NBME 30 Question and Answer 2024| A+ Rated Answers
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Course
NBME CBSE
Institution
NBME CBSE
NBME 30
56 y/o F comes to physician 3 wk hx increasing weakness of arms and legs.
- Smoking
- Weakness of hip girdle muscles, lesser weakness of shoulder girdle muscles.
- Weakness improves with repetitive testing.
- Hilar lung mass
What's impaired:
- Acetylocholinesterase
NBME 30
56 y/o F comes to physician 3 wk hx increasing weakness of arms and legs.
- Smoking
- Weakness of hip girdle muscles, lesser weakness of shoulder girdle muscles.
- Weakness improves with repetitive testing.
- Hilar lung mass
What's impaired:
- Acetylocholinesterase
- Binding of ACh on postsynaptic membrane
- Direct depolarization of muscle by Ca
- Postsynaptic membrane potential
- Presynaptic release of ACh - ANSW Presynaptic release of ACh
- Lambert Eaton myasthenic syndrome (ab to voltage-gated calcium channels on
presynaptic LMNs, which decreased calcium influx and ACh release to postsynaptic
SkM cells
23 y/o F 1 wk history of intermittent fever, chills, rash
- Hx 4 operations (1) scoliosis, (2) tonsillectomy, (3) appendectomy, (4) lipoma.
- Hx admission for N/V
- Dermabrasion to correct acne scarring
- PE: 12 evenly spaced punctate marks in linear patten on abdomen and UE, LE
- patients produced symptoms for primary gain. Primary gain is motivation to be cared
for, which constitutes unconscious motivator in patients production of symptoms. "Care
seeking"
tx - regular f/u with one physician who oversees management & psychotherapy
An investigator is studying the adverse effects of a proteasome inhibitor, bortezomib, on
immune responses. Administered to group of pts with relapsed MM and immune
response observed. Which immunologic processes affected by drug?
- Activation of complement cascade
- Activation of perforin
,- Presentation of antigens to CD8+ T lymphocytes
- Secretion of histamine by mast cells
- Secretion of IL-1 by macrophages - ANSW Presentation of antigens to CD8+ T
lymphocytes
- Proteasomes ar elarge proteases with numerous domains that ar epresent in
cytoplasm adn nuceli. Made of alpha nd beta subunits and have extensive role in cell
cycle regulations and immune function. Caspase, chymotrypsin, and trypsin-like
protease capabilities of this enzyme complex are critical to their role as APC;
intracellular peptides are processed in teh proteasomme for presentation on Class I
MHC. Which are regogized by CD8 T lympocytes.
12 y/o girl sliced her left palm with a knife. Would is cleaned and suture. One week later,
sutures are removed. At this time, which of the following factors is most instrumental in
migration fo fibroblasts into area of would healing?
What is the most common brain tumor in adults? - ANSW Meningiomas - most
common primary brain tumor. Patients may be asymptomatic or experience seisures or
focal neurologic deficits related to tumor locaiton.
Malignant ones may grow rapidly - leading to symptoms of ICP
Glioblastoma - ANSW highly malignant brain tumor in intraaxial mass in cerebral
hemispheres, which typically demonstrate areas of necrosis and can spread to opposite
hemisphere across corpus callosum.
infant understanding of death - ANSW zero
4 year old understanding of death - ANSW temporary and reversible
20 y/o man with 4hr history abd pain, N/V. Binge drinking all weekend. Three doses of
tylenol for HA. Increased risk for liver injury why? - ANSW Induction of CYP450 that
activate acetaminophen to a hepatotoxic metabolite.
Ethanol lead sto induction of P450 enzymes that result in increased production of
NAPQI when high doses of tylenol taken.
depletin of glutathione. give NAC.
, translocations - ANSW balanced - no significant consequence unless the break point
affects a regulatory sequence or section of an exam that results in reduced or absent
translation of encoded protein.
Frank Starling mechanism - ANSW relationship between cardiac output and LVEDV -
preload.
CHF - line falls down
AVM - increased CO per this relationship
Tamponade - decreased ventricular filling but no change on this curve
Cor pulmonale - RVF from chronic pulm HTN no change on this curve
Restrictive cardiomyopathy - decreased compliance of ventricular wall disatolic
dysfunction and preserved LV systolic function (CO would be preserved)
renal autoregulation - ANSW relatively constantly GFR despite change sin glomerular
perfusion and is mediated by delivery of filtered sodium to macula densea in ealry DCT.
in Renal a. stenosis, there is a decreased glomerular perfusion --> decreased filtration
and decreased sodium delivery to macula densa. COmpensates by promoting activatoin
of RAASD system --> constriction of efferent arteriolar. Induces increased
intraglomerular pressure to maintain GFR.
Round ligament - ANSW fibromusclar band of tissue that extends from superolateral
part of uterus where fallopian tubes insert, passes through the inguinal canal, ends in
labia majora. remnant of gubernaculum. this is stretched in preganancy --> pain
an investigator is conducting a study of the effetcs of a newly discovered spider venom
on NM transmission. Isolated nerve muscle prepartion is bathed in a solution containing
the venom; there is a decreased in teh end-plate potential amplitude following
stimulation of the nerve. Presence of venom does not change the amplitude of the
nerve AP or the repsosne to exogenous acetylcholine. BLockage of which fo the
following is the MOA?
- Chloride conductance
- Function of acetylocholinesterase
- Inactiavte of voltage-gated Na channels in muscle
- Insertion of AChR into muscle membrane
- Presynaptic, voltage-gated calcium channels - ANSW Presynaptic, voltage-gated
calcium channels
decreased end-plate potential amplitude.
normallY: AP --> depolarization of terminal bouton of axon --> presynaptic voltage-gated
Ca channels consequently open and allow calcium influx which tiggers exocytosis of
ACh filled vesicle sinto synaptic cleft.
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