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NBME 7 block 4 q 1 to 50 - maryam2009
#31
to add
23. B
Hyperacute Rejection: antibody mediated type II due to presence of presence of performed antidonor antibodies in the transplant recipient. Occurs within minutesafter transplantation.

Acute Rejection: Cell mediated due to cytotoxic T lymphocytes reacting against foreign MHCs. Occurs weeks after transplantation. Reversiblewith immunosuppresants such as cyclosporine and OKT3.

Chronic rejection: T cell- antibody mediated vascular damage ( obliterative vascular fibrosis), occurs months to years after transplantation. Irreversible.

GRAF -VERSUS-HOST DISEASE. GRAFTED IMMUNOCOMPETENT T CELLS PROLIFERATE IN THE RADIATED IMMUNOCOMPROMISED HOST AND REJECT CELLS WITH " FOREINGN" PROTEINS,RESULTING IN SEVERE ORGAN DYSFUNCTION. MAJOR SYMPTOMS INCLUDE A MACULARPAPULAR RASH, JAUNDICE.
hepatomegal and diarrhea. ( FA page 213)
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#32
24 - B, manic episode

Mania = elevated mood, which can take the form of euphoria; increase in energy and a decreased need for sleep, with many often getting as little as 3 or 4 hours of sleep per night, while others can go days without sleeping; pressured speech, with thoughts experienced as racing;Attention span is low, and a person in a manic state may be easily distracted. Judgment may become impaired;engage in behavior that is quite abnormal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants. Their behavior may become aggressive, intolerant, or intrusive. People may feel out of control or unstoppable, or as if they have been "chosen" and are "on a special mission" or have other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood.
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#33
25-A
= increased osteoblastic activity in response to the stress fracture.
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#34
26- D

As the blood circulates to body tissues in which the partial pressure of oxygen is less, the hemoglobin releases the oxygen into the tissue because the hemoglobin cannot maintain its full bound capacity of oxygen in the presence of lower oxygen partial pressures.

A rightward shift, by definition, causes a decrease in the affinity of hemoglobin for oxygen. This makes it harder for the hemoglobin to bind to oxygen (requiring a higher partial pressure to achieve the same oxygen saturation), but it makes it easier for the hemoglobin to release bound oxygen.

Right shift = CADET face right:
- CO2
- acid and altitude
- 2,3 DPG
- exercise
- temperature

2,3-DPG, is an organophosphate, which are created in erythrocytes during glycolysis. The production of 2,3-DPG is likely an important adaptive mechanism, because the production increases for several conditions in the presence of diminished peripheral tissue O2 availability, such as hypoxemia, chronic lung disease, anemia, and congestive heart failure, among others. High levels of 2,3-DPG shift the curve to the right, while low levels of 2,3-DPG cause a leftward shift, seen in states such as septic shock and hypophosphatemia.
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#35
correction
11. A
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#36
27. D
Polyclonal antibodies (or antisera) are antibodies that are obtained from different B cell resources. They are a combination of immunoglobulin molecules secreted against a specific antigen, each identifying a different epitope.
These antibodies are typically produced by immunization of a suitable mammal, such as a mouse, rabbit or goat. Larger mammals are often preferred as the amount of serum that can be collected is greater. An antigen is injected into the mammal. This induces the B-lymphocytes to produce IgG immunoglobulins specific for the antigen. This polyclonal IgG is purified from the mammal’s serum.
By contrast, monoclonal antibodies are derived from a single cell line.
http://en.wikipedia.org/wiki/Polyclonal_antibodies
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#37
28. B
Filgrastim is a granulocyte colony-stimulating factor (G-CSF) analog used to stimulate the proliferation and differentiation of granulocytes.[1] It is produced by recombinant DNA technology. The gene for human granulocyte colony-stimulating factor is inserted into the genetic material of Escherichia coli. The G-CSF then produced by E. coli is only slightly different from G-CSF naturally made in humans.
Therapeutic uses
Filgrastim is used to treat neutropenia[2] (a low number of neutrophils), stimulating the bone marrow to increase production of neutrophils. Causes of neutropenia include chemotherapy and bone marrow transplantation.
Filgrastim is also used to increase the number of hematopoietic stem cells in the blood before collection by leukapheresis for use in hematopoietic stem cell transplantation. It is produced by many companies worldwide.
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#38
29.DD

http://immunology.ucsf.edu/immuno/course...Grad10.pdf
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#39
*********************************correction************************************************
to add
27.DD

http://immunology.ucsf.edu/immuno/course...Grad10.pdf

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#40
29.C

C- this is adenocarcinoma of prostate gland... prostate gland cancer metastasizes to vertebrae via the venous plexus around it... B is keratin pearls of squamous cell cancer so cant be it, D is basophil u can never find a basophil in cancer, E is uniform cells, cancer is never uniform cells, they are anaplastic cells, A is agrregates of plasma cell and plasma blasts this feature is of multiple myeloma


posted by doctorF
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