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NBME 11 block 2 q 1 to 50 - maryam2009
#51
****
some more addition

36.CC
Subdural hematoma....rupture of bridging vein
crescent -shaped hemorrhage that crosses suture lines...cn not cross falx.tentorium
venous bleeding with delayed onset ,seen in elderly,alcoholics,blunt trauma,shaken baby

39.BB

Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which can eventually lead to blindness. It is an ocular manifestation of systemic disease which affects up to 80% of all patients who have had diabetes for 10 years or more.

Diabetic retinopathy is the result of microvascular retinal changes. Hyperglycemia-induced intramural pericyte death and thickening of the basement membrane lead to incompetence of the vascular walls. These damages change the formation of the blood-retinal barrier and also make the retinal blood vessels become more permeable.

Small blood vessels – such as those in the eye – are especially vulnerable to poor blood sugar (blood glucose) control. An overaccumulation of glucose and/or fructose damages the tiny blood vessels in the retina. During the initial stage, called nonproliferative diabetic retinopathy (NPDR), most people do not notice any change in their vision.

Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision.

41.CC

Initiate a diccussion about the patient's concerns regarding the treatment


42.AA

Adenocarcinoma is a type of cancer that develops in cells lining glandular types of internal organs,The World Health Organization (WHO) defines adenocarcinoma as "a malignant epithelial tumor with tubular, acinar, or papillary growth patterns, and/or mucus production by the tumor cells."Currently the WHO recognizes four categories of adenocarcinoma:

acinar
papillary
bronchioloalveolar
solid carcinoma with mucus formation

The majority of adenocarcinomas occur at the periphery of the lung, and, as a resultare often asymptomatic until late in their course. They frequently lie just below the pleura, and cause pleural retraction and thickening on x-ray. Often adenocarcinomas are discovered on routine chest x-rays or in a primary search for distant metastases.

Adenocarcinomas grossly present with the "three P's" - peripheral, pigmented and puckered.Commonly lesions are found near the pleural surface (peripheral) which is retracted (puckered) over the neoplasm.The cut surface is often white .

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#52
43.DD

Physiologically, phosphorylase kinase plays the important role of stimulating glycogen breakdown into free glucose by phosphorylating glycogen phosphorylase and stabilizing its active conformation. This activity is particularly important in liver and muscle cells, though for somewhat different purposes. While muscle cells generally break down glycogen to power their immediate activity, liver cells are responsible for maintaining glucose concentration in the bloodstream. Thus, the regulatory mechanisms of PhK activity vary somewhat depending on cell type.

.44 A oocyte donation
turners sundrome --- streak ovaries-- no germ cells

bosted by nf2011

to add

Genetic mosaicism (46XX/45XO) is most often implicated, alongside nondisjunction (45XO) and partial monosomy (46XX).
Turner syndrome is characterized by primary amenorrhea, premature ovarian failure, streak gonads and infertility. However, technology (especially oocyte donation) provides the opportunity of pregnancy in these patients.

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#53
nf2011 - 05/19/11 21:32

45 B inheritance of amplified CYP2D6 locus
rule out A induction --->increased dose should induce a response
C inactive alleles & D inhibitor --> small doses should do the trick
E tolerance ----> initiall doses should induce a response

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46.EE

Ureters paa under uterine artery and under ductus deferens.
Complication in surgery...ligation the ovarian vasculature in the suspensory lig.....accidental ligationof the Ureter
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#54
47.EE
Microscopic Polyangitis...like wegner but lacks granuloma....P-ANCA positive
All affect small vessels
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#55
47...I'm not sure,but I think it is Microscopic Polyangitis,please clarify the answer.

48.DD

Weber's syndrome (superior alternating hemiplegia) is a form of stroke characterized by the presence of an oculomotor nerve palsy and contralateral hemiparesis or hemiplegia.

This lesion is usually unilateral and affects several structures in the midbrain including:

substantia nigra contralateral parkinsonism because its dopaminergic projections to the basal ganglia innervate the ipsilateral hemisphere motor field, leading to a movement disorder of the contralateral body.

corticospinal fibers contralateral hemiparesis and typical upper motor neuron findings

corticobulbar tract difficulty with contralateral lower facial muscles and hypoglossal nerve functions

oculomotor nerve fibers ipsilateral oculomotor nerve palsy with a drooping eyelid and fixed wide pupil pointed down and out. This leads to diplopia

It is caused by midbrain infarction as a result of occlusion of the paramedian branches of the posterior cerebral artery or of basilar bifurcation perforating arteries


http://en.wikipedia.org/wiki/File:Weber%...ndrome.svg
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49 E zolpidem
Zolpidem (Ambien) is a prescription medication used for the short-term treatment of insomnia, as well as some brain disorders. It is a short-acting nonbenzodiazepine hypnotic that potentiates gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, by binding to GABAA receptors at the same location as benzodiazepines. It works quickly (usually within 15 minutes) and has a short half-life (2–3 hours).
Zolpidem has not adequately demonstrated effectiveness in maintaining sleep, however it is effective in initiating sleep

posted by nf2011

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#56
50.BB
Fragile X syndrome is a genetic disorder caused by mutation of the FMR1 gene on the X-chromosome.

Expansion of the CGG repeating codon to such a degree results in a methylation of that portion of the DNA, effectively silencing the expression of the FMR1 protein.


Mutation of the FMR1 gene leads to the transcriptional silencing of the fragile X-mental retardation protein, FMRP. In normal individuals, FMRP is believed to regulate a substantial population of mRNA: FMRP plays important roles in learning and memory,

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Thank you

god99
dna23
sash11
nf2011
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#57
To nf2011....Can u please send me NBME 11 Block 1 at shwetasin
Thanks
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#58
@sssri -

hi,
please make your request in a separate post,bcz this post is just for NBME's answer.Thank you and GL
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#59
Q 12

According to me the answer should be F..coz they have asked the result of shifting of the O2 dissociation curve to the right..that is the release of oxygen to tissues.

Q19
The answer should be B as they have asked which drug is to be given for 6 months after initiating therapy with heparin.
Typically, before initiating warfarin therapy we start heparin to obtain immediate anticoagulation as warfarin takes time for it action.


Q4
Answer should be A as they are considering it to be a type 1 error.Although the p value is very significant, they might have attributed it to chance alone.


please reconfirm and reply
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#60
@gvdynamic

Hi,Thank you for bringing the answer in discuss..

Q4......A is not correct for sure,the person who did this form ,his choice was A and it was wrong

between Choice B and C
..I think C is more close to correct answer because P value is less than .05 so there is less than a 5% chance that the data will show something that is not really there...type 1 error..
they dicided not to reject the Program B...bcz its P value was .01...
If you pick A because of chance only.....what are you thinking about its P value ...it is given because they wanted us to know about False-positive error and not to reject the null hypotesis when it is realy true and not to reject it because of chance only

please clarify my answer.TY

Q12

..shifting curve into the right is occured in result of increased H+,Co2,tempreture and,2,3-DPG ....these factors assist in the unloading the oxygen to systemic TISUE AND IT MAKES EASIER FOR TISSUE to extract OXYGEN.
in hypoxic situation (high altitude)there is no excess Oxygen in capillaries to be released....tissue needs to get their oxygen that excisting in the hypoxic situation so those factors help to make this process easire

Q19. you are right,I thought the Q is about heparin function...
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