Nbme 7 Block 3 Answers - Mod

8/18/2019 Nbme 7 Block 3 Answers - Mod

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1. ACDEC

6. AEBDC

11. ACCBB

16. AEDBB

21. DBAAD

26. EBACA

31. ECBAD

36. DACAE

41. CABAB

46. DEDAE

1.AA

If elre is no oelr bias in el study, statistical significance guarantees that elre is a 95 percent chance that elstudy’s result reflects what is happening in el population at large.

2.CC


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Opioid receptors are a group of protein!coupled receptors with opioids as ligands.

"orphine is shown to bind to #u receptors.

$.%%

&l 'ugular fora#en #ay be subdi(ided into three co#part#ents, each with elir own contents.

&l anterior co#part#ent trans#its el inferior petrosal sinus.

&l inter#ediate trans#its el glossopharyngeal, (agus, and accessory ner(es )a*a cranial ner(es nu#berI+, +, and +I respecti(ely .

&l posterior trans#its el sig#oid sinus )beco#ing el internal 'ugular (ein and so#e #eningeal branchesfro# el occipital and ascending pharyngeal arteries.

In this case el -ternocleido#astoid #. and rape/oid are iner(ated by Accessory n.....+I

2 !!AA 0afirlu*ast and #ontelu*ast are antagonist at % receptors with slow onset of acti(ity used prophylactically for different for# of asth#a for e3a#ple el e3ercise or drugs li*e A-A

Ipatropiu# cause bronchodilation in acute asth#a!!!!used in CO4% and safer than agonist

in patients wit C6 disease

&lophyline !!!!bronchodilates (ia inhiubition of 4hosphodiesterase 4%& !!!!increased cA"4

and also by antagonist of adenosine)bronchoconstrictor

&l final step of this $ groups of #edicine is wor* o(er el bronchospas#


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.&&

&l anti#icrobial resistance to all #entioned antibiotics .... eta!lacta# antibiotics)4enicillin and itsgeneration is caused by production of e3tended!spectru# beta lacta#ase

5.CC77

+!lin*ed recessi(e inheritance is a #ode of inheritance in which a #utation in a gene on el +chro#oso#e causes el phenotype to be e3pressed

)1 in #ales )who are necessarily he#i/ygous for el gene #utation because ely ha(e only one +chro#oso#e and

)2 in fe#ales who are ho#o/ygous for el gene #utation )i.e., ely ha(e a copy of el gene #utation oneach of elir two + chro#oso#es ....so it is 281

5! AA 777

this don:t ha(e all el infor#ation re;uiered to gi(e el answer, don:t says nothing about her husband< butCA==I&= fe#ale has half of el son affected and half of el daughters carrier eln 5>?5> )1.1

&l is about el e3pected ratio of carrier #oelr (iable fe#ale to #ale children for +!lin*ed recessi(edisease...el fe#ale child #ust get anoelr affected + fro# daddy..to beco#e sic* so she needs to recei(e


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two genes,but #ale child 'ust needs one + that it co#es fro# her carrier #oelr to get el disease...so elratio of getting affected + between fe#ale and #ale children is 281

@ ! AAA had it:s origen than el renal artery, no -uperior #esenteric bc it:s origen is superior to eltop of el *idneys

&l Inferior "esenteric Artery )I"A branches off el anterior surface of el abdo#inal aorta below el renalartery branch points, and appro3i#ately #idway between else and el aortic bifurcation )into el co##oniliac arteries . -upplies el large intestine fro# el left colic )or splenic fle3ure to el upper part of elrectu#, which includes el descending colon, el sig#oid colon, and part of el rectu#. 4ro3i#ally, itsterritory of distribution o(erlaps )for#s a watershed with el #iddle colic artery, and elrefore el superior#esenteric artery. &l -"A and I"A anasto#ose (ia el #arginal artery of el colon )artery of %ru##ond .&l territory of distribution of el I"A is #ore or less e;ui(alent to el e#bryonic hindgut.

http8??en.wi*ipedia.org?wi*i?Inferior #esenteric artery

B & artagener syndro#e, sinusitis, bronchiectasis, infertility, is Autoso#al =, elre is abnor#al

ciliary #otion and i#paired #ucociliary clearence, reason for el clinical signs

D.

Autoi##une "etaplastic Atrophic astritis )A"A is an inherited for# of atrophic gastritischaracteri/ed by an i##une response directed toward parietal cells and intrinsic factor.E1F &l presence ofseru# antibodies to parietal cells and to intrinsic factor are characteristic findings. &l autoi##uneresponse subse;uently leads to el destruction of parietal cells, which leads to profound hypochlorhydria)and ele(ated gastrin le(els . &l inade;uate production of intrinsic factor also leads to (ita#in 12#alabsorption and pernicious ane#ia. A"A is typically confined to el gastric body and fundus.

http://en.wikipedia.org/wiki/Inferior_mesenteric_arteryhttp://en.wikipedia.org/wiki/Inferior_mesenteric_artery


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9. %

Co#ple#ent co#ponent D is a protein in(ol(ed in el co#ple#ent syste#. A hereditary deficiency of CDcan result in increased susceptibility to Geisseria infections, such as #eningitis and gonorrhea.

%eficiency of C5!CD leads to Geisseria bactere#ia.

1>. C

&l Hrachus is el part of el allantoids duct between el bladder and el u#bilicus.

&l #edian u#bilical liga#ent is a structure in hu#an anato#y. It is a shri(elled piece of tissue thatrepresents el re#nant of el e#bryonic urachus.

It e3tends fro# el ape3 of el bladder to el u#bilicus, on el deep surface of el anterior abdo#inal wall. It isunpaired.

It is co(ered by el #edian u#bilical fold

ateral to this structure are el #edial u#bilical liga#ent )which is a different structure, not to beconfused and el lateral u#bilical liga#ent.

11. A


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Addison %isease8 Chronic adrenal insufficiencydue to adrenal atrophy or destruction by disease)Autoi###une, , #etastasis . 1 deficiency of aldosterone and cortisol causing hypotension, and s*inhyperpig#entation. )JA page 291

ecause pri#ary hypocortisolis# is #anifested as a deficiency in glucocorticoid release fro# el adrenalcorte3, increased AC K will be released by el pituitary in order to trigger release of el absentglucocorticoid< it is because of this o(ersti#ulation of AC K that bron/ing of el s*in occurs. In secondaryor tertiary hypocortisolis#, elre is a deficiency of eielr C=K or AC K release by el hypothala#us or

pituitary gland, respecti(ely. &l for#er will #anifest as no AC K release while el latter will #anifest as physiologic )nor#al AC K release< neielr will cause an o(erproduction of AC K. On e3a#ination, elfollowing #ay be noticed8E2F

L ow blood pressure that falls furelr when standing )orthostatic hypotension

LIn long!standing Addison:s %isease, el pinna of el ear #ay beco#e calcified

L"ost people with pri#ary Addison:s ha(e dar*ening )hyperpig#entation of el s*in, including areas not

e3posed to el sun< characteristic sites are s*in creases )e.g. of el hands , nipple, and el inside of el chee*)buccal #ucosa , also old scars #ay dar*en. his occurs because #elanocyte!sti#ulating hor#one )"-Kand adrenocorticotropic hor#one )AC K share el sa#e precursor #olecule, 4ro!opio#elanocortin)4O"C . After production in anterior pituitary gland, 4O"C gets clea(ed into a##a!"-K, AC K and

eta!lipotropin. &l subunit AC K undergoes furelr clea(age to produce Alpha!"-K, el #ost i#portant"-K for s*in pig#entation. In secondary and tertiary for#s of Addison:s, s*in dar*ening does not occur.

L"edical conditions such as type I diabetes, autoi##une thyroid disease )Kashi#oto:s thyroiditis andgoiter and (itiligo often occur togeelr with Addison:s )often in el setting of Autoi##une polyendocrinesyndro#e . Kence, sy#pto#s and signs of any of el for#er conditions #ay also be present in elindi(idual with Addison:s.

http8??en.wi*ipedia.org?wi*i?Addison:s disease

12. C

&thanol )ethyl alcohol and isopropanol )isopropyl alcohol are alcohols that *ill bacteria. Alcohols *ill bacteria by first #a*ing el lipids that are part of el outer protecti(e cell #e#brane of each bacteriu# cell#ore soluble in water so that el cell #e#brane begins to lose its structural integrity and fall apart. As elcell #e#brane disintegrates, alcohol can eln enter el cell and denature proteins within each bacteriu#.

http://en.wikipedia.org/wiki/Addison's_diseasehttp://en.wikipedia.org/wiki/Addison's_disease


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1$. C

Geisseria are fastidious ra#!negati(e cocci that re;uire nutrient supple#entation to grow in laboratorycultures. -pecifically, ely grow on chocolate agar with carbon dio3ide

Infection of el genitals in fe#ales with G. gonorrhoeae can result in pel(ic infla##atory disease if leftuntreated, which can result in infertility. 4el(ic infla##atory disease results if G. gonorrhoeae tra(els intoel pel(ic peritoneu# )(ia el cer(i3, endo#etriu# and fallopian tubes . Infertility is caused byinfla##ation and scarring of el fallopian tube. Infertility is a ris* to 1> to 2>M of el fe#ales infected with

G. gonorrhoeae.

1 .

6aricella /oster (irus )606 is one of eight herpes (iruses *nown to infect hu#ans )and oelr (ertebrates .It co##only causes chic*en!po3 in children and Kerpes /oster )shingles in adults and rarely in children.4ri#ary 606 infection results in chic*enpo3 )(aricella , which #ay rarely result in co#plicationsincluding encephalitis or pneu#onia. &(en when clinical sy#pto#s of chic*enpo3 ha(e resol(ed, 606re#ains dor#ant in el ner(ous syste# of el infected person )(irus latency , in el trige#inal and dorsalroot ganglia.E1F In about 1>N2>M of cases, 606 reacti(ates later in life producing a disease *nown asshingles. -erious co#plications of shingles include poselrpetic neuralgia, /oster #ultiple3, #yelitis,herpes ophthal#icus, or /oster sine herpete.

Kerpes /oster )or si#ply /oster , co##only *nown as shingles and also *nown as /ona, is a (iral diseasecharacteri/ed by a painful s*in rash with blisters in a li#ited area on one side of el body, often in a stripe.&l initial infection with (aricella /oster (irus )606 causes el acute )short!li(ed illness chic*enpo3which generally occurs in children and young people. Once an episode of chic*enpo3 has resol(ed, el(irus is not eli#inated fro# el body but can go on to cause shingles an illness with (ery differentsy#pto#s often #any years after el initial infection.


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http8??en.wi*ipedia.org?wi*i?Kerpes /oster

15.

Cardiac ta#ponade is caused by a large or uncontrolled pericardial effusion, i.e. el buildup of fluid insideel pericardiu#.E2F his co##only occurs as a result of chest trau#a )both blunt and penetrating ,E$F but

can also be caused by #yocardial rupture, cancer, urae#ia, pericarditis, or cardiac surgery,E2F and rarelyoccurs during retrograde aortic dissection.

http8??en.wi*ipedia.org?wi*i?Cardiac ta#ponade

1@. A

An acetylcholinesterase inhibitor )often abbre(iated ACh&I or anti!cholinesterase is a che#ical thatinhibits el cholinesterase en/y#e fro# brea*ing down acetylcholine, increasing both el le(el and durationof action of el neurotrans#itter acetylcholine.

-o#e #a'or effects of cholinesterase inhibitors8

Actions on el autono#ic ner(ous syste#, that is parasy#paeltic ner(ous syste# will cause bradycardia,

hypotension, hypersecretion, bronchoconstriction, I tract hyper#otility, and decrease intraocular pressure.

- H% & syndro#e.

Actions on el neuro#uscular 'unction will result in prolonged #uscle contraction.

http8??en.wi*ipedia.org?wi*i?Acetylcholinesterase inhibitor

http://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Cardiac_tamponadehttp://en.wikipedia.org/wiki/Acetylcholinesterase_inhibitorhttp://en.wikipedia.org/wiki/Herpes_zosterhttp://en.wikipedia.org/wiki/Cardiac_tamponadehttp://en.wikipedia.org/wiki/Acetylcholinesterase_inhibitor


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1B. &

I 28 -ecreted by h cells. -ti#ulates growth of helper and cytoto3ic cells ) JA page 2>5

is an interleu*in, a type of cyto*ine i##une syste# signaling #olecule, which is a leu*ocytotrophichor#one that is instru#ental in el body:s natural response to #icrobial infection and in discri#inating

between foreign )non!self and self. I !2 #ediates its effects by binding to I !2 receptors, which aree3pressed by ly#phocytes, el cells that are responsible for i##unity.

http8??en.wi*ipedia.org?wi*i?Interleu*in 2

1D. %

4eripheral (ascular disease )46% , co##only referred to as peripheral arterial disease )4A% or peripheral artery occlusi(e disease )4AO% , refers to el obstruction of large arteries not within elcoronary, aortic arch (asculature, or brain. 46% can result fro# aelrosclerosis, infla##atory processesleading to stenosis, an e#bolis#, or thro#bus for#ation. It causes eielr acute or chronic ische#ia )lac* of

blood supply . Often 4A% is a ter# used to refer to aelrosclerotic bloc*ages found in el lower e3tre#ity.E1F

46% also includes a subset of diseases classified as #icro(ascular diseases resulting fro# episodalnarrowing of el arteries )=aynaud:s pheno#enon , or widening elreof )erythro#elalgia , i.e. (ascularspas#s.4eripheral artery occlusi(e disease is co##only di(ided in el Jontaine stages, introduced by =enPJontaine in 195 for ische#ia8E2FE$F

1. "ild pain when wal*ing )claudication , inco#plete blood (essel obstruction<

2. -e(ere pain when wal*ing relati(ely short distances ) inter#ittent claudication , pain triggered bywal*ing Qafter a distance of R15> # in stage IIa and after

http://en.wikipedia.org/wiki/Interleukin_2http://en.wikipedia.org/wiki/Interleukin_2


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19.

A G8 "ost co##on cause of acute renal failure in el hospital. -elf re(ersible, but fatal if left untreated)pro(ide supporti(e dialysis . Associated with renal ische#ia.

o3ic A G can be caused by free he#oglobin or #yoglobin, by #edication such as antibiotics andcytostatic drugs, or by into3ication )ethylene glycol, Qanti!free/eQ .

Kistopathology8 o3ic A G is characteri/ed by pro3i#al tubular epielliu# necrosis )no nuclei, intenseeosinophilic ho#ogeneous cytoplas#, but preser(ed shape due to a to3ic substance )poisons, organicsol(ents, drugs, hea(y #etals . Gecrotic cells fall into el tubule lu#en, obliterating it, and deter#iningacute renal failure. ase#ent #e#brane is intact, so el tubular epielliu# regeneration is possible.

lo#eruli are not affected

http8??en.wi*ipedia.org?wi*i?Acute tubular necrosis

19.

A G, It #ay be classified as eielr to3ic or ische#ic. o3ic A G occurs when el tubular cells are e3posedto a to3ic substance )nephroto3ic A G . Ische#ic A G occurs when el tubular cells do not get enougho3ygen, a condition that ely are highly sensiti(e and susceptible to, due to elir (ery high #etabolis#.

Acute tubular necrosis is classified as a QrenalQ )i.e. not pre!renal or post!renal cause of Acute renalfailure. %iagnosis is #ade by a JeGA )fractional e3cretion of sodiu# R $M and presence of #uddy castsin urinalysis. On histopathology, elre is usually tubulorrhe3is, that is, locali/ed necrosis of el epielliallining in renal tubules, with focal rupture or loss of base#ent #e#brane. 4ro3i#al tubule cells can shedwith (ariable (iability and not be purely QnecroticQ.

2>.

http://en.wikipedia.org/wiki/Acute_tubular_necrosishttp://en.wikipedia.org/wiki/Acute_tubular_necrosis


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eish#ania is a genus of rypanoso#atid proto/oa, and is el parasite responsible for el diseaseleish#aniasis. It is spread through sandflies of el genus 4hleboto#us in el Old Sorld, and of el genus

ut/o#yia in el Gew Sorld. &lir pri#ary hosts are (ertebrates< eish#ania co##only infects hyra3es,canids, rodents, and hu#ans.

Cutaneous leish#aniasis )locali/ed and diffuse infections appear as ob(ious s*in reactions.

&l #ost co##on is el Oriental -ore )caused by Old Sorld species . #a'or, . tropica, and . aethiopica .In el Gew Sorld, el #ost co##on culprits is . #e3icana.

Cutaneous infections are #ost co##on in Afghanistan, ra/il, Iran, 4eru, -audi Arabia and -yria.

http8??upload.wi*i#edia.org?wi*ipedia?co##ons?e?e>? eish#aniasis life cycle d...ra# en.s(gn

21.%%

!-eru# HG?cr ratio is greater than 15 and this is prerenal a/ote#ia....which is caused by a decrease incardiac output)e(idenced by el increase in heart rate and decreased 4 in el ;uestion ste# ....el decreasedcardiac output causes hypoperfusion of el *idneys ...and else causes A decrease in J= ...this in turncauses An increase in HG and Cr

22.

Ke#iballis#us is usually characteri/ed by in(oluntary flinging #otions of el e3tre#ities. &l #o(e#ents

are often (iolent and ha(e wide a#plitudes of #otion.&ly are continuous and rando# and can in(ol(e pro3i#al and?or distal #uscles on one side of el body. -o#e cases e(en include el facial #uscles.

It is co##on for ar#s and legs to #o(e togeelr. &l #ore a patient is acti(e, el #ore el #o(e#entsincrease. Sith rela3ation co#es a decrease in #o(e#ents.

&l subthala#ic nucleus essentially pro(ides el e3cite#ent needed to dri(e el globus pallidus. In'ury to thisarea or its efferent or afferent connections can induce this disorder. &l structure itself is a regulator of

http://upload.wikimedia.org/wikipedia/commons/e/e0/Leishmaniasis_life_cycle_d...ram_en.svgnhttp://upload.wikimedia.org/wikipedia/commons/e/e0/Leishmaniasis_life_cycle_d...ram_en.svgn


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#otor function and is also in(ol(ed in associati(e and li#bic functions.

It was traditionally thought that el disorder was only caused by in'ury to el subthala#ic nucleus, but newstudies are showing that da#age to oelr areas of el brain can also be responsible for causing this disorder.Ke#iballis#us caused by lesions in el subthala#ic nucleus is #ore se(ere than oelr for#s of el disorder

2$.AA

for ; 2$... egally, a patient is inco#petent if unable to do el following8

!! )1 respond *nowingly and intelligently to ;uestions about reco##ended treat#ent<

!!)2 participate in treat#ent decisions by #eans of rational thought processes< and

!! )$ understand el ite#s of #ini#u# basic #edical treat#ent infor#ation with respect to that treat#ent

!!hence el paranoid schi/ophrenic patient is legally co#petent and able to decide and refuse treat#ent....

it could be said that e(en a patient whose :delusions are plainly irrational :#ay be co#petent to #a*e atreat#ent decision if he or she fulfills el following criteria

1!co#prehending and retaining infor#ation relating to el decision

2!belie(ing el infor#ation pro(ided by el treating physician

$!weighing it in el balance when #a*ing a choice....

2 .AA


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A/athioprine is an i##unosuppressi(e agent. It is first #etabolised to @!#ercaptopurine, which in turn iscon(erted to inacti(e products by 3anthine o3idase. Allopurinol inhibits el second step of #etabolis#, andhigher @!#ercaptopurine plas#a le(els result, with associated to3ic effects on el bone #arrow and oelrtissues. &l resulting blood dyscrasias, leucopenia, thro#bocytopenia or pancytopenia, can be lifethreatening.

25.%% -taphylococcus aureus 8is a facultati(e anaerobic, ra#!positi(e coccus, and is el #ostco##on cause of staph infections. It is fre;uently part of el s*in flora found in el nose and on s*in. About2>M of el hu#an population are long!ter# carriers of -. aureus

-. aureus can cause a range of illnesses fro# #inor s*in infections, such as pi#ples, i#petigo, boils)furuncles , cellulitis folliculitis, carbuncles, scalded s*in syndro#e, and abscesses, to life!threateningdiseases such as pneu#onia, #eningitis, osteo#yelitis, endocarditis, to3ic shoc* syndro#e ) -- , chest

pain, bactere#ia, and sepsis.

2@.&&

; 2@!!Shen el patient ca#e to el clinic to be fitted for el diaphrag#...she is gonna be gi(en infor#edconsent before el procedure....and one part of el infor#ed consent is ...infor#ing el patient about

alternati(e treat#ent benefits and disad(antages....

!!si#ply put...before any procedure ...infor#ed consent....part of that is e3plaining alternati(es...


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2B.%% u dont ha(e to *now el e3act che#ical reaction...and el e3act inter#ediates and el en/y#es...!!el;uestion is about regulation of #etabolis# by inter#ediates

!!!in el ;uestion co#pund 5 is produced fro# co#pund by el en/y#e % ....and when this reaction produces #ore co#pund 5 ...co#piund 5 inturn regulates &n/y#e % by negati(e feed bac*....#y answeris &n/y#e %...which is %%%%

2B...% is wrong for sure.......

el answer *ey is .... waiting for e3planation

2D.A

-ic*le!cell disease #ay lead to (arious acute and chronic co#plications, se(eral of which are potentiallylethal.

-ic*le cell crisis

-ic*le cell disease results in anae#ia and crisis that could be of #any types including el (aso!occlusi(ecrisis, aplastic crisis, se;uestration crisis, hyper hae#olytic crisis and oelrs. "ost episodes of sic*le cellcrises last between fi(e and se(en days.

6aso!occlusi(e crisis4ain crisis, or sic*le crisis ! when el flow of blood is bloc*ed to an area because el sic*led cells ha(e

beco#e stuc* in el blood (essel. &lse are also called Q(asoocclusi(e crises.Q &l pain can occur anywhere, but #ost often occurs in el chest, ar#s and legs. 4ainful swelling of el fingers and toes, called dactylitis,can occur in infants and children under $ years of age. 4riapis# is a painful sic*ling that occurs in el

penis. Any interruption in blood flow to el body can result in pain, swelling and possible death of elsurrounding tissue not recei(ing ade;uate blood and o3ygen.


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29.C

Geuroleptic #alignant syndro#e )G"- is a life! threatening neurological disorder #ost often caused byan ad(erse reaction to neuroleptic or antipsychotic drugs. It generally presents with #uscle rigidity, fe(er,autono#ic instability and cogniti(e changes such as deliriu#, and is associated with ele(ated creatine

phospho*inase )C4 .

Incidence of el disease has declined since its disco(ery )due to changes in prescription habits , but it isstill a potential danger to patients being treated with antipsychotics. ecause of its unpredictability, elre isno one set course of action to treat el syndro#e, but generally, re#o(al of el antipsychotic drug treat#ent,along with supporti(e #edical #anage#ent, lead to a positi(e outco#e.

$>.A

Jerritin ser(es to store iron in a non!to3ic for#, to deposit it in a safe for#, and to transport it to areaswhere it is re;uired. &l function and structure of el e3pressed ferritin protein (aries in different cell types.

his is controlled pri#arily by how #uch #=GA is translated, and how stable el #=GA is. #=GAconcentration is furelr twea*ed by changes to how it is stored and how efficiently it is transcribed.&l

presence of iron itself is a #a'or trigger for el production of ferritin, with so#e e3ceptions )such as elyol* ferritin of el gastropod y#naea, which lac*s an iron!responsi(e unit .

Jree iron is to3ic to cells as it acts as a catalyst in el for#ation of free radicals fro# reacti(e o3ygenspecies (ia el Jenton =eaction. Kence (ertebrates use an elaborate set of protecti(e #echanis#s to bindiron in (arious tissue co#part#ents. Sithin cells, iron is stored in a protein co#ple3 as ferritin orhe#osiderin. Apoferritin binds to free ferrous iron and stores it in el ferric state. As ferritin accu#ulateswithin cells of el reticuloendoellial syste#, protein aggregates are for#ed as he#osiderin. Iron in ferritinor he#osiderin can be e3tracted for release by el =& cells although he#osiderin is less readily a(ailable.Hnder steady state conditions, el seru# ferritin le(el correlates with total body iron stores< thus, el seru#ferritin J=5=l is el #ost con(enient laboratory test to esti#ate iron stores.


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$1.&&

Geuroblasto#a..."ost co##on tu#or of el adrenal #edulla in children.

can occur anywhere along el sy#paeltic chain

K6A...itis abrea*down product of %opa#ine in urine

G!"TC...oncogene

less li*ely to de(elop K G

$2.CC

"ost #alignant )cancerous li(er tu#ors arise when cancer spreads )#etastasi/es fro# anoelr part of el body to el li(er, #ost co##only fro# el colon.

$1. &

Geuroblasto#a is el #ost co##on e3tracranial solid cancer in childhood and el #ost co##on cancer ininfancy. Close to 5> percent of neuroblasto#a cases occur in children younger than two years old. It is aneuroendocrine tu#or, arising fro# any neural crest ele#ent of el sy#paeltic ner(ous syste# or -G-. It


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#ost fre;uently originates in one of el adrenal glands, but can also de(elop in ner(e tissues in el nec*,chest, abdo#en, or pel(is.

Geuroblasto#a is one of el few hu#an #alignancies *nown to de#onstrate spontaneous regression fro#an undifferentiated state to a co#pletely benign cellular appearance. It is a disease e3hibiting e3tre#eheterogeneity, and is stratified into three ris* categories8 low, inter#ediate, and high ris*. ow!ris*disease is #ost co##on in infants and good outco#es are co##on with obser(ation only or surgery,whereas high!ris* disease is difficult to treat successfully e(en with el #ost intensi(e #ulti!#odalelrapies a(ailable.

&l first sy#pto#s of neuroblasto#a are often (ague #a*ing diagnosis difficult. Jatigue, loss of appetite,fe(er, and 'oint pain are co##on. -y#pto#s depend on pri#ary tu#or locations and #etastases if

present.

$$.

&l #uscular branches of el radial ner(e supply el riceps brachii, AnconUus, rachioradialis, &3tensorcarpi radialis longus, and rachialis, and are grouped as #edial, posterior, and lateral.

http8??en.wi*ipedia.org?wi*i?Jile8Ku#erus spiral fracture.png

http8??upload.wi*i#edia.org?wi*ipedia?co##ons?e?e2? rayD1D.png

$ . A

A co#plete #ole is caused by a single sper# co#bining with an egg which has lost its %GA )el sper# elnredupplicates for#ing a Qco#pleteQ @ chro#oso#e set &l genotype is typically @,++ )diploid due tosubse;uent #itosis of el fertili/ing sper#, but can also be @,+T )diploid .

In contrast, a partial #ole occurs when an egg is fertili/ed by two sper# or by one sper# which

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reduplicates itself yielding el genotypes of @9,++T )triploid or 92,+++T );uadraploid . Co#pletehydatidifor# #oles ha(e a higher ris* of de(eloping into choriocarcino#a !! a #alignant tu#or oftrophoblast cells !! than do partial #oles.

Choriocarcino#a is a #alignant, trophoblastic and aggressi(e cancer, usually of el placenta. It ischaracteri/ed by early he#atogenous spread to el lungs. It belongs to el far end of el spectru# ofgestational trophoblastic disease ) % , a subset of ger# cell tu#ors.

$5.%

4yelonephritis is an ascending urinary tract infection that has reached el pyelu# )pel(is of el *idney. If elinfection is se(ere, el ter# QurosepsisQ is used interchangeably )sepsis being a syste#ic infla##atoryresponse syndro#e due to infection . It re;uires antibiotics as elrapy, and treat#ent of any underlyingcauses to pre(ent recurrence. It is a for# of nephritis. It can also be called pyelitis.

-e(ere cases of pyelonephritis lead to sepsis, a syste#ic response to infection characteri/ed by fe(er, araised heart rate, rapid breathing and decreased blood pressure )occasionally leading to septic shoc* .Shen pyelonephritis or oelr urinary tract infections lead to sepsis, it is ter#ed urosepsis.

"ost cases of Qco##unity!ac;uiredQ pyelonephritis are due to bowel organis#s that enter el urinary tract.Co##on organis#s are &. coli )B>!D>M and &nterococcus faecalis. Kospital!ac;uired infections #ay bedue to colifor#s and enterococci, as well as oelr organis#s unco##on in el co##unity )e.g. lebsiellaspp., 4seudo#onas aeruginosa . "ost cases of pyelonephritis start off as lower urinary tract infections,#ainly cystitis and prostatitis.

$@.%

&l posterior inferior cerebellar artery )4ICA , el largest branch of el (ertebral artery, is one of el three#ain arterial blood supplies for el cerebellu#.


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It winds bac*ward around el upper part of el #edulla oblongata, passing between el origins of el (agusand accessory ner(es, o(er el inferior cerebellar peduncle to el undersurface of el cerebellu#, where itdi(ides into two branches.&l #edial branch continues bac*ward to el notch between el two he#ispheresof el cerebellu#< while el lateral supplies el under surface of el cerebellu#, as far as its lateral border,where it anasto#oses with el anterior inferior cerebellar and el superior cerebellar branches of el basilarartery.

ranches fro# this artery supply el choroid ple3us of el fourth (entricle.%iseases

Infarction of this artery due to thro#bosis or a stro*e leads to lateral #edullary syndro#e, also *nown as4ICA syndro#e or Sallenberg syndro#e. -e(ere occlusion of this or (ertebral arteries could lead toKorner:s -yndro#e as well.

http8??upload.wi*i#edia.org?wi*ipedia?co##ons?2?2e?Circle of Sillis en.s(g

$5.%

Acute pyelonephritis is a potentially organ! and?or life!threatening infection that characteristically causesso#e scarring of el *idney with each infection and #ay lead to significant da#age to el *idney )any gi(enepisode , *idney failure, abscess for#ation )eg, nephric, perinephric , sepsis, or sepsissyndro#e?shoc*?#ultiorgan syste# failure.

"ost cases of Qco##unity!ac;uiredQ pyelonephritis are due to bowel organis#s that enter el urinary tract.Co##on organis#s are &. coli )B>!D>M and &nterococcus faecalis.

Antibiotics are el #ainstay of treat#ent. "ild cases #ay be treated with oral elrapy, but generallyintra(enous antibiotics are re;uired for el initial stages of treat#ent. &l type of antibiotic depends on local

practice, and #ay include fluoro;uinolones )e.g. ciproflo3acin , beta!lacta# antibiotics )e.g. a#o3icillinor a cephalosporin , tri#ethopri# )alone or in co#bination with sulfa#etho3a/ole . A#inoglycosides aregenerally a(oided due to elir to3icity, but #ay be added for a short duration.

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$B.A

a#bert!&aton #yaselnic syndro#e ) &"- #ain causal cancer s#all!cell lung cancer

In &"-, antibodies against 6 CC, particularly el 4? !type 6 CC, decrease el a#ount of calciu# thatcan enter el ner(e ending, hence less acetylcholine can be #obili/ed to el neuro#uscular 'unction. Apartfro# s*eletal #uscle, el autono#ic ner(ous syste# also re;uires acetylcholine neurotrans#ission< thise3plains el occurrence of autono#ic sy#pto#s in &"-. 4? (oltage!gated calciu# channels are alsofound in el cerebellu#, e3plaining why so#e e3perience proble#s with coordination. Antibodies #ayalso bind oelr 6 CCs. "any people with &"-, both with and without 6 CC antibodies, ha(edetectable antibodies against el "1 subtype of el acetylcholine receptor< it is thought that elir presence

participates in a lac* of co#pensation for el slow calciu# influ3.

$D.C

lycogen storage disease type I ) -% I or (on ier*e:s disease, is el #ost co##on of el glycogenstorage diseases. his genetic disease results fro# deficiency of el en/y#e glucose!@!phosphatase. hisdeficiency i#pairs el ability of el li(er to produce free glucose fro# glycogen and fro# gluconeogenesis.-ince else are el two principal #etabolic #echanis#s by which el li(er supplies glucose to el rest of el

body during periods of fasting, it causes se(ere hypoglyce#ia. =educed glycogen brea*down results inincreased glycogen storage in li(er and *idneys, causing enlarge#ent of both. oth organs functionnor#ally in childhood but are susceptible to a (ariety of proble#s in el adult years. Oelr #etabolicderange#ents include lactic acidosis and hyperlipide#ia. Jre;uent or continuous feedings of cornstarchor oelr carbohydrates are el principal treat#ent. Oelr elrapeutic #easures #ay be needed for associated

proble#s.

$9.AA

AC& inhibitors reduce el progress of diabetic nephropathy independently fro# elir blood pressure!lowering effect. his action of AC& inhibitors is used in el pre(ention of diabetic renal failure.

AC& inhibitors bloc* el con(ersion of angiotensin I to angiotensin II.


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Hnder nor#al conditions, angiotensin II will constrict el efferent arterioles of el *idney leads to increased perfusion pressure in el glo#eruli....Rinc J=.

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hro#bo3ane A2 ) +A2 , produced by acti(ated platelets, has prothro#botic properties, sti#ulatingacti(ation of new platelets as well as increasing platelet aggregation.

1.CC

A%& HA & %O-&- OJ "A G&-IH" =I-I ICA & "AT CAH-& %IA==K&A %H& O &AC IOG OJ -O H & "A G&-IH" -A - IG & &G &=IC =AC .

"agnesiu# trisilicate is an inorganic co#pound that is used as a food additi(e.

It can also be used in oral phar#aceutical for#ulations and food products as a glidant. It is also usedelrapeutically as an antacid, and also for el treat#ent of ciproflo3acin o(erdose or to3ic

2.AA

Geisseria #eningitidis, el #eningococcus, is a ra#!negati(e, o3idase!positi(e diplococcus.


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identical in its staining and #orphological characteristics to Geisseria gonorrhoeae.

Kowe(er, at an ultrastructural le(el, G. #eningitidis has a pro#inent polysaccharide capsule not seen in elgonococcus.

&l capsule is antiphagocytic and is an i#portant (irulence factor in #eningococcal disease. G.#eningitidis strains are grouped on el basis of elir capsular polysaccharides, into 12 serogroups, so#e ofwhich are subdi(ided according to el presence of outer #e#brane protein and lipopolysaccharideantigens.

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Co#pensated =espiratory acidosis.........low 4K,low icarbonate ,and low 4co2 while

Hnco#pensated =espiratory acidosis .....low 4K, low icarbonate and high 4co2

2.A

Geisseria #eningitidis is a heterotrophic gra#!negati(e diplococcal bacteriu# best *nown for its role in#eningitis and oelr for#s of #eningococcal disease such as #eningococce#ia.

ipooligosaccharide ) O- is a co#ponent of el outer #e#brane of G. #eningitidis which acts as anendoto3in which is responsible for fe(er, septic shoc*, he#orrhage due to el destructions of red bloodcells.E9F Oelr (irulence factors include a polysaccharide capsule which pre(ents host phagocytosis and

aids in e(asion of el host i##une response< and fi#briae which #ediate attach#ent of el bacteriu# to elepiellial cells of el nasopharyn3


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.AA

In nor#al patients, after a s#all a#ount of gas has been e3haled, el flow is li#ited by airwayco#pression and deter#ined by el elastic recoil of el lung and resistance upstrea# of that point.

In restricti(e diseases, el #a3i#u# flow rate is reduced, as is el total (olu#e e3pired. &l flow isabnor#ally high in el latter part of e3piration because of increased recoil.

In obstructi(e diseases, el flow rate is (ery low in relation to lung (olu#e, and a scooped out appearanceis often seen following el point of #a3i#al flow.

http8??www.frca.co.u*?article.asp37articleidV1>>>2$

5. ,

I need e3planation please .....

@. %

-e(ere co#bined i##unodeficiency )-CI% , )also *nown as QAly#phocytosis,Q Q lan/#annN=ini*ersyndro#e,Q Q-e(ere #i3ed i##unodeficiency syndro#e,Q and Q hy#ic aly#phoplasiaQ is a geneticdisorder in which both Qar#sQ ) cells and cells of el adapti(e i##une syste# are i#paired due to adefect in one of se(eral possible genes.

-CI% is a se(ere for# of heritable i##unodeficiency. It is also *nown as el Qbubble boyQ disease becauseits (icti#s are e3tre#ely (ulnerable to infectious diseases and so#e of el#, such as %a(id 6etter, beco#efa#ous for li(ing in a sterile en(iron#ent.

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-CI% is el effect of a highly co#pro#ised, so #uch it is al#ost considered absent, i##une syste#. &lgene #utations that cause -CI% are not 'ust for el disorder. &l buildup of dA 4, which induces el cell to#a*e cytochro#e c, destroys and signals for apoptosis in all rapidly proliferating cells. his includes cellsin el I tract, i##une syste# ly#phocytes, and sper# cells.

Chronic diarrhoea, ear infections, recurrent 4neu#ocystis 'iro(ecii pneu#onia, and profuse oralcandidiasis co##only occur. &lse babies, if untreated, usually die within 1 year due to se(ere, recurrentinfections unless ely ha(e undergone successful Ke#atopoietic ste# cell transplantation.

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=espiratory acidosis with #etabolic acidosis.

Hsing el winter:s for#ula, calculate el 4CO2

4CO2V 1.5 W KCO$ XD )X?!2

1.5 W 12 X D )X?!2

V2@ )X?!2

&lrefore elre is no co#pensation and thus since 4co2 is high and Kco$ is low,it is both respiratoryacidosis with #etabolic acidosis.

nor#al KCO$ range is 22! 2@

and in this case it is 12 thus it is also #etabolic acidosis.

5.

pyse#a...per#anent enlarge#ent of all part of el respiratory unit...respiratory


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bronchioles,al(eolar,al(eoli

Causes8

cigarette s#o*ing

alpha1 antitrypsin deficiency

&lre are 2 types....

1.Centriacinar...is charachteri/ed by trapping of air in el respiratory bronchiole...elastic fibers of el distal are destroyed,causing obbstruction to airflow...this causes el trapped air to distend el = s,whose

elastic tissue support is destroyed.

2.panacinar...is charachteri/ed by trapping of air in el entire respiratory unite behindd el collapsed

http8??www.google.co#?i#gres7i#gurlVhttp8??www.#eddean.luc.edu?lu#en?#eded?=a...>C s 9 &wAg

B.&&

D.%%

...&l study design is Case Control and in case control studies u can only deter#ine el pre(alence of eldisease...In this case el duration is one year and it is period pre(alence raelr than point pre(alence

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9.AA

&l sarcoplas#ic reticulu# ser(es as a repository for CaXX.

1.In rested #uscle, CaXX is found in high concentration in el cisternae at el triad.

2.In recently acti(e #uscle, el calciu# is found in el narrowed, longitudinal portion fro# which it #o(esto el triad as ti#e passes.

$.%uring contraction, CaXX is found in high concentration outside el sarcoplas#ic reticulu# a#ong el#yofila#ents

5>.&&

%iphelria to3oid el for#aldehyde!inacti(ated to3in of Corynebacteriu# diphelriae, used as an acti(ei##uni/ing agent against diphelria, usually in #i3tures with tetanus to3oid and pertussis (accine )% 4 or % a4 or with tetanus to3oid alone )% for pediatric use and d, which contains less diphelria to3oid, foradult use .

@ -CI% deficiencies in and cells!!!!!!!!!!this defect is early in el ste# Vcell differentition. 4resentswith recurrents (iral, bacterial , fungal and proto/oal infections, "ay ha(e #ultiple causes )failure tosynelsi/e "KCII antigens, defects I !2 receptors or adenosine deficiency

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Nbme 7 Block 3 Answers - Mod

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