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NBME 7 block 2 q 1 to 50 - maryam2009
#11
9.AA

When blood volume is low, juxtaglomerular cells in the kidneys secrete renin. Renin stimulates the production of angiotensin I, which is then converted to angiotensin II. Angiotensin II causes blood vessels to constrict, resulting in increased blood pressure. Angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes the tubules of the kidneys to increase the reabsorption of sodium and water into the blood. This increases the volume of fluid in the body, which also increases blood pressure.

so when blood volum is become higher by receiving 1 liter fluid........>dec. renin-angiotensin aldosteron system
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#12
10.EE

Osteopetrosis,, also known as marble bone disease is an extremely rare inherited disorder whereby the bones harden, becoming denser,

Normal bone growth is achieved by a balance between bone formation by osteoblasts and bone resorption (break down of bone matrix) by osteoclasts.

In osteopetrosis, the number of osteoclasts may be reduced, normal, or increased. Most importantly, osteoclast dysfunction mediates the pathogenesis of this disease.

deficiency of carbonic anhydrase in osteoclasts is noted. The absence of this enzyme causes defective hydrogen ion pumping by osteoclasts and this in turn causes defective bone resorption by osteoclasts, as an acidic environment is needed for dissociation of calcium hydroxyapatite from bone matrix. Hence, bone resorption fails while its formation persists. Excessive bone is formed.

Osteopetrosis :
Calcium....unaffected
Phosphate...unaffected
Alkalin phosphatase....elevated
Parathyroid Hormone....unaffected

Symptoms:

Pain
Frequent fractures, especially of the long bones, which often do not heal
Nerve compression, leading to headache, blindness, deafness
Hematological difficulties, including anemic thrombocytopenia, leukopenia
Enlarged spleen
Osteomyelitis
Frontal bossing of the skull
Unusual dentition, including malformed and unerrupted teeth
Infection
Bleeding
Stroke


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#13
11. D
Respiratory Acidosis: Ph ↓, PO2 ↓, PCO2 ↑, represented by the letters Y - W
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#14
To add Qs 10

Barbiturate overdose
Poisoning by barbiturates
Classification and external resources
ICD-10 T42.3
eMedicine med/207
Phenobarbital causes a "depression" of the body's systems, mainly the central and peripheral nervous systems; thus, the main characteristic of phenobarbital overdose is a "slowing" of bodily functions, including decreased consciousness (even coma), bradycardia, bradypnea, hypothermia, and hypotension (in massive overdoses). Overdose may also lead to pulmonary edema and acute renal failure as a result of shock.

The electroencephalogram of a person with phenobarbital overdose may show a marked decrease in electrical activity, to the point of mimicking brain death. This is due to profound depression of the central nervous system, and is usually reversible.[24]

http://en.wikipedia.org/wiki/Phenobarbital
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#15
***************Correction*************** Qs 11 *************************
Barbiturate overdose
Poisoning by barbiturates
Classification and external resources
ICD-10 T42.3
eMedicine med/207
Phenobarbital causes a "depression" of the body's systems, mainly the central and peripheral nervous systems; thus, the main characteristic of phenobarbital overdose is a "slowing" of bodily functions, including decreased consciousness (even coma), bradycardia, bradypnea, hypothermia, and hypotension (in massive overdoses). Overdose may also lead to pulmonary edema and acute renal failure as a result of shock.

The electroencephalogram of a person with phenobarbital overdose may show a marked decrease in electrical activity, to the point of mimicking brain death. This is due to profound depression of the central nervous system, and is usually reversible.[24]

http://en.wikipedia.org/wiki/Phenobarbital
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#16
12. D
Major Depressive Disorder: Characterized by at least 5 of the following 9 symptoms for 2 weeks. Symptoms must include patient - report depressed mood or anhedonia:
1. Sleep disturbance
2. loss of interest ( anhedonia)
3. Guilt or feeling of worthlessness
4. Loss of energy
5. Loss of concentration
6. Appetite/ weight changes
7. Psychomotor retardation or agitation
8. Suicidal ideations
9. Depressed mood
(FA page 443)
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#17
11.D
Phenobarbital causes a "depression" of the body's systems, mainly the central and peripheral nervous systems; thus, the main characteristic of phenobarbital overdose is a "slowing" of bodily functions, including decreased consciousness (even coma), bradycardia, bradypnea, hypothermia, and hypotension (in massive overdoses). Overdose may also lead to pulmonary edema and acute renal failure as a result of shock.
decreased respiration (hypoventilation) causes increased blood carbon dioxide and decreased o2 and pH (a condition generally called acidosis).
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#18
13. D
Key answer is D and I would go for D too.
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#19
13. D
Rule #6- Negociate: Negotiate rather than order
a. Treatment choices are the result of agreement, noy commands by the physician.
c. Relationship and agreement support adherence. (Kaplan BS book page 131)

Rule # 16- Accept the health beliefs of the patients
a. Be accepting of benign folk medicine practice. Expect them. Dx need to be explained in the way patients can understand, even if not technically precise.
b. Offer to explain things to family members for the patients. (Kaplan BS book page 133)
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#20
god99
Thanks for the explanation.
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