NBME 11 block 3 q 1 to 50 - maryam2009

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Welcome....,Please choose and answer the Qs in order. We are always looking for more volunteers. ... Any help would be appreciated .Thank you.

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1.EE

Sucralfate and bismuth....bind to ulser base....pysical protection,and allow bicarbonate secretion to restablish PH gradient in the mucous layer

Misoprostol....a PGE1 analog.....inc.production and secretion of gastric mucous barrier and dic acid production

A,B..can affect absorbtion,bioavailibility or urinary excreation of other drugs by altering gastric and urinary PHor by delaying gastric emptying

Ranitidin....H2 blocker...reversible block of histamine H2 receptors.....dec H+ secretion by parietal cells

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2.AA

CFTR gene on chromosome 7 ..deletion of Phe 508,folding of the CFTR protein in the endoplasmic reticulum is affected by this mutation

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3.BB
Digoxin toxicity......inc.parasympathetic activity..nausea,vomitingdiarrhea,blurry yellow visionand arrhythmia
may cause inc.PR and decQT,scooping of STad T-wave inversion

Antidote...slowly normalize K+and Mg+,lidocain,anti-dig fragments...

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4.CC

Cystic Fibrosis....AR with high heterozigot frequency, most common lethal genetic disease of caucasians.......deletion of Phe 508,folding of the CFTR protein in the endoplasmic reticulum is affected by this mutation
defective Cl- chanel.......secretion abnormally thick mucous that pluge lung ,pancreas and lver.....recurent pulmonary infection,Fat-soluble vitamine deficiency....failure to thrive in infancy

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5.CC

Spirochete Infections: Lyme Disease and Leptospirosis
• Lyme disease is characterized by dermatological, neurological, cardiac, rheumatic, and ophthalmic manifestations that result from tick-borne transmission of the spirochete Borrelia burgdorferi

• Three chronological stages:
1.
Primary or initial phase—rash at the site of tick bite (erythema chronicum migrans) and flu-like symptoms.
2.
Secondary or dissemination stage—further dermatological, cardiac, and neurological manifestations.
3.
Tertiary or late stage—arthritis, meningoencephalitis, cranial neuropathy, peripheral neuropathy, carditis.

ASSOCIATED FEATURES

• Conjunctivitis, most common manifestation in stage 1.

• Cranial nerve palsies, optic nerve inflammation can occur in stage 2.

• Corneal, uveal, and retinal inflammation can occur in stage 3.

Leptospirosis is a zoonotic infection of worldwide distribution caused by pathogenic Leptospira species.

Biphasic disease.

• Leptospiremic phase—severe headache, fever, myalgia.

• Immune phase—high fever, meningismus, central and peripheral nervous system manifestations.

• Ocular manifestations occur in the majority of patients.

• Conjunctivitis, uveitis, subconjunctival hemorrhages.

ASSOCIATED FEATURE

• Weil’s disease—severe disease with hemorrhages, renal failure, and jaundice.

6.DD

the bulla is seen inside the spleen

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7.BB

The lesser omentum (small omentum; gastrohepatic omentum; omentum minus) is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the start of the duodenum.
The lesser omentum is extremely thin, and is continuous with the two layers of peritoneum which cover respectively the antero-superior and postero-inferior surfaces of the stomach and first part of the duodenum.

http://en.wikipedia.org/wiki/File:Gray1104.png

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8.CC

The paraaortic lymph node group is divided into three subgroups: preaortic, retroaortic, and right and left lateral aortic.

The preaortic group drains the abdominal part of the gastrointestinal tract above the mid-rectum.
The retroaortic group drains from the lateral and preaortic glands.
The lateral group drains the iliac lymph nodes, the ovaries, and other pelvic organs. The lateral group nodes are located adjacent to the aorta, anterior to the spine, extending laterally to the edge of the psoas major muscles, and superiorly to the crura of the diaphragm.

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9.EE

Otitis media is most commonly caused by infection with viral, bacterial, or fungal pathogens. The most common bacterial pathogen is Streptococcus pneumoniae.

Others include Pseudomonas aeruginosa, nontypeable Haemophilus influenzae, and Moraxella catarrhalis.
Among older adolescents and young adults, the most common cause of ear infections is Haemophilus influenzae. Viruses such as respiratory syncytial virus (RSV) and those that cause the common cold may also result in otitis media by damaging the normal defenses of the epithelial cells in the upper respiratory tract.

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10.AA

most human rabies cases in the United States were caused by bat bites that probably were unrecognized or undetected,Rabis is a viral disease that causes acute encephalitis .

The period between infection and the first flu-like symptoms is normally two to twelve weeks, but can be as long as two years. Soon after, the symptoms expand to slight or partial paralysis, cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia, terror, hallucinations, progressing to delirium

The production of large quantities of saliva and tears coupled with an inability to speak or swallow are typical during the later stages of the disease; this can result in hydrophobia, in which the patient has difficulty swallowing because the throat and jaw become slowly paralyzed, shows panic when presented with liquids to drink, and cannot quench his or her thirst.

Negri bodies are 100% diagnostic for rabies infection, but are found in only about 80% of cases