NBME 4 block 4 Q 1 to 50 - maryam2009

[ArchivalUser]

*thrombosis , sorry for misspellings

34.DD

Physiologic compensation mechanisms for hemorrhage include initial peripheral and mesenteric vasoconstriction to shunt blood to the central circulation. This is then augmented by a progressive tachycardia and a fluid shift from interestitial to vascular compartment.

[ArchivalUser]

35.AA

***************between 2-4 days afte MI....
tissue sourronding infarct shows acute infalmmation,dilated vessels...hyperemia
neutrophil emigration
muscle shows extensive coagulative necrosis,
RISK FOR ARRHYTHMIA

Gross:
Hyperemia
****************first day...no vesible change by light microscopic....

contraction band visible after 1-2 h,early coagulative necrosis after 4 hs,release of contents of necrotic cells into bloodstream and begining of neutrophil emigration
Grros:
Dark mottling,pale with tetrazolium stain

******************5-10 days

RISK FOR FREE WALL RUPTURE,TAMPONADE,PUPILLARY MUSCLE RUPTURE
due to macrophages have degraded important structural components
outer zone...ingrowth of granulation tissues
Gross:
Hyperemic border
central yelloww-btown softening maximally yellow and soft by 10 days
*******************7 weeks

RISK FOR VENTRICULAR ANEURYSM

CONTRACTED scar complete

Gross:
Recanalized artery
Gray-white scar

[ArchivalUser]

36.AA

Cholestyramine removes bile acids from the body by forming insoluble complexes with bile acids in the intestine, which are then excreted in the feces. When bile acids are excreted, plasma cholesterol is converted to bile acid to normalize bile acid levels. This conversion of cholesterol into bile acids lowers plasma cholesterol concentrations

The following side effects have been noted.:

Most frequent: Constipation
Seldom: tooth discoloration, tooth enamel erosion, and premature tooth decay, all from prolonged oral exposure to the suspension
Increased risk for gallstones due to increased cholesterol concentration of bile.
l

[ArchivalUser]

26.BB
Coz we are decreasing the maximal response of the muscle, thats the characteristic of non-competitive blockade.

Phenoxybenzamine non-selective, irreversible alpha antagonist.
Phentolamine is non-selective competitive alpha blocker
Doxazosine, Prazosin & Tolazoline are selective alpha 1 receptor competitive blocker

posted by doc_study

37.AA
Appendicitis a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock.

Pain first, vomiting next and fever last has been described as classic presentation of acute appendicitis.
Signs include localized findings in the right iliac fossa. The abdominal wall becomes very sensitive to gentle pressure (palpation). Also, there is severe pain on suddenly releasing a deep pressure in lower abdomen rebound tenderness.

In case of a retrocecal appendix, however, even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix), the reason being that the cecum, distended with gas, prevents the pressure exerted by the palpating hand from reaching the inflamed appendix.

Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of the abdominal rigidity. In such cases, a digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point) and this is the least painful way to localize the inflamed appendix. If the abdomen on palpation is also involuntarily guarded (rigid), there should be a strong suspicion of peritonitis requiring urgent surgical intervention.

There are several sign that help to make diagnosis, I just write some of them that more positive:

Psoas sign
Psoas sign or "Obraztsova's sign" is right lower-quadrant pain that is produced with either the passive extension of the patient's right hip (patient lying on left side, with knee in flexion) or by the patient's active flexion of the right hip while supine. The pain elicited is due to inflammation of the peritoneum overlying the iliopsoas muscles and inflammation of the psoas muscles themselves. Straightening out the leg causes pain because it stretches these muscles, while flexing the hip activates the iliopsoas and therefore also causes pain.

Blumberg sign
Also referred as rebound tenderness. Deep palpation of the viscera over the suspected inflamed appendix followed by sudden release of the pressure causes the severe pain on the site indicating positive Blumberg's sign and peritonitis.

Blumberg sign
Also referred as rebound tenderness. Deep palpation of the viscera over the suspected inflamed appendix followed by sudden release of the pressure causes the severe pain on the site indicating positive Blumberg's sign and peritonitis.


for more information

http://en.wikipedia.org/wiki/Appendicitis

[ArchivalUser]

38.GG

Under normal physiological state, spleen vein, portal, such as the superior mesenteric vein blood from the portal vein flows through the liver, pooled in the inferior vena cava, the blood in circulation. Cirrhosis, liver cycle was severely damaged, portal system disruption of blood returning to increase the pressure, cirrhosis of the formation of an important pathological changes, "portal hypertension." As a direct-entry splenic vein vein, portal hypertension can delay returning splenic vein, reticuloendothelial cells and fibrous tissue proliferation, spleen congestion, so that congestive enlarged spleen. And hypersplenism phenomenon, clinical "liver and spleen syndrome

[ArchivalUser]

39.BB

Enterobiosis vermicularis....Pinworm
caused by food contaminated with eggs............intestinal infection........causes anal prurittus

Traetment:
Mebendazole/Pyantel Pamoate

[ArchivalUser]

40.FF

For acute kidney injury, the tubules are often (but not always) capable of recovering completely.
the replacement cells after injury are coming from the epithelium .

http://www.hsci.harvard.edu/newsroom/kidney-repair-shop

[ArchivalUser]

41.CC

Hyperphosphatemia occurs most often in patients with renal insufficiency. Most patients with acute or chronic renal failure have hyperphosphatemia to some degree.

Hyperphosphatemia causes hypocalcemia by precipitating calcium, decreasing vitamin D production, and interfering with parathyroid hormone-mediated bone resorption. Severe life-threatening hypocalcemia may result. Signs and symptoms of acute hyperphosphatemia are due to the effects of hypocalcemia.

Prolonged hyperphosphatemia promotes metastatic calcification, an abnormal deposition of calcium phosphate in previously healthy connective tissues such as cardiac valves and in solid organs such as muscles. The calcium-phosphate product predicts the risk of metastatic calcification

[ArchivalUser]

42.EE

WAYS TO REDUCE THE RISK OF UTI IN WOMEN:

Urinate within 10 - 15 minutes after sex may help prevent UTIs in women
Drinking 6--8 glasses of water each day
Routine drinking of cranberry juice
Urinating as soon as you feel the urge and completely emptying the bladder
Avoid excessive caffeine and alcohol use as these substances may irritate the bladder
Diaphragms and spermicides (nonoxynol-9) may increase UTIs in some women

43.DD

Bladder outlet incompetence
Lower motor neuron lesion (rare)

In women, multiple vaginal deliveries, pelvic surgery (eg, hysterectomy), or age-related changes (eg, atrophic urethritis)

In men, radical prostatectomy*
Intrinsic sphincter deficiency

Urethral hypermobility

[ArchivalUser]

43.??

the answer key is B ,but not sure ,waiting for correct answer