NBME#3 block 2 Q1----------------------Q50 - maryam2009

[ArchivalUser]

**************************the latest correction:*****************************

7.E
The invasion and metastasis of cancer cells is a complex multistep process involving destruction of basement membranes as an early event in the metastatic cascade.

the invasion of human tumor cells through basement membranes may be the result of net type IV collagenolytic activity that is the result of a balance of activated enzyme species and inhibitors.

Q.32.E
***drona99

for this q ans is 6 septic shcok which is leading to ARDS
if we look into pathogenesis of ARDS

Pathogenesis
A--Acute damage to alveolar capillary walls and epithelial cells
Alveolar macrophages release cytokines.
Cytokines are chemotactic to neutrophils.
Neutrophils transmigrate into the alveoli through pulmonary capillaries.
***Capillary damage causes leakage of a protein-rich exudate producing hyaline membranes.
Neutrophils damage type I and II pneumocytes.
Decrease in surfactant causes atelectasis with intrapulmonary shunting.

B--Late findings
Repair by type II pneumocytes
Progressive interstitial fibrosis (restrictive lung disease)

***Raheem B

causes of aspiration pneumonia(OLD AGE)..........
•Coma
•Decreased or absent gag reflex in people who are not alert (unconscious or semi-conscious)
•Dental problems
•Disorders that affect normal swallowing
•Disorders of the esophagus (esophageal stricture, gastroesophageal reflux)
•Excessive alcohol use
•Medications that affect alertness
•Old age
•Sedatives

2-alveolar damage .....aspiration pneumonia..... coz in emphysema there is core pulmonale...amyloidosis no alveolar damage amyloid is extra cellular....pulm. odema and pneumonia no hyaline....septic shock no fever or septic pathology...best regard

***sooner

i think answer is E,
take a look at rubin's path Page 126:

http://books.google.com/books?id=7HdzBBh...&q&f=false

4.D it is minimal change disease,because proteinuria>3.5 and no hypertention.

[ArchivalUser]

Q32.....
sodium - 03/19/11 16:40

---Q stem started with CHF then leading to pulmonary edema( sign of dyspnea) and when you read the last sentence it says protienaceous hyaline material IN THE alveoli.which can happen only when there is a leak of the capillary i.e the capillaries surrounding the alveoli are damaged and the protiens from the capillary leaked into alveoli.


1.cardiogenic cause of pulmonary edema--- presents with TRANSUDATE.due to increase in hydrostatic pressure.( here there will be no damage of the alveoli or there will be any leak).one way of distinguishing is measuring PCWP if its more than its cardiogenic.

2. NON-cardiogenic cause of pul.edema---presents with EXUDATE.due to leaky capillaries also called as leaky capillary syndrome or DAD( diffuse alveolar damage).if pul. edema due to lungs than the PCWP would be low.

a) same as in septic shock--- with the help of cytokines like IL-1 and TNF-alpha mediates for sepsis. now it can be called as endotoxic shock.this would be a general term.happening elsewhere other than the lungs..

if the same process happens in the alveoli as our friend DRONA explained in detail how the neutrophils arrived to alveoli. now we call it as DAD or leaky capillary syndrome .(ARDS)

causes of sepsis are already been explained by our friends very nicely---

so here is the trend how it follows----

SEPTIC SHOCK----(24 HOURS)------> ARDS ------( 48 HOURS)-------> DIC.

ty.

[ArchivalUser]

bump

[ArchivalUser]

Q32

I think it's EE pulm edema

one of the causes of pulmonary edema itself can be ARDS....or they can be present togather...

look at pictures here..
the q stem more points towards pulmonary edema..

http://peir.path.uab.edu/iplab/messages/598/459.html....

look at the noncardiogenic causes of pulmonary edema...
It says pulm edema can be present with ARDS..

Causes

Pulmonary edema is either due to direct damage to the tissue or a result of inadequate functioning of the heart or circulatory system.
When directly or indirectly caused by increased pulmonary blood pressure, pulmonary edema may appear when this pressure increases from the normal 15 mmHg to above 25 mmHg.


Cardiogenic
Congestive heart failure
Severe heart attack with left ventricular failure
Severe arrhythmias (tachycardia/fast heartbeat or bradycardia/slow heartbeat)
Hypertensive crisis
Pericardial effusion with tamponade
Fluid overload, e.g., from kidney failure or intravenous therapy


Non-cardiogenic
May occur after upper airway obstruction, intravenous fluid overload, neurogenic causes (seizures, head trauma, strangulation, electrocution). Can also be seen with ARDS (acute respiratory distress syndrome):

Alveolar
Inhalation of toxic gases
Pulmonary contusion, i.e., high-energy trauma
Aspiration, e.g., gastric fluid or in case of drowning
Reexpansion, i.e. post [[large volume thoracentesis, resolution of pneumothorax, post decortication, removal of endobronchial obstruction
Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation
Immersion pulmonary edema[5][6]
Multiple blood transfusions
Severe infection


Other/unknown
Multitrauma, e.g., severe car accident
Neurogenic, e.g., subarachnoid hemorrhage
Certain types of medication, illicit drug use
Upper airway obstruction, i.e. negative pressure pulmonary edema
Arteriovenous malformation
Hantavirus pulmonary syndrome
Ascent to high altitude occasionally causes high altitude pulmonary edema (HAPE)
Envenomation, such as with the venom of Atrax robust...


i think its pulmonary Edema.........correct me if wrong!!

[ArchivalUser]

regarding the q 16 just to correct the answer .. sarim explained very well but just little thing he forgot .. if the patient is going to survive to 4 years years that means he survived 3 years wich it means the right equation should be 0.875 times 0.9 = 0.7875 which is c

[ArchivalUser]

ne1 for step 1 preparation for exam in nov??
reply here with skype id.

[ArchivalUser]

@sooner,its back pain because the pancreas is a retroperitoneal structure and problems her tend to radiate to the back.

[ArchivalUser]

test

[ArchivalUser]

32.E

sarim - 09/29/11 14:20

i'll pick "E"

Cardiogenic or Noncardiogeneic(e.g.ARDS) BOTH lead to "Pulmonary Edema"(Transudate or Exudate)......although it is the exudate that give us the Hyaline material.

-stem does not say much if the pt had septic shock....but that could also be the possibility......BUT on the other hand "Why not Pneumonia" as it can also lead to ARDS

-In either case end result is "Pulmonary Edema" that caused:

"alveolar damage with distended lymphatics, congested alveolar capillaries, and pink-staining homogenous proteinaceous hyaline material in alveoli".


is posted by Sarim