nbme 5 edited
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nbmTRANSCRIPT
NBME form 5 – 1
NBME Form 5-2
Uzair
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1.E Fc fragment..... is a complement binding region. 1...variable light chain domain 2...constant light chain 5...variable gama heavy chain 6...constant gama heavy chain
Uzair
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"D" Respiratory burst:activation of memberane bound NADPH oxydase in neutrophils and macrophages plar an important role in the immune response.,,,,,,,rapid release of reactive oxygene speces,,,,O2.....>O2 radicals Chronic granulomatous disease is associated with NADPH oxidase deficiency
Uzair
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carrier frequency for male and female is 1/30 so if male and female from same population marry that means each of them being carrier will be 1/30 X 1/30 and if they have children then chance of kid getting disease will be 1/4 so 1/30X1/30X1/4= 1/3600
Uzair
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"D" when the lytic phage infects the E.coli (transduction) the clevage of bacterial DNA and synthesis of viral protein will be hapened then parts of bacterial DNA become package in viral capsis...the new phage with new genes can infect another bacterium and transfer these new combination of genes to another bacterial DNA so because of this new comination the primary gene T7 does not exist anymore
Uzair
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Diabetic type I DKA.....Beta-hydroxybutyrate is an organic acid and also known as one of the ketone bodies
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"B" The defective copies are covalently marked for destructon by the addition of multiple copies of ubiquitin......polyubiquinted proteins are directed to proteasomes for destruction.
Uzair
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"D" by pseudomonas in diabetics ndividuals with underlying diabetes or disorders of the immune system are more likely to develop complications, including malignant otitis externa. In these individuals, rapid examination by an otolaryngologist (ear, nose, and throat physician) is very important. Chronic otitis externa Spread of infection to other areas of the body Necrotizing external otitis
Uzair
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"d" Transposons are sequences of DNA that can move or transpose themselves to new positions within the genome of a single cell. The mechanism of transposition can be either "copy and paste" or "cut and paste". Transposition can create phenotypically significant mutations and alter the cell's genome size Genetic recombination is a process by which a molecule of nucleic acid (usually DNA, but can also be RNA) is broken and then joined to a different one. Recombination can occur between similar molecules of DNA, as in homologous recombination, or dissimilar molecules, as in non-homologous end joining.
Uzair
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B A granuloma is therefore a special type of inflammation that can occur in a wide variety of diseases. Macrophages (also known as histiocytes) are the cells that define a granuloma Infections that are characterized by granulomas include tuberculosis, leprosy, histoplasmosis, cryptococcosis, coccidioidomycosis, blastomycosis and cat scratch disease. Examples of non-infectious granulomatous diseases are sarcoidosis, Crohn's disease, berylliosis, Wegener's granulomatosis, Churg-Strauss syndrome, pulmonary rheumatoid nodules and aspiration of food and other particulate material into the lung.
Uzair
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"C"
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Streptococcus pneumonia.....alpha hemolytic,,,,,Capsule (+quellung),,,,,,OPTOCHIN SENSITIVE,BILE SOLUBLE. Viridans streptococci,,,,,s.Mutans,,,,,no capsule,,,,OPTICHIN RESISTANCE,NOT BILE SOLUBLE
Uzair
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"E" glycerol kinase is a unique enzyme in liver that helps in picking up glycerol after TG breaks down. TG metablizes to Glycerol and Fatty Acid . Adipocytes lack glycerol kinase so they cannot metabolize the glycerol produced during triacyl glycerol degradation. This glycerol is instead shuttled to the liver via the blood where it is: phosphorylated by glycerol kinase to glycerol phosphate converted to DHAP (dihydroxyacetone phosphate) which can participate in glycolysis or gluconeogenesis.
Uzair
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"A" bacillus subtilis can form spores, which are resistant to heat hay bacillus or grass bacillus, is a Gram-positive, catalase-positive bacterium commonly found in soil. A member of the genus Bacillus, B. subtilis is rod-shaped, and has the ability to form a tough, protective endospore, allowing the organism to tolerate extreme environmental conditions. pathogenesis-- polysacchride capsules. reproduction-- B. subtilis can divide symmetrically to make two daughter cells (binary fission), or asymmetrically, producing a single endospore that is resistant to environmental factors such as heat, acid, and salt, and which can persist in the environment for long periods of time.
Uzair
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"B" intercalated discs which have gap junctions within intercalated discs lie the macula adherens (aka desmosomes) , fascia adherens , and gap juctions. Fascia adherens : anchoring sites for actin and connects to closest sarcomere Macula adherens : stop separation during contraction by binding intermediate filaments joining the cells together also called as desmosomes. Gap junctions :allow Action potentials to spread b/w cardiac muscle cells by permitting the passage of ions b/w cells producing depolarization of heart muscle.
Uzair
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"A" individual native american tribes maintain their own death customs and adapted them to their regional environmets into which they migrated ,although such rituals and belief could pass from one group to the other , most native american believed that the souls of the dead passed into a spirit world and became part of spiritual forces rgar influenced every aspect of their life common in some tribes to talk to dead ones
Uzair
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"E" follicular lymphoma t (14 ;18 )
Uzair
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The clues are 1-Time duration=6 weeks ---CHOICE B is out 2-Being native american (Indian American)----choice A is IN 3-Loss of loved one=husband----CHOICE A IS IN 4-Repeated visit from the dead one---CHOICE A IS IN 5-Normal appetite and energy with no suicidal ideation ---CHOICES B ,d are out 6-Bruised arm and leg and normal NEURO AND CT SCAN-choice E is OUT explanation in my understanding ---Individual NATIVE AMERICAN tribes maintained their own death customs and adapted them to their regional environments into which they migrated, although such rituals and beliefs could pass from one group to the other through trade and intermarriage. Most Native American tribes believed that the souls of the dead passed into a spirit world and became part of the spiritual forces that influenced every aspect of their lives --Many tribes believed in two souls: one that died when the body died and one that might wander on and eventually die. ---And also it is common in some tribes talking to dead ones --hence my answer is AAA(schizophrenia is out ...due to short duration and alsom lack of other common symptoms)....
Uzair
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FF stem is simply asking that "Once the Cytokine provided the signal , Which intracellular Enzyme is, that Inhibit (oppose/antagonize ) the Transmission of This Mitogenic Signal" Mitogenic Signal transmission uses "MAP Kinases".......it is the "Phosphatases" that oppose the signal at all levels where kinases are used. Kinases............. promote Mitogenic Signal Phosphatases..... oppose Mitogenic signal -so the signal transmission is controlled by the balance b/w the above two enzymes activity.
Uzair
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CC When there is no history of DMD in the family, the mother or the patient may have a de novo (or sporadic) mutation. In 2/3 of DMD cases, the boy inherited the gene from a carrier mother. 1/3 of cases where there are no other affected family members are due to a new mutation. When a new mutation is suspected, the patient may have a new mutation, or the mother may be germline mosaic for the disorder Typically, a person with only germline mosaicism will not be affected with the disorder caused by the mutation because the mutation is not in the other cells of the body. Genetic testing using blood or tissue samples (other than germline tissue) from individuals who only have a germline mutation will be negative for the mutation. Germline mosaicism can be observed with any inheritance pattern, but it is most commonly seen with autosomal dominant and X-linked disorders. Most individuals are unaware they possess a germline mutation until they have children that are affected. Because the mosaic germline mutation is present in the egg or sperm cell, it will also be present in all cells of the child developing from that germ cell. If it is an autosomal dominant mutation, the child will be affected with the disorder, and will not be a mosaic like his or her parent. The recurrence risk for a parent with germline mosaicism for an AD disorder is hard to predict since it depends on the proportion of germline cells with the mutation, which can not be determined through testing. Based on family studies, the risk for another affected child may be low (around 1%), moderate (as in 6%), or high (30%), depending on both the proportion of mutated germ cells and the disorder in question. In most instances where unaffected parents have a child with an autosomal dominant (AD) disorder, it is because of a new mutation that occurred by chance in only one egg or sperm cell, not in a proportion of them. This is called a sporadic mutation. However, in rare situations, unaffected parents can have more than one child with an AD disorder. This can be caused by germline mosaicism. Germline mosaicism has been observed in a number of conditions, including osteogenesis imperfecta and Duchenne muscular dystrophy.
Uzair
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"C"
Uzair
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x linked recessive diseases more chance of males to show the disease while incase of x inactivation the feales may show disease signs too
Uzair
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"A" apoptosis regulator proteins encoded by the BCL2 gene. Bcl-2 derives its name from B-cell lymphoma 2, as it is the second member of a range of proteins initially described in chromosomal translocations involving chromosomes 14 and 18 in follicular lymphomas.
Uzair
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"D" .DD Throughout the coagulation cascade, every factor constitutes a substrate ready to be cleaved by the previous factor, once activated. Coagulation factors are mainly serine proteases. A is related to successive phosphorylations. B is related to polymerization-depolymerization of tubulins. C is related to Fe binding to proteins (transferrin & ferroportin). E is related to nuclear pore complexes, importins
Uzair
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"G" 22.GG Congenital toxoplasmosis is a special form in which an unborn child is infected via the placenta. If a woman receives her first exposure to toxoplasmosis while pregnant, the baby is at particular risk. A woman with no previous exposure should avoid handling raw meat, exposure to cat feces, and gardening (cat feces are common in garden soil).
Uzair
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"F" Superantigens bind first to the MHC Class II and then coordinate to the variable alpha or beta chain of T-cell Receptors (TCR). Superantigens (SAgs) are a class of antigens which cause non-specific activation of T-cells resulting in polyclonal T cell activation and massive cytokine release. SAgs can be produced by pathogenic microbes like Staphylococcus aureus, and Streptococcus pyogenes.
Uzair
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"C" .CC splicing of primary gene is a process by which the exons of the RNA produced by transcription of a gene (a primary gene transcript or pre-mRNA) are reconnected in multiple ways during RNA splicing. The resulting different mRNAs may be translated into different protein isoforms; thus, a single gene may code for multiple proteins.
Uzair
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"A"
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1-STEROID HARMONE RECEPTARS STRUCTURE Steroid harmone receptars are present INTRACELLULARLY * They are composed of polypeptide contain one ZINC atom which bound to four cystein residue . They also have gene regulatory proteins that have one harmone binding domain and one DNA binding region [which activates transcription]. Mechanism of gene transcription --- these inactive steroid receptars are present in the cytoplasm and bound to heat shock protein 90 ie hsp90 and immunophillin hsp56.[these hsp covers DNA binding regions] * When steroid harmone diffuses across the cell membrane and bind to harmone binding site of receptar hsp90 and hsp56 are relased ---------this now leads to exposure of DNA binding site or region. ----Now this steroid -receptar complex is transported to the nucleus where it binds to DNA and activates transcription of small number of specific gene within 30 seconds -[this is primary response] ----gene product of primary response activates other gene to produce secondary response . eq of streoid receptars- 1-glucocoticoids 2-estrogen 3-progesteron 4-thyroid harmones ie T3/T4 5-Retinoic acid receptar 6-vitamin D3.
Uzair
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"D" vit B12 is found in animal products.Human body has very large reserve pool of it,but its deficiency is usually caused by Veg.diet ,sprue,enteritis,Diphollobutrium latum,lack of intrinsic factor and absence of terminal ileum due to sergical resection or Crohn's disease B12 is a cofactor for hemocysteinMethyltransferase and Methylmalonyl.-coA mutase. .......................................vit B12....................... Homocystein+N-Methyl THF............>Methionin+THF Methylmalonyl-coA........................> Succinyl coA its deficiency causes megaloblastic ,Macrocytic Anemia, NEUROLOGIC SYMPTOMES,,,,LIKE paresthesias,subacute combined degeneration....due to demyelination of neurons
Uzair
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"C" Macrophages are white blood cells produced by the differentiation of monocytes in tissue. When a leukocyte enters damaged tissue through the endothelium of a blood vessel (a process known as the leukocyte extravasation), it undergoes a series of changes to become a macrophage. Monocytes are attracted to a damaged site by chemical substances through chemotaxis, triggered by a range of stimuli including damaged cells, pathogens and cytokines released by macrophages already at the site. Functions: 1. Phagocytosis,,,,,, When a macrophage ingests a pathogen, the pathogen becomes trapped in a phagosome, which then fuses with a lysosome. Within the phagolysosome, enzymes and toxic peroxides digest the pathogen. However, some bacteria, such as Mycobacterium tuberculosis, have become resistant to these methods of digestion. Macrophages can digest more than 100 bacteria before they finally die due to their own digestive compounds. The removal of necrotic tissue . 2.Role in adaptive immunity,,,,, After digesting a pathogen, a macrophage will present the antigen of the pathogen to the corresponding helper T cell. The presentation is done by integrating it into the cell membrane and displaying it attached to an MHC class II molecule, indicating to other white blood cells that the macrophage is not a pathogen, despite having antigens on its surface. Eventually, the antigen presentation results in the production of antibodies that attach to the antigens of pathogens, making them easier for macrophages to adhere to with their cell membrane and phagocytose. 3.Role in Muscle Regeneration. Tissue Macrophages: Name of cell Location Dust cells/Alveolar macrophages pulmonary alveolus of lungs Histiocytes..... connective tissue Kupffer cells...... liver Microglia..... neural tissue Epithelioid cells..... granulomas Osteoclasts..... bone Sinusoidal lining cells.... spleen
NBME Form 5-3
NBME form 5-4
Uzair
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"A"
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"D" flatulence and bloating
Uzair
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decreased pul vascular markings "tetralogy of fallot VSD pul stenosis overriding of arch of aorta RVH
Uzair
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"B" FSH increases the estrogen production as the women is in her menopause so there is inc in FSH but there is no such inc in the level of estrogen.
Uzair
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"E" they are actually asking after the ovulation has occured which hormone is increased and that is progesterone cause LH surge causes ovulation and decreases and then progesteronen increases to form corpus luteum
Uzair
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"C"
Uzair
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"D"
Uzair
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"D" Respiratory center is located in medulla oblongata presence of elevated carbon dioxide levels in the blood is the stimulant that the RC responds to in order to signal the respiratory muscles to breathe. Chemoreceptors found in carotid bodies and aortic bodies are responsible for detecting decrease in blood pH by this carbon dioxide Respiratory centre is divided four major cliques Inspiratory centre (Dorsal respiratory group)[edit] Location: Dorsal portion of medulla Nucleus: Nucleus tractus solitarii Function: causes inspiration while stimulated. Expiratory centre (Ventral respiratory group)[edit] Location: Antero- lateral part of medulla, about 5 mm anterior and lateral to dorsal respiratory group Nucleus: Nucleus ambiguous and nucleus retro ambiguous. Function: It generally causes expiration but can cause either expiration or inspiration depending upon which neuron in the group is stimulated. It sends inhibitory impulse to the apneustic centre. Pneumotaxic centre[edit] Location: Pons(upper part ) Nucleus: Nucleus parabrachialis Function: It controls both rate and pattern of breathing. Limit inspiration. Apneustic centre[edit] Location: Pons(lower part) Functions: It discharges stimulatory impulse to the inspiratory centre causing inspiration. It receives inhibitory impulse from pneumotaxic centre and from stretch receptor of lung. It discharges inhibitory impulse to expiratory centre. Ventilatory rate (minute volume) is tightly controlled and determined primarily by blood levels of carbon dioxide as determined by metabolic rate. Blood levels of oxygen become important in hypoxia. These levels are sensed by chemoreceptors in the medulla oblongata for pH, and the carotid and aortic bodies for oxygen and carbon dioxide. Afferent neurons from the carotid bodies and aortic bodies are via the glossopharyngeal nerve (CN IX) and the vagus nerve (CN X), respectively. Respiratory center depression[edit] Depression of a respiratory center can be a result of next reasons: medical drug action (opioids, sedatives and etc.) sudden cessation of blood circulation in brain heavy brain trauma sharp neuroinfections brain tumors damage of a brainstem
Uzair
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"A" S suprarenal gland A Ascending colon D duodenum(second and third part) P pancreas (tail is intraperitoneal) Ureter C colon (ascending and descending part) K Kidney E Esophagus R Rectum
Uzair
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"C" in nephrogenic DI there is inc ADH but there is no action of it on the kidney tubules
Uzair
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"C" hereditary RCC occurs in both kidneys. with VHL disease so B/L other features of VHL chrosome no 3 VHL gene bilateral RCC, hemangioblastoma (produces EPO), pheochromcytomas , cavernous hemangiomas
Uzair
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"C" epididymitis
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"G"
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"B"
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E
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"C" A: macrophages B: capillaries C: type 2 pneumocytes D: type 1 pneumocytes
Uzair
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"D" Takayasu arteritis Age < 40 years , female , col extremities ( suggests decrease in blood flow) ,increased blood pressure , aortic arch involvement leads to dec in radial and carotid pulses , and also retinal hemorrhages due to granulomatous inflammation
Uzair
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"D" 02 L is the residual volume remaining in the lungs
Uzair
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"A"
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"E"
Uzair
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"C" cresentic or RPGN associated with goodpastures , wegners granulomatosis and patient has positine ANCA ,pul and renal involvement suggesting immune complex mediated disease by wegners