the iddle ear space by the noralsecretions %ond in the back o% the nose/

4 dys%nctional 2stachian tbe that is al1ays open is called a

"patlos" 2stachian tbe/ Patients 1ith this rare condition arepla!ed by chronic ear in%ections/ 4 ch ore coon probleis a %ailre o% the 2stachian tbe to e5ecti$ely re!late airpressre/ Partial or coplete blocka!e o% the 2stachian tbe cancase sensations o% poppin!3 clickin!3 and ear %llness andoccasionally oderate to se$ere ear pain/ 6on! children aydescribe the poppin! sensation as "a tickle in y ear/


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7ethylparaben4 deri$ati$e o% P4B4 8para-ainoben9oic acid)


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l;---#centriloblar necrosis3 %atty chance in li$er


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the $accin is prodced by recobinant


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@A/BPre$alance,incidence*disease dration


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The ost coon sorces o% ebolis are proial le! deep $enos throbosis(


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In the natral a!in! process3 aortic stenosis o%tenincreases a%terload becase the le%t $entricle sto$ercoe the pressre !radient cased by thecalci>ed and stenotic aortic $al$e in addition to theblood pressre in order to eGect blood into the aorta


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BLOCK 2

M7P TO:

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control stdy easres 1ith Odds ratio////////abcd,adbc


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2ternal Obli.e

The eternal obli.es are also a sper>cial scle

that is %ond Gst laterally to the rects abdoins/They ori!inate %ro the eternal sr%aces o% thelo1er N ribs3 and insert into the anterior hal% o% theoter lip o% the iliac crest and the aponerosis o%the anterior abdoinal 1all/

Its %nction incldes Fein! the trnk (in bilateralcontraction)3 posterior pel$ic tilt3 sae side Feion3and rotation o% the trnk to the opposite side(drin! nilateral contraction)/ The eternalobli.es are the lar!est o% the abdoinal scles/


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Patient has yoa- ost coon cardiac tor in

adlts- JD o% the occr in atri(especially le%t one)7yoaa neoplas coposed o% stellate to plpcytolo!ically bland esenchyal cells set in ayoid stroa/cytolo!ically bland esenchyal cells3 so-calledyoa or lepidic cells /7yoa cells are %re.ently stellate 1itheosinophilic cytoplas and indistinct cell borders/Their o$oid nclei are typically pale 1ith open

chroatin/ 'cleoli ay be proinent/


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enal in%arct prodces !ross heatria///

M can see peripheral 1ed!e shaped in%arct in thepic///That cased her heatriaenal in%arct is beco9 o% soe ebols///ebols later lod!ed in her brain and becaecase o% her death/


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case fatality rate=fatal case/totalnumber of eole !it" #isease


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$rimary care "ysicians fre%uently encounter c"il#ren!it" "eart murmurs&1 Most of t"ese youn' atients #onot "a(e "eart #isease&

Ec"ocar#io'ra"y is not al!ays nee#e# to #ia'nosee#iatric murmurs& #irect referral for ec"ocar#io'ra"y!as an e*ensi(e !ay to e(aluate c"il#ren !it" "eartmurmurs& $e#iatric car#iolo'y consultation !assi'ni+cantly less costly in t"at many innocent murmurs!ere #ia'nose# !it"out ec"ocar#io'ra"y&


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BLOCK 3

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BLOCK 2BLOCK 3BLOCK 4


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AJJD SP2IIIT6///2AJJD S2'SITI?IT6///7OST 4M4T2//////


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BLOCK 4

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en9a chocolate a!ar 1ith %actor ? +'4


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abis////en$eloped '4 SS-


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Pel$ic inFaatory disease (PI


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Probenecid is a ricosric dr! that increases ricacid ecretion in the rine/ It is priarily sed intreatin! !ot and hyperriceia/

7echanisIn the kidneys probenecid is >ltered at the!loerls3 secreted in the proial tble andreabsorbed in the distal tble/

Probenecid 1orks by inter%erin! 1ith the kidneyEsor!anic anion transporter (O4T)3 1hich reclaisric acid %ro the rine and retrns it to theplasa+C/ I% probenecid (an or!anic acid) ispresent3 the O4T binds pre%erentially to it (insteado% to ric acid)3 pre$entin! re-absorption o% the ricacid/ =ence3 the rine retains ore ric acid3


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=orseshoe kidney3 also kno1n as renal %sion3 is a con!enitaldisorder a5ectin! abot A in ;JJ people

In patients 1ith this condition3 the central portion o% the kidneyay be %ond Gst in%erior to the in%erior esenteric arterybecase the noral ebryolo!ic ascent o% the kidneys isarrested by its presence in people 1ith central %sion o% thekidneys/

ost cases o% horseshoe kidneys are asyptoatic anddisco$ered pon atopsy


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heatic %e$er is an inFaatory disease that occrs%ollo1in! a Hrop 4 streptococcal in%ection3 (sch as strep

throat or scarlet %e$er)/ Belie$ed to be cased by antibodycross-reacti$ity that can in$ol$e the heart3 Goints3 skin3 andbrain3 the illness typically de$elops t1o to three 1eeks a%ter astreptococcal in%ection/4cte rheatic %e$er coonly appears in children bet1eenthe a!es o% C and AR3 1ith only JD o% >rst-tie attacksoccrrin! in adlts/

4scho5 bodies are nodles %ond in the hearts o% indi$idals1ith rheatic %e$er/4scho5 bodies are areas o% inFaationo% the connecti$e tisse o% the heart3 or %ocal interstitialinFaation/


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In $arios sitations sch as in%ection3 inslindeands rise bt are not atched by the %ailin!

pancreas/ Blood s!ars rise3 dehydration enses3and resistance to the noral e5ects o% inslinincreases %rther by 1ay o% a $icios circle/(4$irtos circle or a $icios circle is a cople o%e$ents that rein%orces itsel% thro!h a %eedbackloop)


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yclosporine is a polypeptide o% AA aino acids o% %n!al ori!in and is acti$ea!ainst helper T cells3 pre$entin! the prodction o% IL- $ia calcinerininhibition (binds to cyclophilin protein)/ This a!ent is sed %or indction andaintenance inosppression/

4d$erse e5ects inclde nephrotoicity 1ith sta!es:(A) iediate3 secondary to renal ischeia() - 1eeks a%ter transplantation3 secondary to renal $asoconstriction and() chronic3 secondary to interstitial nephritis/

Other ad$erse e5ects inclde hyperkaleia3 hypoa!neseia3 nasea3$oitin!3 diarrhea3 hypertrichosis3 hirstis3 !in!i$al hyperplasia3

hyperlipideia3 !lcose intolerance3 in%ection3 ali!nancy3 and hyperriceia/=ypertrichosis and hirstis can be alle$iated by s1itchin! %ro cyclosporineto tacrolis3 pro$ided the patient is care%lly onitored/ 7ltiple dr!interactions are possible3 priarily 1ith a!ents a5ectin! the cytochroe P-;CJsyste


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serotonine syndroe 1ith cheese and 74O inhibitors3

Serotonin syndroe ost o%ten occrs 1hen t1o dr!s that a5ect thebodyEs le$el o% serotonin are taken to!ether at the sae tie/ Thedr!s case too ch serotonin to be released or to reain in thebrain area/

%e1 e!-+other than steyo can de$elop this syndroe i% yo take i!raine edicines calledtriptans to!ether 1ith antidepressants called selecti$e serotoninreptake inhibitors (SSIs) and selecti$e serotoninnorepinephrinereptake inhibitors (SS'Is)

)/Older antidepressants called onoaine oidase inhibitors (74OIs)can also case serotonin syndroe 3 as 1ell as eperidine (


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lead poisonin!lead inhibits delta ainole$lenic acid and%errochelatase leadin! to icrocytic aneia


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The ost coon %ore!t cysts3 thebroncho!enic cyst and the esopha!ealdplication representin! abnoral bddin! o%the $ertebral and dorsal priiti$e %ore!t3respecti$ely3 indicatin! their coon ori!in %rothe priiti$e %ore!t and close ebryolo!icrelationship


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Documents

NBME 2 BLOCK 1-4 (With Answers)