1. EABEA 6. BDABE 11. ABADG 16. AADBB 21. FDCED 26. FEDEA 31. GCBCA 36. BCBCA 41.

FECAE 46. DABDE

1.EE

HMG-coA reductase inhibitors are more e ecti!e or brin"in" the #D# to norma$ $e!e$.... %he& inhibit cho$estro$ 'recursor(Me!a$onate )*E...+habdom&o$isis re!ersib$e hi"h $e!e$ $i!er unction test

#o!astatin('ra!astatin(sim!astatin(Ator!astatin(+oso!astatin...........astatin +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 4235152/ mar&am2335 - 32*35*11 36-25

2.AA

7a ir$ucast(Monte$ucast.....#eu0oterine rece'tor b$oc0ers 're!ent bronchoconstriction +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42351561 mar&am2335 - 32*35*11 35-36

3.

bet8en B and C....9:$$ choose C bcause accordin" to !erba$ recommendation (sendin" a $ist o $o8 sodium diet 8ith 'atient that needs to o$$o8 it is more e icient.

i there is an& other ideas('$ease add (%;

+e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 4235156/ usm$e<"u& - 32*35*11 35-35

8e ha!e to in orm the 'atient about 8hat oods ha!e hi"h sodium...%hat:s the correct ans8er or sure. +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42351565 mar&am2335 - 32*35*11 35-43

4.EE

the tumor sho8s a ha'ha=ard arran"ement o somatic tissues re'resentin" deri!ati!es o ecto...(meso.. and endoderm.....it is a characteristic o "erm ce$$s.

2.AA

%ric&c$ic antide'ressant o!erdose....%ric&c$ics ha!e a narro8 thera'eutic inde>( i.e.( the thera'eutic dose is c$ose to the to>ic dose.

%he 'eri'hera$ autonomic ner!ous s&stem( centra$ ner!ous s&stem and the heart are the main s&stems that are a ected o$$o8in" o!erdose. 9nitia$ or mi$d s&m'toms t&'ica$$& de!e$o' 8ithin 2 hours and inc$ude tach&cardia( dro8siness( a dr& mouth( nausea and !omitin"( urinar& retention( con usion( a"itation( and headache. More se!ere com'$ications inc$ude h&'otension( cardiac rh&thm disturbances( ha$$ucinations( and sei=ures. E$ectrocardio"ram ?ECG@ abnorma$ities are re1uent and a 8ide !ariet& o cardiac d&srh&thmias can occur( the most common bein" sinus tach&cardia and intra!entricu$ar conduction de$a& resu$tin" in 'ro$on"ation o the A+) com'$e> and the B+*A% inter!a$s. )ei=ures( cardiac d&srh&thmias( and a'nea are the most im'ortant $i e threatenin" com'$ications.C +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42352313 mar&am2335 - 32*35*11 13-11

6.BB

Bro essiona$ ABCs are !er& e icient at interna$i=in" anti"en( either b& 'ha"oc&tosis%he acidic com'artments o macro'ha"es are a$so res'onsib$e or the de"radation o in"ested microor"anisms @ or b& rece'tor-mediated endoc&tosis( and then dis'$a&in" a ra"ment o the anti"en( bound to a c$ass 99 MHC mo$ecu$e( on their membrane. %he % ce$$ reco"ni=es and interacts 8ith the anti"en-c$ass 99 MHC mo$ecu$e com'$e> on the membrane o the anti"en-'resentin" ce$$.

+e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42352343 "od55 - 32*35*11 13-22

/. D B&ru!ate carbo>&$ase is a mitochondria en=ime re1uirin" biotin. 9t is acti!ated b& acet&$CoA? rom beta- o>idation. %he 'roduct o>a$oacetate?DAA@( a citric acid c&c$e intermediate( cannot $ea!e the mitochondria but is reduced to ma$ate that can $ea!e !ia a Ma$ate shu $e. 9n the c&to'$asm ma$ate is reduced to ?DAA@. B&ru!ate carbo>&$ase de icienc& is an inherited disorder that causes $actic acid and other 'otentia$$& to>ic com'ounds to accumu$ate in the b$ood. Hi"h $e!e$s o these substances can dama"e the bod&:s or"ans and tissues( 'articu$ar$& in the ner!ous s&stem. B&ru!ate carbo>&$ase de icienc& is a rare condition( 8ith an estimated incidence o 1 in 223(333 births 8or$d8ide. %his disorder a''ears to be much more common in some A$"on0ian 9ndian tribes in eastern Canada. htt'-**en.8i0i'edia.or"*8i0i*B&ru!ate<carbo>&$ase<de icienc& +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42352341 mar&am2335 - 32*35*11 13-22

/.DD

A de icienc& o '&ru!ate carbo>&$ase can cause $actic acidosis as a resu$t o $actate bui$d u'. .orma$$&( e>cess '&ru!ate is shunted into "$uconeo"enesis !ia con!ersion o '&ru!ate into o>a$oacetate( but because o the en=&me de icienc&( e>cess '&ru!ate is con!erted into $actate instead. As a 0e& ro$e o "$uconeo"enesis is in the maintenance o b$ood su"ar( de icienc& o '&ru!ate

carbo>&$ase can a$so $ead to h&'o"$&cemia +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 423523/2 mar&am2335 - 32*35*11 13-36

6.AA

9-ce$$ disease is an autosoma$ recessi!e disorder caused b& a de icienc& o G$c.Ac 'hos'hotrans erase( 8hich 'hos'hor&$ates mannose residues to mannose-6-'hos'hate on .$in0ed "$&co'roteins in the Go$"i a''aratus 8ithin the ce$$.

Eithout mannose-6-'hos'hate to tar"et them to the $&sosomes( the en=&mes are trans'orted rom the Go$"i to the e>trace$$u$ar s'ace( resu$tin" in $ar"e intrace$$u$ar inc$usions o mo$ecu$es re1uirin" $&sosoma$ de"radation in 'atients 8ith the disease .

%he Go$"i a''aratus is unab$e to tar"et the $&sosoma$ 'rotein ?8hich is norma$@ to the $&sosome. Eithout 'ro'er unctionin" o .-acet&$"$ucosamine-1-'hos'hotrans erase( a bui$d u' o substances occurs 8hen en=&mes are unab$e to tra!e$ inside o the $&sosome +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 423523/3 "od55 - 32*35*11 13-3/

6. A 9- Ce$$ Disease- ?9nc$usion ce$$ disease@. 9nherited $&sosoma$ stora"e disorderF ai$ure o addition to mannose 6 'hos'hate to $&sosome 'roteins? en=ime are secreted outside the ce$$ instead o bein" tar"eted to the $&sosme. +esu$t in coarse acia$ uture( c$ouded corneas( restricted Goin mo!ement( and hi"h '$ama $e!e$s o $&sosomes. D ten ata$ chi$dhood. htt'-**en.8i0i'edia.or"*8i0i*9-ce$$<disease

5.BB

13.EE

M&asthenia "ra!is is a chronic autoimmune neuromuscu$ar disease characteri=ed b& !ar&in" de"rees o 8ea0ness o the s0e$eta$ ?!o$untar&@ musc$es o the bod&.

%he ha$$mar0 o m&asthenia "ra!is is musc$e 8ea0ness that increases durin" 'eriods o acti!it& and im'ro!es a ter 'eriods o rest. Certain musc$es such as those that contro$ e&e and e&e$id mo!ement( acia$ e>'ression( che8in"( ta$0in"( and s8a$$o8in" are o ten( but not a$8a&s( in!o$!ed in the disorder.

9n m&asthenia "ra!is( antibodies b$oc0( a$ter( or destro& the rece'tors or acet&$cho$ine at the neuromuscu$ar Gunction 8hich 're!ents the musc$e contraction rom occurrin" +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42352366

mar&am2335 - 32*35*11 13-44

hi there(0ee' "oin"(9:$$ come $ater(%han0 &ou +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42352116 "od55 - 32*35*11 12-33

11. A

A constant rate o in usion o GnH+ 8i$$ cause a transient increase in #H and FH) secretion( o$$o8ed b& a decrease caused b& the do8nre"u$ation o "onadotro'h rece'tors. 0a'$an 'h&sio$o"& ?Ba"e 323@. htt'-**en.8i0i'edia.or"*8i0i*Gonadotro'in-re$easin"<hormone +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42352123 "od55 - 32*35*11 12-36

12. B Crest )&ndrome- Ca$ci ications( +a&naud:s 'henomenon( Eso'ha"ea$ d&smoti$it&( )c$erodact&$&( and %e$an"iectasia. #imited s0in in!o$!ement( o ten con ined to in"ers and ace. More beni"n c$inica$ course. Associated 8ith Anticentromere Antibod&. +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42352126 "od55 - 32*35*11 12-23

13. A Acute a''endicitis htt'-**en.8i0i'edia.or"*8i0i*A''endicitis +e'ort Abuse , +e-.BME / b$oc0 1 1 1 to 23 42352136 "od55 - 32*35*11 12-34

14. D

A9D) Bar!o!irus B15 is a cause o chronic anemia in indi!idua$s 8ho ha!e A9D). 9t is re1uent$& o!er$oo0ed. %reatment 8ith er&thro'oetin or intra!enous immuno"$obu$in ha!e been he$' u$ in some 'atients. %he 'ar!o!irus in ection ma& tri""er an in $ammator& reaction in A9D) 'atients 8ho ha!e Gust be"un antiretro!ira$ thera'&.C14H.

htt'-**en.8i0i'edia.or"*8i0i*Bar!o!irus<B15 12. G Ehen associated 8ith the $un"( it o ten causes ecto'ic 'roduction o 'arath&roid hormone-re$ated 'rotein ?B%HrB@( resu$tin" in h&'erca$cemia. )1uamous-ce$$ carcinoma o the $un" is more common in men than in 8omen. 9t is c$ose$& corre$ated 8ith a histor& o tobacco smo0in"( more so than most other t&'es o $un" carcinoma. 9t most o ten arises centra$$& in $ar"er bronchi( and 8hi$e it o ten metastasi=es to $ocore"iona$ $&m'h nodes ?'articu$ar$& the hi$ar nodes@ ear$& in its course( it "enera$$& disseminates outside the thora> some8hat $ater than other maGor t&'es. #ar"e tumors ma& under"o centra$ necrosis( resu$tin" in ca!itation. A s1uamous-ce$$ carcinoma is o ten 'receded or &ears b& s1uamous-ce$$ meta'$asia or d&s'$asia in the res'irator& e'ithe$ium o the bronchi( 8hich $ater trans orms to carcinoma in situ. 9n carcinoma in situ( at&'ica$ ce$$s ma& be identi ied b& c&to$o"ic smear test o s'utum( bronchoa$!eo$ar $a!a"e or sam'$es rom endobronchia$ brushin"s. Ho8e!er( s1uamous-ce$$ carcinoma in situ is as&m'tomatic and undetectab$e on I-ra& radio"ra'hs. E!entua$$&( it becomes s&m'tomatic( usua$$& 8hen the tumor mass be"ins to obstruct the $umen o a maGor bronchus( o ten 'roducin" dista$ ate$ectasis and in ection. )imu$taneous$&( the $esion in!ades into the surroundin" 'u$monar& substance. Dn histo'atho$o"&( these tumors ran"e rom 8e$$-di erentiated( sho8in" 0eratin 'ear$s and ce$$ Gunctions( to ana'$astic 8ith on$& minima$ residua$ s1uamous-ce$$ eatures. htt'-**en.8i0i'edia.or"*8i0i*)1uamous-ce$$<carcinoma

16.AA Ba"et:s disease ma& be dia"nosed usin" one or more o the o$$o8in" testsBa"etic bone has a characteristic a''earance on I-ra&s. A s0e$eta$ sur!e& is there ore indicated. htt'-**u'$oad.8i0imedia.or"*8i0i'edia*commons*3*35*Ba"ets<s0u$$.G'" An e$e!ated $e!e$ o a$0a$ine 'hos'hatase in the b$ood in combination 8ith norma$ ca$cium( 'hos'hate( and

aminotrans erase $e!e$s in an e$der$& 'atient are su""esti!e o Ba"et:s disease. Bone scans are use u$ in determinin" the e>tent and acti!it& o the condition. 9 a bone scan su""ests Ba"et:s disease( the a ected bone?s@ shou$d be I-ra&ed to con irm the dia"nosis

%he 'atho"enesis o Ba"et:s disease is described in 3 sta"es( 8hich arei. Dsteoc$astic acti!it& ii. Mi>ed osteoc$astic-osteob$astic acti!it& iii. E>hausti!e ?burnt out@ sta"e 9nitia$$&( there is a mar0ed increase in the rate o bone resor'tion at $oca$i=ed areas caused b& $ar"e and numerous osteoc$asts. %hese $oca$i=ed areas o osteo$&sis are seen radio$o"ica$$& as an ad!ancin" $&tic 8ed"e in $on" bones or osteo'orosis circumscri'ta in the s0u$$. %he osteo$&sis is o$$o8ed b& a com'ensator& increase in bone ormation induced b& osteob$asts recruited to the area. %his is associated 8ith acce$erated de'osition o $ame$$ar bone in a disor"ani=ed ashion. %his intense ce$$u$ar acti!it& 'roduces a chaotic 'icture o trabecu$ar bone ?JmosaicJ 'attern@( rather than the norma$ $inear $ame$$ar 'attern. %he resorbed bone is re'$aced and the marro8 s'aces are i$$ed b& an e>cess o ibrous connecti!e tissue 8ith a mar0ed increase in b$ood !esse$s( causin" the bone to become h&'er!ascu$ar. %he bone h&'erce$$u$arit& ma& then diminish( $ea!in" a dense J'a"etic bone(J a$so 0no8n as burned-out Ba"et:s disease.

1/.AA a$$ choices e>ce't A are arti icia$ 'rocedures that 'ro$on" his $i e. 16. D %%B- %hrombotic %hromboc&to'enia Bur'ura- is a rare disorder o the b$ood-coa"u$ation s&stem( causin" e>tensi!e microsco'ic thromboses to orm in sma$$ b$ood !esse$s throu"hout the bod& ?thrombotic microan"io'ath&@.C2HC3H Most cases o %%B arise rom inhibition o the en=&me ADAM%)13( a meta$$o'rotease res'onsib$e or c$ea!in" $ar"e mu$timers o !on Ei$$ebrand actor ?!EF@ into sma$$er units. A rarer orm o %%B( ca$$ed K'sha8-)chLM$man s&ndrome( is "enetica$$& inherited as a d&s unction o ADAM%)13. 9 $ar"e !EF mu$timers 'ersist there is tendenc& or increased coa"u$ation. htt'-**en.8i0i'edia.or"*8i0i*%hrombotic<thromboc&to'enic<'ur'ura %BB- FA 'a"e 345@ )&m'toms- 'entada o neuro$o"ic and rena$ s&m'toms( e!er( thromboc&to'enia( and microan"io'athic hemo$&tic anemia. #ab- )chistoc&tes( increase #DH.

15. D .iemann 'ic0 disease- 9s an Autosoma$ recessi!e disease( Bro"resi!e neurode"eneration( de!e$o'menta$ de$a&( cherr& red s'ot on macu$a( oam ce$$s. De . en=ime- )'hin"om&e$inaseF Accumu$ated substrate)'hin"om&e$in. ?FA 'a"e 111@

#i'o uscin- is the name "i!en to ine$& "ranu$ar &e$$o8-bro8n 'i"ment "ranu$esC1H com'osed o $i'idcontainin" residues o $&sosoma$ di"estion. 9t is considered one o the a"in" or J8ear and tearJ 'i"ments( ound in the $i!er( 0idne&( heart musc$e( adrena$s( ner!e ce$$s( and "an"$ion ce$$s. 9t is s'eci ica$$& arran"ed around the nuc$eus( and is a t&'e o #i'ochrome. #i'o uscin accumu$ation is a maGor ris0 actor im'$icated in macu$ar de"eneration( a de"enerati!e disease o the e&e.C5H

Abnorma$ accumu$ation o $i'o uscin is associated 8ith a "rou' o diseases o neurode"enerati!e disorder t&'e ca$$ed $i'o uscinoses( e.".( neurona$ ceroid $i'o uscinosis( a$so 0no8n as Batten disease( as 8e$$ as some other names.

Batho$o"ica$ accumu$ation o $i'o uscin is im'$icated in A$=heimer:s disease( Bar0inson:s disease( am&otro'hic $atera$ sc$erosis( certain $&sosoma$ diseases( acrome"a$&( dener!ation atro'h&( $i'id m&o'ath&( chronic obstructi!e 'u$monar& diseaseC13H( centronuc$ear m&o'ath&

15 is BBBBBBBBBBBBB is %a& )ach Disease 9 or"ot that the "ir$ is Ash0ena=i Ge8ish descent htt'-**en.8i0i'edia.or"*8i0i*%a&NE2N63N53)achs<disease %a& sach disease- A+( Bro"resi!e neurode"eneration( de!e$o'menta$ de$a&( cherr& red s'ot on macu$a( $&sosoma$ 8ith onion s0in ( .D HEBA%DMEGA#;. De . en=ime- He>osaminidase AF Accumu$ated substrateG2 "an"$ioside. ?FA 'a"e 111@.

23. B D$ ator& C. 9 is the on$& C. 8ithout tha$amic re$a& to corte>. Function- )me$$ ? FA 413@ 21.FF

the ans8er is F because the Auestion don:t "i!e us an& in ormation about the rate o e$imination o the dru" and then( the o'tion o c$earence and ha$ $i e are discard. Ksin" the ormu$a....CODose*Pd Po$ o distribution or I is 233*2 O133 or; is 233*2.2O233

22.DD Bneumothora> is de ined as the 'resence o air or "as in the '$eura$ ca!it&( that is( in the 'otentia$ s'ace bet8een the !iscera$ and 'arieta$ '$eura o the $un". %he resu$t is co$$a'se o the $un" on the a ected side. Air can enter the intra'$eura$ s'ace throu"h a communication rom the chest 8a$$ ?ie( trauma@ or throu"h the $un" 'arench&ma across the !iscera$ '$eura. Brimar& s'ontaneous 'neumothora> ?B)B@ occurs in 'eo'$e 8ithout under$&in" $un" disease and in the absence o an incitin" e!ent . 9n other 8ords( air is 'resent in the intra'$eura$ s'ace 8ithout 'recedin" trauma and 8ithout under$&in" c$inica$ or radio$o"ic e!idence o $un" disease. +is0s actors or 'rimar& s'ontaneous 'neumothora> ?B)B@ inc$ude the o$$o8in"QR)mo0in" QR%a$$( thin stature in a hea$th& 'erson QRMar an s&ndrome QRBre"nanc& QRFami$ia$ 'neumothora> B$ebs and bu$$ae ?sometimes ca$$ed em'h&sematous$i0e chan"es or E#Cs@ are re$ated to the occurrence o 'rimar& s'ontaneous 'neumothora>. )econdar& s'ontaneous 'neumothora> ?))B@ occurs in 'eo'$e 8ith a 8ide !ariet& o 'arench&ma$ $un" diseases( that is( these indi!idua$s ha!e under$&in" 'u$monar& structura$ 'atho$o"& ?see the ima"e be$o8@. Air enters the '$eura$ s'ace !ia distended( dama"ed( or com'romised a$!eo$i. Batients ma& 'resent 8ith more serious c$inica$ s&m'toms and se1ue$ae due to comorbid conditions. Diseases and conditions associated 8ith secondar& s'ontaneous 'neumothora> inc$ude the o$$o8in"QRChronic obstructi!e $un" disease ?CDBD@ or em'h&sema- 9ncreased 'u$monar& 'ressure due to cou"hin" 8ith a bronchia$ '$u" o mucus or 'h$e"m bronchia$ '$u" ma& '$a& a ro$e. QRAsthma QRHuman immunode icienc& !irus*ac1uired immunode icienc& s&ndrome ?H9P*A9D)@ 8ith BCB in ection

QR.ecroti=in" 'neumonia QR%ubercu$osis QR)arcoidosis QRC&stic ibrosis QRBroncho"enic carcinoma or metastatic ma$i"nanc& QR9dio'athic 'u$monar& ibrosis QR9nha$ationa$ and intra!enous dru" use ?e"( mariGuana( cocaine@C6H QR9nterstitia$ $un" diseases associated 8ith connecti!e tissue diseases QR#&m'han"io$eiom&omatosis QR#an"erhans ce$$ histioc&tosis QR)e!ere acute res'irator& s&ndrome ?)A+)@- A re'orted 1./N o )A+) 'atients de!e$o'ed s'ontaneous 'neumothora>. QR%horacic endometriosis and catamenia$ 'neumothora> QRCo$$a"en !ascu$ar disease( inc$udin" Mar an s&ndrome htt'-**emedicine.medsca'e.com*artic$e*42424/-o!er!ie84a3134

23.CC Gancic$o!ir is an anti!ira$ medication used to treat or 're!ent c&tome"a$o!irus ?CMP@ in ections 9t is irst 'hos'hor&$ated to a deo>&"uanosine tri'hos'hate ?dG%B@ ana$o"ue. %his com'etiti!e$& inhibits the incor'oration o dG%B b& !ira$ D.A 'o$&merase( resu$tin" in the termination o e$on"ation o !ira$ D.A. Ad!erse e ects-Gancic$o!ir is common$& associated 8ith a ran"e o serious haemato$o"ica$ ad!erse e ects. "ranu$oc&to'enia( neutro'enia( anaemia( thromboc&to'enia( e!er( nausea( !omitin"( d&s'e'sia( diarrhoea( increased serum creatinine and b$ood urea concentrations %o>icit&-Gancic$o!ir is considered a 'otentia$ human carcino"en( terato"en( and muta"en. 9t is a$so considered $i0e$& to cause inhibition o s'ermato"enesis. %hus( it is used Gudicious$& and hand$ed as a c&toto>ic dru" in the c$inica$ settin" 24.EE Ho$os&sto$ic murmur is best heard at the a'e> in the $e t $atera$ decubitus 'osition....Mitra$ +e"ur"itation . Murmur-B$o8in" ho$os&sto$ic murmur

Heard best at the a'e> +adiation to the a>i$$a and in erior ed"e o $e t sca'u$a. Bossib$e associated indin"s)2- 8ide 'h&sio$o"ic s'$ittin" )3 htt'-**de'ts.8ashin"ton.edu*'h&sd>*heart*tech.htm$

22.DD Coronar& b$ood $o8 occurs most$& durin" diasto$e( because durin" s&sto$e the b$ood !esse$s 8ithin the m&ocardium are com'ressed. 9ncreased heart rates( 8hich reduce the time or diasto$e i$$in"( can reduce the m&ocardia$ b$ood su''$& and cause ischaemia.D&namic e>ercise increases coronar& b$ood $o8 in 'ro'ortion to the heart rate( 8ith 'ea0 !a$ues durin" ma>ima$ e>ercise t&'ica$$& three to i!e times the restin" $e!e$ . 26.FF )e!ere$& 'remature in ants ma& ha!e underde!e$o'ed $un"s( because the& are not &et 'roducin" their o8n sur actant. %his can $ead direct$& to res'irator& distress s&ndrome( a$so ca$$ed h&a$ine membrane disease( in the neonate. %o tr& to reduce the ris0 o this outcome( 're"nant mothers 8ith threatened 'remature de$i!er& 'rior to 34 8ee0s are o ten administered at $east one course o "$ucocorticoids( a steroid that crosses the '$acenta$ barrier and stimu$ates the 'roduction o sur actant in the $un"s o the etus. 2/.EE in DSA ,beta-H&dro>&but&ric acid is a 0etone bod&....inc ,Due to $oss o 8ather......inc. serum osmo$a$it&. ,%he anion "a' is the di erence in the measured cations and the measured anions in serum( '$asma( or urine. %he ma"nitude o this di erence ?i.e. J"a'J@ in the serum is o ten ca$cu$ated in medicine 8hen attem'tin" to identi & the cause o metabo$ic acidosis. on$& .aT( C$U and HCD3U ?T*- S@ are used 8hen ca$cu$atin" the anion "a'... hea$th& adu$ts is 6-12 mE1*# ? C.aTH @ U ? CC$UHTCHCD3UH @ a use u$ mnemonic to remember the hi"h anion "a' is MKDB9#E) ?methano$( uremia( diabetic 0etoacidosis( 'ro'&$ene "$&co$( isonia=id( $actic acidosis( eth&$ene "$&co$( sa$ic&$ates@.

26.DD

9t is a Gram-ne"ati!e( aerobic( rod-sha'ed bacterium 8ith uni'o$ar moti$it& and o>idase 'ositi!e B. aeru"inosa secretes a !ariet& o 'i"ments( inc$udin" '&oc&anin ?b$ue-"reen@(Because it thri!es on most sur aces( this bacterium is a$so ound on and in medica$ e1ui'ment( inc$udin" catheters( causin" crossin ections in hos'ita$s and c$inics. 9t is im'$icated in hot-tub rash.

25.EE Mar an s&ndrome can $ead to mitra$ !a$!e 'ro$a'se ?MPB@.

33. A Beta tha$asemia- 're!a$ent in mediterranea 'o'u$ation. De ect- 'oint mutation in s'$icin" sites and 'romoter se1uences Beta tha$asemia minor ?hetero=&"ote@ 1. beta chain in un'roduced 2. usua$$& as&ntom'tomatic 3. D> con irmed b& increase HbA2 ? V 3.2N@ Beta tha$asemia maGor- ?Homo=&"ote@ 1. beta chain is absent- se!ere anemia re1uirin" b$ood trans usion ?2QW hemochromatosis@ 2. Marro8 e>'ansion ? cre8 cut on s0u$$ >-ra&@- s0e$eta$ de romities( chi'mun0 acies Both maGor and minor - increase Hb F ?FA 'a"e 343@. htt'-**888."oo"$e.com*searchXsourceidOna!c$ientYa1O3Yo1ObetaTtha$asemiaYieOK%...tha$assemia

31. G Beta 2 adrener"ic a"onist- Bronchodi$ation? re$a> bronchia$ smooth muc$es@ htt'-**en.8i0i'edia.or"*8i0i*Beta2-adrener"ic<a"onist

32. C %)H- %h&roid-stimu$atin" hormone ?a$so 0no8n as %)H or th&rotro'in@ is a 'e'tide hormone s&nthesi=ed and secreted b& th&rotro'e ce$$s in the anterior 'ituitar& "$and( 8hich re"u$ates the endocrine unction o the th&roid "$and. %)H is the 1st ste' in e!a$uation o th&roid unction.

htt'-**en.8i0i'edia.or"*8i0i*%h&roid-stimu$atin"<hormone

33. B Adenocarcinoma o the endometriumCarcinoma endometria$ is the Most common "&neco$o"ic ma$i"nanc&. 'ea0 occurrence at 22-62&ear o a"e. C$inica$$& 'resents 8ith !a"ina$ b$eedin". %&'ica$$& 'receded b& endometria$ h&'er'$asia. +is0 actors inc$ude 'ro$on"ed use o estro"en 8ithout 'ro"estins( obesit&( diabetes( h&'ertension( nu$$i'arit& and $ate meno'ause. 9ncreas m&ometria$ in!asion( decrease 'ro"nosis. ?FA 'a"e 46/@ htt'-**en.8i0i'edia.or"*8i0i*Endometria$<cancer

34. C Bar0inson disease )ur"er& and dee' brain stimu$ation B$acement o an e$ectrode into the brain. %he head is stabi$ised in a rame or stereotactic sur"er&.%reatin" motor s&m'toms 8ith sur"er& 8as once a common 'ractice( but since the disco!er& o $e!odo'a( the number o o'erations dec$ined.C32H )tudies in the 'ast e8 decades ha!e $ed to "reat im'ro!ements in sur"ica$ techni1ues( so that sur"er& is a"ain bein" used in 'eo'$e 8ith ad!anced BD or 8hom dru" thera'& is no $on"er su icient.C32H )ur"er& or BD can be di!ided in t8o main "rou's- $esiona$ and dee' brain stimu$ation ?DB)@. %ar"et areas or DB) or $esions inc$ude the tha$amus( the "$obus 'a$$idus or the subtha$amic nuc$eus. C32H Dee' brain stimu$ation ?DB)@ is the most common$& used sur"ica$ treatment. 9t in!o$!es the im'$antation o a medica$ de!ice ca$$ed a brain 'acema0er( 8hich sends e$ectrica$ im'u$ses to s'eci ic 'arts o the brain. DB) is recommended or 'eo'$e 8ho ha!e BD 8ho su er rom motor $uctuations and tremor inade1uate$& contro$$ed b& medication( or to those 8ho are into$erant to medication( as $on" as the& do not ha!e se!ere neuro's&chiatric 'rob$ems.C25H Dther( $ess common( sur"ica$ thera'ies in!o$!e the ormation o $esions in s'eci ic subcortica$ areas ?a techni1ue 0no8n as 'a$$idotom& in the case o the $esion bein" 'roduced in the "$obus 'a$$idus@.C32H htt'-**en.8i0i'edia.or"*8i0i*Bar0inson:s<disease

32. A Dee' Fibu$ar ner!e- Eea0ness in!ersion( #oss e>tension o the di"its( $oss dorsi $e>ion ? oot dro'@( sensor& $oss on antero $atera$ $e" and dorso o the oot( irts 8eb s'ace. ?Sa'$an anatom& 'a"e 252 and 252@. htt'-**en.8i0i'edia.or"*8i0i*Dee'< ibu$ar<ner!e

36. B B$aceta accreta- An in!asion o the m&ometrium 8hich does not 'enetrate the entire thic0ness o the musc$e. %his orm o the condition accounts or around /2N o a$$ cases. B$acenta 'erccreta- %he 8orst orm o the condition is 8hen the '$acenta 'enetrates the entire m&ometrium to the uterine serosa ?in!ades throu"h entire uterine 8a$$@. %his !ariant can $ead to the '$acenta attachin" to other or"ans such as the rectum or b$adderC1H. htt'-**en.8i0i'edia.or"*8i0i*B$acenta<accreta

3/. C Crohn Disease- A$so 0no8n as re"iona$ enteritis( is an in $ammator& disease o the intestines that ma& a ect an& 'art o the "astrointestina$ tract rom mouth to anus( causin" a 8ide !ariet& o s&m'toms. 9t 'rimari$& causes abdomina$ 'ain( diarrhea ?8hich ma& be b$ood& i in $ammation is at its 8orst@( !omitin"( or 8ei"ht $oss(C1HC2HC3H but ma& a$so cause com'$ications outside the "astrointestina$ tract such as s0in rashes( arthritis( in $ammation o the e&e( tiredness( and $ac0 o concentration.C1H Crohn:s disease is thou"ht to be an autoimmune disease( in 8hich the bod&:s immune s&stem attac0s the "astrointestina$ tract( causin" in $ammationF it is c$assi ied as a t&'e o in $ammator& bo8e$ disease. %here is e!idence o a "enetic $in0 to Crohn:s disease( 'uttin" indi!idua$s 8ith sib$in"s a $icted 8ith the disease at hi"her ris0.C4H 9t is thou"ht to ha!e a $ar"e en!ironmenta$ com'onent as e!idenced b& a hi"her incidence in 8estern industria$i=ed nations com'ared to other 'arts o the 8or$d. Ma$es and ema$es are e1ua$$& a ected. )mo0ers are t8o times more $i0e$& to de!e$o' Crohn:s disease than. htt'-**en.8i0i'edia.or"*8i0i*Crohn:s<disease. Gross mor'ho$o"&- transmura$ in $amation( Cobb$estone mucosa( cree'in" at( bo8e$$ 8a$$ thic0nin"( ?strin" si"n on barium s8a$$o8 >- ra&@ $inear( u$cers( issures( istu$as. Microsco'ic mor'ho$o"&- .oncaseatin" "ranu$omasand $&m'hoid a"re"ates. ?FA 'a"e 323@

36. B e 'redicti!e !a$ue Bositi!e ?BBP@- %B* ?%BTFB@ BBPO /3*?/3T333@O 3.16 in this case a'ro>. 3.15 BBP - Bositi!e Bredicti!e Pa$ue

35. C Membranous G$omeru$one'hritis- #M -di use ca'i$$ar& and GBM thic0enin". EM J s'i0e and domeJ

a''earance 8ith sube'ithe$ia$ de'osits. 9F - "ranu$ar. Caused b& dru"s ? 'enici$$amine( Go$d( .)A9D@. Most common cause o adu$t ne'hrotic s&ndrome. %he c$ose$& re$ated terms membranous ne'hro'ath&C1H and membranous "$omeru$o'ath&C2H both re er to a simi$ar conste$$ation but 8ithout the assum'tion o in $ammation. )ome 'atients ma& 'resent as ne'hrotic s&ndrome 8ith 'roteinuria( edema 8ith or 8ithout rena$ ai$ure. Dthers ma& be as&m'tomatic and ma& be 'ic0ed u' on screenin" or urina$&sis as ha!in" 'roteinuria. A de initi!e dia"nosis o membranous ne'hro'ath& re1uires a 0idne& bio's&. htt'-**en.8i0i'edia.or"*8i0i*Membranous<"$omeru$one'hritis4C$inica$<'...resentation 43. A 9nto>ication or Am'hetamine- Bs&chomotor a"itation ( im'aired Gud"ment( 'u'i$$ar& di$ation( h&'ertension( tach&cardia( eu'horia( 'ro$on"ed 8ea0 u$ness sand attention( cardiac arr&thmia( de$usions( ha$$ucinations( e!er. ?FA 446@ Am'hetamine- B$oc0s o neurotransmiter u'ta0e at the 'res&na'tic ner!e termina$ 41. C F$e>ion or ante!ersion ?143QZ@- i$io'soas ?8ith 'soas maGor rom !ertebra$ co$umn@F tensor ascia $atae( 'ectineus( adductor $on"us( adductor bre!is( and "raci$is. %hi"h musc$es actin" as hi' $e>ors- rectus emoris and sartorius. 42.E Duchenne muscu$ar d&stro'h& ?DMD@ is a recessi!e I-$in0ed. %he disorder is caused b& a mutation in the d&stro'hin "ene( $ocated in humans on the I chromosome ?I'21@. %he d&stro'hin "ene codes or the 'rotein d&stro'hin( an im'ortant structura$ com'onent 8ithin musc$e tissue. 43.C Media$ co$$atera$ $i"amentJ 0no8n as the tibia$ co$$atera$ $i"ament too.MC# strains and tears are air$& common in American ootba$$. Most$& the center and the "uards are ones 8ho "et this inGur&( due to the "ri' trend on their c$eats. An MC# inGur& can be !er& 'ain u$ and is caused b& a !a$"us stress to a s$i"ht$& bent 0nee( o ten 8hen $andin"( bendin" or on hi"h im'act. De'endin" on the "rade o the inGur&( the $o8est "rade ?"rade 1@ can ta0e bet8een 2 and 13 8ee0s or the inGur& to u$$& hea$. +eco!er& times or "rades 2 and 3 are di icu$t to 'redict because o the amount o dama"e done can ta0e 8ee0s to se!era$ months. 9t is di icu$t to a''$& 'ressure on the inGured $e" or at $east a e8 da&s.

44. 0e& ans8er is A. 42.E

)t [ohn:s 8ort has been sho8n to cause mu$ti'$e dru" interactions throu"h induction o the c&tochrome B423 en=&me C;B3A4( but a$so C;B2C5. %his resu$ts in the increased metabo$ism o those dru"s( resu$tin" in decreased concentration and c$inica$ e ect. E>am'$es o dru"s causin" c$inica$$&-si"ni icant interactions 8ith )t [ohn:s 8ort C$ass Dru"s antiretro!ira$s ben=odia=e'ines a$'ra=o$am( mida=o$am hormona$ contrace'tion combined ora$ contrace'ti!es immunosu''ressants ca$cineurin inhibitors( cic$os'orin( tacro$imus non-nuc$eoside re!erse transcri'tase inhibitors( 'rotease inhibitors

others( di"o>in( methadone( ome'ra=o$e( 'henobarbito$( theo'h&$$ine( 8ar arin( $e!odo'a( subo>one( 9rinotecan 46. D htt'-**en.8i0i'edia.or"*8i0i*Diabetic<0etoacidosis Dsmotic diuresis is increased urination caused b& the 'resence o certain substances in the sma$$ tubes o the 0idne&s.C1H %he e>cretion occurs 8hen substances such as "$ucose enter the 0idne& tubu$es and cannot be reabsorbed ?due to a 'atho$o"ica$ state or the norma$ nature o the substance@. %he substances cause an increase in the osmotic 'ressure 8ithin the tubu$e( causin" retention o 8ater 8ithin the $umen( and thus reduces the reabsor'tion o 8ater( increasin" urine out'ut ?ie. diuresis@. %he same e ect can be seen in thera'eutics such as mannito$( 8hich is used to increase urine out'ut and decrease e>trace$$u$ar $uid !o$ume. )ubstances in the circu$ation can a$so increase the amount o circu$atin" $uid b& increasin" the osmo$arit& o the b$ood. %his has the e ect o 'u$$in" 8ater rom the interstitia$ s'ace( ma0in" more 8ater a!ai$ab$e in the b$ood and causin" the 0idne& to com'ensate b& remo!in" it as urine. 9n h&'otension( o ten co$$oids are used intra!enous$& to increase circu$atin" !o$ume in themse$!es( but as the& e>ert a certain amount o osmotic 'ressure( 8ater is there ore a$so mo!ed( urther increasin" circu$atin" !o$ume. As b$ood 'ressure increases( the 0idne& remo!es the e>cess $uid as urine. )odium( ch$oride( 'otassium are e>creted in Dsmotic diuresis( ori"inatin" rom Diabetes Me$$itus ?DM@. Dsmotic diuresis resu$ts in deh&dration rom 'o$&uria and the c$assic 'o$&di'sia ?e>cessi!e thirst@ associated 8ith DM. htt'-**en.8i0i'edia.or"*8i0i*Dsmotic<diuresis

44.AA

Assumin" A is the correct ans8er.... %he B !a$ue or a stud& shou$d be $ess than 3.32. %his !a$ue means that 8hen 8e 'er orm a stud&( the 52N o the time the obser!ations are rite Y 2 N o the time the obser!ation are due to chance a$one. 9n this 1uestion the !a$ue o B is 3.3 8hich means that the 'robabi$it& that these obser!ations are due to chance a$one is 33N( 8hich is not a statistica$$& acce'tab$e number.

4/.AA 9n this test( Jstimu$atorJ $&m'hoc&tes rom a 'otentia$ donor are irst 0i$$ed b& irradiation and then mi>ed 8ith $i!e Jres'onderJ $&m'hoc&tes rom the reci'ientF the mi>ture is incubated in ce$$ cu$ture to 'ermit D.A s&nthesis( 8hich is measured b& incor'oration o tritiated th&midine. %he "reater the amount o D.A s&nthesis in the res'onder ce$$s( the more orei"n are the c$ass 99 MHC 'roteins o the donor ce$$s. A $ar"e amount o D.A s&nthesis indicates an unsatis actor& JmatchJF i.e.( donor and reci'ient c$ass 99 ?H#A-D@ MHC 'roteins are not simi$ar( and the "ra t is $i0e$& to be reGected. %he best donor is( there ore( the 'erson 8hose ce$$s stimu$ated the incor'oration o the $east amount o tritiated th&midine in the reci'ient ce$$s. htt'-**boo0s."oo"$e.com*boo0sXidOE[I&B)-%GBKCY'"O+A1-BA26Y$'"O+A1-BA26Yd1Oth&...ionY O a$se

46.BB #actu$ose inhibits bacteria$ ammonia 'roduction b& acidi &in" the content o the bo8e$. 9t 'romotes "ro8th o co$onic $ora. %he "ro8in" biomass uses ammonia and nitro"en rom amino acids to s&nthesise bacteria$ 'rotein( 8hich in turn inhibits 'rotein de"radation to .H3. #actu$ose $eads to $ess ammonia b& inhibitin" bacteria$ urea de"radation and reduces co$onic transit time( thus reducin" the time a!ai$ab$e or ammonia 'roduction and e>'editin" ammonia e$imination. 45.DD Barrett:s eso'ha"us is a condition in 8hich the norma$ s1uamous e'ithe$ium o the eso'ha"us has been re'$aced b& an abnorma$ red co$umnar e'ithe$ium ca$$ed s'ecia$i=ed intestina$ meta'$asia. )'ecia$i=ed intestina$ meta'$asia is red( $i0e norma$ stomach tissue( but does not $oo0 $i0e stomach tissue under the microsco'e. 23.EE Kro$ithiasis is the condition 8here urinar& ca$cu$i are ormed in the urinar& tract. Most common 0idne& stons...Ca$cium D>a$ate(Ca$cium 'hos'hate(or both...+adio'a1ue D>a$ate cr&sta$..resu$t romEth&$en "$&co$

)ecound most common....Ammonium Ma"nesium 'hos'hate..)tru!ite....caused b& in ecction 8ith Krease'ositi!e bu"s.......can orm sta"horn ca$cu$i Kric acid....associated 8ith h&'eruricemia........readio$ucent C&steine...secondar& to C&stinuria..He>o"ona$ sha'e......... aint$& radio'a1ue...treat 8ith a$0a$i=ation 9n some cases( 0idne& stones 'ass out o the bod& 8ithout 'roducin" an& s&m'toms. Most 0idne& stones( ho8e!er( do cause some s&m'toms. %he most common s&m'tom rom 0idne& stones is 'ain. %he 'ain rom 0idne& stones is a resu$t o the stone "ettin" stuc0 on its 8a& out. 9 e!er and chi$$s accom'an& an& o these s&m'toms( an in ection ma& be 'resent and medica$ attention is needed sooner rather than $ate. #aborator& %estin"-#aborator& testin" inc$udes urina$&sis to detect the 'resence o b$ood ?hematuria@ and bacteria ?bacteriuria@ in the urine. Dther tests inc$ude b$ood tests or creatinine ?to e!a$uate 0idne& unction@( BK. and e$ectro$&tes to detect deh&dration( ca$cium to detect h&'er'arath&roidism( and a com'$ete b$ood count to detect in ection. I-ra&s- A standard >-ra& o the 0idne&( ureter( and b$adder( ma& be ade1uate as a irst ste' or identi &in" man& stones since most are !isib$e on >-ra&. K$trasound- %his test uses hi"h re1uenc& sound 8a!es to 'roduce 'ictures. K$trasounds can detect a di$ated 0idne& and ureter caused b& a stone $od"ed in the ureter. K$trasound( ho8e!er( cannot re$iab$& detect a$$ stones es'ecia$$& stones $ocated outside the 0idne&. 9t is the 're erred ima"in" method or 0idne& stone 'atients 8ho are 're"nant. 9PB ?9ntra!enous B&e$o"ram@- For an 9PB( a s'ecia$ d&e is inGected into the 'atient:s !eins. %he d&e co$$ects in the urinar& s&stem and 'roduces a 8hite shado8 8hen an >-ra& is ta0en. %he d&e a$$o8s to 'recise$& $ocate the stone and to determine the condition o the 0idne&s and ureters. Most 0idne& stones can be 'recise$& $ocated usin" this 'rocedure.C% )can ?Com'uteri=ed %omo"ra'h&@- %his test uses a scanner and a com'uter to create ima"es o the urinar& s&stem. A C% scan done to $oo0 or 0idne& stones does not use contrast materia$. 9t is the most common ima"in" test used toda& to e!a$uate a 'ossib$e 0idne& stone attac0.