NBME Form 4 Section 4

7/27/2019 NBME Form 4 Section 4

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CORRECTIONS:

3.C

4.A

5.A

20.A

21.A

22.D34.D

36.A

40.C

42.E

46.E

49.C

PTH:Block 11... zinc finger motif is a DNA binding domain for steriod receptor

so A is right answer

2 McArdle disease Glycogen is there in the muscle but cant be used becauseof deficievy of Glycogen phospholylase enzyme3- Discuss4- Tight junction are present between the cells and when they are

damaged the + discussion

5- CF is autosomal recessive disease ... the child with diease is homozygousfor CF gene.. carrier are heterogygous for the mutation...

For the parent to produce a homozygous child they must both be carrier of theCF.discuss

6- We are transplanting gene in the bone marrow so is cant be structural geneand the probable answer could be B

7- here its cant be sarcoma becasue vimentin antibodies reaction arenegative... only clue is keratin antibodies as in squamous cell ca

there is keratin pearls so E seem to be right8 BE SURE THAT YOU UNDERSTAND THE PROBLEM so its better to get more info rathergoing to fast...........

9-He is without food from the last one week... note he consumed his food in

the first two weeks. A is wrong as no diet is therehepatic glycogen store are for the first few hours.skeletal muscleglycogen cant be used because of abscence of glucose 6 phosphataseenzyme in muscle

D is the correct answer .. muscle protein are being used by the

gluconeogenesis processurea nitrogen cant help

10- D is the correct11-Bleomycin causes pulmonary fibrosis mean a restrictive lung diseasein restrictive lung diease either there is increase in FEV1/FVC ratio or

there is no change in it..... total lung volume decrease as there isrestriction in filling the lungs to there capacity

please add what will be the effect of diffusing capacity

C is the answer12-AZT is reverse transtriptase inhibitor so E is right13- urease is the answer but what is the substrate of urease and whatthe product??

14-Broad base point to blastomycosis

15-these are sign of acute cholecystitis so E is right16-this is acute rejection as occur after weeks of transplantations...so T lymphocyte play there role17-need explanations

18 need explanations

19-TNF is produced in response to Endotoxin and then TNF causes releaseof NO which is the main mediator of shock and hypotension

20-D dimer are specific for DIC , D dimer can only assay the cross linkedfibrin monomer while FDP assay detect all the product of plasmin cleaveof fibrenogen and insloluble fibrin clots

21-H lateral corticospinal tract....what is at G position?22-diagram is not clear any way they terminate at thalamus

23- A neostigmine inhibiot the enzyme

24- B is right DM causes accumulation of sorbitol in the schwann cellbecuase of ALDOSE REDUCTASE ENZYME which convert glucose intosorbitol and lead to osmotic damage to the shwaan cell anddefective myelination of peripheral nerve and so peripheral

neuropathy..........

25-need explanations from net26-C anti psychotic drug SE27-what is the diagnosis?????????28-iliopsoas

29-need net help

30-B31-case of asthma which is an obstructive lung diseas FEV1. FVC is typically

decreased and residual volume is increased32-superior vena cava syndrome due to small cell lung carcinoma causeingobstruction of the vena cava and so puffiness of the face and neck

33- Patent ductus arterosis connecting aorta with left pulmonary vein34-as we are increasing the precapillary resistance when flow will dec

and the filtration will decrease ....


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35-Beta 1 increase renin secretion but alpha 1 decrease renin secretion.36...

37 J38-Cystic fibrosis patient have short stature

39-Did you noticed that when we add the drug X we need more histamineto get the same response mean there is a revercible competitive

inhibitor there...40- its 30

41-discuss net ................

42- becuase there are bruit its mean there is atherosclerosis of therenal artery .. less blood goes to the kidney and renin is secretedwhich convert angiotensin 1 into angiotensin 2 and which in turn

increases aldosterone and increase Na absortion and so HTN.43- Oxcytocin but what is the 2nd messenger of Oxcitocin?

44-PCOS clue is decreased FSH45-B

46-net search today47-We know that radiation induced thyroid papillary ca is most commonbut can it be Laryngeal CA????

48-E but see notes49-M blocker block secretion and so cause dry mouth ipratropium

50-the oral drugs pioglitazone and rosiglitazone can cause orexacerbate heart failure and pulmonary edema and should be

avoided in patients with left ventricular dysfunction(impaired pumping ability of the heart) or chronic renalinsufficiency.

BLOCK TWO

1-B seem to be right... when we add antibiotic resistance plasmid,we can get the colonies who are resistance to a particular drug

and can eliminate the drug that are sensitive ...2- C seem to be right as we see that in CF there is a defectmutation and 508 codon is missing coding for Phenylalanine

amino acid .. in C only phenylalanine is shown there

3-Phenylalanine Hydroxylase deficiency leading to PTU....4-Nondisjunction will produce either an egg with 24 chromosome orwith 22 chromsomes..

5-Acute pancreatitis so enzymatic fat necrosis6-X linked recessive disease more common in male and if female

are symptomatic then its because of inactivation of morematernal chromsome than paternal... female are homozygouys

for the abnormal chromosome.7-A8-Unstable mood , impulsiveness.. female more than male

9-here is a point never assist the patient to die ....passively is ok but actively is not ok.... i think C seem to be right

10-D??11-E

12-transplant patient often get CMV infection so Gancyclovir13-A14-CCR5 i% of US population give protection to HIV infection

15-B

16-D because IgG protect respiratory mucosa from infection

17-listen steven daughtery

18-D lack of ramdomization need explanations19-see physio

20-A21-polycythemia so F

22-c abducent nevre23-Radial nevre24-circle of willus

25-D should know from where various seizure arise in the brain

26-E can any body explain?27- Cohesion BW adjacent cells ......... and held them togethers28-D never problem

29-G30-what is the diagnosis31-D seem to be right

32-what is the diagnosis?33-C34-During exercise the heart rate increases and when HR reach 180it compromise the coronary blood supply .. OK now pumping action

increases the heart metabolism and increases metabolite causescoronary vasodilation..... and so increases blood flow. Now in

exercise increase work volume occur at same pressure so Cseem to be right

35- Aortic pressure will be less than ventricular pressure soD seem to be right36-D

but need to check

37-Parietal cell38-E39-F

40-c41- see picture of renal ameyloidosis from google

42-F

43-B44-history is relevent to adenocarcimona45-Babies Blue Normal reaction to birth46-E

47-D need to check lab value48-D

49-C seem to be right ... physiostigmine enter CNS , neostigmine not sowhen you have confusion about which enter then think N is for NOT ..

50- C

BLOCK 31- A/T rich region are where Histone bind to DNA, Nucleosome

are formed by the histone octamer plus DNA wound round it.One nucleosome is connected to the other by H1 histone.

Need net search or discussion..

2-C release factor3-Alanine is converted to pyruvate for Gluconeogenesis4-F


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5-reperfusion injury by free redical6-Autosomal recessive

7-Gamma interferon secreted by Th1 cell causes Macrophagesactivation and activated macrophages become fused to

form multinucleated giant cell8-A

9-C but not sure need forum discussion10-Vit. C11-E

12-A

13-Alkylating agent14-D as this virus is segmented so produces a number of bandneed discussion

15-discussion16- Pneumococcus encapsulated bacteria

17-this is a bar graph ok first you count how many are total childrenso 25+30+35+10=100 now how many children have two episode of UTI?

answer 10 now out of hundred children 10 have two episode of UTI andwill be be 10 percent .18-Case cantrol study

19-A20-Aferican type of Burkit lymphoma classic picture of starry sky

appearance of histo slide associated with c myc oncongene..21-B

22-F23-A24-E

25-D

26-C27-A melanocyte are derivative of neural crest cell28-Posterior cruciate ligament Tibia move posterioly while for anterior

cruciate ligament tibia move anteriorly29-B polumyalgia rheumatica is associated with Temporal arteritis

30-A???31-Type11 form new type 1 cells

32-Pneumothorax there will be Hyperresonant, deviation of tracha toopposite plus decreased breath sound and absent fremitus33-A

34-A

35-B36-D but need discussion37-C

38-F for hurshsprung disease symptoms appear soon after birht39-A but how need explanation40-Absent of kidney lead to oligohydoamnious

41- ADH causes increase water reabsorption so serum osmolarity

would Dec , Urine osmolarity inc and urine sodium conc will be high42-F43-A accessory nipple got inlarged due to Pregnency

44-Guljan says thatage MC tumor of gynae

45 Cervical55 endometrial

65 OvariansNote CEO alphabat come accordinglyin the Q stem ist mention that she has PCOS mean has high estrogen

plus Height is normal mean she dont have tuner syndrome

which point to ovarian syndrome ... but its endometrial Capost menopausal bleeding45-E

46-D PID47-B

48-D due to parathyroid removal49-need discussion

50-D but need to know whether is this a brush border enzyme??

BLOCK 41-A2-D need clarification

3-Need to see YH biology notes C?4-A action potential travel to the interior of myocyte due to

T tubule5-its X linked recessive mean only diease gene on X chromosome

and if that male parent would have defective gene on his Xchromosome then he would have the disease and he dont haveits mean that he is not carrier of this disease

6-B

7-need clarification from YH biology notes8-B??9-A not congenital because he is 70 year old10-Partial agonist as at low dose its acting as agonist but

at high dose its acting as antagonist.

11-A12-Penecillin are excreted by kidney so when renal

function are compromised then serum drug level increse as this ypatient13-D

14-B15-E

16-C but what is ghost cell?17-Need mastering of Biostatistics

18-Thymus19-E20-A but need to check

21-A

22-Cerebellum and in cerebellum has ipsilateral signs23-E24-Duodenal atresia and ths diagnosis seem to be hurshsprug disease25-E

26-B but need to check this nusty Q

27-B28- D increase blood circulation

29-need to discuss A?30-H31-E


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32-G DVT33-E

34-D35-A but need to memorise the time sequence of infarction

36-A37-A but how to differentiate between the rest of conditions

38-cirrhosis and increase in splenic vein pressure due to portalhypertension39-B need to revise all the antihelmeitic drugs

40-what is the main function of mesengial cell....

41-C42-i think E but some says c43-B because for outlet incontenence there is continouse voiding

without a stress factor44-5 alpha reductase convert testosterone into DHT which is necessary

for the development of external ganitalia including prostatewhen DHT is not formed female external feature are formed but

internal male system is developed because testosterone is required toform normal internal male struture .45-E

46-An inhibitory hormone so inhibit all the function47- Diabetic ketoacidosis mucor specific

48-C49-C

50-Spironolactone aldosterone antagonist...

Documents

NBME Form 4 Section 4