NBME 23

 10% of patients with Rituximab treatment without chemotherapy or

glucocorticoid exposure developed PcP pneumonia.
 in Asian peoplethe cis-alphaÐhalassemia deletion is prominent, while the
trans deletion is prominent in African Americans. Both parents have alpha
thalassemia minima (silent).Beta thalassemia is prevalent amongst the
mediterranean population.
 Heating and drying cause damage to envelope.Loss of the envelope will
lead to a loss of viral infectivity because it will not be able to combine with our
lipid membrane,
 S1 split first component of splitdue to mitral closure.
 The three criteria for causality are: 1) empirical association (i.e. strength of
association; a change in independent variable correlates or is associated with a
change in dependent variable), 2) time order (i.e. temporal relationship; the
independent variable must come before change in the dependent variable,or
plainly stated, cause must come before effect). and 3) nonspuriousness (i.e.
dose-response gradient; the relationship between 2 variables is due to a direct
relationship between the two, not because of the actions of changes in a third
variable... this can be evinced by a dose-dependent response).
 Patients with SLE are associated with early complement deficiencies (C1q,
C2, C4).
 I) Hypovolemic shock may occur due to loss of plasma from the burn
surface.loss of protein from the plasma loss may result in generalized pitting
edema. II) Infection of the wound site and sepsis may occur.Sepsis due to
Pseudomonas aeruginosa is the most common cause of infection in burn
patients.Ðb) Other pathogens include methicillin-resistant S. aureus and
Candida species.3) Curling ulcers may occur in the proximal duodenum.4)
Hypermetabolic syndrome may occur if >40% of the body surface is
burned.
 Malaria can impair hepatic gluconeogenesis and can also consume
glucose for its own metabolic demands.
 the puborectalis muscleplays an important role in both fecal continence
and defecation, is tonically contracted and maintains the anorectal angle at rest.
 Misoprostol side effect diarrhea
 Myelin speeds up nerve conduction by reducing the capacitance and increasing
the resistance.
 Cyclophophamide side effectgranulocytes depletion
 NBME 17
 In B-cell neoplasms (lymphoma, MM), the ratio of immunoglobulins is
thrown off. Kappa and lambda refer to the Ig light chain genotypes, and is
normally 2-3:1 for kappa to lambda. Here, it's almost 16:1, and this is a huge
sign that there is a monoclonal proliferation of one cell type
 septic shock can present with hyper or hypothermia.
 Hyperplastic polyp--> most common, generally smaller and in rectosigmoid
region.

 HCG injections down regulate the pituitary release of GnRH.,however HCG

alpha subunit can stimulate cells influenced by LH, FSH, TSH.

NBME 20
 MELAS tRNAleucine.

 Bronchophony= pneumoniaÞxpiratory stridor= tracheobronchial obstruction

(mass/foreign body)inspiratory stridor = laryngeal obstruction. succussion splash= test
for pyloric stenosis

 CCB and thiazide are better for the elderly and the black patients.

 pharmacokinetic factors which can be expected to potentially exhibit racial differences.

 actinic purpura results from extravasation of blood into the dermis. This phenomenon is
due to the skin atrophy and the fragility of the blood vessels in elderly individuals, which
is exacerbated by chronic sun exposure. Actinic purpura lesions are located on sun-
exposed areas, like the arms, face, and neck.

 if there is abnormal plasmacholinesterase (=psuedocholinesterase), it will lead to delayed

metabolism of succinylcholine as well as mivacirum, heroin,suucinylcholine.

 Shigella is colorless when stained with methylene blue; E coli stains blue with methylene
blue because it ferments lactose.

 Tenesmus is pretty specific to Shigella,

 The left upper extremity and breast are drained by the axillary lymph node. The kidney is
drained by the thoracic duct.the heart has its own lymph system going on surrounding the
heart. Everything must ultimately reach the SVC.

 Clonality can be determined by glucose-6-phosphate dehydrogenase (G6PD) enzyme

isoforms. G6PD is X-linked.

 Cannon "a" waves are seen in complete AV block, as right ventricle and atrium contract
independentlyÚnd the right atrium ends up contracting against a closed tricuspid valve.

 Bifid carotid pulses are seen in Aortic stenosis or regurgitation.

 Sometimes the effects of missense mutations may be only apparent under certain
environmental conditions;such missense mutations are called conditional mutations.many
missense mutations result in proteins that are still functional, at least to some degree.

 Normally daytime naps go to directly to REM.In narclepsy day time napsN1 and at
night directly into REM.

 As a rule of thumb, if you give someone an ACE inhibitor and they get a problem, they
had renal artery stenosis, usually bilaterally.

 with the Froment sign you know the deep branches of the ulnar nerve are being effected

 You are more likely to have dumping syndrome if you eat a meal heavy in starches or
sugars. The sugars can be either fructose or table sugar (sucrose).insulin levels can
increase to high levels, then lower your blood sugar too much.