NBME 2 BLOCK 1-4

SKIPTO: BLOCK1BLOCK2BLOCK3BLOCK4

*Lipopolysacharides(Bacteria)

LPS bind to "Toll-like receptor"(TLR) (a single Transmembrane receptor)------> activation ofInhibitory kappa B kinase (IKB kinase)------->

Note: NF-kB is a transcription Factor that exist in cytoplasm bound to Inhibitory kappa B(IKB) protein in Inactive form [NF-kB=IKB]

so continuing the above sequence ..

LPS----> TLR---->+IKB kinase----->phosphorylation of IKB of the complex[NF-kB=IKB] andnow this phosphorylated IKB get degraded and NF-kB is released----->NF-kB move to Nucleuswhere it upregulate gene expression of TNF------>Sepsis

Loading...

Loading...The Eustachian tube (or auditory tube or pharyngotympanic tube) is a tube that linksthe pharynx to the middle ear.

Normally, the Eustachian tube is closed, which helps prevent the inadvertentcontamination of the middle ear space by the normal secretions found in the back of thenose. A dysfunctional Eustachian tube that is always open is called a "patulous" Eustachiantube. Patients with this rare condition are plagued by chronic ear infections. A muchmore common problem is a failure of the Eustachian tube to effectively regulate airpressure. Partial or complete blockage of the Eustachian tube can cause sensations ofpopping, clicking, and ear fullness and occasionally moderate to severe ear pain. Youngchildren may describe the popping sensation as "a tickle in my ear.

MethylparabenA derivative of PABA {para-aminobenzoic acid)

Loading...CCl4--->centrilobular necrosis, fatty chance inliver

Esam

Pencil

Esam

Pencil

the vaccin is produced by recombinant DNA technology,the genecoding for the HBsag inserted into yeast cells,which then releasethis molecule into the culture medium.the molecule is thenpurefied and used as the immunogen in the vaccin.

HPV is also produced by recombinant DNA

Esam

Pencil

Q19.BPrevalance=incidence*disease duration

The most common sources of embolism are proximal leg deep venous thrombosis (DVTs) or pelvic veinthromboses. Any risk factor for DVT also increases the risk that the venous clot will dislodge and migrate to thelung circulation, which happens in up to 15% of all DVTs. The conditions are generally regarded as a continuumtermed venous thromboembolism (VTE).The development of thrombosis is classically due to a group of causes named Virchow's triad (alterations in bloodflow, factors in the vessel wall and factors affecting the properties of the blood). Often, more than one risk factoris present.Alterations in blood flow: immobilization (after surgery, injury or long-distance air travel), pregnancy (alsoprocoagulant), obesity (also procoagulant), cancer (also procoagulant)Factors in the vessel wall: of limited direct relevance in VTEFactors affecting the properties of the blood (procoagulant state): Estrogen-containing hormonal contraceptionGenetic thrombophilia (factor V Leiden, prothrombin mutation G20210A, protein C deficiency, protein Sdeficiency, antithrombin deficiency, hyperhomocysteinemia and plasminogen/fibrinolysis disorders)Acquired thrombophilia (antiphospholipid syndrome, nephrotic syndrome, paroxysmal nocturnalhemoglobinuria)Cancer (due to secretion of pro-coagulants)

The main indication for thrombolysis is in submassive PE where right ventricular dysfunction can bedemonstrated on echocardiography, and the presence of visible thrombus in the atrium.

Loading...

Esam

Pencil

Esam

Pencil

Esam Khalifa

Pencil

Esam

Pencil

In the natural aging process, aortic stenosis often increases afterloadbecause the left ventricle must overcome the pressure gradient causedby the calcified and stenotic aortic valve in addition to the bloodpressure in order to eject blood into the aorta

Esam

Pencil

Esam Khalifa

Pencil

JUMPTO: BLOCK1BLOCK

BLOCK 2BLOCK2BLOCK3BLOCK4

Esam Khalifa

Pencil

case control study measures with Odds ratio........a/b/c/d=ad/bc

Esam

Pencil

External Oblique

The external obliques are also a superficial muscle that is found justlaterally to the rectus abdominus. They originate from the externalsurfaces of the lower 8 ribs, and insert into the anterior half of theouter lip of the iliac crest and the aponeurosis of the anteriorabdominal wall. Its function includes flexing the trunk (in bilateral contraction),posterior pelvic tilt, same side flexion, and rotation of the trunk to theopposite side (during unilateral contraction). The external obliques

are the largest of the abdominal muscles.

Esam

Pencil

Esam

Pencil

Patient has myxoma- most common cardiac tumor in adults- 90% of them occur in atrium(especially left one)Myxomaa neoplasm composed of stellate to plump cytologically blandmesenchymal cells set in a myxoid stroma.cytologically bland mesenchymal cells, so-called “myxoma” or“lepidic” cells .Myxoma cells are frequently stellate with eosinophilic cytoplasm andindistinct cell borders. Their ovoid nuclei are typically pale with openchromatin. Nucleoli may be prominent.

Renal infarct produces gross hematuria...U can see peripheral wedge shaped infarct in the pic...That caused her hematuriaRenal infarct is becoz of some embolus...embolus later lodged in her brain and became cause of her death.

Esam

Pencil

Esam Khalifa

Pencil

Loading...

case fatality rate=fatal case/total number of peoplewith disease

Esam Khalifa

Pencil

Esam

Pencil

Esam

Pencil

Esam

Pencil

Esam Khalifa

Pencil

Primary care physicians frequently encounter children with heartmurmurs.1 Most of these young patients do not have heart disease.

Echocardiography is not always needed to diagnose pediatric murmurs.direct referral for echocardiography was an expensive way to evaluatechildren with heart murmurs. Pediatric cardiology consultation wassignificantly less costly in that many innocent murmurs were diagnosedwithout echocardiography.

Esam

Pencil

Esam

Pencil

Esam

Pencil

BLOCK 3

JUMPTO: BLOCK1BLOCK2BLOCK3BLOCK4

Esam

Pencil

Esam

Pencil

Esam

Pencil

Esam

Pencil

Esam Khalifa

Pencil

Esam

Pencil

Esam

Pencil

Esam

Pencil

100%SPECIFICITY...E100%SENSITIVITY...CMOSTACCURATE......D

Esam

Pencil

Esam

Pencil

Esam

Pencil

Esam

Pencil

Esam Khalifa

Pencil

BLOCK 4

JUMPTO: BLOCK1BLOCK2BLOCK3BLOCK4

h influenza chocolate agar with factor V [NAD] and X

h influenza chocolate agar with factor V [NAD] and X[hematin]

Rabis....enveloped RNA SS-

Dynein, a motor protein responsible for retrograde axonal

Dynein, a motor protein responsible for retrograde axonaltransport, carries vesicles and other cellular products towardthe cell bodies of neurons.

Pelvic inflammatory disease (PID) refers to infection of the uterus(womb), fallopian tubes (tubes that carry eggs from the ovaries to theuterus) and other reproductive organs that causes symptoms such aslower abdominal pain. It is a serious complication of some sexuallytransmitted diseases (STDs), especially chlamydia and gonorrhea.PID can damage the fallopian tubes and tissues in and near theuterus and ovaries. PID can lead to serious consequences includinginfertility, ectopic pregnancy (a pregnancy in the fallopian tube orelsewhere outside of the womb), abscess formation, and chronicpelvic pain

Probenecid is a uricosuric drug that increases uric acid excretion inthe urine. It is primarily used in treating gout and hyperuricemia.

MechanismIn the kidneys probenecid is filtered at the glomerulus, secreted inthe proximal tubule and reabsorbed in the distal tubule.

Probenecid works by interfering with the kidney's organic aniontransporter (OAT), which reclaims uric acid from the urine andreturns it to the plasma[5]. If probenecid (an organic acid) is present,the OAT binds preferentially to it (instead of to uric acid), preventingre-absorption of the uric acid. Hence, the urine retains more uricacid, lowering uric acid concentration in the plasma.

Horseshoe kidney, also known as renal fusion, is a congenital disorder affectingabout 1 in 400 peopleIn patients with this condition, the central portion of the kidney may be found justinferior to the inferior mesenteric artery because the normal embryologic ascent ofthe kidneys is arrested by its presence in people with central fusion of the kidneys.

most cases of horseshoe kidneys are asymptomatic and discovered upon autopsy

Rheumatic fever is an inflammatory disease that occurs following a Group Astreptococcal infection, (such as strep throat or scarlet fever). Believed to be caused byantibody cross-reactivity that can involve the heart, joints, skin, and brain, the illnesstypically develops two to three weeks after a streptococcal infection.Acute rheumatic fever commonly appears in children between the ages of 5 and 17,with only 20% of first-time attacks occurring in adults.

Aschoff bodies are nodules found in the hearts of individuals with rheumaticfever.Aschoff bodies are areas of inflammation of the connective tissue of the heart, orfocal interstitial inflammation.

Esam

Pencil

Esam Khalifa

Pencil

In various situations such as infection, insulin demands rise but arenot matched by the failing pancreas. Blood sugars rise, dehydrationensues, and resistance to the normal effects of insulin increasesfurther by way of a vicious circle.(A virtuous circle or a viciouscircle is a complex of events that reinforces itself through afeedback loop)

Esam Khalifa

Pencil

Esam

Pencil

Cyclosporine is a polypeptide of 11 amino acids of fungal origin and is active against helper T cells,preventing the production of IL-2 via calcineurin inhibition (binds to cyclophilin protein). This agent isused for induction and maintenance immunosuppression.

Adverse effects include nephrotoxicity with 3 stages: (1) immediate, secondary to renal ischemia; (2) 2-3 weeks after transplantation, secondary to renal vasoconstriction; and (3) chronic, secondary to interstitial nephritis.

Other adverse effects include hyperkalemia, hypomagnesemia, nausea, vomiting, diarrhea, hypertrichosis,hirsutism, gingival hyperplasia, hyperlipidemia, glucose intolerance, infection, malignancy, andhyperuricemia. Hypertrichosis and hirsutism can be alleviated by switching from cyclosporine totacrolimus, provided the patient is carefully monitored. Multiple drug interactions are possible, primarilywith agents affecting the cytochrome P-450 system

serotonine syndrome with cheese and MAO inhibitors,

Serotonin syndrome most often occurs when two drugs that affect the body's level of serotoninare taken together at the same time. The drugs cause too much serotonin to be released or toremain in the brain area.

few eg-[other than stem]you can develop this syndrome if you take migraine medicines called triptans together withantidepressants called selective serotonin reuptake inhibitors (SSRIs) and selectiveserotonin/norepinephrine reuptake inhibitors (SSNRIs)).Older antidepressants called monoamine oxidase inhibitors (MAOIs) can also cause serotoninsyndrome , as well as meperidine (Demerol, a painkiller) or dextromethorphan (coughmedicine)

Drugs of abuse, such as ecstasy and LSD have also been associated with serotonin syndrome

Esam

Pencil

lead poisoning lead inhibits delta aminolevulenic acid and ferrochelatase leadingto microcytic anemia

The most common foregut cysts, the bronchogenic cyst and theesophageal duplication representing abnormal budding of thevertebral and dorsal primitive foregut, respectively, indicatingtheir common origin from the primitive foregut and closeembryologic relationship

Esam

Pencil