[praru]

Hello guys,
I am going to take step 1 in a few days. these days i'm trying to do as much q as possible from various sources. i am doing nbmes offline. but i am not sure whether all the ans i have are correct or not. i'm looking forward to discuss some doubts. hope more people will join me. thanks.

1. nbme 7- block 3 16. A 31-year-old man receives medication to reverse the effects of a neuromuscular-blocking drug. Two minutes later, he has
decrease in heart rate to 28/min. Which of the following drugs or combination of drugs was most likely used to reverse the
neuromuscular blockade in this patient?
O A) Anticholinesterase drug only
O B) Anticholinesterase and cholinesterase reactivator drugs in combination
O C) Anticholinesterase and muscarinic antagonist drugs in combination
O D) Cholinesterase reactivator drug only
O E) Direct muscarinic agonist drug only

 

[praru]

my ans was E. is A the right ans?

 

[smita]

i think it is A.....because neuromuscular junction has nicotinic receptors and not muscarinic receptors....so if u give an ach enzyme inhibitor....this increase acetylcholine which acts on both the NMJ and the unwanted action onM2 receptors in athe avnode resulting in bradycardia....
hope this helps

 

[mick]

it is a this patient was given curuinum as muscle relaxand NM blocker then we want reverse it so DOC is neostigmin acetylcholine esterase inhibitor usually we have to give neostigmin with atropine to block muscarinic action so all acetylcholine act on NM receptor but in this patient not given so he has bradycardia

 

[praru]

correct ans and if possible a bit of explanation.

1. 38 yr male, BMI-24kg/m2, unable to conceive. O/E small testis, no sperm.Dx?
a- chromosome analysis
b- SRY gene sequencing

2. 24 yr old male, unable to have erection with occasional penile pain,mild chronic backache and hemorrhoids for 2 yrs.have a 2yr old son. rides bicycle 2 hrs daily and 5 hrs on weekends.no nocturnal erections.O/E tenderness on lower back and external hemorrhoids.cause of patient's erectile dysfunction?
a-damaged blood and nerve supply to erectile tissue
b-lumbosacral strain
c-compromised blood supply to pampiniform plexus.

 

[faisalm]

Fr 1 i think option a..

 

[praru]

1- i thought since SRY determines testis development the ans would be b.. but i got it wrong.. can you explain why you said 'a'?

 

[praru]

nbme 12

3. 10 yr old girl with mass removed in left side of neck. after 1 day developed pupillary constriction,vasodilation,ptosis on left side.
a-postsynaptic sympathetic fibres from superior cervical ganglion.
b-splanchnic nerve fibres from the cervical sympathetic trunk

 

[praru]

4- a 20 yr old female presents to the ER with acetaminophen toxicity following a breakup with her boyfriend.on further questioning the physician finds that she had only 2 dates with her bf although she was saying ' i loved him so much and was going to marry him'. she tells the physician ' i can't bear being alone. i can tell that you understand me,you are the only doctor who have understood how i feel '.
a- dependent personality
b-borderline

 

[praru]

5. a 14 yr old boy brought to physician with complaints of decreased appetite and vague abdominal pain for 3 weeks. his mother says that during the same time he has withdrawn himself from everyone and sleeps constantly. he describes his symptoms vaguely,physical exam-normal.most critical for physician to obtain information about?
a-family history of affective disorder
b-suicidal thoughts
c-school history
d-developmental history

6- 25 yr old with 6 mo ammenorhea. h/o normal childbirth 2 yrs ago.serum fsh and lh increased.reason?
a-adrenal insufficiency
b-chronic illness
c-major depressive disorder
d-pituitary insufficiency
e-primary ovarian failure.

 

[faisalm]

According to uworld..person wd SrY gene defect is genotypicaly male but phenotypicaly female..

 

[faisalm]

6 E
Premature ovarian failure causes early menopause nd hence the increased fsh nd lh..

 

[praru]

6 E
Premature ovarian failure causes early menopause nd hence the increased fsh nd lh..

But the option e says- primary ovarian failure. which is not possible in this case as she already gave birth to a baby.

 

[faisalm]

They both r the same thing..nd it can occur anytime before age 40 cox of depletion of eggs..

 

[praru]

They both r the same thing..nd it can occur anytime before age 40 cox of depletion of eggs..

thanks a lot. could you help me with rest of my doubts.

 

[hazelzac]

All the very best!!

 

[faisalm]

No prblm..
Sorry dont thm too..otherwise would have answered..still in my preparatry phase..