NBME 15 Missed

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11.

African American, bilateral hilar adenopathy, righ paratracheal node enlargment, noncaseating granuloma =???: sarcoidosis (ethnicity is risk factor)

44.

I Cell Disease MOA: mannose 6 phosphate addition allows enzymes to go to lysosome, but this is defective = abnormal targeting of these enzymes to lysosomes

40. 35.

aneurysm of PCA?: oculomotor nerve palsy (NOT Horner's) ATP concentration doesn't fall much dring normal twitches because?: ATP is quickly regenerated from creatine phosphate

19.

IkB function?: releases NFkB after undergoing phosphorylation incomplete penetrance vs. variable expressivity: IP = not all with mutant genotype show mutant phenotype; VE = genotype SAME, phenotype varies

39.

10.

baby, respiratory distress, cyanosis, narrow thorax, ears with periauricular skin tags, micrognathia, glossoptosis, mandibular cleft, short palate = which artch?: first arch (Treacher-Collins)
37. 15.

Loss of left vision in both eyes =?: occipital lobe lesion lump in upper neck, mass moves up with swallowing and tongue protusion, uptake of technetium 99m pertechnetate, what type of cells?: thyroid follicles

21.

blast proliferation, eosinophils?: CML (9:22) responds to imatinib

29.

Melanoma ABCDE: Asymmetry, Border irregularity, Color variation, Diameter >6 mm, Evolution over time Michaelis constant (Km) =?: Km = 1/2 Vmax normal heart weight (450), enlarged at 600g after poorly controlled HTN?: hypertrophy optic nerve, Chiasm, optic tract: parietal lesion = optic tract lesion

28.

brown-black, mottled, scaly, irregular borders, atypical melanocytes along basilar layer?: lentigo maligna (melanoma)
22. 32.

42. 45.

cervical cancer drains to?: internal iliac nodes defect in ihibitory NT = seizures, floppy baby: glycine receptor defect in renal ammoniagenesis, which substrate is source of ammonia production?: glutamine (and aspartate donate NH4 in agenesis)

17.

20.

2.

pain associated with diabetic neuropathy?: burning pain pain in shoulder, reproduced with resisted abduction at 90, giving thumbs down: supraspinatus

33.

34.

DEXA decreased bone density: increased osteoclast, RANKL, decreased osteoblast activity
1. 9.

pancreatic cancer associated with?: depression paraesophageal hernia: portion of gastric fundus herniates through the diaphragm parathyroid adenoma, decreased?: calcium concentration in feces postpartum hemorrhage treated with?: oxytocin progestin challenge with withdrawal bleed?: low estrogen production = estrogen increased in adipose tissue protease inhibitors (navirs): protein processing (assmebling of virions = cleave of polypeptide products of HIV mRNA into functional parts)

8.

DKA, give insulin, increases activity of which enzyme?: glucokinase Ejection Fraction equation: SV/EDV (EDV-ESV)/EDV elevated very-long-chain FA, phytanic acid, pipecolic acid = absence of?: peroxisomes (causes hypotonia, poor feeding)

4.

13.

30.

12. 14.

38.

germline mosaicism: produces disease that is not carried by parent's somatic cells
16.

3.

guy with ulcers, what to do to improve symptoms?: stop smoking heme biosynthesis pathway: glycine + succ (ALA synthase) 5-ALA (ALA dehydratase) porphobilinogen (PBG deaminase) Hydroxymethylbilane (uro synthase) Urophyrinogen III (Uro decarboxylase) Coproporphyrinogen III (Copro oxidase) protoporphyrinogen IX (proto oxidase) protophorphyrin (IX) ferrochelatase + Fe = HEME
36.

41.

renal failure causes loss of?: 1,25-dihydroxycholecalciferol (from decreased conversion via 1a-hydroxylase in PCT)

7.

Septic shock: high-output failure, decreased TPR, dilated arterioles, high venous return, hot patient side effect of H1 blocker: drowsiness stratified sample: NOT random, created to ensure a more representative sample of the population at large (ADHD more likely in boys than girls, therefore assigned differently)

43. 5.

Statin MOA (upregulate what?): LDL receptors

31.

Homozygous for point mutation (GT->AT) causes skipping of exon 12, mech?: RNA Splice error How to calculate A-a gradient: PAO2 - PaO2 (PAO2=150 PaCO2/0.8)

23.

25.

27.

Type I error =: saw a difference when none existed = p-value (false positive error) ubiquitin tagged proteins go where?: proteosome for degradation zanamivir, oseltamivir MOA: inhibits virion release

24. 6.

How to identify a variant protein?: immunohistochemistry

26.

Hypovolemic/cardiogenic shock: low-output failure, increased TPR, low CO, cold, clammy (hypovolemic = low volume, no JVD; cardiogenic = poor pumping, backflow, increased JVD)

18.