NBME NOTES

NBME: 2

Block: 1

1. LPS bind to “toll-like receptors(TLR) leads to activation of inhibitory kappa B kinase(IKB), NF-KB is
transcription factor that exist in cytoplasm bound to IKB in inactive form which then becomes active by
phophoryalation of IKB by LPS and IKB gets degraded and NF-KB released. KF-KB move into nucleus where it
regulates tumor necrosis factor initiated by lipopolysaccharide and leads to septic shock
2. Aspirin acts on platelets in the blood vessel.
3. The largest collection of neurons in CNS that use norepinephrine as a neurotransmitter is found in Locus ceruleus.

4. With obstruction of the auditory tube there would be absorption of air in the middle ear...and the tympanic
membrane will be pulled inwards and so will not move with changes in pressure in the nasopharynx. The external
canal appears normal and so does the appearance of the tympanic membrane.
5. Methylparaben is a derivative of PABA (para-aminobenzoic acid).
6. Ibuprofen needs a larger dose in patients with inflammatory arthritis because it has nearly twice dose of anti-
inflammatory than analgesic dose.
7. A patient with spiking fever in ICU after abdominal operation is given cephalosporin. After this antibiotic therapy
he develops abdominal pain, diarrhea, and stool test positive for clostridum difficile. Rx- Metronidazole.
8. Consumption of carbon tetrachloride causes severe hepatotoxicity as a consequence of damage to the plasma
membrane with centrilobular necrosis, fatty change.
9. An inverted 35-nucleotide repeats that are present at the ends of genetic element which are incapable of
replicating in the hepatocytes independently are complex transposon.
10. Substance P causes dysesthesia sensation.
11. Transposition of the great vessels- Prominent lift, soft, systolic murmur heard along the left sternal border, s1 loud
with normal heart size and pulmonary vascular pattern with aorta overlying the pulmonary artery.
12. Headache, easy bruising, with temp, low Platelet, low MCV, Low hemoglobin- TTP/HUS. A peripheral blood
smear shows schistocytes (fragmented red cells).
13. The recombinant vaccine used to immunized agains hep B elicits antibiodies against HBsAG. HPV recombinant
vaccines are also used.
14. When a teen with neutrophilic leukemoid reaction has acute appendicitis due to neutrophilic infiltrated of the
muscularis not the general lymphoid hyperplasia.
15. During 2nd and 3rd trimesters of pregnancy, women have increased levels of circulating glucocorticoids but have
few catabolic responses associated with excess glucocorticoids due in increased steroid-binding proteins.
16. Prevalence= incidence rate x Average duration of disease; If the average duration of the disease remains constant,
then preventive measures that reduce the incidence of disease would be expected to result in a decreased
prevalence. Similarly, if the incidence remained constant, and no change in average duration of disease then
increase in prevalence.
17. Increased natural killer cell activity is seen in patients that are on IL- 2 therapy with RCC and melanoma which
causes the tumor to regress
18. Pulmonary infract/embolism- due to immobilization (after surgery, injury or long-distance air travel), pregnancy
obesity, cancer, estrogen-containing hormonal contraception, Genetic thrombophilia (factor V leiden,
prothrombin mutation G20210A, Protein C deficiency, protein S deficiency, antithrombin deficiency,
hyperhomocysteinemia, plasminogen/fibrinolysis disorders, Acquired thrombophilia (antiphospholipid syndrome,
nephrotic syndrome, paroxysmal nocturnal hemoglobinuria).
19. Clostridium perfingens evades destruction by neutrophils in patients with clostridial myonecrosis by damaging
neutrophil membranes by means of a membrane-damaging toxin.
20. 3mm calculus is mostly of calcium salts
 21. Aortic dissection with cardiac tamponade- excruciating stabbing-like chest pain radiating to left shoulder, high bp,
heart sounds are distant, pulus paradoxus, ECG low voltage and ST wave changes with widening of the
mediastinum.
22. Biotin deficiency- tonic clonic seizure, ataxia, hypotonia, hearing loss, hair loss, rash, normal plasma amino acid
concentrations with abnormal multiple carboxylase deficiency.
23. Q-27 ?
24. Epstein-Barr virus is mostly likely to initially replicate in the pharyngeal B lymphocytes.
25. Infant with weak, muscles appear larger than before is – Duchenne’s muscular dystrophy.
26. Destruction of the hepatocytes, collapse, with production of fibrous material around the central lobular is likely to
result in increased portal pressure.
27. Mass at midline of neck that goes above the larynx that does not move when he swallows and not painfull is
thyroglossal duct cyst
28. Haemophilus influenza type B initially was prepared for 18 months older. Subsequent vaccines greatly improved
by conjugated of the capsular polysaccharides to one of several proteins to improve the CD4+ T lymphocytes
activation.
29. A coronary stent restores blood flow, but reperfusion causes increase in lipid peroxidation of membranes.
30. Child with vomiting, rapid breathing, urinating excessively, with loss of weight, fruity odor on his breath, with
decrease pH, glucose above 500, increase in BUN and creatinine. Along with increase in B-hydroxybutyrate in
patient’s blood.
31. Reddish-brown discharge from the nipple with no mases, no pain or tenderness is due to intraductal papilloma
32. Multi-infarct dementia- small lacunar lesions in lenticulostriate arteries of internal capsules widely disparate on
cerebral cortices.
33. Increase in the plateau value of expiratory flow rate is by lung volume
34. Misoprostol causes spontaneous abortion.
35. Patient of old age with aortic stenosis (radiates to the neck, 3/6 systolic murmur at the upper right sternal border).
Has shortness of breath with exercising due to rise in left ventricle pressure during exercise, increase in CO which
aortic valve aperture is not sufficient for the increase flow leading to increase pressure in LV> back pressure
develops>> pulmonary edema>>shortness of breath + basal crackles. Increased end-diastolic pressure of the left
ventricle during exercise.
36. Type 1 collagen defect- Multiple bone fractures, mild hearing loss, and blue sclerae.
37. Prolonged episodes of wheezing, dyspnea, and anxiety that are relieved by B-adrenergic agoists. The major
mediator is leukotrienes.
38. Bronchial asthma, eosinophil products that damage the epithelium are major basic protein.
39. IgA nephropathy- erythrocytes in urine, with no renal or recent illness, no Antistreptolysin O titer, no proteinuria
40. When skin feels pink, dry, and hot the postganglionic sympathetic fibers are disrupted.
41. Cyclophophamide used in non-hodgkin lymphoma can cause gross hematuria.
42. CSF leaving the ventricular system through the median aperture-magendie collects all the way at the bottom
where the spinal cord begins.
43. Acromegaly- frequent headaches, diffuse arthralgias, generalized weakness, pain in both hands, pain in the
temporomandibular joint, increasing shoe size, difficulity picking up small objects
44. Closure of pulmonic valve occurs when the pressure in the pulmonary artery exceeds the right ventricle
45. Patient with bronchopneumonia has numerous neutrophils, attracted in party by 5-hydroperoxyeicosatetraenoic
acid (5-HPETE) and leukotrienes, present in affected bronchioles and alveoli are caused by 5-lipoxygenase.

Block: 2

1. The diminishing of physiological or emotional response to a frequently repeated stimulus. Like an infant who
initially was startled by sound of beepers but no longer reacts after.
2. Propranolol- is used to treat atrial fibrillation with adequately controlled ventricular response rate and during
exercise this drug helps control the patient’s ventricular response rate during activity stress.
3. Methimazole is effective for the treatment of Grave’s disease because it inhibits thyroidal peroxidase activity.
4. Bradykinesia, cogwheel rigidity, decreased facial expression, and festinating gait is due to decreased dopamine in
the neurons.
5. Gastrointestinal bleeding due to meckel’s diverticulum. Histologic evaluation of resected diverticulum will show
gastric mucosa.
6. Hodgkin’s disease- respiratory distress, large mediastinal mass, cervical lymph nodes, with small lymphocytes
interspersed with binucleate cells with clear chromatin and large eosinophilic nucleoli.
7. Bronchial carcinoid tumor- persistent cough, intermittent flushing, diarrhea, solitary, well-defined mass that
projects into the lumen of the mainstem bronchus. The mucosa of the bronchus is intact.
8. 1- week history of confusion, disorientation, talk to self, and incontinency- delirium

9. Thickened stratum corneum and epidermis and vacuolated squamous cells.

10. Case control study measures with Odds ratio---- a/b/c/d=ad/bc
11. In the biosynthesis of glucose from pyruvate by the liver, the first intermediate formed from pyruvate is
oxaloacetate.
12. Tumor in the posterior lobe of pituitary gland affects secretion of ADH (vasopressin).
13. Weight loss, bulky, frothy, foul-smelling stools, biopsy examination is atrophy of villi and microvilli.
14. Uncontrolled bleeding from cystic fibrosis with no family history of bleeding disorder and prolonged prothrombin
and partial thromboplastin requires carboxylation of prothrombin. Carboxylation is a posttranslational
modification of glutamate residues, to γ-carboxyglutamate, in proteins. It occurs primarily in proteins involved in
the blood clotting cascade, specifically factors II, VII, IX, and X, protein C, and protein S, and also in some bone
proteins. This modification is required for these proteins to function.
15. When a women is unable to conceive and have bent cilia on biopsy of her nasal mucosa. This will cause infertility
due to deficiency of migration conceptus (denotes the embryo and its adnexa (appendages or adjunct parts) or
associated membranes (i.e. the products of conception).
16. Chronic pancreatitis- Moderate abdominal pain that is exacerbated by eating, alcoholic, abdomen has diffuse
retroperitoneal calcifications.
17. External oblique are superficial muscle that is found laterally to the rectus abdominus. They originate from the
external surfaces of the lower 8 ribs, and insert into the anterior half of the outer lip of iliac crest. Its function
includes flexing the truck (in bilateral contraction), posterior pelvic tilt, same side flexion, and rotation of the
trunk to the opposite side (during unilateral contraction).
18. Right-sided pleural effusion- crackles, decreased respiratory sounds with right-sided chest pain has a
inflammatory process involving neutrophils, increased vascular permeability, edema
19. Myasthenia gravis – intermittent ptosis and diplopia, limited abduction is treated with pyridostigmine therapy.
After one week nausea and abdominal cramping due to overdose of pyridostigmine(anticholinesterase) for which
atropine is given.
20. Q21-?
21. Renal disease to result from long-term administration of aspirin
22. Endothelial cell layer produces Nitric oxide which cause stimulation of cyclic GMP accumulation.
23. Myxoma- cardiac tumor that occurs in left atrium mostly 90% is a neoplasm composed of stellate to plump
cytologically bland mesenchymal cells set in myxoid stroma, so-called “myxoma” or “lepidic” cells. Amphorous
myoxid matrix. Rhadomyoma has clear cells and large, rounded, polygonal cells (“spider cells”) with glycogen
vacuoles separated by strands of cytoplasm extending between cell membrane and nucleus; no mitotic activity
24. In a patient with mutation in calcium receptors on cell surfaces of PTH gland and on basolateral (blood) side of
the thick ascending limb of loop of henle causes hypocalcemia, low PTH, and high urine calcium
25. Two months after a renal transplants- increasing dyspnea, chest infiltrate is caused by cytomegalovirus which
have “owl eyes” intranuclear inclusion bodies. Don’t get confused with reed cells
26. Renal infarct produces gross hematuria- peripheral wedge shaped infarct which causes embolus later to lodged in
brain .
27. Twin sibiling with variant duchenne’s muscular dystrophic symptoms is due to skewed X inactivation.
28. Basic fibroblast growth factor applied on a dermal wound would increase number of blood vessels.
29. Side effect of Diethylstillbestrol on the fetus if taken by mother to decrease the risk of spontaneous abortion is
clear cell adenocarcinoma of the vagina.
30. Painful clustered erythematous vesicle distributed in a dermatomal pattern that rarely crosses the midline-Herpes
Zoster. Rx- Acyclovir – inhibits DNA synthesis by inhibition of DNA polymerase.
31. Case fatality rate = fatal case/total number of people with disease
32. Type 1 collagen secretion in the first stage of matrix formation is mediated by osteoblasts.
33. Renal stenosis(systolic bruit) when given treatment with ACE there will be raise in plasma renin activity.
34. In HEp B virus double stranded DNA is converted to single stranded RNA by host RNA polymerase.
35. Panic disorder- 1month history of episodes of tachypnea, dyspnea, feeling of choking, and sensation of not being
able to aken in enough air. Physical examination/ECG are all normal.
36. The primary structural protein of the mitotic spindle is tubulin.
37. 38?
38. administering the peptide with an enteric coating: WILL DECREASE ABSORPTION, Decreasing the number of
amino acids in the peptide : INCREASE RATE OF METABOLISm , Ensuring a free amino group at the N
terminal : DEAMINASE CAN BREAK IT , Ensuring a free carboxyl group at the C terminal :
DECARBOXYLASE CAN BREAK IT , Substituting a D for an L amino acid Proteolytic enzymes"(endogenous
protease) prefer L-configuration(natural) rather than D-configuration(unnatural).so in a peptide chain to break the
bond between two amino acids(L-configurated) peptidases quickly recognize it and will lead to peptide
degradation hence short half life(e.g. endogenous Opiod peptide) But if we replace either or both of the chain with
D-configurated aa the endogenous peptidases/proteases will be unable to cleave the bond b/w the amino acids that
will lead to decrease or prevent peptide degradation hence the LONGER half life.
39. When there is decrease pH more O2 is unloaded from hemoglobin.
40. Staphylococcus aureus causes bacterial endocarditis in IV drug addict with normal heart valves.
41. Endothelial cells(inner layer of blood vessel) produce nitric oxide; where as nitric oxide action in producing
vasodilation is on the smooth muscle cells which is located in the middle of the blood vessel.
42. A neonate with normal heart murmur- should tell the parents and examine the infant again in 24 hours.
43. Low serum sodium with increased urine osmolality and with paraneoplastic syndrome –x-ray film of chest
44.