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NBME 11 block 4 q 1 to 50 - maryam2009
#41
36. C
Leigh's disease, also known as Subacute Necrotizing Encephalomyelopathy (SNEM), is a rare neurometabolic disorder that affects the central nervous system.
There is another form of this disease called the X-linked Leigh's syndrome (OMIM 308930), which is a mutation in the oxidative phosphorylation enzymes (which are on both the mtDNA and the nuclear DNA). The X-linked Leigh's disease is a mutation of a gene encoding PDHA1, part of the pyruvate dehydrogenase complex, located on the X chromosome
It is an inherited disorder that usually affects infants between the age of three months and two years, but, in rare cases, teenagers and adults as well. In the case of the disease, mutations in mitochondrial DNA (mtDNA) or in nuclear DNA (gene SURF1[2] and some COX assembly factors) cause degradation of motor skills and eventually death.
Mitochondria are an essential organelle in eukaryotic cells. Their function is to convert the potential energy of glucose, amino acids, and fatty acids into adenosine triphosphate (ATP). Mitochondria carry their own DNA, called mitochondrial DNA [mtDNA]. The information stored in the mtDNA is used to produce several of the enzymes essential to the production of ATP.
Mutations in the mtDNA that cause the mitochondria to fail, to function improperly, a person is at risk for a number of disorders, including Leigh's disease. In the case of Leigh's disease, crucial cells in the brain stem have mutated mtDNA, creating poorly functioning mitochondria. This causes a chronic lack of energy in the cells, which, in turn, affects the central nervous system and inhibits motor functions.
http://en.wikipedia.org/wiki/Leigh's_disease
37. B
Mebendazole or MBZ is a benzimidazole drug developed by Janssen Pharmaceutica and marketed as Vermox, Ovex, Antiox, and Pripsen. It is used to treat infestations by worms including pinworms, roundworms, tapeworms, hookworms, and whipworms
Mechanism of action
Mebendazole is thought to work by selectively inhibiting the synthesis of microtubules in parasitic worms, and by destroying extant cytoplasmic microtubes in their intestinal cells: thereby blocking the uptake of glucose and other nutrients, resulting in the gradual immobilization and eventual death of the helminths. The drug is a highly effective broad spectrum antihelminitic indicated for the treatment of nematode infestations, including round worm, whip worm, thread worm, and hook worm. It is poorly absorbed and has no systemic effects.
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#42
38. C

39. A
Acute pyelonephritis: Affects cortex with relative sparing of glomeruli /vessels white cells cast in urine are clssic. Present fever, CVA tenderness, nausea and vomiting. Acute pyelonephritis is characterized by neutrophilic inflitrationand abscessformation within the renal interstitium. Abscess may rupture, introduction collections of white cells to the tubular lumen.
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#43
40. A
Middle cerebral artery syndrome is a condition whereby the blood supply from the middle cerebral artery (MCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the lateral aspects of frontal, temporal and parietal lobes, the corona radiata, globus pallidus, caudate and putamen. The MCA is the most common site for the occurrence of ischemic stroke
Signs and Symptoms
1. Hemiparesis or hemiplegia of the lower half of the contralateral face[2]
2. Hemiparesis or hemiplegia of the contralateral upper and lower extremities*[2]
3. Sensory loss of the contralateral face, arm and leg*[2]
4. Ataxia of contralateral extremities*[1]
5. Speech impairments/aphasia: Broca's, Wernicke's or Global aphasia as a result of a dominant hemisphere lesion (usually the left brain)[1][2][3]
6. Perceptual deficits: hemispatial neglect, anosognosia, apraxia, and spatial disorganization as a result of a non-dominant hemisphere lesion (usually the right brain)[1][3]
7. Visual disorders: deviation conjugée, a gaze preference towards the side of the lesion; contralateral homonymous hemianopsia.
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#44
41. B
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances. DKA results from a shortage of insulin; in response the body switches to burning fatty acids and producing acidic ketone bodies that cause most of the symptoms and complications.
Diabetes mellitus type 1 (Type 1 diabetes, IDDM, or, formerly, juvenile diabetes) is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas.[2] The subsequent lack of insulin leads to increased blood and urine glucose. The classical symptoms are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.
Pathophysiology
The pathophysiology in diabetes type I is basically a destruction of beta cells in the pancreas, regardless of which risk factors or causative entities have been present.
Individual risk factors can have separate pathophysiological processes to, in turn, cause this beta cell destruction. Still, a process that appears to be common to most risk factors is an autoimmune response towards beta cells, involving an expansion of autoreactive CD4+ and CD8+ T helper cells, autoantibody-producing B cells and activation of the innate immune system.[9]
http://en.wikipedia.org/wiki/Diabetes_mellitus_type_1
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#45
42. C
In contraction, the wound is made smaller by the action of myofibroblasts, which establish a grip on the wound edges and contract themselves using a mechanism similar to that in smooth muscle cells. When the cells' roles are close to complete, unneeded cells undergo apoptosis.
If contraction continues for too long, it can lead to disfigurement and loss of function.[44]
http://en.wikipedia.org/wiki/Wound_healing
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#46
43. B.
Anorexia nerviosa: excessive dieting +/- purging intense fear of gaining weight , body imagen distortion, and ↑ exercise , leading to body weight < 85% below ideal body weight. Associated with ↓ body density.severe weight loss, metatarsal stress fractures, amenorrhea ( ↓ GnRH, ↓LH, ↓FSH, ↓ estrogen), anemia, and electrolyte disturbances. Sen primarily in adolescent girls. Commonly coexist with depression. ( FA 2010 page 447)
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#47
44. D
Vitamine B12 defficiency: Macrocytic , megaloblastic anemia, hypersegmented PMN, neurologic symptoms ( paresthesias, subacuted combined degeneration) due to anormal myelin. Prolonged deficiency leads to irreversible nervous system damage
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#48
45. E
Standard deviation is a widely used measurement of variability or diversity used in statistics and probability theory. It shows how much variation or "dispersion" there is from the average (mean, or expected value). A low standard deviation indicates that the data points tend to be very close to the mean, whereas high standard deviation indicates that the data are spread out over a large range of values.
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#49
46. A
Calcitonin: Source: Parafollicular cells ( C cells ) of thyroid. Acts to ↓ bone reabsorption. Regulation: ↑ serum Ca causes calcitonin secretion. ( FA 2010 page 289)
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#50
Hi ,
I took NBME 11 online, but the order of questions were different from what you have here.
So instead of the question number, is it possible to type the questions there? it would be more helpful. please
thank you
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