NBME 13:

Uterosacral
ligament is the
only structure
that extends
posteriorly and
attaches to
cervical region.
Local IL-1 and
TNF effects lead
to activation of
osteoclasts and
bone resorption in multiple myeloma! --> hypercalcemia
Cocaine works by inhibiting NE reuptake at the presynaptic
terminals.
Chronic malabsorption leading to signs of severe vitamin deficiencies
(retinal degeneration, ataxia, motor dysfunction) + acanthocytosis + low
cholesterol--> abetalipoproteinemia due to Apo B 100 deficiency
Exposure to paint thinner + ophthalmologic and neurologic symptoms +
anion gap metabolic acidosis--> probably methanol exposure (give
fomepizole = inhibits alcohol dehydrogenase)
Chronic transplant rejection carried out by CD8+ T cells is due to
direct cytotoxicity to graft cells
Withdrawal symptoms of heroin include hyper-excitability (over react to
stimuli around/startle response) and increased sympathetic discharge in
newborns.
Fibrosis = decreased tone (loss of function). Esophageal fibrosis->
decreased peristalsis and LES tone.
Tetanus toxin works by inhibiting release of the inhibitory neurotransmitter
glycine.
Cushing disease = hyperplasia of the cells in the zona fasciculata of the
adrenal glands
Homing - It is postulated that when tumor cells metastasize they are
guided by release of cytokines or by presence of certain cell surface
receptors, which explains why different tumors preferentially metastasize
to certain organs. In this question, the antibody that was given blocked
the cell surface receptors on liver cells preventing "homing" of tumor
cells to the liver.

Photograph shows a collection of blood vessels

of abnormal shape in the medial side of the
brain, together with the history of seizures =
congenital vascular malformation
You never insert a needle BELOW a rib since
the neurovascular bundle runs in the lower part
of the rib.
Thoracentesis should be done between 8th and
10th ribs to avoid lung injury.
Glucagon and Epinephrine use Gs, adenyl cyclase pathway.
Presence of weak pulse in lower limbs makes leaking aortic aneurysm the
most probable answer.
IgG response requires isotype switching from IgM which depends on T cell
stimulation to B cells, T cells in that case were not stimulated
because they recognize only protein antigens not
polysaccharides.
Hand cleansing is generally the most important and effective measure in
preventing nosocomial infections.
Praziquantel increases permeability of membranes to calcium, cause
paralysis and death of parasite.
Relative Risk < 1 = decreased risk. If CI doesnt contain 1 the result =
significant.
Using compression sleeves is one of the recommended treatments for
lymphedema.
Slow nerve conduction = problem in the myelin sheath = slowing down of
action potential propagation = depends on voltage gated Na channels. NT
gated channels = initial excitation to the nerve; impairment = absent
impulse not slowed conduction.
Tachycardia, hypertension, pupillary dilatation and diaphoresis: typical of
amphetamine and cocaine intoxication.
Pheochromocytoma, when such a tumor occurs outside the adrenal gland,
it is called paraganglioma.
Alcoholism selectively destroys the vermis (central) part of the
cerebellum which is responsible for coordination of truncal movements,
leading to gait
instability.

Collapse of the femoral head with preservation of the cartilage indicates

avascular (aka aseptic) necrosis; the cartilage being an avascular
structure
is protected from the effects of ischemia, while the femoral head is highly
vulnerable to ischemia due to its limited blood supply. The
corticosteroids taken by the patient is a known risk factor for
aseptic necrosis of the femur.
The thoracic portion of the esophagus takes blood supply from
branches of the aorta and the bronchial arteries.
Peptidyl transferase is an aminoacyltransferase which forms peptide
bonds (covalent) between adjacent amino acids using tRNAs
during the translation process of protein biosynthesis.
Function of myeloperoxidase = converting hydrogen peroxide into hyalide
radicals.
Adductor magnus (damage = weak hip adduction) origin: partially from
the inferior ramus of the ischium, and inserts into the medial side of the
femur.
Chediak-Higashi syndrome, an immunodeficiency syndrome with giant
granules in neutrophils and albinism, due to defective neutrophil function
because of failure of phagolysosome formation.
Acute intermittent porphyria is autosomal dominant. Except for
congenital erythropoietic porphyria (AR), all the other well-known types of
porphyria are AD.
HPV E6 protein is the only foreign protein in a cancer (from options) so it
produces the strongest immune response.
Branchial cyst, formed due to incomplete obliteration of the 2nd branchial
cleft by the branchial arch during embryonic development; it is found in
front of the anterior border of the sternomastoid muscle.
(The other cystic neck swelling, cystic hygroma, is found along the
posterior border).
High carboxyhemoglobin indicates CO poisoning, CO impairs oxidative
phosphorylation in the mitochondria by inhibiting the last step
catalyzed by the enzyme cytochrome oxidase (aka Cyt a+a3)
Whenever you see fever and are asked cytokine = IL-1!
Vertebral osteoporosis with a compression fracture associated with IL-1
(since it activates osteoclasts and is increased in postmenopausal
osteoporosis which is characterized by increased resorption).

The sequence (AATAAA) which is transcribed into (AAUAAA) is the signal

required to start adenylation and formation of the poly A tail, and it
is located downstream (3) of the coding region. The function of the tail is
to protect the mRNA from cleavage, in its absence most of the mRNA
would be broken down by the endonucleases in the nucleus.
Tyrosine kinases family acts as downstream effectors of various growth
factors.
Function through phosphorylating tyrosine residues on different
proteins.
Missense mutation = it didnt lead to a premature termination of
translation, so didnt affect the amount of the enzyme formed, so it
probably led to the formation of a non-functional enzyme that cant
phosphorylate.
Thyroid hormone is a steroid (lipid-soluble) so it acts intracellularly on a
nuclear receptor.
Periosteum = Inner layer has osteoblasts which cause new bone
formation post fracture.