NBME 5 Review:

(Block 1)

Occlusion of the anterior cerebral in a pt with hypertension will cause sudden onset of weakness of the right lower extremity (or contralateral part). The right upper extremity will not be affected. Pag. 405

Laceration of the middle meningeal artery will be seen in head injuries were the pt will have a lucid interval and after that will present with CN III palsy (left hemiparesis, with dilated and unresponsive right pupil. CT scan will present a diffuse extra-axial hemorrhage over the right cerebral hemisphere). Pag. 406 & 416)

Know the CN well!!!!!

Olfactory I- smell (*the only CN without thalamic relay to cortex). Optic II- sight Oculomotor III- eye movement, pupillary constriction, accommodation, eye lid opening. Trochlear IV- eye movement superior oblique. Trigeminal V- mastication, facial sensation. Abducens VI- eye movement lateral rectus Facial VII- facial movement, taste from ant 2/3 of tongue, lacrimation, salivation, eyelid closing,

stapedius muscle in ear. Vestibulocohlear VIII- hearing & balance. Glossopharyngeal IX- taste from posterior 1/3 of tongue, swallowing, salivation (parotid gland),

monitoring carotid body and sinus chemo and baroreceptors, and elevates pharynx and larynx.

Vagus X- taste from epiglottic region, swallowing, palate elevation, midline uvula, talking, coughing, thoracoabdominal viscera, monitoring aortic arch chemo- and baroreceptors.

Accessory XI- head turning, shoulder shrugging. Hypoglossal XII- tongue movement.

2,3-bisphosphoglyceric acid: erythrocytes will increase its production when there is inability to maintain adequate tissue oxygenation. Pag. 505

Delirium tremens: life threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink. Symptoms: tachycardia, hypotension, tremors, seizures, hallucinations, delirium. Pag. 451

Glutamate as a neurotransmitter: excitotoxicity due to excessive glutamate released and impaired uptake occurs as part of the ischemic cascade and is associated with stroke and diseases like amyotrophic lateral sclerosis, autism, and Alzheimer’s disease. This process causes Ca ions to enter cells via NMDA receptor channels, leading to neuronal damage and eventual cell death.

Conversion disorder: sudden loss of sensory or motor function (might mimic a stroke). Often following an acute stressor, pt is aware but indifferent toward symptoms. Pag.447

Amyotrophic lateral sclerosis: can be caused by defect in superoxide dismutase 1 (SOD1). Histological findings: transverse sections of cervical spinal cord at C-6 will show degeneration of both corticospinal tracts, and atrophy of ventral roots. Pag. 411

Narcolepsy: disordered regulation of sleep-wake cycles; primary characteristic is excessive daytime sleepiness. Cataplexy manifestations are shown in some pt’s. Pag. 63

Pick’s disease: a neurodegenerative disease. Dementia, aphasia, parkinsonian aspects, lethargy and confusion; change in personality. Findings in autopsy: degeneration of cortical and basal forebrain neurons. Pag 425

Posterior cruciate ligament: injury to this ligament will show excessive sliding of the tibia when it is pushed backward with the knee flexed (positive drawer sign).

CD 4 and T-lymphocytes are responsible for the rash that develops in a contact dermatitis. ****Know the cerebral cortex functions****Pag. 402

An example question:

When a movement is planned but not executed which region of the brain will increase activity in a MRI? The premotor cortex. Letter B. g

In drug induced thrombocytopenia you will find heavy bleeding (could be from menstruation, gums, colon, etc), and petechiae. And decrease number of megakaryocytes in bone marrow. The varyou will find hypocellular bone marrow with fatty infiltration. Pag. 361

Virus vaccines: Pag. 164o Life attenuated: small pox, yellow fever, chicken pox (VZV), Sabin’s polio virus, MMR

(measles, mumps, rubella).o Killed: rabies, influenza, Salk polio, HAVo Recombinant: HBV (antigen), HPV.

In organ transplantation, graft-versus-host disease may be induced by donor T lymphocytes. Bone marrow transplantation for acute myelogenous leukemia is more likely to derive some benefit fron this graft-versus-host response. Pag. 215

Somatization disorder: variety of complaints in multiple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over a period of years. Most common in women.

A pt with severe pain in his thumb, with a history of diabetes. X rays of the thumb shows osteomyelitis. The flexor policis longus tendon would be the most likely affected by the pathologic process.

Interleukin-2 is the primary T-cell stimulator. So a HIV positive pt with a decreased CD4 T lymphocyte count IL-2 would be decreased too. Pag. 208

In multiple myeloma: monoclonal plasma cells cancer that arises in the bone marrow. Is the most common primary tumor arising within bone in elderly. Finding of M spike in protein electrophoresis (k light chain proteinuria). Pag.358

Multiple Myeloma

In a pt with a mean corpuscular volume (MCV) <80, is indicative of: Iron deficiency, α-thalassemia, β-thalassemia, lead poisoning, and sideroblastic anemia. Pag. 349

Osteoarthritis: mechanical-wear and tear of joints leads to destruction of articular cartilage. (early stage of the development of this condition is cracking of the cartilaginous surface).

Vertical gaze palsy: are due to damage to pre-motor structures in the midbrain. *A pt with 3 weeks of hedache.*

Axillary nerve: lesioned by fracture of surgical neck; dislocation of the humerus, or intramuscular injections. (Pain in shoulder and inability to move the involved extremity).

Subarachnoid hemorrhage: rupture of aneurism (usually berry aneurism in Marfan, Ehrlers-Danlos) or an arterio venous malformation. Described as sudden and “the worst headache of their life”. Pag.406

This term: “the prevalence is 3 times higher in non whites than in whites, but the incidence of the disease is no different in whites than in non whites.” Means that the duration of the disease is shorter in whites.

The action of C5-9 complex of complement is the one responsible for the cytolysis by membrane attack complex (MAC) in a erroneous blood transfusion. (E.g. giving a type O pt type A blood). Pag. 207

The Ca channel blockers work by disrupting the release of the neurotransmitter in to the cleft. Pag. 280 In benign paroxysmal positional vertigo: will present with vertigo. And when you infuse warm water in the

affected ear of the supine pt, you will see rotatory nistagmus, were the top of the eye rotates toward the affected ear. (E.g. in a affected left ear, the lesion will be in the left vestibular apparatus and vice versa).

In the thenar eminence: is composed of three muscles:o Abductor pollicis brevis- abducts the thumb; flexor pollicis brevis- flex the thumb curling it up to

the palm; and opponens pollicis- opposes the thumb bringing it up to the fingers.o *So in the case of a pt with numbness over the thenar eminence will have decreased strength in

any of these movements.* In muscle growth due to heavy lifting exercise, the number of mitochondria will elevate, but the amount

of actin per myocyte and the total number of myocytes will not change. Stenosis of the aqueduct of Sylvius: is an obstructive non communicating hydrocephalus, caused by a

structural blockage of CFS circulation within the ventricular system. Seen in newborns. Pag. 408 In chronic granulomatous disease: pt has recurrent infections of the skin and respiratory tract by S. aureus

due to the production of catalase by this organism. In Ehrlers-Danlos: there is a faulty collage synthesis. It may be associated with joint dislocations, berry

aneurisms, and organ rupture. (E.g. rupture of the colon and large arteries.) Pag. 80 Parkinson disease: you will find lewy bodies in the substantia nigra, which is located in the mesencephalon

(midbrain), which is in charge of reward, addiction, and movement. Letter C

C6 deficiency: pt suffering from this is prone to bacterial infection. It is part of the membrane attack complex which can insert into the cell membrane and cause cell to lyse. (E.g. in children with this deficiency have neisseria meningitidis-induced sepsis. Incubation of antibody coated N. meningitidis with plasma from affected children is most like to produce: a lowering in bacterial killing and no change in generation of anaphylatoxins). Anaphylatoxins found only in C3a, C4a, C5a.

Neutrophils: an example of this would be a pt that comes to the ER with a lesion on the ball of his feet infected and painful subcutaneous swelling in his groin area, would be indicative of recirculation of neutrophils from the wound site.

Dermatomyositis: Signs and symptoms- progressive bilateral proximal muscle weakness, heliotrope facial rash. Findings: positive ANA and muscle biopsy shows *perifascicular inflammation and muscle atrophy. Pag.386

Epidermolysis bullosa: is an inherited connective tissue disease causing chronic blisters in the skin and mucosal membranes. It is due to a molecular defect in the basement membrane of the skin.

Kaposi’s sarcoma: seen in HIV pt’s, due to sexual contact. Caused by herpes virus type 8. Findings: a skin lesion that won’t go away. Pag. 174

Sarcoidosis: characterized by immune-mediated, widespread noncaseating granulomas, and elevated serum ACE levels. Common in black females. Findings in chest x ray: *hilar lymphadenopaty. Histology: granulomas with foreign giant cells. Pag. 386

Kallikrein: the kinin-kallikrein system is a poorly understood system of blood proteins that plays a role in inflammation, blood pressure control, coagulation, and pain. Factor XII is involved.

Ulnar nerve: is directly connected to the little finger, and the adjacent half of the ring finger. Lesion to it will cause anesthesia of the little finger. Letter D

Prion disease: accumulation of prion results in spongiform encephalopathy and dementia, ataxia, and death. It can be sporadic (rapidly progressive), inherited, or acquired. (E.g. may be caused by a corneal transplant… ;)) Pag. 175

(Block 2)

Rheumatoid arthritis: analysis serum shows antibodies able to bind human IgG which most likely recognize the pair 3 and 4 of the IgG molecule: (Pag. 205, 383)

Chronic granulomatous disease: they have a deficiency of NADPH oxidase, thereby causing recurrent

infections. Catalase-producing microbes easily degrade what little H2O2 is present in this type of pt’s. Pag. 145

Yes 0 Ketone bodies: in the liver, fatty acids and amino acids are metabolized to acetoacetate and β-

hydroxybutyric acid (to be used in muscle and brain). Pag. 112 An enzyme that folds in an abnormal manner due to an error in the reading most likely will get a faster

degradation. Malignant otitis externa: due to pseudomonas in diabetic pt’s. May present with no history of drainage,

and progressively severe pain. Endonuclease sites: these enzymes are often used in genetic engineering to make recombinant DNA for

introduction into bacterial cells. This is an example of a granulomatous inflammation.

Optochin (P disk) susceptibility: is the laboratory test most useful to differentiate Streptococcus pneumoniae from other α-hemolytic streptococci.

Glycerol kinase: is a phosphotransferase enzyme involved in triglycerides and glyserophospholipids synthesis. (When adipocyte triglycerides are mobilized, the nonfatty acid domain of this molecule can be used by the liver for Gluconeogenesis. This enzyme initiates this process).

Bacillus subtilis: will survive an sterilization of dry heat at 100 C for 60 min. The labeled structures are gap junctions: (with the arrow)

In a lymph node biopsy that shows replacement of nodal architecture by neoplastic follicules composed of cleaved lymphocytes, is due to alteration of regulation of apoptosis.

The mitogenic signal provided by a cytokine to smooth muscle cells at sites of vascular injury in pt’s with myocardial infarction, is most likely to be inhibited by the intracellular enzyme phosphatase.

In Duchenne’s muscular dystrophies, there is maternal germline mosaicism. It has a high rate of spontaneous mutation. Pag. 83 & 87

Experimental drug used as a tx for human lymphoid tissue causing over expression of the bcl2 protein will decrease apoptosis. B-cell lymphoma-2 (bcl2) is the founding member of Bcl-2 family of apoptosis regulator proteins encoded by the BCL2 gene.

The initiation of coagulation is played by a sequence- specific cleavage of proteins. Pag. 345 Toxoplasmosis: Congenital toxoplasmoses have a classic triad of choreorenitis, hydrocephalus, and

intracranial calcifications. It is due to transplacental transmission. The toxic shock syndrome toxin is induced by a superantigen that binds to MHC II and T-cell receptor,

resulting in polyclonal T-cell activation. Pag. 145 The splicing of primary gene transcripts in eukaryotic cells is most likely to have an increased repertoire of

gene products. Influenza virus: contain hemagglutinin (promotes viral entry) and neuraminidase (promotes progeny viral

release). Pag. 170 In alcoholic liver disease, the findings will be jaundice, abdominal distention, spider angiomata, and

tanner stage 2 gynecomastia. The development of gynecomastia in cirrhosis is due to transmembrane diffusion and binding of signaling molecule to transcription factor. Pag. 494

Vitamin B12 (Cobalamin or cyanocobalamin): is a cofactor for homocysteine methyltransferase and methylmalonil-CoA mutase. It is used as a tx to eliminate methylmalonic aciduria. Pag. 92

Macrophage: it contributes to the subside of pain and erythema in the tissue, after a lesion. Think of it as the scavenger cell. Pag. 343

In iron deficiency anemia the gold standard to dx is a bone marrow extraction. But you can use a reticulocyte count because it is a quantitative measure of the bone marrow production of new red blood cells.

Nucleolus: its function is to transcribe ribosomal RNA (rRNA) and assemble it within the cell. So if you have a question talking about precursor rRNA, nucleolus should be your answer.

A pt with a history of watery diarrhea for a few days, must be dehydrate, so in an arterial blood test everything is going to be low (pH, PCO2, HCO3). An example would be: pH-7.0, PCO2-28, HCO3-15.

Topoisomerases: in eukaryotic DNA replication create a nick in the helix to relieve supercoils created during replication. (Free rotation of the two sections of the DNA helix on either side of the nick) Pag. 70

When receiving a female pt with sings of marital abuse, the next step to take is to inform her about domestic violence shelter.

Cryptococcus neoformans: is an opportunistic fungus that can cause meningitis in AIDS pts and pts undergoing chemotherapy treatment. It stains with india ink. His major virulence factor is his polysaccharide capsule. Pag. 158

Streptococcus pneumoniae: is a α-hemolytic, gram + diplococcic. It develops pneumonia in pts due to expression of a polysaccharide capsule, and is associated with pink sputum. Pag. 145

Glucose-6-phosphate dehydrogenase-catalyzed generation of NADPH, is the reaction responsible for protecting the erythrocyte from injury by oxidations processes. Pag. 102

Tight junctions: (zona occludens) prevents diffusion across paracellular space. Are in charge of the backflow of glucose from the basal side of the intestinal epithelium into the lumen of the gut. Pag. 370

Borderline personality disorder: unstable mood and interpersonal relationships (may do male or female), impulsiveness, self mutilation, boredom, sense of emptiness. Females>males. Pag. 448

Maple syrup disease: blocked degradation of branched amino acids (isoleucine, Leucine, valine). Urine smells like burned sugar or maple syrup. Pag. 108

Human papilloma virus: number 16, 18 in a long term can cause cervical cancer (squamous cell carcinoma). Pag. 166

In squamous cell carcinoma of the lung, you will find elevated calcium serum (hypercalcemia), due to the ectopic production of parathyroid hormone- related protein. Pag. 513

This one must be checked…… A 25 yld primigravid comes to the physician for her first prenatal visit. She request an amniocentesis “to make me feel better that everything is alright with my baby”. There is no family history of genetic disorders. Everything is beyond normal; the likelihood of finding an abnormality is low. The physician needs to balance which of the following ethical principles when deciding whether to grant this pt request? *I think is B* pag.57

Prostacyclin (PGI2) is synthesized by the endothelial cells, and inhibits platelet activation, and is an effective vasodilator.

Coxsackievirus: is a single stranded, no envelope RNA virus. Hand-foot-mouth disease. With vesicular rash on palms and soles, ulcers in oral mucosa. Pag. 168 & 180

Lesch-Nyham syndrome: deficiency of hypoxanthine-guanine phosphoribosyltransferase. Results in accumulation of urea in serum. Findings: retardation, self-mutilation, aggression, hyperuricemia, gout, choreoathetosis. Pag. 69

Review early developmental milestones in page 60. Squamous metaplasia: one adult cell type is replaced by another. Often secondary to irritation and/ or

environmental exposure (e.g. squamous metaplasia in trachea and bronchi of smokers). Pag. 226 Fragile X syndrome: x-linked defect, and trinucleotide repeat disorder (CGG), methylation and expression

of the FMR1 gene. Findings: macrocephaly, large jaw, large ears, retardation. Pag. 87 Vitamin E: antioxidant (protects erythrocytes and membranes from free radical damage). Pag. 93

(Block 3)

Abciximab: is a monoclonal antibody that binds to the glycoprotein IIb/IIIa on activated platelets, preventing aggregation. Used for pt’s with acute coronary syndromes, or treated with percutaneous coronary intervention (angioplasty/catheterization). Pag. 217 &364

Statins: like lovastatin are used as lipid lowering agents. But since they are hepatotoxic, you have to be careful with alcoholic pt’s because alcohol increase toxicity of the statins. Pag. 282

Hypocalcemia: in this condition you will find convulsion, arrhythmias, tetany, and numbness/paresthesias in hands, feet, around mouth and lips.

Itraconazole: is from the family of the azoles, and is used to treat sporothricosis. The mechanism of action is cell membrane sterol synthesis reduced by inhibition of C14 lanosterol demethylase. Pag. 193

Thiopental: used for induction of anesthesia and short surgical procedures. Effect terminated by rapid redistribution into tissue and fat (adipose tissue). Pag. 434

Cyclosporine: inhibits the production of interleukin-2 (IL-2) in resting T-lymphocytes and the production of γ- interferon in activated T-lymphocytes. Pag. 215

Loop diuretics (furosemide) site of action. Letter D. Pag. 473 Others site of action:

o Letter A: acetazolamideo Letter B & C: osmotic agents (mannitol)o Letter E: thiazideso Letter F: ADH agonists

Norepinephrine and prazosin: o Prazosin is a α-1 selective used for hypertension, and urinary retention in BPH. (Pag. 241). The

receptors α-1 are found on vascular smooth muscle, were they are responsible for the vasoconstrictive action of Norepinephrine.

Emergence of HIV variants resistant to antiviral drugs is due to that HIV transcriptase is error prone. 5-fluoracil: is a cancer treatment that is effective because it prevents methyl group transfer to dUMP to

form dTMP. Pag. 365 Lorazepam: is a benzodiazepine used for status epilepticus (sometimes seen in cocaine overdose), which

facilitate GABA action by increasing influx of Cl. Pag. 433 Hydroxyurea: is the treatment used for sickle cell anemia (↑HbF), which helps to lower the frequency of

the acute crisis. Pag.352 & 367 In vaccines containing polysaccharide capsule, the polysaccharide antigen alone would not be recognized

and presented by T cells; therefore, only IgM antibodies would be produced. (E.g. pneumovax, H. influenza type B, meningococcal vaccines) Pag. 139

A young pt with suddenly acute distress, chest pain, difficulty breathing, Whit a chest x-ray that shows a sharp line running parallel to the chest wall adjacent to a radiolucent area without lung markings, the appropriate next step to take is a needle aspiration.

Aortic arch derivatives: Pag. 127o 1st- maxillary arteryo 2nd – stapedial artery and hyoid art.o 3rd- common Carotid and proximal part of internal carotid.o 4th- on left: aortic arch; on right: proximal part of right subclavian

o 6th- proximal part of pulmonary artery. Tubocurarine: is a neuromuscular blocking drug used for muscle paralysis in surgeries. Reversal of

blockade – neostigmine + atropine. Pag. 435

α-adrenergic and β-adrenergic Pag. 240 Clostridium difficile: diarrhea with this organism is usually secondary to antibiotic use, specially

clindamycin or ampicillin. And it is diagnosed by detection of one or both toxins in stool. (Toxin A or B). Pag. 147

Risperidone: is an atypical antipsychotic that is used for schizophrenia (both, positive and negative symptoms). Pag. 453

Aspirin prevents conversion of arachidonic acid to thromboxane A2. Pag. 363 Letter B

Ondansetron: is a 5-HT3 antagonist who is used to treat and prevent chemotherapy- induced nausea and vomiting. (Blockade of serotoninergic 5-HT3 receptors)

ACE inhibitors (angiotensin-converting enzyme inhibitor): in addition to blocking the conversion of angiotensin I to angiotensin II, this drug also produces systemic vasodilation by decreasing bradykinin degradation.

Hypoactive sexual desire disorder: is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time.

Adenosine: is a rapidly acting agent whose direct effects last only seconds, and is the drug of choice to treat supraventricular tachycardia.

Mefloquine: is one of the drugs given for the tx of malaria. It is also used to prevent it. Pag. 161 A pt with anorexia nervosa, which have a secondary amenorrhea, the most important step for her to take

if she wants to restore her reproductive and endocrine functions to normal is to gain weight. In heroin overdose, you will see many signs and symptoms, but the principal ones will be coma, miosis,

and cyanosis. Pag. 450 Methocarbamol: is a central muscle relaxant used to treat skeletal muscle spasms. Streptomycin: is an aminoglycoside. It is a protein inhibitor that binds to the small 16S rRNA of the 30S

subunit of the bacterial ribosome, interfering with the binding of formyl-methionyl-tRNA to the 30S subunit. Pag. 187

Meckel’s diverticulum: is the most common congenital anomaly of the GI tract. Commonly presents in the first 2 years of life. You will find a child pt with chronic iron deficiency anemia and a positive stool for occult blood test. Pag. 327

Serotonin syndrome: the use of an SSRI (paroxetine) and any drug that ↑serotonin (e.g. MDMA aka ecstasies) will cause this syndrome, were you will find abdominal pain, and diarrhea. Pag. 455

Hydrochlorothiazide: is a thiazide diuretic that inhibits NaCl (Na –Cl transporter) reabsorption in the early distal tubule. Pag. 474

After a whole blood transfusion there is going to be a decreased calcium concentration, because the ion-chelation compounds will remove the extra calcium from the blood stream.

A pt that is undergoing surgery and is under general anesthesia and suddenly develops a temperature of 40 C and spasms of the masseter muscles, this adverse effect should be treated by facilitation of Ca sequestration in sarcoplasmic reticulum of skeletal muscle.

Potter’s syndrome: embryological bilateral renal agenesis. Findings: oligohydramnios, limb deformities, facial deformities and pulmonary hypoplasia. Pag. 132

Bicornucate uterus: results from the incomplete fusion of the paramesophrenic (mullerian) ducts. Pag. 133

Resistance to acyclovir is due to lack of viral thymidine kinase. The preferred treatment for basal cell carcinoma is cryotherapy. In 2nd meiotic methaphase the oocytes within responding antral follicles reinitiate meiotic development

as they are released from this stage. Pag. 484 Enoxaparin: is a low molecular weight heparin. It is used to treat and prevent pulmonary embolism, and

deep vein thrombosis. Compared to heparin, less monitoring is required. Sulfasalazine: is the most appropriate maintenance drug for ulcerative colitis.

This one is a tricky one, I really have no idea of what the answer could be, and the only thing that is under the young person is the heart rate…. I strongly think is E. read this article and make your own conclusions: http://www.medscape.com/viewarticle/450564_4

Misoprostol: (also known as cytotec) it is used for the prevention of NSAID induced peptic ulcers. Also used to induce labor. It may worsen menstrual cramping due to uterus contraction. Pag. 338

Methylphenidate: (Ritalin) is a CNS stimulant used for the tx of ADHD. Pag. 452 In the next question I strongly think is E. Most choose C, read it and you decide. Pag.449

BLOCK 4

Aortic regurgitation: high pitched, blowing, diastolic decrescendo murmur best heard at the second right intercostal space. Pag. 258 (Review)

Atrial flutter ECG: “sawtooth” appearance. Pag. 263

*Not to be confused with sinus tachycardia:

Pseudomonas aeruginosa: is the pneumonia causing bacteria in cystic fibrosis pt. Pag. 176

Mitral regurgitation: also known as mitral insufficiency is the most common form of valvular heart disease. It produces a holosystolic murmur that is loudest at the apical impulse and radiates to the axillae. Pag.258

Giardia lamblia: is a protozoa, which causes *bloating, flatulence and diarrhea*. Tetralogy of fallot: the pulmonary stenosis is the most important determinant of prognosis (chest x ray

shows decreased pulmonary vascular markings indicating a decrease in pulmonary blood flow). Baby is cyanotic since birth (the most common cause of early cyanosis). Pag. 267

A drug that increases the force expiratory volume in one second (FEV1) to greater than 80% forced vital capacity (FVC) during an asthmatic episode, this drug mechanism of action is by dilation of the pulmonary bronchioles.

In a diabetic ketoacidosis, the HCO3↓, PCO2↓, and pH↓. Pag. 302 Tiiodothyronine (T3): its signaling mechanism used to transmit its effects is: T3 binding activates the DNA

binding activity of an intracellular receptor. Pag. 295 In menopause, there is a high concentration of follicle stimulating hormone (FSH) in the blood, this is

best way to confirm it. Pag. 485 In thyroxine-binding globulin deficiency you are going to find a decreased serum thyroxine (T4)

concentration and a normal serum TSH. To confirm, in the venous blood you will find normal free T4 concentrations.

Elevation of progesterone is indicative of ovulation. Pag. 483 In hyperaldosteronism (Conn’s syndrome): you will find hypertension, hypokalemia, metabolic alkalosis,

and low plasma renin. ↓Plasma renin activity, ↓Plasma K concentration, ↑extracellular fluid volume. Pag. 296

Human placental lactogen: it acts synergistically with estrogen during the differentiation of mammary gland alveolar cells in late pregnancy.

To DNA Dilated cardiomyopathy: is the most common cardiomyopathy. You will find *the 4 chambers enlarged.

Not to confuse with hypertrophic cardiomyopathy, that the septum is the one enlarged. Pag. 273

Pulmonary infarct: (pulmonary embolism) is a blockage of the main artery of the lung or one of its branches by a substance that has traveled elsewhere in the body through the bloodstream.

Chronic obstructive pulmonary disease: in the emphysema type you will find enlargement of air spaces and ↓recoil resulting from destruction of alveolar walls, this ie very often seen in chronic smokers. (Breakdown of elastic fibers). Pag. 510

The next question we spend like an hour discussing it, but never came to a final conclusion. What we know for sure is that the pain in a myocardial infarction is due to the lack of oxygen supply to the tissue, if you can figure out how to match this info with any of the answers, well done! We are between A, B, and E. *I strongly suggest E. http://www.annualreviews.org/doi/abs/10.1146/annurev.physiol.61.1.143?journalCode=physiol

Compared values of a women jogging at a steady rate.

A newborn with external genitalia that appear to be female, but the vagina ends as a blind pouch. The chromosome analysis shows a 46, XY. The explanation for these physical findings is due to abnormal androgen receptors. Pag. 291

Respiratory alkalosis: is a compensatory response to a pH <40mmHg. The body can achieve that by increasing the respiratory rate. (It might be seen in a bacterial sepsis and other causes) Pag. 465

Carotid bodies: are peripheral chemoreceptors that respond to changes in ↓PO2 (<60mmHg), ↑PCO2, and ↓pH of blood. In the case of removal of this receptors, you will find the following graph: (Pag. 265) Normal without carotid bodies

Oligohydramnios: it is <0.5L of amniotic fluid. Some of the causes are: parental insufficiency, bilateral

renal agenesis, or posterior urethral valves (in males) resulting in inability to excrete urine. Pag. 488 Perforation of the ascending colon will produce retroperitoneal gas. In diabetes insipidus, one of the findings will be an increase concentration in serum ADH (vasopressin).

Pag. 300 The reason of hirsutism after menopause is due to increased androgen production. Pag. 485 The pituitary stalk (or infundibulum) is the connection between the hypothalamus and the posterior

pituitary. In the case of a head trauma and due to it the transection of the pituitary stalk, all the hormones produced by the ant. Pit. And the post. Pit. Are going to be decreased. Ex.

CA 125 (mucin 16) is a tumor marker that is used to identify some types of cancer, for example ovarian cancer (mucinous cystadenocarcinoma). Pag. 492

In benign prostatic hyperplasia, the most likely complication of this disease is bacterial cystitis. Pag. 495 In this question, answer is either B or C, I really didn’t look for it …

An untreated gonorrhea (gram – diplococcic) or Chlamydia, will cause epididymitis in males, and PID in women.

A finding that is suggestive of hereditary renal cell carcinoma is the presence of tumors in both kidneys. Pag. 469

Parietal cells are gastrin-mediated cells that when hyper stimulated contribute the most in the formation of duodenal ulcers. Pag. 319 &325

If taking a blood sample 1 hour after eating, the concentration of glucose is most likely to be increased. An increase in efferent arteriolar resistance causes an increase in filtration factor. Pag. 460 The twin placentation present here is monochorionic monoamniotic:

Type II pneumocytes are the responsible for the secretion and production of surfactant in the lungs; are the responsible for infant respiratory distress syndrome. Letter C Pag. 502

The alveoli bring RBCs into close proximity with inspired air. Type I pneumocytes (blue) are the squamous cells that form a component of the air-blood barrier. The cuboidal Type II pneumocytes (green) secrete surfactant that reduces surface tension and prevents atelectasis.

Pernicious anemia is caused by the lost of gastric parietal cells. Since the gastric parietal cells are the responsible for the secretion of gastrin, an additional finding in this pt’s will be an increase of gastrin in blood.

Meckel’s diverticulum: true diverticulum. Persistence of the vitelline duct or yolk stalk. (Persistence of a remnant of the proximal portion of the yolk sac). Pag. 327

Gilbert’s syndrome is a hereditary hyperbilirubinemia. Is asymptomatic, elevated unconjugated bilirubin without overt hemolysis. Bilirubin increases with fasting and stress. Pag. 333

Pituitary adenoma is the most common prolactinoma. Findings: amenorrhea, galactorrhea, low libido, infertility. It can impinge on optic chiasm causing bitemporal hemianopia. Pag.300

Takayasu’s arteritis is a form of large vessel granulomatous vasculitis. The next is a pt presentation with the disease.

Hydrocele: ↑fluid secondary to incomplete fusion of processus vaginalis. Pag. 496

Letter D Pag. 505

A pt who is a chronic smoker, comes with hypoxia and hypercapnia,his gas exchange is 15%of that of a healthy individual. A CT of the chaste shows numerous obstructed small bronchioles with air trapping. In alveoli beyond the obstructions, which of the following points on the graph best represents the relationship between PO2 and PCO2 if the pt is breathing room air at sea level? Letter A

-Many red cell casts and erythrocytes.