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Block 4

1 E ? (not clear which one is posterior cruciate) posterior cruciate ligament/ ? meniscus

stability is lost in posterior part of knee due to the extensive posterior movement of tibia relative to

A- quardriceps tendon

B-articular cartilage

C-patellar ligament

D-ant cruciate lig

E- posterior cruciate ligament/ ? meniscus

2 A compressed # of L4

severe low back pain after lifting groceries

tenderness over the lumbosacral spine

68 yrs , never have HRT,

No focal neurological signs

Osteoporosis-type 1
3 C- yg athelete, stress # tibia, decreased bone density,

estrogen excess ( steroids)

4 B - pg 189 KME pdf

light in R eye ---R contstrict ( direct ) , L does not constrict ( consesual)

light in L eye -- L does not constrict ( direct) , R constrict ( consensual)

Light reflex

afferent --- CN II (to pretectal area in midbrain )

efferent -- CN III ( both eyes -- through Edinger Westphal fibers )

so far --- light stimuli is carried by both eyes ---- as both eyes shows one of the light reflex
(AFFERENT limb is intact in both eyes)

both light reflex ---- can't be shown in Left

so defect in efferent limb is affected )

so defects in Left CN III

a) LGB --- vision

e) superior cervical ganglion --- sym chain

5 D decreased need for sleep

increased self esteem


speech is rapid and pressured

manic episode

history of major depressive disorders 6 yrs ago

Dx -- bipolar d/o

e) cyclothymia --- mild form of bipolar , at least 2 yrs

6 b-if u have 100 kids...... n u start listing the UTI number in every kid, first u'd write "0" 25 times, then u'd
write "1" 30 times, "2" 10 times and "3" 35 times...... so in the middle of the list ie the 50th and 51st no ( cz
this is an even no of kids) u have "1" n "1" so their mean wd be 1.... so median is 1

7 A different cases can come to center and it can affect the mortality

like if the serious terminal cases , less severe cases can give different result of mortality rates

we are not controlling the same condition for the complexity of the cases

the more complex the cases are , the larger the mortality rate it would be
e) sample size --- usually affects power of the test

c) lack of follow up ---late look bias

Tertiary hospitals usually get more complicated cases than do community hospitals.

B) -This should not have any effect on 30 day mortality.

C, D, E.. no data has been given to suggest such errors.

8 A pulmonary collateral circulation

lung -- 2 blood supply

pul arteries

bronchial arteries
9 D D is the right answer

Rupture of bridging vein leading to a subdural hematoma cresent- shaped

A epidural biconvex

10 E ? posterior longi ligament protecting it medially that's why it herniates to its lateral compressing the
spinal nerve passing thru the intervertebral foramen.Now in the Qz it says
herniation into spinal canal and posterior longitu ligament is the only thing between disc and the spinal canal.
Ligamentum Flavum is on the otherside of the canal
11 c- c substantia nigra, D-red nucleu

A - Periaquiductal grey

D - Red nucleus

c - Substantia nigra

B - IIIrd nerve

E cerebral peduncle

12 C- 12) C
13 C Spaceflight osteopenia refers to the characteristic bone loss that occurs during spaceflight.
Astronauts lose an average of more than 1% bone mass per month spent in space." "These effects can
be minimized through a regimen of exercise."
loss of gravity-metabolic acidosis-bone loss
"Female-specific side effects [of anabolic steroid abuse] include increases in body hair, deepening of
the voice, enlarged clitoris, and temporary decreases in menstrual cycles." "Weight lifting reduces the
risks of osteoporosis."
14 A
15 D [5:51:27 PM] physiology: RR99,299

[5:51:30 PM] physiology: D

[5:52:10 PM] physiology: Cutaneous anergy defect in cell-mediated immunity.Anergy skin testing
assesses the responses to skin-test antigens to which a cell-mediated, delayed-type hypersensitivity
(DTH) response is expected. Persons who have positive skin tests are considered to have relatively
intact cell-mediated immunity. Persons who do not mount a DTH response are considered to be anergic
and to be at elevated risk for complications of deficient cell-mediated immunity

PPD— ifno infeclion or anergic Neroids. malnutrition, imuuinocompromise, sarcoidosis).

16 A ?
17- F TIE

FA 212

: IgA 76-390

IgG 650-1500

IgM 40-345

Wiskott-Aldrich syndrome is an x-linked recessive disease caused by a defective gene

encoding for wiskott-Aldrich syndrome protein. The classic presentation involves a

young boy with eczema, thrombocytopenia, and recurrent infections with encapsulated

germs. Immunologic findings include low IgM, high IgA and IgE, poor antibody

responses to polysaccharide antigens, and moderately reduced number of T cells and

18 E·

Chemical forms in which CO2 is transported:

1) Dissolved state [5%]
i) arterial blood PCO2= 40 mmHg; 2.4 ml CO2 in 100 ml blood
ii) venous blood PCO2=45 mm Hg; 2.7 ml CO2 in 100 ml blood
iii) therefore, 1.3 ml is transported as dissolved CO2 by each 100 ml blood
2) Bicarbonate [90 %]

3) Carbaminohemoglobin [5%

19 D

conduction defect weber lateralize to same side rinnie-bc>ac

Sensory neuronal deafness-weber lat to opposite side and ac> bc both ear.

Rinne's Test
A vibrating tuning fork (512 cps) is placed on the mastoid process. When it becomes inaudible to the patient, the
vibrating end is placed near the external auditory meatus. If heard at the external auditory meatus, air conduction
is greater than bone conduction (i.e. Rinne positive). In reverse situation, if heard on mastoid process after air
conduction lost, the test is Rinne negative
(+) Air conduction < bone conduction - Conductive deafness (e.g. wax, perforated tympanum, otosclerosis, glue
ear, otitis media, foreign body, dislocated ossicles, tumours, meatal stenosis, exostoses, barotrauma)
(+) Air conduction > bone conduction - Normal hearing
(+) Reduced time - Perceptive deafness (e.g. presbycousis, vascular causes, measles, mumps, influenza,
meningitis, labyrinthitis, congenital causes [maternal rubella], trauma [blast], prolonged noise exposure, drugs
(e.g. streptomycin, aspirin, quinine), Menière's disease, late otosclerosis, CNS tumours, haemorrhage, leukaemia,
multiple sclerosis, vitamin B deficit), psychogenic

Weber's Test
Vibrating tuning fork placed on midline of forehead or a central incisor, is normally heard at midline
In conductive deafness sound is referred to deafer ear. In perceptive deafness sound is referred to the better ear
Often unreliable. In conductive deafness the cochlear is undisturbed by extraneous noises encountered by the
better ear
20 H merkel-touch
21 D
22 C- Acquired bronchiectasis with lobar Pneumonia

Mucociliary escalator –cilia push mucous up the airway and remove particles. Microorganisms hoping
to infect the respiratory tract are caught in the sticky mucus and moved up by the mucociliary

Smoking destroy cilia of the mucociliary escalator-increase susceptibility of the respiratory tract to

A-muramyl dipeptide-Acomponent of the cell wall of the mycobacteria - enhances T cell mediated
immune responses.

B- Macrophages in the alveolar spaces phagocytose particles and infectious agents that are deposited in
the alveoli. Some macrophages travel to lymph nodes and may re-enter the alveolar space. Other
macrophages are wafted up the mucociliary escalator and are swallowed.

D-Ig A first line of defence against invasion by inhaled and ingested pathogens at the vulnerable
mucosal surfaces.

E- Coughing is a reflex action started by stimulation of sensory nerves in the lining of the respiratory passages -
the tubes we use to breathe.

something in the respiratory passages that should not be there. This can be caused by breathing in dust
particles in the air or when a piece of food goes down the wrong way

The mucociliary escalator consists of the ciliary beat that push mucous (produced by the columnar
epithelial cells in the respiratory epithelium as well as the bronchial glands) up the airways. The
mucociliary escalator is responsible for removing particles that sediment out in the airways as a result
of the branching of the tracheobronchial tree (filtering mechanism).

The cilia are continually beating, pushing mucus up and out into the throat. The mucociliary escalator is
a major barrier against infection.

23 B- the amount of air that reaches the alveoli and is available for gas exchange with the blood per unit time.

alveolar ventilation = (tidal volume − anatomical dead space) × respiratory frequency.


24 B

C Papilledema--Usually, vision is good in Papilledema.

E- Retrobulbar Neuritis, the Disc looks normal. except one very important sign i.e RAPD ( relative
afferent pupillary defect) as they mentioned in the question too that pupils react normally!
B- Optic Neuritis, usually vision acuity is affected. 20/70 or less.

Hemorrahage near nerve can be found in Papilledema

In evaluating papilledema, - true disc edema or nly pseudopapilledema (2).

A. True papilledema must have increased intracranial pressure. –

causes include metastatic intracranial tumor, aquaductal stenosis, pseudotumor cerebri (often in young,
overweight females), subdural hematoma, subarachnoid hemorrhage, arteriovenous malformations,
brain abscess (often with high fevers), meningitis (with fever, stiff neck, headache), encephalitis (often
with mental status changes), and sagittal sinus thrombosis.

B. Pseudopapilledema is optic nerve head elevation caused by hyaline deposition within the optic
nerve head itself. An elevated nerve exists, but not true disc edema. The vessels will have an anomalous
branching pattern and tiny hyaline deposits can be seen in the optic nerve head ophthalmoscopically.

C. Disc swelling without increased intracranial pressure

1. Optic neuritis. An afferent pupillary defect exists along with decreased vision and pain on
extraocular movement. Color vision will be decreased in this normally unilateral condition.
2. Malignant hypertension. Blood pressure is markedly elevated here. The eye findings are
characteristic: bilateral prominent disc edema, flame hemorrhages that extend peripherally, and cotton
wool spots
3. Central retinal vein occlusion is a unilateral disc swelling with very prominent flame and blot
hemorrhages, without elevated increased blood pressure.
4. Anterior ischemic optic neuropathy. Arteritic versus nonarteritic type: usually, in the arteritic type is
found headache, stiff neck, temporal tenderness, jaw claudication, elevated sedimentation rate, and
severe visual loss in one eye followed by visual loss of the other eye in 60% of cases. In nonarteritic,
typically no symptoms are present except decreased vision. Associated systemic findings include
systemic hypertension, diabetes mellitus, or collagen vascular disorders.
5. Infiltration of the optic nerve. Tuberculosis granuloma, leukemic infiltrate, sarcoidosis, and
metastatic disease are the more common examples of infiltrative processes. The infiltration can be
unilateral or bilateral and can lead to rapid loss of vision. Radiation therapy can be helpful to preserve
6. Leber’s optic neuropathy usually affects men in the second or third decade. This is unilateral
progressive loss of vision with disc swelling.
7. Diabetic papillitis is an ischemic infarction to the nerve in advanced diabetics. Often this is bilateral
and causes mild disc elevation
26 D
27 B
28 D A-? platelet

B-red blood cell

C-type I pneumocytes(are- large, thin cells stretched across a large surface area)

D--type II pneumocytes( are-granular and roughly cuboidal in shape)-are mainly found at the alveolar
septal junction

E-alveolar macrophages(usually project into the alveolar space)

29 A
30 B
31 A ? conductive aphasia secondary to a MCA stroke. Arcuate Fasciculus connects Broca to Wernicke
so he can hear and understand but cannot reply nor can he repeat.

d- he uncinate fasciculus is a white matter tract in the human brain that connects parts of the limbic
system such as the hippocampus and amygdala in the temporal lobe with frontal ones such as the
orbitofrontal cortex. Its function is unknown though it is affected in several psychiatric conditions

32 cc

-Huntingtons does have progressive dementia as a symptom, and the writhing movements are
characteristic of athetosis which signifies a Basal Ganglia problem (aka striatum)...therefore basal
ganglia disease + dementia = Huntingtons

33 D
34 C 401pg,,,,left sided homonymous hemianopia with partial macular sparing.

a. small vessel involvement branches of middle cerebral artery

b. contralateral face and arm paralysis n sensory loss ,aphasia

d. one of several branches of the basilar artery and the posterior cerebral arteries supplying blood to the
midbrain and thalamus withamnesic syndrome, convergence difficulty, third nerve palsies, eyelid
retraction, dysarthria, ataxia and involuntary limb movements.

e.may present with dizziness,nystagmus ???

35 C
36 A
37 B synapsis consist of ..1.presynaptic ending (where neurotransmitter are made)2.postsynaptic ending
(has neurotransmitters in the membrane) 3. Synaptic cleft ( action potentials cannot cross synaptic
cleft)..Nerve impulse is carried by neurotransmitters.

How the impulse is transmitted?:> action potential reaches the presynaptic terminal…voltage Ca
channels open—influx of ca –synaptic vesicles fuse with membrane(exocytosis)---neurotransmitters are
released into cleft and diffuse to postsynaptic membrane---neurotransmitter binds to neuroreceptor on
postsynaptic membrane –cause Na channels to open and Na flows into postsynaptic membrane if
threshold is reached then action potential is initiated…neurotransmitter is broken down by specific
enzymes in the synaptic cleft.

a- Neurotransmitter for excitation

D,c--- not involved….

e – postsynaptic membrane after neurotransmitter binding to neuroreceptor

38 A ? attributable risk is the difference in rate of a condition between an exposed population and an
unexposed population
39 d- Experience of uncontrolled anxiety for at least 6 months

a. Acute Stress Disorder is characterized by the development of severe anxiety, dissociative, and other
symptoms that occurs within one month after exposure to an extreme traumatic stressor (e.g.,
witnessing a death or serious accident).

b. Agoraphobia is a fear of being in places where help might not be available. It usually involves fear of
crowds, bridges, or of being outside alone

c. Pt consciously creates physical symptoms in order to get medical attention

E. Sig e caps not associated here F. social phobia..not the case

40 C

E. scrotum plus penis ‘s Lymphatic drainage is to superficial lymph nodes.

• The external pudendal arteries supply the anterior aspect of the scrotum.

• The internal pudendal arteries supply its posterior aspect.

42 Balso
43 B ? muscle,s length is not changed so preload is not changed, therefore increase in performance can
be explained on the basis of incrased contractility. & contractility is due to Ca++. in isometric as there
no change in length then overlap wouldnt be increase

44 E
45 B
46 F
47 D
48 d this is a role sciatica lesion occurs with lumbar disc prolapse or compression in S1 L5 roots so
once u see ciatica in the exam just look for S1 or L5 in answers the deference between S1 and L5 is 1-
ankle reflex lost onley in s1 + only post pain + intact patellar
49 D
50 I Musculocutaneous

Supplies Brachialis, biceps and corachobrachialis and ends as the lateral cutaneous nerve of forearm.

Oxygen and carbon dioxide transport

A) Transport of Oxygen in the blood

· 97% of oxygen carried with Hb from lungs to tissues

· remaining 3% dissolved in plasma

· oxygen reversibly combines with Hb maximum amount of O2 that can combine with the Hb of blood:

i) 15 gms Hb per 100 ml blood

ii) 1 gm Hb combines with 1.34 ml O2

iii) 100 ml blood combines with 20 ml O2 [100% saturated]

· amount of O2 released from Hb in the tissues:

i) Normal arterial blood: 100 ml blood combines with 19.4 ml O2 [97% sat; PO2 95]

ii) Venous blood: 100 ml blood combines with 14.4 ml O2 [75% sat; PO2 40 mm Hg]
iii) Thus, 5ml of O2 is transported by each 100 ml blood through the tissues per cycle

· transport of O2 during exercise:

i) Exercise —> increased cellular O2 utilization -> decreased interstitual PO2 [15mmHg]

ii) Venous blood: 100 ml blood combines with 4.4 ml O2 [20% sat; PO2 18 mmHg]

iii) Thus, 15ml of O2 is transported by each 100 ml blood through the tissues per cycle

iv) Therefore, increased cellular O2 utilization -> increase rate of O2 release from Hb

· utilization coefficient

i) utilization coefficient = fraction O2 released from blood as passes via tissue capillaries

ii) normally 0.25 [25%]

iii) strenuous exercise:- 0.75 - 0.85

· Hb helps maintain a constant PO2 in tissue fluids (oxygen buffer function of Hb) despite exercise or
changes in atmospheric changes in PO2

· Effect of blood flow on metabolic use of oxygen

i) total amount of O2 available each minute for use in any given tissue is determined by:

a) quantity of O2 transported in each 100 ml blood

b) rate of blood flow

ii) if rate of blood flow approaches zero, amount of O2 available also approaches zero

· Transport of Oxygen in dissolved state

i) Normal arterial blood: 100 ml blood has dissolved 0.29 ml O2 [PO2 95 mmHg]

ii) Venous blood: 100 ml blood has dissolved 0.12 ml O2 [PO2 40 mm Hg]

iii) Thus, 0.17ml of O2 is transported by each 100 ml blood through the tissues per cycle in the
dissolved state

Bohr Effect: increase in CO2 in blood will cause O2 to be displaced from the Hb thereby promoting O2
release in tissues [ie oxygen dissociation curve shifts to the right]; reverse effect occurs in the lungs
B) Transport of Carbon dioxide in the blood

· Normally 4 ml of CO2 is transported from the tissues to the lungs in each 100 ml blood

· Gaseous CO2 (generally not bicarbonate) diffuses out of the cell

· Chemical forms in which CO2 is transported:

1) Dissolved state [7%]

i) arterial blood PCO2= 40 mmHg; 2.4 ml CO2 in 100 ml blood

ii) venous blood PCO2=45 mm Hg; 2.7 ml CO2 in 100 ml blood

iii) therefore, 1.3 ml is transported as dissolved CO2 by each 100 ml blood

2) Bicarbonate [70 %]

i) reaction of CO2 with water in rbc—> carbonic acid

ii) carbonic anhydrase catalyzes the reaction of CO2 & H2O 5000 X

iii) carbonic acid —> H+ & HCO3-

iv) H+ combines with Hb (Hb is a powerful acid-base buffer)

v) HCO3- diffuse into plasma; Cl- diffuses into rbc [chloride shift]

vi) administration of an carbonic anhydrase inhibitor —> reduced CO2 transport —> elevated tissue

3) Carbaminohemoglobin [23%]

i) CO2 combines reversibly with Hb (and to a much lesser extent other plasma proteins)

· Haldane effect

i) is the effect of the oxygen-hemoglobin reaction on CO2 transport

ii) binding of O2 with Hb tends to displace CO2 from the blood

iii) Tissues: have increased CO2 uptake due to O2 removal from Hb

iv) Lungs: have increased release of CO2 because of O2 pickup by Hb

v) Due to increased acidity of Hb when combined with O2

vi) approximately doubles the amount of CO2 picked up in the tissues and released in the lungs

· the formation of carbonic acid decreases the pH in venous blood [effect is attenuated by buffers]