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NBME 7 block 1 q 1 to 50 - maryam2009
#31
23.CC

Ganciclovir is an antiviral medication used to treat or prevent cytomegalovirus (CMV) infections
It is first phosphorylated to a deoxyguanosine triphosphate (dGTP) analogue. This competitively inhibits the incorporation of dGTP by viral DNA polymerase, resulting in the termination of elongation of viral DNA.

Adverse effects:
Ganciclovir is commonly associated with a range of serious haematological adverse effects. granulocytopenia, neutropenia, anaemia, thrombocytopenia, fever, nausea, vomiting, dyspepsia, diarrhoea, increased serum creatinine and blood urea concentrations

Toxicity:

Ganciclovir is considered a potential human carcinogen, teratogen, and mutagen. It is also considered likely to cause inhibition of spermatogenesis. Thus, it is used judiciously and handled as a cytotoxic drug in the clinical setting
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#32
24.EE

Holosystolic murmur is best heard at the apex in the left lateral decubitus position....Mitral Regurgitation .

Murmur:

Blowing holosystolic murmur
Heard best at the apex
Radiation to the axilla and inferior edge of left scapula.
Possible associated findings:

S2: wide physiologic splitting
S3

http://depts.washington.edu/physdx/heart/tech.html
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#33
25.DD

Coronary blood flow occurs mostly during diastole, because during systole the blood vessels within the myocardium are compressed. Increased heart rates, which reduce the time for diastole filling, can reduce the myocardial blood supply and cause ischaemia.

Dynamic exercise increases coronary blood flow in proportion to the heart rate, with peak values during maximal exercise typically three to five times the resting level .

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#34
26.FF

Severely premature infants may have underdeveloped lungs, because they are not yet producing their own surfactant. This can lead directly to respiratory distress syndrome, also called hyaline membrane disease, in the neonate.

To try to reduce the risk of this outcome, pregnant mothers with threatened premature delivery prior to 34 weeks are often administered at least one course of glucocorticoids, a steroid that crosses the placental barrier and stimulates the production of surfactant in the lungs of the fetus.
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#35
27.EE
in DKA
*beta-Hydroxybutyric acid is a ketone body....inc
*Due to loss of wather......inc. serum osmolality.
*The anion gap is the difference in the measured cations and the measured anions in serum, plasma, or urine. The magnitude of this difference (i.e. "gap") in the serum is often calculated in medicine when attempting to identify the cause of metabolic acidosis.

only Na+, Cl− and HCO3− (+/- K) are used when calculating the anion gap... healthy adults is 8-12 mEq/L

( [Na+] ) − ( [Cl−]+[HCO3−] )

a useful mnemonic to remember the high anion gap is MUDPILES (methanol, uremia, diabetic ketoacidosis, propylene glycol, isoniazid, lactic acidosis, ethylene glycol, salicylates).

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#36
28.DD

It is a Gram-negative, aerobic, rod-shaped bacterium with unipolar motility and oxidase positive

P. aeruginosa secretes a variety of pigments, including pyocyanin (blue-green),
Because it thrives on most surfaces, this bacterium is also found on and in medical equipment, including catheters, causing cross-infections in hospitals and clinics. It is implicated in hot-tub rash.

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#37
29.EE

Marfan syndrome can lead to mitral valve prolapse (MVP).
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#38
30. A
Beta thalasemia: prevalent in mediterranea population.
Defect: point mutation in splicing sites and promoter sequences
Beta thalasemia minor (heterozygote)
1. beta chain in unproduced
2. usually asyntomptomatic
3. Dx confirmed by increase HbA2 ( > 3.5%)
Beta thalasemia major: (Homozygote)
1. beta chain is absent- severe anemia requiring blood transfusion (2ยบ hemochromatosis)
2. Marrow expansion ( crew cut on skull x-ray)- skeletal defromities, chipmunk facies
Both major and minor - increase Hb F (FA page 343).

http://www.google.com/search?sourceid=na...halassemia
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#39
31. G
Beta 2 adrenergic agonist: Bronchodilation( relax bronchial smooth mucles)
http://en.wikipedia.org/wiki/Beta2-adrenergic_agonist
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#40
32. C
TSH: Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland, which regulates the endocrine function of the thyroid gland. TSH is the 1st step in evaluation of thyroid function.
http://en.wikipedia.org/wiki/Thyroid-sti...ng_hormone
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