NBME 26 II COMPREHENSIVE QUESTIONS AND
VERIFIED SOLUTIONS
Paresthesias - ✔✔abnormal sensation (e.g., tingling, prickling, "pins and
needles") false positives and false negatives - ✔✔ placenta accreta - ✔✔A rare
disorder in which the placenta is directly adherent to the myometrium (without
penetrating) instead of the decidua basalis. Results in delayed separation
and/or placental retention as well as postpartum hemorrhage. The most
important risk factors for placenta accreta are a previous C-section and
placenta previa. -risk factors include: prior uterine instrumentation (including
ceserean delivery), increased maternal age, placenta previa, and pultiparity.
given the high risk of morbidity and mortality, elective surgical delivery at 34 to
36 weeks is recommended. leiomyomata uteri - ✔✔(uterine fibroids) benign
tumors of the uterus, which can present with abnormal uterine bleeding and
pelvic pain. however, they are more common in older women and are
associated w an irregular shaped uterus on physical exam. Monobactams -
✔✔inhibit transpeptidation by inhibiting penicillin-binding protein 3 antimycin
A - ✔✔inhibits complex III of the electron transport chain cyanide, monoxide,
azides -- electron transport chain inhibitors - ✔✔inhibit complex IV normal
alveolar-arterial gradient (a/A gradient) - ✔✔5-10 mmHg Baclofen - ✔✔a
GABAb receptor agonist, which hyperpolarized muscle cells and relieves muscle
spasticity Bacteroides fragilis - ✔✔an anaerobic, gram-negative bacillus and a
normal component of the gastrointestinal microbiota. it only results in
infections when displaced from the colon, such as following surgery, rupture,
or trauma, where is has the potential to cause bacteremia, intra-abdominal
infections, peritonitis, and subcutaneous abscesses. Bacterial vaginosis - ✔✔is
caused by the vaginal overgrowth of Gardnerella vaginialis, a gram-variable,
facultative anaerobe. It presents with gray, thin, malodorous vaginal discharge,
a vaginal pH greater than 4.5, a fishy odor upon KOH testing, and clue cells on
microscopy Glucagonoma - ✔✔a rare functional malignancy that secretes
glucagon, which raises blood glucose. Glucagon acts on hepatocytes via a
cAMP pathway activating protein kinase A that ends in the activation of
glycogen phosphorylase, with release of glucose monomers in the serum. When
glycogen stores are exhausted, the body relies on the breakdown of fat through
beta oxidation of fatty acids to provide energy. -- occurs in mitochondria of the
cell Carnitine acetyltransferase - ✔✔a transmembrane protein found on the
,surface of mitochondria in liver, muscle, and brain, and catalyzes the bond
between acyl-CoA and carnitine, which permits the long-chain fatty acid to
translocate into the mitochondria matrix where beta-oxidation (breakdown of
fatty acid) can occur. Renal tubular acidosis - ✔✔A normal anion gap
(hyperchloremic) metabolic acidosis in the presence of normal or almost normal
renal function. The various types of RTA include proximal tubular bicarbonate
wasting (type II), distal tubular acid secretion (type I), very rarely carbonic
anhydrase deficiency (type III), and aldosterone deficiency/resistance (type IV).
Renal tubular acidosis arises as a result of defects in the tubular transport of
HCO3- and/or H+. Most forms of RTA are asymptomatic although, rarely, life-
threatening electrolyte imbalances can occur. Salicylate poisoning - ✔✔initially
results in a respiratory alkalosis from the stimulation of respiratory centers
causing hyperventilation. Subsequently, it results in the development of a
delayed anion gap metabolic acidosis secondary to its decoupling effects on the
electron transport chain, resulting in increased anaerobic metabolism and the
production of lactate and ketoacids. ansa cervicalis - ✔✔a loop of nerves in the
anterior neck that originate from the spinal nerve roots C1-C3. the inferior root
is formed by the fibers of C2 and C3 and provides branches to the inferior
portion of the omohyoid, stenothyroid, and sternohyoid muscles. the phrenic
nerve - ✔✔arises from the cervical roots C3-C5 and provides motor innervation
to the diaphragm. it also provides sensory innervation to the mediastinal
pleura and the pericardium phrenic nerve injury can occur during
cardiothoracic surgery or thoracic or cervical trauma and can lead to
diaphragmatic paralysis. developing 20-month old child can typically walk up
stairs (and may be able to run), stack several blocks, and use 100 or more
vocabulary words, and play pretend. - ✔✔aggressive, impulsive behavior is not
uncommon, and cooperative play does not typically develop until the age of 4
years. Osteoarthritis - ✔✔the most common disease of joints in humans. It
affects 60% to 80% of adults over the age of 65. it is characterized by global
degeneration of a joint with fraying, fibrillation, and degradation of cartilage,
thickening of the subchondral plate w sclerotic bone, and SUBCHONDRAL
CYSTS due to inflammation of synovial fluid into the bone. Arthrocentesis
typically demonstrates few leukocytes, normal appearance, and normal
glucose. jejunum - ✔✔possesses several characteristic features, including
prominent plicae circularis, which lends the jejunum an increased mucosal
surface area and feathered appearance w oral contrast material -also
demonstrates a large caliber, thicker muscular walls, longer vasa rectae, and
fever arcades congenital adrenal hyperplasia - ✔✔results from a defect in
adrenal steroid biosynthesis. its most common form, 21-hydroxylase deficiency,
, presents with salt-wasting in infants or precocious puberty in children. it also
causes the virilization of XX fetuses, elevated levels of 17-hydroxyprogesterone,
hypotension, and hyperkalemia. tx: exogenous administration of
mineralcorticoids and glucocorticoids Sex determining region of Y - ✔✔A region
of the Y chromosome gene that encodes for the SRY protein (also known as
testis-determining factor, or TDF), which is a transcription factor that
suppresses ovarian development and regulates male sex determination at
around 6 weeks of gestation. the intracranial compartment is a fixed, rigid
space, and any lesion that occupy space in it may displace normal brain
parenchyma, causing midline shift and mass effect. - ✔✔THERAPEUTIC
HYPERVENTILATION and resulting hypocapnia cause cerebral
vasoconstriction, which results in decreased cerebral blood flow and
intracranial pressure. Interleukin-12 (IL-12) and interferon-gamma -
✔✔activate the two primary cells responsible for granuloma formation in
patients with mycobacterium tuberculosis infection. Tension pneumothorax -
✔✔occurs when air is able to enter the pleural space but is prevented from
exiting. leading to an increasing amount of air trapped in the pleural space w
subsequent collapse of the lung parenchyma and mass effect on the
mediastinum. it is characterized by respiratory distress, tracheal deviation,
hypotension, decreased breath sounds, and hyperresonant percussion on
physical exam Muscle necrosis leads to rhabdomyolysis, myoglobinuria, and
acute renal failure. - ✔✔Evaluation for Rhabdo reveals red or brown urine and
urinalysis is positive for blood due to the presence of myoglobinuria without
microscopic evidence of red blood cells. pressure tracing -- mitral regurg -
✔✔could be due to rupture of the chordae tendineae medially, the precentral
gyrus contains neurons that control the lower extremity. - ✔✔laterally, the
precentral gyrus controls the contralateral face. ??? look up after a cerebral
infarction, - ✔✔neurons undergo liquefactive necrosis and are replaced by a
glial scar consisting of proliferated astrocytes. the glial scar forms
approximately 2 weeks after the initial ischemic event Bartonella bacilliformis -
✔✔a gram-negative coccobacillus found in Peru, Ecuador, Colombia, and some
parts of southern Florida that cause bartonellosis (Carrion disease) or Oroya
fever in the acute phase of infection and verruga perunana in the chronic
phase. It is transmitted by sandflies Babesiosis tx - ✔✔Atovaquone plus
Acithromycin recall Atovaquone = Atovaquone-proguanil --> An antimalarial
drug used for the treatment of chloroquine-resistant P. falciparum infection
and for malaria prophylaxis. Can cause gastrointestinal discomfort. the
hemidesmosome - ✔✔an intricate complex of proteins whose ultimate function
is to anchor the basal keratinocytes of the epidermis to the dermis at the
VERIFIED SOLUTIONS
Paresthesias - ✔✔abnormal sensation (e.g., tingling, prickling, "pins and
needles") false positives and false negatives - ✔✔ placenta accreta - ✔✔A rare
disorder in which the placenta is directly adherent to the myometrium (without
penetrating) instead of the decidua basalis. Results in delayed separation
and/or placental retention as well as postpartum hemorrhage. The most
important risk factors for placenta accreta are a previous C-section and
placenta previa. -risk factors include: prior uterine instrumentation (including
ceserean delivery), increased maternal age, placenta previa, and pultiparity.
given the high risk of morbidity and mortality, elective surgical delivery at 34 to
36 weeks is recommended. leiomyomata uteri - ✔✔(uterine fibroids) benign
tumors of the uterus, which can present with abnormal uterine bleeding and
pelvic pain. however, they are more common in older women and are
associated w an irregular shaped uterus on physical exam. Monobactams -
✔✔inhibit transpeptidation by inhibiting penicillin-binding protein 3 antimycin
A - ✔✔inhibits complex III of the electron transport chain cyanide, monoxide,
azides -- electron transport chain inhibitors - ✔✔inhibit complex IV normal
alveolar-arterial gradient (a/A gradient) - ✔✔5-10 mmHg Baclofen - ✔✔a
GABAb receptor agonist, which hyperpolarized muscle cells and relieves muscle
spasticity Bacteroides fragilis - ✔✔an anaerobic, gram-negative bacillus and a
normal component of the gastrointestinal microbiota. it only results in
infections when displaced from the colon, such as following surgery, rupture,
or trauma, where is has the potential to cause bacteremia, intra-abdominal
infections, peritonitis, and subcutaneous abscesses. Bacterial vaginosis - ✔✔is
caused by the vaginal overgrowth of Gardnerella vaginialis, a gram-variable,
facultative anaerobe. It presents with gray, thin, malodorous vaginal discharge,
a vaginal pH greater than 4.5, a fishy odor upon KOH testing, and clue cells on
microscopy Glucagonoma - ✔✔a rare functional malignancy that secretes
glucagon, which raises blood glucose. Glucagon acts on hepatocytes via a
cAMP pathway activating protein kinase A that ends in the activation of
glycogen phosphorylase, with release of glucose monomers in the serum. When
glycogen stores are exhausted, the body relies on the breakdown of fat through
beta oxidation of fatty acids to provide energy. -- occurs in mitochondria of the
cell Carnitine acetyltransferase - ✔✔a transmembrane protein found on the
,surface of mitochondria in liver, muscle, and brain, and catalyzes the bond
between acyl-CoA and carnitine, which permits the long-chain fatty acid to
translocate into the mitochondria matrix where beta-oxidation (breakdown of
fatty acid) can occur. Renal tubular acidosis - ✔✔A normal anion gap
(hyperchloremic) metabolic acidosis in the presence of normal or almost normal
renal function. The various types of RTA include proximal tubular bicarbonate
wasting (type II), distal tubular acid secretion (type I), very rarely carbonic
anhydrase deficiency (type III), and aldosterone deficiency/resistance (type IV).
Renal tubular acidosis arises as a result of defects in the tubular transport of
HCO3- and/or H+. Most forms of RTA are asymptomatic although, rarely, life-
threatening electrolyte imbalances can occur. Salicylate poisoning - ✔✔initially
results in a respiratory alkalosis from the stimulation of respiratory centers
causing hyperventilation. Subsequently, it results in the development of a
delayed anion gap metabolic acidosis secondary to its decoupling effects on the
electron transport chain, resulting in increased anaerobic metabolism and the
production of lactate and ketoacids. ansa cervicalis - ✔✔a loop of nerves in the
anterior neck that originate from the spinal nerve roots C1-C3. the inferior root
is formed by the fibers of C2 and C3 and provides branches to the inferior
portion of the omohyoid, stenothyroid, and sternohyoid muscles. the phrenic
nerve - ✔✔arises from the cervical roots C3-C5 and provides motor innervation
to the diaphragm. it also provides sensory innervation to the mediastinal
pleura and the pericardium phrenic nerve injury can occur during
cardiothoracic surgery or thoracic or cervical trauma and can lead to
diaphragmatic paralysis. developing 20-month old child can typically walk up
stairs (and may be able to run), stack several blocks, and use 100 or more
vocabulary words, and play pretend. - ✔✔aggressive, impulsive behavior is not
uncommon, and cooperative play does not typically develop until the age of 4
years. Osteoarthritis - ✔✔the most common disease of joints in humans. It
affects 60% to 80% of adults over the age of 65. it is characterized by global
degeneration of a joint with fraying, fibrillation, and degradation of cartilage,
thickening of the subchondral plate w sclerotic bone, and SUBCHONDRAL
CYSTS due to inflammation of synovial fluid into the bone. Arthrocentesis
typically demonstrates few leukocytes, normal appearance, and normal
glucose. jejunum - ✔✔possesses several characteristic features, including
prominent plicae circularis, which lends the jejunum an increased mucosal
surface area and feathered appearance w oral contrast material -also
demonstrates a large caliber, thicker muscular walls, longer vasa rectae, and
fever arcades congenital adrenal hyperplasia - ✔✔results from a defect in
adrenal steroid biosynthesis. its most common form, 21-hydroxylase deficiency,
, presents with salt-wasting in infants or precocious puberty in children. it also
causes the virilization of XX fetuses, elevated levels of 17-hydroxyprogesterone,
hypotension, and hyperkalemia. tx: exogenous administration of
mineralcorticoids and glucocorticoids Sex determining region of Y - ✔✔A region
of the Y chromosome gene that encodes for the SRY protein (also known as
testis-determining factor, or TDF), which is a transcription factor that
suppresses ovarian development and regulates male sex determination at
around 6 weeks of gestation. the intracranial compartment is a fixed, rigid
space, and any lesion that occupy space in it may displace normal brain
parenchyma, causing midline shift and mass effect. - ✔✔THERAPEUTIC
HYPERVENTILATION and resulting hypocapnia cause cerebral
vasoconstriction, which results in decreased cerebral blood flow and
intracranial pressure. Interleukin-12 (IL-12) and interferon-gamma -
✔✔activate the two primary cells responsible for granuloma formation in
patients with mycobacterium tuberculosis infection. Tension pneumothorax -
✔✔occurs when air is able to enter the pleural space but is prevented from
exiting. leading to an increasing amount of air trapped in the pleural space w
subsequent collapse of the lung parenchyma and mass effect on the
mediastinum. it is characterized by respiratory distress, tracheal deviation,
hypotension, decreased breath sounds, and hyperresonant percussion on
physical exam Muscle necrosis leads to rhabdomyolysis, myoglobinuria, and
acute renal failure. - ✔✔Evaluation for Rhabdo reveals red or brown urine and
urinalysis is positive for blood due to the presence of myoglobinuria without
microscopic evidence of red blood cells. pressure tracing -- mitral regurg -
✔✔could be due to rupture of the chordae tendineae medially, the precentral
gyrus contains neurons that control the lower extremity. - ✔✔laterally, the
precentral gyrus controls the contralateral face. ??? look up after a cerebral
infarction, - ✔✔neurons undergo liquefactive necrosis and are replaced by a
glial scar consisting of proliferated astrocytes. the glial scar forms
approximately 2 weeks after the initial ischemic event Bartonella bacilliformis -
✔✔a gram-negative coccobacillus found in Peru, Ecuador, Colombia, and some
parts of southern Florida that cause bartonellosis (Carrion disease) or Oroya
fever in the acute phase of infection and verruga perunana in the chronic
phase. It is transmitted by sandflies Babesiosis tx - ✔✔Atovaquone plus
Acithromycin recall Atovaquone = Atovaquone-proguanil --> An antimalarial
drug used for the treatment of chloroquine-resistant P. falciparum infection
and for malaria prophylaxis. Can cause gastrointestinal discomfort. the
hemidesmosome - ✔✔an intricate complex of proteins whose ultimate function
is to anchor the basal keratinocytes of the epidermis to the dermis at the
