Dr.Najeeb notes & Medical notes
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A channel containing all videos lecture notes of Dr. Najeeb sir
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Channel Dr.Najeeb notes & Medical notes (@drnajeebvideonotesmbbsnotes) in the English language segment is an active participant. Currently, the community unites 13 238 subscribers, ranking 1 968 in the Medicine category.
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Since its creation on невідомо, the project has demonstrated rapid growth, gathering an audience of 13 238 subscribers.
According to the latest data from 21 December, 2025, the channel demonstrates stable activity. Although there has been a change in the number of participants by 360 over the last 30 days and by 0 over the last 24 hours, overall reach remains high.
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The author describes the resource as a platform for expressing subjective opinions:
“A channel containing all videos lecture notes of Dr. Najeeb sir”
Thanks to the high frequency of updates (latest data received on 22 December, 2025), the channel maintains relevance and a high level of publication reach. Analytics show that the audience actively interacts with content, making it an important point of influence in the Medicine category.
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6. A 63-year-old woman undergoes operative repair of a leaking berry aneurysm in the circle of Willis. Two days later, a CT scan of the head shows a widening of the subarachnoid space. Which of the following changes in cerebrospinal fluid is the most likely cause of this finding?
a Decreased absorption by the choroid plexus
b Decreased movement through the arachnoid villi
c Decreased movement through the cerebral aqueduct
d Increased absorption by the choroid plexus
e Increased movement through the arachnoid villi
f Increased production by the choroid plexus
A 27-year-old man comes to the office due to myalgia, nasal congestion, and cough. Temperature is 38.4 C
(100.3 F). Examination shows nasal and pharyngeal hyperemia. Rapid influenza antigen testing of nasopharyngeal secretions is positive. Within the infected cells of the patient's respiratory tract, viral proteins are degraded and attached to major histocompatibility complex class I molecules, which are then expressed on the cell surface for presentation to cytotoxic CD8+ lymphocytes. Which of the following enzymes is most essential to initiating this immune process?
A.Acid phosphatase
B.Caspase
C.Guanylate cyclase
D. Myeloperoxidase
E. Ubiquitin ligase
A researcher studying physician behavior is interested in how often primary care physicians take the sexual histories of patients during clinic visits. As part of the study, patients who attend a primary care clinic are asked to fill out a questionnaire immediately following a visit with their physician. Once the physicians become aware that their own behavior is being studied, which of the following is most likely to be a potential problem?
A. Berkson's bias
B.Hawthorne effect
C.Lead-time bias
D.Pygmalion effect
E. Recall bias
A 12 year-old boy is being evaluated because of poor growth, recurrent episodes of sinusitis, and a chronic cough. An x-ray of the chest shows evidence of bronchietasis. A rare inherited disorder causing immotile, structurally abnormal cilia in the respiratory epithelium is diagnosed. This patient's impaired mucociliary clearance is most likely to predispose him to pulmonary infections with which of the following infectious agents?
A) Candida albicans
B) Cryptococcus neoformans
C) Cytomegalovirus
D) Mycobacterium avium-intracellulare
E) Staphylococcus aureus
A 17-year-old boy is brought to the physician because he is much shorter than his peers. He is proportionally developed and otherwise healthy. An x-ray of the wrist is recommended to assess bone age. Which of the following radiographic findings will be an indication that his growth is complete?
A) Absence of the epiphyseal cartilaginous plate
B) Absence of the primary ossification center
C) Presence of calcified material in the diaphysis
D) Presence of calcified material in the epiphysis
E) Presence of lines of arrested growth
Which of the following initiates the molecular damage that occurs following transient ischemia and reperfusion of cardiac muscle?
A) Glutathione
B) Hydrogen peroxide
C) Lipid peroxides
D) Phosphatidylinositol
E) Superoxide anion
An 79-year-old woman dies shortly after admission to the hospital because of a 3-day history of progressively increasing shortness of breath. She had a history of heart failure. Examination of the lungs during autopsy shows alveolar damage with distended lymphatics, congested alveolar capillaries, and pink-staining homogenous proteinaceous hyaline material in alveoli. Which of the following is the most likely cause of these
A) Amyloidosis
B) Aspiration pneumonitis
C) Emphysema
D) Pneumonia
E) Pulmonary edema
F) Septic shock
During the conversion of proinsulin to insulin, bonds between which of the following amino acid residues keep the two chains of the insulin molecule together?
A) Cysteine
B) Lysine
C) Methionine
D) Serine
E) Tyrosine
A 63-year-old woman with a long history of poorly controlled hypertension suddenly has excruciating anterior upper sternal pain radiating to the neck and back. On admission to the emergency department, her blood pressure is 210/110 mm Hg. Fifteen minutes later, while lying down, it is 110/64 mm Hg. Transesophageal echocardiography shows aortic insufficiency, a suggestion of a double lumen of the ascending aorta, and a pericardial effusion. She dies suddenly while awaiting an operation. Which of the following is the most likely cause of death?
A) Acute hemopericardium
B) Acute myocardial infarct
C) Cerebral infarct
D) Congestive heart failure
E) Massive retroperitoneal hemorrhage
A 80 year-old man who lives in a nursing home has a fever and muscle rigidity after receiving a drug for treatment of a psychotic episode. Serum creatine kinase activity is increased. Which of the following drugs is the most likely cause of these adverse effects?
A) Clozapine
B) Diazepam
C) Haloperidol
D) Lithium carbonate
E) Olanzapine
F) Risperidone
Bacterial strain X is resistant to ampicillin and sensitive to gentamicin. Bacterial strain Y is resistant to gentamicin and sensitive to ampicillin. Bacterial strains X and Y are grown in mixed culture in medium without antibiotics, then the culture is plated on medium containing both ampicillin and gentamicin. Bacterial colonies grow on the plates. In a second experiment, DNase is added to the mixed culture medium. When this mixed culture is plated on medium containing both antibiotics, no colonies grow. Assuming that bacterial cells are impermeable to DNase, which of the following processes best explains these observations?
A) Conjugation
B) Mutation
C) Transduction
D) Transformation
E) Transposition
Which of the following features of the inactivated poliovirus vaccine best explains why it prevents paralytic polio but does not prevent replication of the virulent poliovirus in the enteric tract?
A) It does not elicit cell-mediated immunity to viral capsid proteins
B) It does not elicit neutralizing antibody to virulent poliovirus
C) It elicits IgG but not secretory IgA
D) It only protects against one serotype of virulent poliovirus
47. A 45-year-old woman who has acute diverticulitis develops severe hypotension, tachypnea, and tachycardia.
She subsequently develops cyanosis and hypoxemia unresponsive to oxygen therapy. X-ray films of the chest show a diffuse alveolar infiltrate. Blood culture grows Escherichia coli. A major factor in the pathogenesis of this syndrome is
A) degranulation of mast cells
B) delayed (type IV) hypersensitivity to bactenal products
C) increased surfactant production by type Il pneumocytes
D) production of antibodies to alveolar basement membranes
E) release of oxygen free radicals from sequestered neutrophils
The correct answer is E) Morphine is metabolized to active metabolites that accumulate.
Morphine's metabolism:
1. Morphine is metabolized in the liver to morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G).
2. M6G is an active metabolite with analgesic and sedative properties.
Patient's clinical deterioration:
1. Respiratory depression (6 breaths/min)
2. Pinpoint pupils (miosis)
3. Renal impairment (serum creatinine 1.8 mg/dL)
Explanation:
1. Morphine's active metabolite, M6G, accumulates due to renal impairment.
2. M6G contributes to increased sedation and respiratory depression.
Other options:
A) Incorrect: Morphine's bioavailability doesn't decrease with chronic dosing.
B) Incorrect: Morphine's bioavailability doesn't increase with chronic dosing.
C) Incorrect: Morphine doesn't downregulate µ-opioid receptors with chronic dosing.
D) Incorrect: Morphine doesn't inhibit its own metabolism.
Key concept:
Morphine's active metabolites can accumulate in patients with renal impairment, increasing the risk of respiratory depression and sedation.
Considerations:
1. Renal function monitoring
2. Dose adjustment or alternative analgesics
3. Respiratory monitoring
An 79-year-old woman is diagnosed with a fracture of the right femur and begins treatment with morphine by patient-controlled analgesic pump. Three days later, her respirations are 6/min. Physical examination shows pinpoint pupils. Her serum creatinine concentration is 1.9 mg/dL. Which of the following best explains this patient's clinical deterioration after the initiation of morphine therapy?
A) Chronic dosing of morphine decreases its bioavailability
B) Morphine bioavailability increases with chronic dosing
C) Morphine downregulates µ-opioid receptors with chronic dosing D) Morphine inhibits its own metabolism
E) Morphine is metabolized to active metabolites that accumulate
A 75-year-old man who is being treated for atrial fibrillation has an adequately controlled ventricular response rate at rest. During exercise or stress, his heart rate increases to an unacceptable rate. Which of the following drugs is most likely to be effective in controlling the patient's ventricular response rate during activity or stress?
A) Adenosine
B) Lidocaine
C) Nifedipine
D) Propranolol
E) Quinidine
