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NBME#3 block 2 Q1----------------------Q50 - maryam2009
#11
@maryam2009, thank you. I got it now. Does it work through metalloproteases?
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#12
8. A or C??? I would go with AAA
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#13
yes it does, u r welcome
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#14
8.C you need a person who is familiar with the medical terms,
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#15
ok, sounds like it should be this way
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#16
9.D
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#17
hey lovetest plz try to give explanation..


10--
Pathogenesis
Intrinsic defect with predominantly intravascular hemolysis
Mild component of extravascular hemolysis
Decreased synthesis of NADPH and glutathione (GSH) in the pentose phosphate pathway
GSH normally neutralizes hydrogen peroxide, an oxidant product in RBC metabolism.

In G6PD deficiency, peroxide oxidizes Hb, which precipitates in the form of Heinz bodies.
Heinz bodies damage the RBC membranes causing intravascular hemolysis.
Heinz bodies removed from RBC membranes by splenic macrophages produce bite cells.

Half-life of G6PD in the Mediterranean variant is markedly reduced.
Produces a severe, chronic hemolytic anemia
Half-life of G6PD in the black American variant is moderately reduced.
Episodic type of hemolytic anemia after exposure to oxidant stresses.

Oxidant stresses inducing hemolysis
Infection (most common)
Drugs
Examples-primaquine, chloroquine, dapsone, sulfonamides
Fava beans (mainly in Mediterranean variant)

Clinical findings
Sudden onset of back pain with hemoglobinuria 2 to 3 days after an oxidant stress

Laboratory findings
Normocytic anemia
Heinz bodies
Identified with a supravital stain
Best screen during active hemolysis
RBC enzyme analysis

Confirmatory test after hemolysis has subsided
Peripheral blood findings
Bite cells (macrophage removal of membrane)


http://www.lezen.com.tw/img/img1_detail.asp?ID=1
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#18
ans for 10 BB--X linked recessive disease
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#19
9.D,
the patient has a cirrhosis--->portal HTN-->ascitis---->venous return to right heart is decreased---->decrease in MAP--->activation of RAAS, retention of Na and H2O, secondary hyperaldosteronism.
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#20
11-GG
when drug X and Y combined the number of bacteria killed is increased from 4--to almost 2

Expla -Amipicillin decreases cell wall synthesis or breaks cell membrane which allows more tobramycing to enter the cell and increase in number of cell death..
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