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NBME 11 block 1 q 1 to 50 - maryam2009
#31
36. E
NNRTI: Nevirapine, Efavirenz, Delavirdine: Mechanism of action: Preferentially inhibit reverse transcriptase of HIV, prevent incorporation of DNA copy of viral genome into the host DNA. ( FA 2010 page 195)
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#32
37. C
Congenital hearing loss implies that the hearing loss is present at birth. It can include hereditary hearing loss or hearing loss due to other factors present either in utero (prenatal) or at the time of birth.
Treatment:
A child with a congenital hearing loss should begin receiving treatment before 6 months of age. Studies suggest that children treated this early are usually able to develop communication skills (using spoken or sign language) that are as good as those of hearing peers.
In the United States of America, because of a Federal law (the Individuals with Disabilities Education Act), children with a hearing loss between birth and 3 years of age have the right to receive interdisciplinary assessment and early intervention services at little or no cost. After age 3, early intervention and special education programs are provided through the public school system.

http://en.wikipedia.org/wiki/Congenital_hearing_loss
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#33
38. B
Acidosis Respiratory: ↓ PO2,↓ PH , ↑CO2
A blood sample taken from an artery, i.e. Arterial Blood Gas (ABG), can be tested for blood gas levels which may show low oxygen (hypoxaemia) and/or high carbon dioxide (respiratory acidosis if pH is also decreased). A blood sample taken from a vein may show a high blood count (reactive polycythemia), a reaction to long-term hypoxemia.
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#34
39. A ?
The formation of granulation tissue in an open wound allows the reepithelialization phase to take place, as epithelial cells migrate across the new tissue to form a barrier between the wound and the environment.[29] Basal keratinocytes from the wound edges and dermal appendages such as hair follicles, sweat glands and sebacious (oil) glands are the main cells responsible for the epithelialization phase of wound healing.[34] They advance in a sheet across the wound site and proliferate at its edges, ceasing movement when they meet in the middle.
Keratinocytes migrate without first proliferating.[35] Migration can begin as early as a few hours after wounding. However, epithelial cells require viable tissue to migrate across, so if the wound is deep it must first be filled with granulation tissue.[36] Thus the time of onset of migration is variable and may occur about one day after wounding.[37] Cells on the wound margins proliferate on the second and third day post-wounding in order to provide more cells for migration.
http://en.wikipedia.org/wiki/Wound_healing.
waiting to confirm the answer

40. D
Ropinirole (Requip, Ropark, Adartrel, Ropinotergotirole) is a non-ergoline dopamine agonist.
Ropinirole acts as a D2, D3, and D4 dopamine receptor agonist with highest affinity for D3. It is weakly active at the 5-HT2, and α2 receptors and is said to have virtually no affinity for the 5-HT1, benzodiazepine, GABA, muscarinic, α1, and β-adrenoreceptors.
Ropinirole is metabolized primarily by cytochrome P450 CYP1A2, and at doses higher than clinical, is also metabolized by CYP3A4. At doses greater than 24 mg, CYP2D6 may be inhibited, although this has only been tested in vitro.
http://en.wikipedia.org/wiki/Ropinirole

41. B
The uterine artery usually arises from the anterior division of the internal iliac artery
Uterine artery embolization (UAE) is a procedure where an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the uterine body. If the procedure is done for the treatment of uterine fibroids it is also called uterine fibroid embolization (UFE). Under local anesthesia a catheter is introduced into the femoral artery at the groin and advanced under radiographic control into the uterine arterty.
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#35
42. E
Cell-mediated immunity is an immune response that does not involve antibodies or complement but rather involves the activation of macrophages, natural killer cells (NK), antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in response to an antigen. Historically, the immune system was separated into two branches: humoral immunity, for which the protective function of immunization could be found in the humor (cell-free bodily fluid or serum) and cellular immunity, for which the protective function of immunization was associated with cells. CD4 cells or helper T cells provide protection against different pathogens.
Please note that T cells cause death by apoptosis without using cytokines, therefore in cell mediated immunity cytokines are not always present.
Cellular immunity protects the body by:
1. activating antigen-specific cytotoxic T-lymphocytes that are able to induce apoptosis in body cells displaying epitopes of foreign antigen on their surface, such as virus-infected cells, cells with intracellular bacteria, and cancer cells displaying tumor antigens;
2. activating macrophages and natural killer cells, enabling them to destroy pathogens; and
3. stimulating cells to secrete a variety of cytokines that influence the function of other cells involved in adaptive immune responses and innate immune responses.
http://en.wikipedia.org/wiki/Cell-mediated_immunity

43. C
Schizofrenia: Periods of psychosis and disturbed behavior with a decline in functioning lasting > 6 months. Associated with ↑ dopaminergic activity, ↓dendritic branching. Marijuana use is a risk factor for schizofrenia in teens. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social or occupational dysfunction.
http://en.wikipedia.org/wiki/Schizophrenia
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#36
44. A
Glibenclamide (INN), also known as glyburide (USAN), is an antidiabetic drug in a class of medications known as sulfonylureas, closely related to sulfa drugs.
Mechanism of action: The drug works by inhibiting ATP-sensitive potassium channels[4] in pancreatic beta cells. This inhibition causes cell membrane depolarization, which causes voltage-dependent calcium channels to open, which causes an increase in intracellular calcium in the beta cell, which stimulates insulin release.

45. A
Plasmodium vivax is a protozoal parasite and a human pathogen. The most frequent and widely distributed cause of recurring (tertian) malaria, P. vivax is one of the four species of malarial parasite that commonly infect humans. It is less virulent than Plasmodium falciparum, which is the deadliest of the four, and is seldom fatal. P. vivax is carried by the female Anopheles mosquito, since it is the only sex of the species that bites.
Chloroquine remains the treatment of choice for vivax malaria,[3] except in Indonesia's Irian Jaya (Western New Guinea) region and the geographically contiguous Papua New Guinea, where chloroquine resistance is common (up to 20% resistance). Chloroquine resistance is an increasing problem in other parts of the world, such as Korea,India.
Thirty-two to 100% of patients will relapse following successful treatment of P. vivax infection if a radical cure (eradication of liver stages) is not given.[8][9][10] Eradication of the liver stages is achieved by giving primaquine, after checking the patients G6PD status to reduce the risk of haemolysis.[11] However, in severe G6PD deficiency, primaquine is contraindicated and should not be used.[3] Recently, this point has taken particular importance for the increased incidence of vivax malaria among travelers.[12] At least a 14-day course of primaquine is required for the radical treatment of P. vivax.[3]
http://en.wikipedia.org/wiki/Plasmodium_vivax
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#37
46.EE

vincristine.....M-phase specific alkaloides that bind to tubulin and block polymerization of microtubules...so that mitotic spindel can not form

s/e...neurotoxicity....areflexia,peripheral neurities
paralytic ileus
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Cyclophosphamide....alkylating agent..covalantly x-link DNA at guanine N-7,reqire bioactivation by liver
s/e...myelosuppression,hemorrhagic cystitis..can be prevented by mesna
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Doxorubicin:
.....generate free radicals and noncovalantly intercalate in DNA
s/e...Cardiotoxicity,myelosuppression and marked alopesia,toxic extravasation
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Rituximab:

General side effects have included fever (49%), chills (32%), asthenia (16%), headache (14%), and abdominal pain (6%).

In general, severe side effects from rituximab may be more likely in patients with higher circulating white counts or a greater tumor burden. Severe and life-threatening (Grade 3 and 4) events have been reported in 10% of patients. The Grade 3 and 4 adverse events included neutropenia (1.9%), chills (1.6%), leukopenia (1.3%), thrombocytopenia (1.3%), hypotension (1%), anemia (1%), bronchospasm (1%), urticaria (1%), headache (0.6%), abdominal pain (0.6%), and arrhythmia (0.6%). A fatal case of septicemia has also been reported.
____________________________________________________________________________
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#38
47.CC

Let us start from the definition of perfusion pressure...
-perfusion pressure....the gradient between arterial blood pressure and venous pressure in a comparable location in the vascular tree....in this case the perfusion pressure is the pressure gradient between renal artery and renal vein......

-What is the relationship between flow(Q) ,Resistance®,and Perfusion pressure(P1-P2)....

-According to Poiseuille Equation

P1-P2(Perfusion pressure)= R multiplied by Q.....

P1= Renal artery pressure
P2=Renal Vein pressure

This patient has Hypotension Secondary to Severe Dehydration ....this causes the activation of the Sympathetic Nervous System ....and the RAA system ....both work independently even if the end result is the same .....

Sympathetic Nervous System causes Vasoconstriction of arteriolar beds including the renal arterioles .....this vasoconstriction increases the resistance in the arterioles and according to the above equation Perfusion Pressure decreases ........

The RAA system ....Ag II is apotent vasoconstrictor throughout the body ....including the afferent and efferent arterioes .....even if more on efferent ......When there is vasoconstriction of the afferent arterioles there will be a decrease in flow (Q)....which further decreases the perfusion pressure according to Poiseuille equation ....

a little correction on the sympathetic nervous system action ....the sympathetic nervous system increases the resistance and decreases the flow (Q)....Therby decreasing perfusion pressure ( the difference between arterial presuure and venous pressure)....

posted by yeabiruh - 04/23/11
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#39
48.A?

Those that are immunologically compromised, especially those with HIV and low CD4 T cell counts, frequently show negative results from the PPD test. This is because the immune system needs to be functional to mount a response to the protein derivative injected under the skin.

With the change from 10mm to 5 mm....there are more people can be identified with positive tuberculin test....so incidence and prevalance will be higher


The results of this test must be interpreted carefully. The person's medical risk factors determine at which increment (5 mm, 10 mm, or 15 mm) of induration the result is considered positive.
A positive result indicates TB exposure.

5 mm or more is positive in
HIV-positive person
Recent contacts of TB case
Persons with nodular or fibrotic changes on chest x-ray consistent with old healed TB
Patients with organ transplants and other immunosuppressed patients

10 mm or more is positive in

Recent arrivals (less than 5 years) from high-prevalence countries
Injection drug users
Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
Mycobacteriology lab personnel
Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc.)
Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories

please clarify the answer,TY
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#40
49.CC

The child has less opportunity to use her/his gross muscle for movement and development....so delaied gross motor development could be occured
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50.AA

Hemoglobin electrophoresis is a test that measures the different types of the oxygen-carrying protein (hemoglobin) in the blood.

Many different types of hemoglobin (Hb) exist. The most common ones are HbA, HbA2, HbF, HbS, HbC, Hb H, and Hb M. Healthy adults only have significant levels of HbA and HbA2.

Some people may also have small amounts of HbF (which is the main type of hemoglobin in an unborn baby's body). Certain diseases are associated with high HbF levels (when HbF is more than 2% of the total hemoglobin).

HbS is an abnormal form of hemoglobin associated with sickle cell anemia. In people with this condition, the red blood cells sometimes have a crescent or sickle shape. The cells easily break down, or can block small blood vessels.

HbC is an abnormal form of hemoglobin associated with hemolytic anemia. The symptoms are much milder than they are in sickle cell anemia.

Other, less common, abnormal Hb molecules cause anemias.

.Hemoglobin electrophoresis is a test that measures the different types of the oxygen-carrying protein (hemoglobin) in the blood.

How the Test is PerformedBlood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

How to Prepare for the TestNo special preparation is necessary for this test.

How the Test Will FeelWhen the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the Test is PerformedYou may have this test if your health care provider suspects that you have a disorder caused by abnormal forms of hemoglobin (hemoglobinopathy).

Many different types of hemoglobin (Hb) exist. The most common ones are HbA, HbA2, HbF, HbS, HbC, Hb H, and Hb M. Healthy adults only have significant levels of HbA and HbA2.

Some people may also have small amounts of HbF (which is the main type of hemoglobin in an unborn baby's body). Certain diseases are associated with high HbF levels (when HbF is more than 2% of the total hemoglobin).

HbS is an abnormal form of hemoglobin associated with sickle cell anemia. In people with this condition, the red blood cells sometimes have a crescent or sickle shape. The cells easily break down, or can block small blood vessels.

HbC is an abnormal form of hemoglobin associated with hemolytic anemia. The symptoms are much milder than they are in sickle cell anemia.

Other, less common, abnormal Hb molecules cause anemias.

Normal Results

In adults, these hemoglobin molecules make up the following percentages of total hemoglobin:

•Hb A: 95% to 98%
•Hb A2: 2% to 3%
•Hb F: 0.8% to 2%
•Hb S: 0%
•Hb C: 0%
In infants and children, these hemoglobin molecules make up the following percentages of total hemoglobin:

•Hb F (newborn): 50% to 80%
•Hb F (6 months): 8%
•Hb F (over 6 months): 1% to 2%

The presence of significant levels of abnormal hemoglobins may indicate:

•Hemoglobin C disease
•Rare hemoglobinopathy
•Sickle cell anemia
•Thalassemia
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