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 eecti!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

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2.AA
8a9r%ucast)Monte%ucast.....$eu1oterine rece(tor b%oc1ers (re!ent
bronchoconstriction
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3.
bet:en B and C....;<%% choose C bcause accordin# to !erba% recommendation
)sendin# a %ist o" %o: sodium diet :ith (atient that needs to "o%%o: it is more
e=cient.
i" there is an' other ideas)(%ease add )&>

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:e ha!e to in"orm the (atient about :hat "oods ha!e hi#h
sodium...&hat<s the correct ans:er "or sure.
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4.EE
the tumor sho:s 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.
3.AA
&ric'c%ic antide(ressant o!erdose....&ric'c%ics ha!e a narro: thera(eutic
indeA) i.e.) the thera(eutic dose is c%ose to the toAic dose.
&he (eri(hera% autonomic ner!ous s'stem) centra% ner!ous s'stem and the
heart are the main s'stems that are aected "o%%o:in# o!erdose.
;nitia% or mi%d s'm(toms t'(ica%%' de!e%o( :ithin 2 hours and inc%ude
tach'cardia) dro:siness) 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 BECGC abnorma%ities are
"re2uent and a :ide !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 D,* com(%eA and the E,+D& inter!a%s.
*ei@ures) cardiac d'srh'thmias) and a(nea are the most im(ortant %i"e
threatenin# com(%ications.F
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6.BB
Ero"essiona% AECs are !er' e=cient 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 micro-or#anisms C or b' rece(tor-mediated
endoc'tosis) and then dis(%a'in# a "ra#ment o" the anti#en) bound to a c%ass
;; MHC mo%ecu%e) on their membrane. &he & ce%% reco#ni@es and interacts :ith
the anti#en-c%ass ;; MHC mo%ecu%e com(%eA on the membrane o" the anti#en-
(resentin# ce%%.

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0. D
E'ru!ate carboA'%ase is a mitochondria en@ime re2uirin# biotin. ;t is acti!ated
b' acet'%CoAB "rom beta- oAidation. &he (roduct oAa%oacetateBGAAC) 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 shuHe. ;n the c'to(%asm ma%ate is
reduced to BGAAC.
E'ru!ate carboA'%ase de9cienc' is an inherited disorder that causes %actic
acid and other (otentia%%' toAic 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. E'ru!ate carboA'%ase de9cienc' is a rare
condition) :ith an estimated incidence o" 1 in 234)444 births :or%d:ide. &his
disorder a((ears to be much more common in some A%#on1ian ;ndian tribes
in eastern Canada.
htt(.++en.:i1i(edia.or#+:i1i+E'ru!ate?carboA'%ase?de9cienc'
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0.DD
A de9cienc' o" ('ru!ate carboA'%ase can cause %actic acidosis as a resu%t o"
%actate bui%d u(. /orma%%') eAcess ('ru!ate is shunted into #%uconeo#enesis
!ia con!ersion o" ('ru!ate into oAa%oacetate) but because o" the en@'me
de9cienc') eAcess ('ru!ate is con!erted into %actate instead.
As a 1e' ro%e o" #%uconeo#enesis is in the maintenance o" b%ood su#ar)
de9cienc' o" ('ru!ate carboA'%ase can a%so %ead to h'(o#%'cemia
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7.AA
;-ce%% disease is an autosoma% recessi!e disorder caused b' a de9cienc' o"
G%c/Ac (hos(hotrans"erase) :hich (hos(hor'%ates mannose residues to
mannose-6-(hos(hate on /-%in1ed #%'co(roteins in the Go%#i a((aratus :ithin
the ce%%.
Iithout mannose-6-(hos(hate to tar#et them to the %'sosomes) the en@'mes
are trans(orted "rom the Go%#i to the eAtrace%%u%ar s(ace) resu%tin# in %ar#e
intrace%%u%ar inc%usions o" mo%ecu%es re2uirin# %'sosoma% de#radation in
(atients :ith the disease .
&he Go%#i a((aratus is unab%e to tar#et the %'sosoma% (rotein B:hich is
norma%C to the %'sosome. Iithout (ro(er "unctionin# o" /-acet'%#%ucosamine-
1-(hos(hotrans"erase) a bui%d u( o" substances occurs :hen en@'mes are
unab%e to tra!e% inside o" the %'sosome
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7. A
;- Ce%% Disease. B;nc%usion ce%% diseaseC. ;nherited %'sosoma% stora#e disorderJ
"ai%ure o" addition to mannose 6 (hos(hate to %'sosome (roteinsB 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 Koin mo!ement) and hi#h
(%ama %e!e%s o" %'sosomes. G"ten "ata% chi%dhood.
htt(.++en.:i1i(edia.or#+:i1i+;-ce%%?disease
6.BB
14.EE
M'asthenia #ra!is is a chronic autoimmune neuromuscu%ar disease characteri@ed b'
!ar'in# de#rees o" :ea1ness o" the s1e%eta% B!o%untar'C musc%es o" the bod'.
&he ha%%mar1 o" m'asthenia #ra!is is musc%e :ea1ness 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% eA(ression) che:in#) ta%1in#) and s:a%%o:in# are o"ten) but
not a%:a's) in!o%!ed in the disorder.
;n m'asthenia #ra!is) antibodies b%oc1) a%ter) or destro' the rece(tors "or acet'%cho%ine at
the neuromuscu%ar Kunction :hich (re!ents the musc%e contraction "rom occurrin#
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hi there)1ee( #oin#);<%% come %ater)&han1 'ou
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11. A
A constant rate o" in"usion o" GnH, :i%% cause a transient increase in $H and FH*
secretion) "o%%o:ed b' a decrease caused b' the do:nre#u%ation o" #onadotro(h
rece(tors. 1a(%an (h'sio%o#' BEa#e 334C.
htt(.++en.:i1i(edia.or#+:i1i+Gonadotro(in-re%easin#?hormone
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12. B
Crest *'ndrome. Ca%ci9cations) ,a'naud<s (henomenon) Eso(ha#ea% d'smoti%it')
*c%erodact'%') and &e%an#iectasia. $imited s1in in!o%!ement) o"ten con9ned to 9n#ers and
"ace. More beni#n c%inica% course. Associated :ith Anticentromere Antibod'.
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13. A
Acute a((endicitis
htt(.++en.:i1i(edia.or#+:i1i+A((endicitis
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14. D
A;D*
Ear!o!irus B16 is a cause o" chronic anemia in indi!idua%s :ho ha!e A;D*. ;t is "re2uent%'
o!er%oo1ed. &reatment :ith 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 inLammator' reaction in
A;D* (atients :ho ha!e Kust be#un antiretro!ira% thera('.F14M.
htt(.++en.:i1i(edia.or#+:i1i+Ear!o!irus?B16
13. G
Ihen associated :ith the %un#) it o"ten causes ecto(ic (roduction o" (arath'roid
hormone-re%ated (rotein BE&HrEC) resu%tin# in h'(erca%cemia.
*2uamous-ce%% carcinoma o" the %un# is more common in men than in :omen. ;t is c%ose%'
corre%ated :ith a histor' o" tobacco smo1in#) more so than most other t'(es o" %un#
carcinoma. ;t most o"ten arises centra%%' in %ar#er bronchi) and :hi%e it o"ten metastasi@es
to %ocore#iona% %'m(h nodes B(articu%ar%' the hi%ar nodesC ear%' in its course) it #enera%%'
disseminates outside the thoraA some:hat %ater than other maKor t'(es. $ar#e tumors
ma' under#o centra% necrosis) resu%tin# in ca!itation. A s2uamous-ce%% carcinoma is o"ten
(receded "or 'ears b' s2uamous-ce%% meta(%asia or d's(%asia in the res(irator' e(ithe%ium
o" the bronchi) :hich %ater trans"orms to carcinoma in situ. ;n carcinoma in situ) at'(ica%
ce%%s ma' be identi9ed b' c'to%o#ic smear test o" s(utum) bronchoa%!eo%ar %a!a#e or
sam(%es "rom endobronchia% brushin#s. Ho:e!er) s2uamous-ce%% carcinoma in situ is
as'm(tomatic and undetectab%e on N-ra' radio#ra(hs. E!entua%%') it becomes
s'm(tomatic) usua%%' :hen the tumor mass be#ins to obstruct the %umen o" a maKor
bronchus) o"ten (roducin# dista% ate%ectasis and in"ection. *imu%taneous%') the %esion
in!ades into the surroundin# (u%monar' substance. Gn histo(atho%o#') these tumors
ran#e "rom :e%%-dierentiated) sho:in# 1eratin (ear%s and ce%% Kunctions) to ana(%astic
:ith on%' minima% residua% s2uamous-ce%% "eatures.
htt(.++en.:i1i(edia.or#+:i1i+*2uamous-ce%%?carcinoma
16.AA
Ea#et<s disease ma' be dia#nosed usin# one or more o" the "o%%o:in# tests.
Ea#etic bone has a characteristic a((earance on N-ra's. A s1e%eta% sur!e' is there"ore
indicated.
htt(.++u(%oad.:i1imedia.or#+:i1i(edia+commons+4+46+Ea#ets?s1u%%.K(#
An e%e!ated %e!e% o" a%1a%ine (hos(hatase in the b%ood in combination :ith norma%
ca%cium) (hos(hate) and aminotrans"erase %e!e%s in an e%der%' (atient are su##esti!e o"
Ea#et<s disease.
Bone scans are use"u% in determinin# the eAtent and acti!it' o" the condition. ;" a bone
scan su##ests Ea#et<s disease) the aected boneBsC shou%d be N-ra'ed to con9rm the
dia#nosis
&he (atho#enesis o" Ea#et<s disease is described in 3 sta#es) :hich are.
i. Gsteoc%astic acti!it'
ii. MiAed osteoc%astic-osteob%astic acti!it'
iii. EAhausti!e Bburnt outC sta#e
;nitia%%') there is a mar1ed 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 :ed#e in %on# bones or osteo(orosis circumscri(ta in
the s1u%%. &he osteo%'sis is "o%%o:ed b' a com(ensator' increase in bone "ormation
induced b' osteob%asts recruited to the area. &his is associated :ith 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 BOmosaicO (atternC) rather than the norma%
%inear %ame%%ar (attern. &he resorbed bone is re(%aced and the marro: s(aces are 9%%ed b'
an eAcess o" 9brous connecti!e tissue :ith a mar1ed 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 O(a#etic bone)O a%so 1no:n as burned-out Ea#et<s disease.
10.AA
a%% choices eAce(t A are arti9cia% (rocedures that (ro%on# his %i"e.
17. D
&&E. &hrombotic &hromboc'to(enia Eur(ura. is a rare disorder o" the b%ood-coa#u%ation
s'stem) causin# eAtensi!e microsco(ic thromboses to "orm in sma%% b%ood !esse%s
throu#hout the bod' Bthrombotic microan#io(ath'C.F2MF3M Most cases o" &&E 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 Ii%%ebrand "actor B!IFC into sma%%er units. A rarer "orm o" &&E) ca%%ed
P(sha:-*chQR%man s'ndrome) is #enetica%%' inherited as a d's"unction o" ADAM&*13. ;"
%ar#e !IF mu%timers (ersist there is tendenc' "or increased coa#u%ation.
htt(.++en.:i1i(edia.or#+:i1i+&hrombotic?thromboc'to(enic?(ur(ura
&EE. FA (a#e 346C *'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.
16. D
/iemann (ic1 disease. ;s an Autosoma% recessi!e disease) Ero#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%inaseJ Accumu%ated substrate. *(hin#om'e%in. BFA (a#e 111C
$i(o"uscin. is the name #i!en to 9ne%' #ranu%ar 'e%%o:-bro:n (i#ment #ranu%esF1M
com(osed o" %i(id-containin# residues o" %'sosoma% di#estion. ;t is considered one o" the
a#in# or O:ear and tearO (i#ments) "ound in the %i!er) 1idne') heart musc%e) adrena%s)
ner!e ce%%s) and #an#%ion ce%%s. ;t is s(eci9ca%%' arran#ed around the nuc%eus) and is a
t'(e o" $i(ochrome.
$i(o"uscin accumu%ation is a maKor ris1 "actor im(%icated in macu%ar de#eneration) a
de#enerati!e disease o" the e'e.F6M
Abnorma% accumu%ation o" %i(o"uscin is associated :ith a #rou( o" diseases o"
neurode#enerati!e disorder t'(e ca%%ed %i(o"uscinoses) e.#.) neurona% ceroid
%i(o"uscinosis) a%so 1no:n as Batten disease) as :e%% as some other names.
Eatho%o#ica% accumu%ation o" %i(o"uscin is im(%icated in A%@heimer<s disease) Ear1inson<s
disease) am'otro(hic %atera% sc%erosis) certain %'sosoma% diseases) acrome#a%')
dener!ation atro(h') %i(id m'o(ath') chronic obstructi!e (u%monar' diseaseF14M)
centronuc%ear m'o(ath'
16 is BBBBBBBBBBBBB
is &a' *ach Disease ; "or#ot that the #ir% is Ash1ena@i Ke:ish descent
htt(.++en.:i1i(edia.or#+:i1i+&a'SE2S74S63*achs?disease
&a' sach disease. A,) Ero#resi!e neurode#eneration) de!e%o(menta% de%a') cherr' red
s(ot on macu%a) %'sosoma% :ith onion s1in ) /G HEEA&GMEGA$>. De". en@ime.
HeAosaminidase AJ Accumu%ated substrate. G2 #an#%ioside. BFA (a#e 111C.

24. B
G%"ator' C/ ; is the on%' C/ :ithout tha%amic re%a' to corteA. Function. *me%% B FA 413C
21.FF
the ans:er is F because the Duestion 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.
Psin# the "ormu%a....CTDose+Ud
Uo% o" distribution "or N is 344+3 T144
"or> is 344+2.3T244
22.DD
EneumothoraA is de9ned as the (resence o" air or #as in the (%eura% ca!it') that is) in the
(otentia% s(ace bet:een the !iscera% and (arieta% (%eura o" the %un#. &he resu%t is co%%a(se
o" the %un# on the aected side. Air can enter the intra(%eura% s(ace throu#h a
communication "rom the chest :a%% Bie) traumaC or throu#h the %un# (arench'ma across
the !iscera% (%eura.
Erimar' s(ontaneous (neumothoraA BE*EC occurs in (eo(%e :ithout under%'in# %un#
disease and in the absence o" an incitin# e!ent . ;n other :ords) air is (resent in the
intra(%eura% s(ace :ithout (recedin# trauma and :ithout under%'in# c%inica% or radio%o#ic
e!idence o" %un# disease.
,is1s "actors "or (rimar' s(ontaneous (neumothoraA BE*EC inc%ude the "o%%o:in#.
VW*mo1in#
VW&a%%) thin stature in a hea%th' (erson
VWMar"an s'ndrome
VWEre#nanc'
VWFami%ia% (neumothoraA
B%ebs and bu%%ae Bsometimes ca%%ed em(h'sematous%i1e chan#es or E$CsC are re%ated to
the occurrence o" (rimar' s(ontaneous (neumothoraA.
*econdar' s(ontaneous (neumothoraA B**EC occurs in (eo(%e :ith a :ide !ariet' o"
(arench'ma% %un# diseases) that is) these indi!idua%s ha!e under%'in# (u%monar'
structura% (atho%o#' Bsee the ima#e be%o:C. Air enters the (%eura% s(ace !ia distended)
dama#ed) or com(romised a%!eo%i. Eatients ma' (resent :ith more serious c%inica%
s'm(toms and se2ue%ae due to comorbid conditions.
Diseases and conditions associated :ith secondar' s(ontaneous (neumothoraA inc%ude
the "o%%o:in#.
VWChronic obstructi!e %un# disease BCGEDC or em(h'sema. ;ncreased (u%monar' (ressure
due to cou#hin# :ith a bronchia% (%u# o" mucus or (h%e#m bronchia% (%u# ma' (%a' a ro%e.
VWAsthma
VWHuman immunode9cienc' !irus+ac2uired immunode9cienc' s'ndrome BH;U+A;D*C :ith
ECE in"ection
VW/ecroti@in# (neumonia
VW&ubercu%osis
VW*arcoidosis
VWC'stic 9brosis
VWBroncho#enic carcinoma or metastatic ma%i#nanc'
VW;dio(athic (u%monar' 9brosis
VW;nha%ationa% and intra!enous dru# use Be#) mariKuana) cocaineCF7M
VW;nterstitia% %un# diseases associated :ith connecti!e tissue diseases
VW$'m(han#io%eiom'omatosis
VW$an#erhans ce%% histioc'tosis
VW*e!ere acute res(irator' s'ndrome B*A,*C. A re(orted 1.0S o" *A,* (atients
de!e%o(ed s(ontaneous (neumothoraA.
VW&horacic endometriosis and catamenia% (neumothoraA
VWCo%%a#en !ascu%ar disease) inc%udin# Mar"an s'ndrome
htt(.++emedicine.medsca(e.com+artic%e+424340-o!er!ie:5a4144
23.CC
Gancic%o!ir is an anti!ira% medication used to treat or (re!ent c'tome#a%o!irus BCMUC
in"ections
;t is 9rst (hos(hor'%ated to a deoA'#uanosine tri(hos(hate BdG&EC ana%o#ue. &his
com(etiti!e%' inhibits the incor(oration o" dG&E b' !ira% D/A (o%'merase) resu%tin# in the
termination o" e%on#ation o" !ira% D/A.
Ad!erse eects.Gancic%o!ir is common%' associated :ith a ran#e o" serious
haemato%o#ica% ad!erse eects. #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
&oAicit'.Gancic%o!ir is considered a (otentia% human carcino#en) terato#en) and muta#en.
;t is a%so considered %i1e%' to cause inhibition o" s(ermato#enesis. &hus) it is used
Kudicious%' and hand%ed as a c'totoAic dru# in the c%inica% settin#
24.EE
Ho%os'sto%ic murmur is best heard at the a(eA in the %e"t %atera% decubitus
(osition....Mitra% ,e#ur#itation .
Murmur.B%o:in# ho%os'sto%ic murmur
Heard best at the a(eA
,adiation to the aAi%%a and in"erior ed#e o" %e"t sca(u%a.
Eossib%e associated 9ndin#s.
*2. :ide (h'sio%o#ic s(%ittin#
*3 htt(.++de(ts.:ashin#ton.edu+(h'sdA+heart+tech.htm%
23.DD
Coronar' b%ood Lo: occurs most%' durin# diasto%e) because durin# s'sto%e the b%ood
!esse%s :ithin the m'ocardium are com(ressed. ;ncreased heart rates) :hich reduce the
time "or diasto%e 9%%in#) can reduce the m'ocardia% b%ood su((%' and cause
ischaemia.D'namic eAercise increases coronar' b%ood Lo: in (ro(ortion to the heart rate)
:ith (ea1 !a%ues durin# maAima% eAercise t'(ica%%' three to 9!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 o:n 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 ris1 o" this outcome) (re#nant mothers :ith threatened (remature
de%i!er' (rior to 34 :ee1s 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.
20.EE
in DXA
-beta-H'droA'but'ric acid is a 1etone bod'....inc
-Due to %oss o" :ather......inc. serum osmo%a%it'.
-&he anion #a( is the dierence in the measured cations and the measured anions in
serum) (%asma) or urine. &he ma#nitude o" this dierence Bi.e. O#a(OC in the serum is o"ten
ca%cu%ated in medicine :hen attem(tin# to identi"' the cause o" metabo%ic acidosis.
on%' /aY) C%Z and HCG3Z BY+- XC are used :hen ca%cu%atin# the anion #a(... hea%th'
adu%ts is 7-12 mE2+$
B F/aYM C Z B FC%ZMYFHCG3ZM C
a use"u% mnemonic to remember the hi#h anion #a( is MPDE;$E* Bmethano%) uremia)
diabetic 1etoacidosis) (ro('%ene #%'co%) isonia@id) %actic acidosis) eth'%ene #%'co%)
sa%ic'%atesC.

27.DD
;t is a Gram-ne#ati!e) aerobic) rod-sha(ed bacterium :ith uni(o%ar moti%it' and oAidase
(ositi!e
E. aeru#inosa secretes a !ariet' o" (i#ments) inc%udin# ('oc'anin Bb%ue-#reenC)Because it
thri!es on most sur"aces) this bacterium is a%so "ound on and in medica% e2ui(ment)
inc%udin# catheters) causin# cross-in"ections in hos(ita%s and c%inics. ;t is im(%icated in
hot-tub rash.
26.EE Mar"an s'ndrome can %ead to mitra% !a%!e (ro%a(se BMUEC.
34. A
Beta tha%asemia. (re!a%ent in mediterranea (o(u%ation.
De"ect. (oint mutation in s(%icin# sites and (romoter se2uences
Beta tha%asemia minor Bhetero@'#oteC
1. beta chain in un(roduced
2. usua%%' as'ntom(tomatic
3. DA con9rmed b' increase HbA2 B [ 3.3SC
Beta tha%asemia maKor. BHomo@'#oteC
1. beta chain is absent- se!ere anemia re2uirin# b%ood trans"usion B2V\
hemochromatosisC
2. Marro: eA(ansion B cre: cut on s1u%% A-ra'C- s1e%eta% de"romities) chi(mun1 "acies
Both maKor and minor - increase Hb F BFA (a#e 343C.
htt(.++:::.#oo#%e.com+search]
sourceidTna!c%ient^a2T4^o2TbetaYtha%asemia^ieTP&...tha%assemia
31. G
Beta 2 adrener#ic a#onist. Bronchodi%ationB re%aA bronchia% smooth muc%esC
htt(.++en.:i1i(edia.or#+:i1i+Beta2-adrener#ic?a#onist
32. C
&*H. &h'roid-stimu%atin# hormone Ba%so 1no:n as &*H or th'rotro(inC is a (e(tide
hormone s'nthesi@ed and secreted b' th'rotro(e ce%%s in the anterior (ituitar' #%and)
:hich 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.:i1i(edia.or#+:i1i+&h'roid-stimu%atin#?hormone
33. B
Adenocarcinoma o" the endometrium.
Carcinoma endometria% is the Most common #'neco%o#ic ma%i#nanc'. (ea1 occurrence at
33-63'ear o" a#e. C%inica%%' (resents :ith !a#ina% b%eedin#. &'(ica%%' (receded b'
endometria% h'(er(%asia. ,is1 "actors inc%ude (ro%on#ed use o" estro#en :ithout
(ro#estins) obesit') diabetes) h'(ertension) nu%%i(arit' and %ate meno(ause. ;ncreas
m'ometria% in!asion) decrease (ro#nosis. BFA (a#e 470C
htt(.++en.:i1i(edia.or#+:i1i+Endometria%?cancer
34. C
Ear1inson disease
*ur#er' and dee( brain stimu%ation
E%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 :ith sur#er' :as once a common (ractice) but since
the disco!er' o" %e!odo(a) the number o" o(erations dec%ined.F33M *tudies in the (ast "e:
decades ha!e %ed to #reat im(ro!ements in sur#ica% techni2ues) so that sur#er' is a#ain
bein# used in (eo(%e :ith ad!anced ED "or :hom dru# thera(' is no %on#er su=cient.F33M
*ur#er' "or ED can be di!ided in t:o main #rou(s. %esiona% and dee( brain stimu%ation
BDB*C. &ar#et areas "or DB* or %esions inc%ude the tha%amus) the #%obus (a%%idus or the
subtha%amic nuc%eus.F33M Dee( brain stimu%ation BDB*C is the most common%' used
sur#ica% treatment. ;t in!o%!es the im(%antation o" a medica% de!ice ca%%ed a brain
(acema1er) :hich sends e%ectrica% im(u%ses to s(eci9c (arts o" the brain. DB* is
recommended "or (eo(%e :ho ha!e ED :ho suer "rom motor Luctuations and tremor
inade2uate%' contro%%ed b' medication) or to those :ho are into%erant to medication) as
%on# as the' do not ha!e se!ere neuro(s'chiatric (rob%ems.F26M Gther) %ess common)
sur#ica% thera(ies in!o%!e the "ormation o" %esions in s(eci9c subcortica% areas Ba
techni2ue 1no:n as (a%%idotom' in the case o" the %esion bein# (roduced in the #%obus
(a%%idusC.F33M
htt(.++en.:i1i(edia.or#+:i1i+Ear1inson<s?disease
33. A
Dee( Fibu%ar ner!e. Iea1ness in!ersion) $oss eAtension o" the di#its) %oss dorsiLeAion
B "oot dro(C) sensor' %oss on antero %atera% %e# and dorso o" the "oot) 9rts :eb s(ace.
BXa(%an anatom' (a#e 263 and 263C.
htt(.++en.:i1i(edia.or#+:i1i+Dee(?9bu%ar?ner!e
36. B
E%aceta accreta. An in!asion o" the m'ometrium :hich does not (enetrate the entire
thic1ness o" the musc%e. &his "orm o" the condition accounts "or around 03S o" a%% cases.
E%acenta (erccreta. &he :orst "orm o" the condition is :hen the (%acenta (enetrates the
entire m'ometrium to the uterine serosa Bin!ades throu#h entire uterine :a%%C. &his
!ariant can %ead to the (%acenta attachin# to other or#ans such as the rectum or
b%adderF1M.
htt(.++en.:i1i(edia.or#+:i1i+E%acenta?accreta

30. C
Crohn Disease. A%so 1no:n as re#iona% enteritis) is an inLammator' disease o" the
intestines that ma' aect an' (art o" the #astrointestina% tract "rom mouth to anus)
causin# a :ide !ariet' o" s'm(toms. ;t (rimari%' causes abdomina% (ain) diarrhea B:hich
ma' be b%ood' i" inLammation is at its :orstC) !omitin#) or :ei#ht %oss)F1MF2MF3M but ma'
a%so cause com(%ications outside the #astrointestina% tract such as s1in rashes) arthritis)
inLammation o" the e'e) tiredness) and %ac1 o" concentration.F1M
Crohn<s disease is thou#ht to be an autoimmune disease) in :hich the bod'<s immune
s'stem attac1s the #astrointestina% tract) causin# inLammationJ it is c%assi9ed as a t'(e
o" inLammator' bo:e% disease. &here is e!idence o" a #enetic %in1 to Crohn<s disease)
(uttin# indi!idua%s :ith sib%in#s aHicted :ith the disease at hi#her ris1.F4M ;t is thou#ht to
ha!e a %ar#e en!ironmenta% com(onent as e!idenced b' a hi#her incidence in :estern
industria%i@ed nations com(ared to other (arts o" the :or%d. Ma%es and "ema%es are
e2ua%%' aected. *mo1ers are t:o times more %i1e%' to de!e%o( Crohn<s disease than.
htt(.++en.:i1i(edia.or#+:i1i+Crohn<s?disease. Gross mor(ho%o#'. transmura% inLamation)
Cobb%estone mucosa) cree(in# "at) bo:e%% :a%% thic1nin#) Bstrin# si#n on barium s:a%%o:
A- ra'C %inear) u%cers) 9ssures) 9stu%as.
Microsco(ic mor(ho%o#'. /oncaseatin# #ranu%omasand %'m(hoid a#re#ates. BFA (a#e
324C
37. B
e (redicti!e !a%ue Eositi!e BEEUC. &E+ B&EYFEC
EEUT 04+B04Y344CT 4.17 in this case a(roA. 4.16
EEU . Eositi!e Eredicti!e Ua%ue
36. C
Membranous G%omeru%one(hritis. $M -diuse ca(i%%ar' and GBM thic1enin#. EM O s(i1e
and domeO a((earance :ith sube(ithe%ia% de(osits. ;F - #ranu%ar.
Caused b' dru#s B (enici%%amine) Go%d) /*A;DC. Most common cause o" adu%t ne(hrotic
s'ndrome.
&he c%ose%' re%ated terms membranous ne(hro(ath'F1M and membranous
#%omeru%o(ath'F2M both re"er to a simi%ar conste%%ation but :ithout the assum(tion o"
inLammation.
*ome (atients ma' (resent as ne(hrotic s'ndrome :ith (roteinuria) edema :ith or
:ithout rena% "ai%ure. Gthers ma' be as'm(tomatic and ma' be (ic1ed u( on screenin# or
urina%'sis as ha!in# (roteinuria. A de9niti!e dia#nosis o" membranous ne(hro(ath'
re2uires a 1idne' bio(s'.
htt(.++en.:i1i(edia.or#+:i1i+Membranous?#%omeru%one(hritis5C%inica%?(...resentation
44. A
;ntoAication "or Am(hetamine. Es'chomotor a#itation ) im(aired Kud#ment) (u(i%%ar'
di%ation) h'(ertension) tach'cardia) eu(horia) (ro%on#ed :ea1"u%ness sand attention)
cardiac arr'thmia) de%usions) ha%%ucinations) "e!er. BFA 447C
Am(hetamine. B%oc1s o" neurotransmiter u(ta1e at the (res'na(tic ner!e termina%
41. C
F%eAion or ante!ersion B144V_C. i%io(soas B:ith (soas maKor "rom !ertebra% co%umnCJ tensor
"ascia %atae) (ectineus) adductor %on#us) adductor bre!is) and #raci%is. &hi#h musc%es
actin# as hi( LeAors. rectus "emoris and sartorius.
42.E
Duchenne muscu%ar d'stro(h' BDMDC is a recessi!e N-%in1ed. &he disorder is caused b' a
mutation in the d'stro(hin #ene) %ocated in humans on the N chromosome BN(21C. &he
d'stro(hin #ene codes "or the (rotein d'stro(hin) an im(ortant structura% com(onent
:ithin musc%e tissue.
43.C
Media% co%%atera% %i#amentO 1no:n as the tibia% co%%atera% %i#ament too.MC$ strains and
tears are "air%' common in American "ootba%%. Most%' the center and the #uards are ones
:ho #et this inKur') due to the #ri( trend on their c%eats.
An MC$ inKur' can be !er' (ain"u% and is caused b' a !a%#us stress to a s%i#ht%' bent 1nee)
o"ten :hen %andin#) bendin# or on hi#h im(act. De(endin# on the #rade o" the inKur') the
%o:est #rade B#rade 1C can ta1e bet:een 2 and 14 :ee1s "or the inKur' to "u%%' hea%.
,eco!er' times "or #rades 2 and 3 are di=cu%t to (redict because o" the amount o"
dama#e done can ta1e :ee1s to se!era% months. ;t is di=cu%t to a((%' (ressure on the
inKured %e# "or at %east a "e: da's.
44. 1e' ans:er is A.
43.E
*t `ohn<s :ort has been sho:n to cause mu%ti(%e dru# interactions throu#h induction o"
the c'tochrome E434 en@'me C>E3A4) but a%so C>E2C6. &his resu%ts in the increased
metabo%ism o" those dru#s) resu%tin# in decreased concentration and c%inica% eect.
EAam(%es o" dru#s causin# c%inica%%'-si#ni9cant interactions :ith *t `ohn<s :ort
C%ass
Dru#s
antiretro!ira%s non-nuc%eoside re!erse transcri(tase
inhibitors) (rotease inhibitors
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
others) di#oAin) methadone) ome(ra@o%e) (henobarbito%) theo(h'%%ine) :ar"arin) %e!odo(a)
suboAone) ;rinotecan
46. D
htt(.++en.:i1i(edia.or#+:i1i+Diabetic?1etoacidosis
Gsmotic diuresis is increased urination caused b' the (resence o" certain substances in
the sma%% tubes o" the 1idne's.F1M &he eAcretion occurs :hen substances such as #%ucose
enter the 1idne' tubu%es and cannot be reabsorbed Bdue to a (atho%o#ica% state or the
norma% nature o" the substanceC. &he substances cause an increase in the osmotic
(ressure :ithin the tubu%e) causin# retention o" :ater :ithin the %umen) and thus reduces
the reabsor(tion o" :ater) increasin# urine out(ut Bie. diuresisC. &he same eect can be
seen in thera(eutics such as mannito%) :hich is used to increase urine out(ut and
decrease eAtrace%%u%ar Luid !o%ume.
*ubstances in the circu%ation can a%so increase the amount o" circu%atin# Luid b'
increasin# the osmo%arit' o" the b%ood. &his has the eect o" (u%%in# :ater "rom the
interstitia% s(ace) ma1in# more :ater a!ai%ab%e in the b%ood and causin# the 1idne' to
com(ensate b' remo!in# it as urine. ;n h'(otension) o"ten co%%oids are used intra!enous%'
to increase circu%atin# !o%ume in themse%!es) but as the' eAert a certain amount o"
osmotic (ressure) :ater is there"ore a%so mo!ed) "urther increasin# circu%atin# !o%ume. As
b%ood (ressure increases) the 1idne' remo!es the eAcess Luid as urine.
*odium) ch%oride) (otassium are eAcreted in Gsmotic diuresis) ori#inatin# "rom Diabetes
Me%%itus BDMC. Gsmotic diuresis resu%ts in deh'dration "rom (o%'uria and the c%assic
(o%'di(sia BeAcessi!e thirstC associated :ith DM.
htt(.++en.:i1i(edia.or#+:i1i+Gsmotic?diuresis

44.AA
Assumin# A is the correct ans:er....
&he E !a%ue "or a stud' shou%d be %ess than 4.43.
&his !a%ue means that :hen :e (er"orm a stud') the 63S o" the time the obser!ations
are rite ^ 3 S o" the time the obser!ation are due to chance a%one.
;n this 2uestion the !a%ue o" E is 4.3 :hich means that the (robabi%it' that these
obser!ations are due to chance a%one is 34S) :hich is not a statistica%%' acce(tab%e
number.
40.AA
;n this test) Ostimu%atorO %'m(hoc'tes "rom a (otentia% donor are 9rst 1i%%ed b' irradiation
and then miAed :ith %i!e Ores(onderO %'m(hoc'tes "rom the reci(ientJ the miAture is
incubated in ce%% cu%ture to (ermit D/A s'nthesis) :hich 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 ;; MHC (roteins o" the donor ce%%s. A %ar#e amount o" D/A
s'nthesis indicates an unsatis"actor' OmatchOJ i.e.) donor and reci(ient c%ass ;; BH$A-DC
MHC (roteins are not simi%ar) and the #ra"t is %i1e%' to be reKected. &he best donor is)
there"ore) the (erson :hose ce%%s stimu%ated the incor(oration o" the %east amount o"
tritiated th'midine in the reci(ient ce%%s.
htt(.++boo1s.#oo#%e.com+boo1s]idTE`N'E*-&GEPC^(#T,A1-EA36^%(#T,A1-
EA36^d2Tth'...ion^"T"a%se
47.BB
$actu%ose inhibits bacteria% ammonia (roduction b' acidi"'in# the content o" the bo:e%. ;t
(romotes #ro:th o" co%onic Lora. &he #ro:in# biomass uses ammonia and nitro#en "rom
amino acids to s'nthesise bacteria% (rotein) :hich 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
eA(editin# ammonia e%imination.
46.DD
Barrett<s eso(ha#us is a condition in :hich the norma% s2uamous 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) %i1e norma% stomach tissue)
but does not %oo1 %i1e stomach tissue under the microsco(e.
34.EE
Pro%ithiasis is the condition :here urinar' ca%cu%i are "ormed in the urinar' tract.
Most common 1idne' stons...Ca%cium GAa%ate)Ca%cium (hos(hate)or both...,adio(a2ue
GAa%ate cr'sta%..resu%t "romEth'%en #%'co%
*ecound most common....Ammonium Ma#nesium (hos(hate..*tru!ite....caused b'
in"ecction :ith Prease-(ositi!e bu#s.......can "orm sta#horn ca%cu%i
Pric acid....associated :ith h'(eruricemia........readio%ucent
C'steine...secondar' to C'stinuria..HeAo#ona% sha(e........."aint%' radio(a2ue...treat :ith
a%1a%i@ation
;n some cases) 1idne' stones (ass out o" the bod' :ithout (roducin# an' s'm(toms.
Most 1idne' stones) ho:e!er) do cause some s'm(toms. &he most common s'm(tom
"rom 1idne' stones is (ain. &he (ain "rom 1idne' stones is a resu%t o" the stone #ettin#
stuc1 on its :a' out.
;" "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
BhematuriaC and bacteria BbacteriuriaC in the urine.
Gther tests inc%ude b%ood tests "or creatinine Bto e!a%uate 1idne' "unctionC) BP/ 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.
N-ra's. A standard A-ra' o" the 1idne') ureter) and b%adder) ma' be ade2uate as a 9rst
ste( "or identi"'in# man' stones since most are !isib%e on A-ra'.
P%trasound. &his test uses hi#h "re2uenc' sound :a!es to (roduce (ictures. P%trasounds
can detect a di%ated 1idne' and ureter caused b' a stone %od#ed in the ureter. P%trasound)
ho:e!er) cannot re%iab%' detect a%% stones es(ecia%%' stones %ocated outside the 1idne'. ;t
is the (re"erred ima#in# method "or 1idne' stone (atients :ho are (re#nant.
;UE B;ntra!enous E'e%o#ramC. For an ;UE) a s(ecia% d'e is inKected into the (atient<s !eins.
&he d'e co%%ects in the urinar' s'stem and (roduces a :hite shado: :hen an A-ra' is
ta1en. &he d'e a%%o:s to (recise%' %ocate the stone and to determine the condition o" the
1idne's and ureters. Most 1idne' stones can be (recise%' %ocated usin# this (rocedure.C&
*can BCom(uteri@ed &omo#ra(h'C. &his test uses a scanner and a com(uter to create
ima#es o" the urinar' s'stem. A C& scan done to %oo1 "or 1idne' stones does not use
contrast materia%. ;t is the most common ima#in# test used toda' to e!a%uate a (ossib%e
1idne' stone attac1.