NBME 7 block 4 q 1 to 50 - maryam2009

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Welcome....,Please choose and answer the Qs in order. We are always looking for more volunteers. ... Any help would be appreciated .Thank you.

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A- Cisplatin Dose-related and cumulative renal insufficiency, is the major dose-limiting toxicity of Cisplatin. Renal toxicity has been noted in 28% to 36% of patients treated with a single dose of 50 mg/m2. It is first noted during the second week after a dose and is manifested by elevations in BUN and creatinine, serum uric acid and/or a decrease in creatinine clearance. Renal toxicity becomes more prolonged and severe with repeated courses of the drug. Renal function must return to normal before another dose of Cisplatin can be given. Elderly patients may be more susceptible to nephrotoxicity.
The same side effects had the aminoglycosides and the loop diuretics

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2- the patient had a cryptococcal infection, this fungus is heavily encapsulated yest, found in soil, pingeon -droppings. Culture on Subouraud agar. Sain with India Ink and with the latex agglutination test detects polysaccharide capsular antigen.

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2-A see above explanation.

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3-A Diabetic nephropathy in light Micro Kimmelstiel-Wilson lesions "wire loop" the basement membrane is thick and in the pic you can see nodules in the periphery of the glomerulos classic imagine of diabetic GS, the nodules had the name of Kimmrdiel-Wilson

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4- D the risk of endometrial cancer increased if you used estrogen and don't have a balance with the progesterone hormone, but remember the risk of HRT after five years, to get breast cancer is around 30-40%

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5.AA

At days 3 and 7, the mitotic rates of basal cells of regenerating epithelium were 3 times higher than that of controls.
Processes that are involved in active wound healing can lead to an increased risk for basal cell carcinoma in the skin.

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6.BB

p53 (also known as protein 53 or tumor protein 53), is a tumor suppressor protein that in humans is encoded by the TP53 gene. p53 is important in multicellular organisms, where it regulates the cell cycle and, thus, functions as a tumor suppressor that is involved in preventing cancer.

If the TP53 gene is damaged, tumor suppression is severely reduced. People who inherit only one functional copy of the TP53 gene will most likely develop tumors in early adulthood, a disease known as Li-Fraumeni syndrome. The TP53 gene can also be damaged in cells by mutagens (chemicals, radiation, or viruses), increasing the likelihood that the cell will begin decontrolled division. More than 50 percent of human tumors contain a mutation or deletion of the TP53 gene.

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7- E Zenker diverticulum often causes clinical manifestations such as dysphagia (difficulty swallowing), and sense of a lump in the neck; moreover, it may fill up with food, causing regurgitation (reappearance of ingested food in the mouth), cough (as some food may be regurgitated into the airways), halitosis (smelly breath, as stagnant food is digested by microrganisms) and involuntary gurgling noises when swallowing. It rarely, if ever, causes any pain.
wikipedia.org/wiki/Zenker's_diverticulum

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8-B
make diagnosis and offer to educate the patient

9-D
acute MI, tPA catalyzes the conversion of plasminogen into plasmin.
To be most effective in ischemic stroke, tPA must be administered as early as possible after the onset of symptoms. Protocol guidelines require its use intravenously within the first three hours of the event, after which its detriments may outweigh its benefits.