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NBME#2 block 2 Q1-----------Q50 - maryam2009
#1
Please choose and answer the Questions in order.Thank you
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#2
Q1. C. Habitation.

Habituation: decreased response with repeated stimulation.
Sensitization: increased response with repeated stimulation.

Punishment: aversive stimuli leads to decreased unwanted behavior.

Positive Reinforcement: something you want is being given.
Negative Reinforcement: something you do NOT want is being taken.

Look first aid P 436, 2010 ed.
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#3
Q2. A.

pt's with chronic renal disease will have low Ca and high PTH.


PTH vs. Ca. vs. Phosphate

Choice A. Chronic renal disease: initial = decreased Vit D, Consequence: decreased Ca, phosphate and high PTH (secondary hyperparathyroidism)

Choice B. Hyperparathyroidism: initial increased PTH, Consequence: increased Ca, decreased phosphate (loss in urine).

Choice E. high Ca, low PTH. like in Vitamin D poisoning, hypercalcemia of malignancy.

Choice C. shows normal calcium

Choice D: low calcium and low PTH: hypoparathyroidism.
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#4
Q3. D.

pt's having AF with rapid ventricular response. You control rate by Beta blocker or CCB or Digoxin.

Digoxin controls rate only at rest, whereas BB and CCB control at rest and exercise.
Question's asking about a drug to control rate at exercise and had listed on propranolol as a BB.

Note: pts with AF and having little symptoms because of AF will be better treated with rate control.
pts who have more severe disease or structural abnormality of the heart are unlikely to stay on sinus rhythm for a long time (rhythm control).
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#5
4. C.

Grave disease pt n asking for mechanism of the drug used in the Rx.

Methimazole or PTU, both inhibit thyroperoxidase activity (oxidation, organification and coupling).
PTU also inhibit peripheral T4 to T3 conversion and is better used in pregnant because it's better protein bound.

A journey to step 2 CK.
best treatment for hyperthyroidism is to control symptoms by using BB and achieve normal thyroid function by PTU/Meth, FOLLOWED BY definitive Rx (ablation). Surgery is done only for pregnant (2nd trimester) and children or massive thyroid enlargement.
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#6
Q5.C

Parkinson's disease
loss of dopaminegic neurons
degenerative disorder of CNS associated with LEWY BODIES .....composed OF ALPHA SYNUCLEIN OR UBIQUITIN and depigmentation of the SUBSTANIA NIGRA
rare case......exposure to heroin(1methyl-4-phenyl1,2,3,6tetrahydropyridin
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#7
Q5.C

MAY HAVE 2 TYPES OF EPITHELIA gastric/pancreatic
contain ectopic acid-secreting gastric mucousa and/or pancreatic tissue
can cause bleeding,intussuseption,volvolus,or obstruction near the TERMINAL ILEUM

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#8
Q7.D
Hodgkin's LYMPHOMA
presense of REED -STRENBURG cells
Good prognosis depends on high lymphocytes and low RS ...
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#9
Q8.A

bronchial carcinoid tumor.....low grade cancer of neuroendocrine origin no associattion with smoking
secretes serotonin,.....cause carcinoid syndrom..flushing,wheezing,diarrhea
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#10
Q9.B
Delirium
Waxing and waning level of conciousness
rapid decrease in attentionspan and level of arousal
acute change in mental status
disorgganized thinking
hallucinations
illusions
misperceptions
disturbance in sleep-wake cycle
cognitive dysfunction
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