NBME 2 BLOCK 1-4 (With Answers)

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NBME 2 BLOCK 1-4

*Lipopolysacharides(Bacteria) LPS bind to "Toll-like receptor"(TL) (a sin!le Transebrane receptor)------# acti$ation o% Inhibitory kappa B kinase (IK B kinase)-------# 'ote: '-kB is a transcription actor that eist in cytoplas bond to Inhibitory kappa B (IKB) protein in Inacti$e %or +'-kB,IKB so continin! the abo$e se.ence // LPS----# TL----#0IKB kinase-----#phosphorylation o% IKB o% the cople+'-kB,IKB cople+' -kB,IKB and no1 this phosphorylated IKB !et ! et de!raded and '-kB is released-----#'-kB o$e to 'cles 1here it pre!late !ene epression o% T'------#Se T'------#Sepsis psis

*Lipopolysacharides(Bacteria) LPS bind to "Toll-like receptor"(TL) (a sin!le Transebrane receptor)------# acti$ation o% Inhibitory kappa B kinase (IK B kinase)-------# 'ote: '-kB is a transcription actor that eist in cytoplas bond to Inhibitory kappa B (IKB) protein in Inacti$e %or +'-kB,IKB so continin! the abo$e se.ence // LPS----# TL----#0IKB kinase-----#phosphorylation o% IKB o% the cople+'-kB,IKB cople+' -kB,IKB and no1 this phosphorylated IKB !et ! et de!raded and '-kB is released-----#'-kB o$e to 'cles 1here it pre!late !ene epression o% T'------#Se T'------#Sepsis psis

The 2stachian tbe (or aditory tbe or pharyn!otypanic tbe) is a tbe that links the pharyn to the iddle ear/ 'orally3 the 2stachian tbe is closed3 1hich helps pre$ent the inad$ertent containation o% the iddle ear space by the noral secretions %ond in the back o% the nose/ 4 dys%nctional 2stachian tbe that is al1ays open is called a "patlos" 2stachian tbe/ Patients 1ith this rare condition are pla!ed by chronic ear in%ections/ 4 ch ore coon proble is a %ailre o% the 2stachian tbe to e5ecti$ely re!late air pressre/ Partial or coplete blocka!e o% the 2stachian tbe can case sensations o% poppin!3 clickin!3 and ear %llness and occasionally oderate to se$ere ear pain/ 6on! children ay describe the poppin! sensation as "a tickle in y ear/

7ethylparaben 4 deri$ati$e o% P4B4 8paraainoben9oic acid)

l;---#centriloblar necrosis3 %atty chance in li$er

the $accin is prodced by recobinant <'4 technolo!y3the !ene codin! %or the =Bsa! inserted into yeast cells31hich then release this olecle into the cltre edi/the olecle is then pre>ed and sed as the ino!en in the $accin/ =P? is also prodced by recobinant <'4

@A/B Pre$alance,incidence*disease dration

The ost coon sorces o% ebolis are proial le! deep $enos throbosis (ciency3 protein S de>ciency3 antithrobin de>ciency3 hyperhoocysteineia and plasino!en>brinolysis disorders) 4c.ired throbophilia (antiphospholipid syndroe3 nephrotic syndroe3 paroysal noctrnal heo!lobinria) ancer (de to secretion o% pro-coa!lants) The ain indication %or throbolysis is in sbassi$e P2 1here ri!ht $entriclar dys%nction can be deonstrated on echocardio!raphy3 and the presence o% $isible throbs in the atri/

In the natral a!in! process3 aortic stenosis o%ten increases a%terload becase the le%t $entricle st o$ercoe the pressre !radient cased by the calci>ed and stenotic aortic $al$e in addition to the blood pressre in order to eGect blood into the aorta

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control stdy easres 1ith Odds ratio////////abcd,adbc

2ternal Obli.e The eternal obli.es are also a sper>cial scle that is %ond Gst laterally to the rects abdoins/ They ori!inate %ro the eternal sr%aces o% the lo1er N ribs3 and insert into the anterior hal% o% the oter lip o% the iliac crest and the aponerosis o% the anterior abdoinal 1all/ Its %nction incldes Fein! the trnk t rnk (in bilateral contraction)3 posterior pel$ic tilt3 sae side Feion3 and rotation o% the trnk to the opposite side (drin! nilateral contraction)/ The eternal obli.es are the lar!est o% the abdoinal scles/

Patient has yoa- ost coon cardiac tor in adlts - JD o% the occr in atri(especially le%t one) 7yoa a neoplas coposed o% stellate to plp cytolo!ically bland esenchyal cells set in a yoid stroa/ cytolo!ically bland esenchyal cells3 so-called yoa or lepidic cells / 7yoa cells are %re.ently stellate 1ith eosinophilic cytoplas and indistinct cell borders/ Their o$oid nclei are typically pale 1ith open chroatin/ 'cleoli ay be proinent/

enal in%arct prodces !ross heatria/// M can see peripheral 1ed!e shaped in%arct in the pic/// That cased her heatria enal in%arct is beco9 o% soe ebols/// ebols later lod!ed in her brain and becae case o% her death/

case fatality rate=fatal case/total number of eole !it" #isease

$rimary care "ysicians fre%uently encounter c"il#ren !it" "eart murmurs&1 Most of t"ese youn' atients #o not "a(e "eart #isease& Ec"ocar#io'ra"y is not al!ays nee#e# to #ia'nose e#iatric murmurs& #irect referral for ec"ocar#io'ra"y !as an e*ensi(e !ay to e(aluate c"il#ren !it" "eart murmurs& $e#iatric car#iolo'y consultation !as si'ni+cantly less costly in t"at many innocent murmurs !ere #ia'nose# !it"out ec"ocar#io'ra"y&

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AJJD SP2IIIT6///2 AJJD S2'SITI?IT6/// 7OST 4M4T2//////<

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en9a chocolate a!ar 1ith %actor ? +'4< and Q +heatin

abis////en$eloped '4 SS
Pel$ic inFaatory disease (PI<) re%ers to in%ection o% the ters (1ob)3 %allopian tbes (tbes that carry e!!s %ro the o$aries to the ters) and other reprodcti$e or!ans that cases syptos sch as lo1er abdoinal pain/ It is a serios coplication o% soe seally transitted diseases (ST
Probenecid is a ricosric dr! that increases ric acid ecretion in the rine/ It is priarily sed in treatin! !ot and hyperriceia/ 7echanis In the kidneys probenecid is >ltered at the !loerls3 secreted in the proial tble and reabsorbed in the distal tble/ Probenecid 1orks by inter%erin! 1ith the kidneyEs or!anic anion transporter (O4T)3 1hich reclais ric acid %ro the rine and retrns it to the plasa+C/ I% probenecid (an or!anic acid) is present3 the O4T binds pre%erentially to it (instead o% to ric acid)3 pre$entin! re-absorption o% the ric acid/ =ence3 the rine retains ore ric acid3

=orseshoe kidney3 also kno1n as renal %sion3 is a con!enital disorder a5ectin! abot A in ;JJ people In patients 1ith this condition3 the central portion o% the kidney ay be %ond Gst in%erior to the in%erior esenteric artery becase the noral ebryolo!ic ascent o% the kidneys is arrested by its presence in people 1ith central %sion o% the kidneys/ ost cases o% horseshoe kidneys are asyptoatic and disco$ered pon atopsy

heatic %e$er is an inFaatory disease that occrs %ollo1in! a Hrop 4 streptococcal in%ection3 (sch as strep throat or scarlet %e$er)/ Belie$ed to be cased by antibody cross-reacti$ity that can in$ol$e the heart3 Goints3 skin3 and brain3 the illness typically de$elops t1o to three 1eeks a%ter a streptococcal in%ection/ 4cte rheatic %e$er coonly appears in children bet1een the a!es o% C and AR3 1ith only JD o% >rst-tie attacks occrrin! in adlts/ 4scho5 bodies are nodles %ond in the hearts o% indi$idals 1ith rheatic %e$er/4scho5 bodies are areas o% inFaation o% the connecti$e tisse o% the heart3 or %ocal interstitial inFaation/

In $arios sitations sch as in%ection3 inslin deands rise bt are not atched by the %ailin! pancreas/ Blood s!ars rise3 dehydration enses3 and resistance to the noral e5ects o% inslin increases %rther by 1ay o% a $icios circle/(4 $irtos circle or a $icios circle is a cople o% e$ents that rein%orces itsel% thro!h a %eedback loop)

yclosporine is a polypeptide o% AA aino acids o% %n!al ori!in and is acti$e a!ainst helper T cells3 pre$entin! the prodction o% IL- $ia calcinerin inhibition (binds to cyclophilin protein)/ This a!ent is sed %or indction and aintenance inosppression/ 4d$erse e5ects inclde nephrotoicity 1ith  sta!es: (A) iediate3 secondary to renal ischeia () - 1eeks a%ter transplantation3 secondary to renal $asoconstriction and () chronic3 secondary to interstitial nephritis/ Other ad$erse e5ects inclde hyperkaleia3 hypoa!neseia3 nasea3 $oitin!3 diarrhea3 hypertrichosis3 hirstis3 !in!i$al hyperplasia3 hyperlipideia3 !lcose intolerance3 in%ection3 ali!nancy3 and hyperriceia/ =ypertrichosis and hirstis can be alle$iated by s1itchin! %ro cyclosporine to tacrolis3 pro$ided the patient is care%lly onitored/ 7ltiple dr! interactions are possible3 priarily 1ith a!ents a5ectin! the cytochroe P-;CJ syste

serotonine syndroe 1ith cheese and 74O inhibitors3 Serotonin syndroe ost o%ten occrs 1hen t1o dr!s that a5ect the bodyEs le$el o% serotonin are taken to!ether at the sae tie/ The dr!s case too ch serotonin to be released or to reain in the brain area/ %e1 e!-+other than ste yo can de$elop this syndroe i% yo take i!raine edicines called triptans to!ether 1ith antidepressants called selecti$e serotonin reptake inhibitors (SSIs) and selecti$e serotoninnorepinephrine reptake inhibitors (SS'Is) )/ Older antidepressants called onoaine oidase inhibitors (74OIs) can also case serotonin syndroe 3 as 1ell as eperidine (
lead poisonin! lead inhibits delta ainole$lenic acid and %errochelatase leadin! to icrocytic aneia

The ost coon %ore!t cysts3 the broncho!enic cyst and the esopha!eal dplication representin! abnoral bddin! o% the $ertebral and dorsal priiti$e %ore!t3 respecti$ely3 indicatin! their coon ori!in %ro the priiti$e %ore!t and close ebryolo!ic relationship