Keep all comments on this assessment (Form 1) within this thread. Giving questions and answers out in other threads is not helpful for people taking the CBSSA later.

Here's a FAQ because I'm sure there's going to be a dozen questions about what this exam is: http://www.nbme.org/PDF/sas.pdf

Here's the menu: http://www.nbme.org/programs/sas.asp

In summary, there are two assessment exams (both are 200 questions each and each one costs $45). It assesses your strengths and weaknesses (very loosely I might add) and gives you a "predicted" score.

To those of you that have taken the real thing, how well do you think this test correlated? (especially if you have received you score!)

To those of you that have taken the real thing, how well do you think this test correlated? (especially if you have received you score!)


If you search the step 1 results thread, you'll see that there is an awsome correlation between this grade and your real results, with almost everyone doing slightly better on the real thing than the pretests predicted. Worked for me, said i'd get a 201 both times i took the NBME, and i ended up getting a 205.

If you search the step 1 results thread, you'll see that there is an awsome correlation between this grade and your real results, with almost everyone doing slightly better on the real thing than the pretests predicted. Worked for me, said i'd get a 201 both times i took the NBME, and i ended up getting a 205.

Sweet. It does give a standard deviation but it's HUGE.

I took form A 3 days before my actual step 1 and ended up getting almost 20 points above my predicted score. The questions are more similar to those on the real thing than qbank and gave me an idea of my weakest points to focus on in the last days before my exam. I didn't take form B (too cheap), but I would encourage every one to take at least one of them.

I took form A 3 days before my actual step 1 and ended up getting almost 20 points above my predicted score. The questions are more similar to those on the real thing than qbank and gave me an idea of my weakest points to focus on in the last days before my exam. I didn't take form B (too cheap), but I would encourage every one to take at least one of them.

That is awesome.

My question is how are these questions compared to the real exam. Someone who took this and the boards please tell us.

I keep reading that board questions are in clinical vignette form (suppossedly about 80%) these days and are multi-reasoning questions. I took the first NBME exam and felt the apart from 1 or 2 questions, they were pure memorization. Also it didn't seem to be hitting BIG topics and very few (just a few) were in clinical vignette format. Any thougths out there.....

I agree w/ the above poster. Plus Step 1 is not supposed to be heavy on the buzzwords and I felt both form A and B were loaded w/ buzzwords :confused:

There are still alot of buzzwords on step 1. These exams are just like step 1. I actually got quite a few repeats from these tests. Some were word for word, others asked the NBME q in a different way so the same diseases and concepts were being tested over and over.

There are still alot of buzzwords on step 1. These exams are just like step 1. I actually got quite a few repeats from these tests. Some were word for word, others asked the NBME q in a different way so the same diseases and concepts were being tested over and over.

Row Jimmy just posted this on another thread I had started about buzzwords on step 1: "I had exactly 1 buzzword on my exam."

You guys must have gotten extremely different versions of the test.

Row Jimmy just posted this on another thread I had started about buzzwords on step 1: "I had exactly 1 buzzword on my exam."

You guys must have gotten extremely different versions of the test.

Either that Row Jimmy didn't know his Shi* and didn't pick up on the buzzwords or omar really knew his shi* and found little subtle things to be buzzwords :laugh:

Either that Row Jimmy didn't know his Shi* and didn't pick up on the buzzwords or omar really knew his shi* and found little subtle things to be buzzwords :laugh:

Hey Now Pharmer!!! I am confident in my knowledge and I know I did OK on the exam. When I think of Buzzwords, I think of "cherry red macula", "clue cells", "blue sclera" etc... I only had one like that on my exam. Now, I suppose you could make a case that every question has buzzwords and those are the words that lead us to the correct answer so maybe it is just a definition of "buzzword" difference of opinion.

So to rephrase; I had exactly 1 "classic" buzzword on my exam and many, many descriptions of "classic" buzzwords that were quite easy to fugure out.


RJ

Okay I just took the sucker last night and had a dum question. What the hell doest it mean when you don't have a bar at all on a content area and only have an asterisks on the performance profile? Does that mean you did good in that area? This can't be, cause I feel like no way did I do good in that area cause i guessed on almost all the questions on that subject.

Okay I just took the sucker last night and had a dum question. What the hell doest it mean when you don't have a bar at all on a content area and only have an asterisks on the performance profile? Does that mean you did good in that area? This can't be, cause I feel like no way did I do good in that area cause i guessed on almost all the questions on that subject.
Here's what the form says below the performance profile "Performance bands indicate areas of relative strength and weakness. Some bands are wider than others. The width of the performance band indicates the precision of measurement...An asterisk indicates that your performance band extends beyond the displayed portion of the scale..." So if your asterisk is on the right side, then hopefully yes, it's because you guessed really well on that section...but if it's on the left, then maybe your guesses were all off.

I got some questions... took it today.

-Anyone know the answer for the vertebral arterogram?

-Why would the woman sue the doctor?

-How about the young lady with treatment for gingivitus by dentist?

WISC-ite

I thought the dentist one was actinomyces israelii but its been a while since I took the test

I got some questions... took it today.

-Anyone know the answer for the vertebral arterogram? I put ataxia as I thought it was in the cerebellar region.

-Why would the woman with the breast lump sue the doctor? I thought it was lack of communication.

-How about the young lady with treatment for gingivitus by dentist, then develops a pleural effusion. What is organism? Gram -'s? If so, what is the organism?

WISC-ite

first 2 are what i put, 3rd one i put gram +, probably viridans strep or actinomyces

i agree oral infections followed by endocarditis or lung infections are almost always anaerobic infections - i think actinomycetes was the only anaerobes in the choices.

well while we're talking about form 1, i have a Q that has been driving me nuts:

that picture of the kid with the nose skin problem and then the Q asks what is more likely to have happened, special ed since kindergarten, special ed since high school, episode of major depression, that kind of thing...
oh and he had had a tonic-clonic seizure?

WHAT WAS THAT? i'm just curious, i've search the web 5 ways and asked several other people who also had no clue.

i think that stuff on his nose were sebacious adenomas and he had tuberous sclerosis- u get seizures, mental retardations, etc... I put he had special ed since kindergarten

doh! tuberous sclerosis, one of those things in FA that i can never pin down.

(at the time, all i could think of was 'that looks like leprosy...that makes no sense....but that looks like leprosy...uuuuh)

My question is how are these questions compared to the real exam. Someone who took this and the boards please tell us.

I keep reading that board questions are in clinical vignette form (suppossedly about 80%) these days and are multi-reasoning questions. I took the first NBME exam and felt the apart from 1 or 2 questions, they were pure memorization. Also it didn't seem to be hitting BIG topics and very few (just a few) were in clinical vignette format. Any thougths out there.....

You will find that the actual test is about 60% "I actually studied for this?", 30% "I'm glad I read that last week" and 10% "WTF was that?"

Your score is all about how you handled the middle part.

What were the answers to these questions?

1. An asymptomatic 65 year old woman comes to the gynecologist for a routine examination. Physical examination shows a left adnexal enlargement that was not present 1 year ago. Which of the following is the most likely diagnosis?

A) Endometriosis
B) Leiomyoma
C) Ovarian tumor
D) Polycystic ovarian disease
E) Ruptured luteal cyst

2. That kid with that big tumor-like thing sticking out of his head

A) Angiogenesis
B) Cell adhesion
C) Cell migration
D) Gastrulation
E) Somitogenesis

3. That embryo picture asking about the precursor cells derived from somites?

4. The gout question asking about lack of feedback inhibition of GDP or ADP at which enzyme?

A) Adenosine deaminase
B) Dihydrofolate reductase
C) G6P dehydrogenase
D) Nucleotide phophorylase
E) Phosphoribosylpyrophosphate synthetase

5. The 4 month year old kid with DiGeorge syndrome who was diagnosed with truncus arteriosus. I put that the mediastinum was widened, in addition to normal gamma globulins and decreased peripheral lymphocytes but wasn't sure of the answer.

6. A female neonate has profound hypotonia. The only known complication of pregnancy was polyhydramnios. The mother has a lack of facial expression and weak muscles; she says she did not have any problems as an infant or child. Which of the following best explains the difference in presentations in the mother and child?

A) Anticipation
B) Delayed onset
C) Genetic heterogeneity
D) Incomplete penetrance
E) Pleiotropy

was it delayed onset? I wasn't sure.

What were the answers to these questions?

1. An asymptomatic 65 year old woman comes to the gynecologist for a routine examination. Physical examination shows a left adnexal enlargement that was not present 1 year ago. Which of the following is the most likely diagnosis?

A) Endometriosis
B) Leiomyoma
C) Ovarian tumor
D) Polycystic ovarian disease
E) Ruptured luteal cyst

2. That kid with that big tumor-like thing sticking out of his head

A) Angiogenesis
B) Cell adhesion
C) Cell migration
D) Gastrulation
E) Somitogenesis

3. That embryo picture asking about the precursor cells derived from somites?

4. The gout question asking about lack of feedback inhibition of GDP or ADP at which enzyme?

A) Adenosine deaminase
B) Dihydrofolate reductase
C) G6P dehydrogenase
D) Nucleotide phophorylase
E) Phosphoribosylpyrophosphate synthetase

5. The 4 month year old kid with DiGeorge syndrome who was diagnosed with truncus arteriosus. I put that the mediastinum was widened, in addition to normal gamma globulins and decreased peripheral lymphocytes but wasn't sure of the answer.

6. A female neonate has profound hypotonia. The only known complication of pregnancy was polyhydramnios. The mother has a lack of facial expression and weak muscles; she says she did not have any problems as an infant or child. Which of the following best explains the difference in presentations in the mother and child?

A) Anticipation
B) Delayed onset
C) Genetic heterogeneity
D) Incomplete penetrance
E) Pleiotropy

was it delayed onset? I wasn't sure.


1. Ovarian tumor. AGE, location of mass, and unilaterality is the key. Goljan also told me. Haha
2. Angiogenesist. The picture was a cavernous hemangioma. As Dr. Goljan would say, don't do anything.
3. The most lateral rod on the right. The picture looks like a hot dog on the right arm. The arrow that points at the right bun is the MUSCLE somite.
4. Phosphoribosylpyrophosphate synthetase. This is a key regulatory enzyme. Know all of these including HGPRT.
5. narrow mediastinum due to lack of thymus, normal gamma globulins, and decreased t lymphocytes.
6. Anticipation. The tipoff was that the mother has a lack of facial expression and muscle weakness so you know she was has the disease. The hypotonia and facial expression is give away that the disease is myotonic dystrophy. Sorry Dr. goljan, there are more ways than shaking one's hand to find out if they have this disease. Key associations myotonic dystrophy -> triple repeat and anticipation. If you understand Goljan and can apply his lectures you will anhilate this exam. Most people when they listen to his lecture memorize what he says. The smart ones think about what he says and applies it. Example, pleural effusion vs lung consolidation. He talks about it in his audio, but you have to sit down and think about the differences due to tactile fremitus, egophony etc.

Those keeping score at home. I still have my answer key for the 770 so people can verify it when they take the test. I will post it on SDN in due time. I promise. Still debating whether someone like Hidden should have an advantage on this test because they are taking the exam after since people before him didn't have access to this. Whatever I choose, the class of 2008 will have access to my answer key to give everyone in next year's class a level playing field. Until then, if you have any other questions. I will answer NBME questions on form A and give you my rationale.

p53 is back. You Heard

1. Ovarian tumor. AGE, location of mass, and unilaterality is the key. Goljan also told me. Haha
2. Angiogenesist. The picture was a cavernous hemangioma. As Dr. Goljan would say, don't do anything.
3. The most lateral rod on the right. The picture looks like a hot dog on the right arm. The arrow that points at the right bun is the MUSCLE somite.
4. Phosphoribosylpyrophosphate synthetase. This is a key regulatory enzyme. Know all of these including HGPRT.
5. narrow mediastinum due to lack of thymus, normal gamma globulins, and decreased t lymphocytes.
6. Anticipation. The tipoff was that the mother has a lack of facial expression and muscle weakness so you know she was has the disease. The hypotonia and facial expression is give away that the disease is myotonic dystrophy. Sorry Dr. goljan, there are more ways than shaking one's hand to find out if they have this disease. Key associations myotonic dystrophy -> triple repeat and anticipation. If you understand Goljan and can apply his lectures you will anhilate this exam. Most people when they listen to his lecture memorize what he says. The smart ones think about what he says and applies it. Example, pleural effusion vs lung consolidation. He talks about it in his audio, but you have to sit down and think about the differences due to tactile fremitus, egophony etc.

Those keeping score at home. I still have my answer key for the 770 so people can verify it when they take the test. I will post it on SDN in due time. I promise. Still debating whether someone like Hidden should have an advantage on this test because they are taking the exam after since people before him didn't have access to this. Whatever I choose, the class of 2008 will have access to my answer key to give everyone in next year's class a level playing field. Until then, if you have any other questions. I will answer NBME questions on form A and give you my rationale.

p53 is back. You Heard

cool, thanks p53, u gonna rock this exam. I'm gonna post a couple of more from this test

1. Ovarian tumor. AGE, location of mass, and unilaterality is the key. Goljan also told me. Haha
2. Angiogenesist. The picture was a cavernous hemangioma. As Dr. Goljan would say, don't do anything.
3. The most lateral rod on the right. The picture looks like a hot dog on the right arm. The arrow that points at the right bun is the MUSCLE somite.
4. Phosphoribosylpyrophosphate synthetase. This is a key regulatory enzyme. Know all of these including HGPRT.
5. narrow mediastinum due to lack of thymus, normal gamma globulins, and decreased t lymphocytes.
6. Anticipation. The tipoff was that the mother has a lack of facial expression and muscle weakness so you know she was has the disease. The hypotonia and facial expression is give away that the disease is myotonic dystrophy. Sorry Dr. goljan, there are more ways than shaking one's hand to find out if they have this disease. Key associations myotonic dystrophy -> triple repeat and anticipation. If you understand Goljan and can apply his lectures you will anhilate this exam. Most people when they listen to his lecture memorize what he says. The smart ones think about what he says and applies it. Example, pleural effusion vs lung consolidation. He talks about it in his audio, but you have to sit down and think about the differences due to tactile fremitus, egophony etc.




as per the DiGeorge question--> wouldn't you have a decreased gamma globulin if you couldn't isotype switch as well (dec T Lymphocytes)? does this refer to the Ig in general or the specific isotype. Sorry if this seems dumb; thanks for the help..

ucb

as per the DiGeorge question--> wouldn't you have a decreased gamma globulin if you couldn't isotype switch as well (dec T Lymphocytes)? does this refer to the Ig in general or the specific isotype. Sorry if this seems dumb; thanks for the help..

ucb

IgG defect is variable. It really depends on the number of "viable" T cells, and on the expression of CD40L

1. A series of experiments are performed to determine the mechanism by which a pharmacologic agent transverses cell membranes and accumulates within target cells. The rate of transport depends on the concentration of the drug only. When the extracellular concentration of the agent exceeds 10nM, no further increase in the rate of uptake is observed. Structurally similar compounds pass through the cell membrane, but at a lower rate. Ouabain, an inhibitor of Na+/K+ ATPase, fails to inhibit transport. Which of the following is the most likely mechanism by which this agent enters cells?

A) Antiport
B) Facilitated diffusion
C) Ion-gated coupling
D) Simple diffusion
E) Symport

I thought it was either facilitated diffusion or simple diffusion since it wasn't dependent on a cation gradient but I wasn't sure...

2) A 74 year old man has a cough. On auscultation of the right posterior chest, the patient's spoken "ee" sounds more like an "ay". Which of the following conditions on the right is most likely?

A) Bronchopleural fistula
B) Lower lobe consolidation
C) Middle lobe atelectasis
D) Pleural effusion
E) Pleural plaque
F) Pneumothorax
G) Pleural sequestration

Had no idea...please enlighten us p53

3) A 42 year old man with pneumococcal pneumonia has acute fibrinous pleuritis. Which of the following proteolytic enzymes is required to eliminate the exudate and restore normal pleural anatomy?

A) Collagenase
B) Plasmin
C) Stromeolysin
D) Thrombrin
E) Trypsin

I chose E) trypsin since it was acute inflammation. I wouldn't think it was collagenase because that would breakdown fibrin (fibrosis is chronic inflammation), but then again it said 'fibrinous' pleuritis. Stromeolysin is a matrix metalloproteinase... but I don't know if this is relevant...

4) During an experiment on the cough reflex in humans, a subject inhales air containing different amounts of particles that will impact and adhere to mucus primarily in the trachea. Blockade of which of the following afferent pathways would most likely prevent this subject's reflex to initiate a cough?

A) Glossopharyngeal
B) Laryngeal
C) Olfactory
D) Trigeminal
E) Vagal

I was between Glossopharyngeal and Vagal but I wasn't sure so I picked Vagal.

5) A 24 year old man is brought to the Emergency department after being stabbed in the left 4th intercostal space, immediately next to the sternum.
Which structure was most likely damaged?

A) Pulmonary trunk
B) Right atrium
C) Right ventricle
D) Superior vena cava
E) Thoracic aorta

I put right ventricle, but I wasn't sure.

6) A 5-year-old boy with a history of recurrent ear infections receives his preschool booster immunization against diphtheria-tetanus-pertussis. He is participating in a community-sponsored study to determine the humoral immune response to tetanus toxoid (tt). His response is well below normal for age- and sex-matched children. Peripheral B lymphocyte count and T lymphocyte count and function are within the reference range. The antibody he makes is positive in both the passive hemagglutination and complement-mediated lysis of tt-coated erythrocytes. His antibodies do not opsonize tt-coated latex particles for phagocytosis and do not directly precipitate tt efficiently. This child most likely has a defect in which of the following processes?

A) Affinity maturation of immunoglobulins
B) Immunoglobulin isotype switching
C) Recombination of heavy chain variable region genes
D) Recombination of light chain variable region genes
E) Somatic mutation of immunoglobulin genes

I chose A, but i wasn't sure

7. A 25-year-old woman, gravida 1, para 0, who is Rh-negative, delivers a full-term Rh-positive neonate. The mother is given prophylactic anti-Rho(D) immune globulin immediately post partum. During her second pregnancy 3 years later, she is screened each trimester for Rho(D) antibodies. An indirect antiglobulin test done during the third trimester indicates the presence of anti-Rho(D) antibodies in her serum. Which of the following is the most likely mechanism for the occurrence of these maternal antibodies?

A) Anamnestic production of maternal anti-Rho(D) immunoglobulin
B) Intrauterine transplacental fetal-maternal hemorrhages during the second pregnancy
C) Residual circulating prophylactic anti-Rho(D) immunoglobulin
D) Transplacental passage of fetal IgG anti-Rho(D) antibodies

I picked A) since I thought this was a secondary (amnestic) immune response. I was confused though because the woman received anti-Rho(D) immediately post partum so this should've prevented Rh antigen exposure. I was between A) and B).

8. A 25 year old woman at 32 weeks' gestation begins taking a drug to delay the onset of preterm labor. After the first dose, she notices tremulousness in her hands. Which of the following types of receptors is most likely to be involved in this effect?

A) alpha-1 adrenergic
B) Beta-2 adrenergic
C) Dopaminergic (D1)
D) Muscarinic (M1)
E) NMDA

I thought she might have been taking ritodrine or terbutaline which are both B) Beta-2 agonists, but I wasn't sure on the tremulousness of the hands.

9. The bone marrow picture with that bright red line from the top right corner to the bottom left corner. Fever, fatigue, easy bruising. Low crit, Hgb, leukocyte count, and platelets. I chose aplastic anemia, but I wasn't so sure because it could have been myelofibrosis.

10. Which of the following antimicrobial agents is most likely to be administered orally for the treatment of serious systemic infections because of it's predictable bioavailability?

A) Amphotericin B
B) Ciprofloxacin
C) Gentamicin
D) Polymyxin B
E) Vancomycin

I thought it was vanco... but I wasn't sure.

11. The cross sectional picture at T-12 to L-1. Patient was nervous had heart pounds and clammy skin and was also hypertensive. Neoplasm in? I was thinking sympathetic chain tumor or something near the aorta causing an obstruciton but I could be way off.

Actually now that I think about it, that last question might have been pheochromocytoma...

IgG defect is variable. It really depends on the number of "viable" T cells, and the expression of CD40L

While your statement is true, there is thymic aplasia in DiGeorge syndrome so I think it's safe to assume that there are decreased T-Cells in the periphery that's why you have defective cellular immunity but intact humoral immunity albeit it's not as functional because there is less class-isotype switching. As for the gamma globulin and isotype switching, it is dependent on CD40/CD40L interaction like IdQ1 said, but gamma globulin refers to the Ig sublcasses: IgG, IgM, IgA. So you would still have normal IgM even though you don't have class isotype switching. If you want a reference, check this out.

http://www.nlm.nih.gov/medlineplus/ency/article/003544.htm

Peace out

While your statement is true, there is thymic aplasia in DiGeorge syndrome so I think it's safe to assume that there are decreased T-Cells in the periphery that's why you have defective cellular immunity but intact humoral immunity albeit it's not as functional because there is less class-isotype switching. As for the gamma globulin and isotype switching, it is dependent on CD40/CD40L interaction like IdQ1 said, but gamma globulin refers to the Ig sublcasses: IgG, IgM, IgA. So you would still have normal IgM even though you don't have class isotype switching. If you want a reference, check this out.

http://www.nlm.nih.gov/medlineplus/ency/article/003544.htm

Peace out

Yep, I agree with the above statement. You should be a little less confident about your responses before you post them idq1i or check them over or provide a reference because you'll confuse or lead people astray. I'm pretty sure that was not your intention but it's something to keep in mind.

While your statement is true, there is thymic aplasia in DiGeorge syndrome so I think it's safe to assume that there are decreased T-Cells in the periphery that's why you have defective cellular immunity but intact humoral immunity albeit it's not as functional because there is less class-isotype switching. As for the gamma globulin and isotype switching, it is dependent on CD40/CD40L interaction like IdQ1 said, but gamma globulin refers to the Ig sublcasses: IgG, IgM, IgA. So you would still have normal IgM even though you don't have class isotype switching. If you want a reference, check this out.

http://www.nlm.nih.gov/medlineplus/ency/article/003544.htm

Peace out

"Gamma" refers to the gamma heavy chain. Therefore, Gamma globulins are technically IgG molecules. However, If you refer to the electrophoretic definition, then gamma globulins are indeed IgA, IgM and IgG.

Looks to me like the NBME is being too vague with the definitions

You should be a little less confident about your response

Likewise

Variable secondary humoral defects can be present, including hypogammaglobulinemia, selective antibody deficiency, and polysaccharide antigens.
http://www.emedicine.com/ped/topic589.htm

Here is the original q: as per the DiGeorge question--> wouldn't you have a decreased gamma globulin if you couldn't isotype switch as well (dec T Lymphocytes)? does this refer to the Ig in general or the specific isotype.

Here is my original post, again: IgG defect is variable. It really depends on the number of "viable" T cells, and on the expression of CD40L

Where exactly is my error?

Likewise

Variable secondary humoral defects can be present, including hypogammaglobulinemia, selective antibody deficiency, and polysaccharide antigens.
http://www.emedicine.com/ped/topic589.htm


Here is my original post, again: IgG defect is variable. It really depends on the number of "viable" T cells, and on the expression of CD40L

Where exactly is my error?

LOL, I didn't say your statement was wrong. I agree with your statement too. NOTHING is wrong with it, but it didn't explain the other person's confusion until you clarified it later. Apologies if I offended you in the last post. It's just etiquette to provide a reference if you feel very strongly about something that's not so totally obvious.

LOL, I didn't say your statement was wrong. I agree with your statement too. NOTHING is wrong with it, but it didn't explain the other person's confusion until you clarified it later. Apologies if I offended you in the last post. It's just etiquette to provide a reference if you feel very strongly about something that's not so totally obvious.

Not offensive at all - no apologies necessary :thumbup: Sorry for missing your point - i did neglect the 1st part of his q.

I posted my take on the matter in the post above the one you quoted:


"Gamma" refers to the gamma heavy chain. Therefore, Gamma globulins are technically IgG molecules. However, If you refer to the electrophoretic definition, then gamma globulins are indeed IgA, IgM and IgG.

Looks to me like the NBME is being too vague with the definitions

1. A series of experiments are performed to determine the mechanism by which a pharmacologic agent transverses cell membranes and accumulates within target cells. The rate of transport depends on the concentration of the drug only. When the extracellular concentration of the agent exceeds 10nM, no further increase in the rate of uptake is observed. Structurally similar compounds pass through the cell membrane, but at a lower rate. Ouabain, an inhibitor of Na+/K+ ATPase, fails to inhibit transport. Which of the following is the most likely mechanism by which this agent enters cells?

A) Antiport
B) Facilitated diffusion
C) Ion-gated coupling
D) Simple diffusion
E) Symport

I thought it was either facilitated diffusion or simple diffusion since it wasn't dependent on a cation gradient but I wasn't sure...

2) A 74 year old man has a cough. On auscultation of the right posterior chest, the patient's spoken "ee" sounds more like an "ay". Which of the following conditions on the right is most likely?

A) Bronchopleural fistula
B) Lower lobe consolidation
C) Middle lobe atelectasis
D) Pleural effusion
E) Pleural plaque
F) Pneumothorax
G) Pleural sequestration

Had no idea...please enlighten us p53

3) A 42 year old man with pneumococcal pneumonia has acute fibrinous pleuritis. Which of the following proteolytic enzymes is required to eliminate the exudate and restore normal pleural anatomy?

A) Collagenase
B) Plasmin
C) Stromeolysin
D) Thrombrin
E) Trypsin

I chose E) trypsin since it was acute inflammation. I wouldn't think it was collagenase because that would breakdown fibrin (fibrosis is chronic inflammation), but then again it said 'fibrinous' pleuritis. Stromeolysin is a matrix metalloproteinase... but I don't know if this is relevant...

4) During an experiment on the cough reflex in humans, a subject inhales air containing different amounts of particles that will impact and adhere to mucus primarily in the trachea. Blockade of which of the following afferent pathways would most likely prevent this subject's reflex to initiate a cough?

A) Glossopharyngeal
B) Laryngeal
C) Olfactory
D) Trigeminal
E) Vagal

I was between Glossopharyngeal and Vagal but I wasn't sure so I picked Vagal.

5) A 24 year old man is brought to the Emergency department after being stabbed in the left 4th intercostal space, immediately next to the sternum.
Which structure was most likely damaged?

A) Pulmonary trunk
B) Right atrium
C) Right ventricle
D) Superior vena cava
E) Thoracic aorta

I put right ventricle, but I wasn't sure.

6) A 5-year-old boy with a history of recurrent ear infections receives his preschool booster immunization against diphtheria-tetanus-pertussis. He is participating in a community-sponsored study to determine the humoral immune response to tetanus toxoid (tt). His response is well below normal for age- and sex-matched children. Peripheral B lymphocyte count and T lymphocyte count and function are within the reference range. The antibody he makes is positive in both the passive hemagglutination and complement-mediated lysis of tt-coated erythrocytes. His antibodies do not opsonize tt-coated latex particles for phagocytosis and do not directly precipitate tt efficiently. This child most likely has a defect in which of the following processes?

A) Affinity maturation of immunoglobulins
B) Immunoglobulin isotype switching
C) Recombination of heavy chain variable region genes
D) Recombination of light chain variable region genes
E) Somatic mutation of immunoglobulin genes

I chose A, but i wasn't sure

7. A 25-year-old woman, gravida 1, para 0, who is Rh-negative, delivers a full-term Rh-positive neonate. The mother is given prophylactic anti-Rho(D) immune globulin immediately post partum. During her second pregnancy 3 years later, she is screened each trimester for Rho(D) antibodies. An indirect antiglobulin test done during the third trimester indicates the presence of anti-Rho(D) antibodies in her serum. Which of the following is the most likely mechanism for the occurrence of these maternal antibodies?

A) Anamnestic production of maternal anti-Rho(D) immunoglobulin
B) Intrauterine transplacental fetal-maternal hemorrhages during the second pregnancy
C) Residual circulating prophylactic anti-Rho(D) immunoglobulin
D) Transplacental passage of fetal IgG anti-Rho(D) antibodies

I picked A) since I thought this was a secondary (amnestic) immune response. I was confused though because the woman received anti-Rho(D) immediately post partum so this should've prevented Rh antigen exposure. I was between A) and B).

8. A 25 year old woman at 32 weeks' gestation begins taking a drug to delay the onset of preterm labor. After the first dose, she notices tremulousness in her hands. Which of the following types of receptors is most likely to be involved in this effect?

A) alpha-1 adrenergic
B) Beta-2 adrenergic
C) Dopaminergic (D1)
D) Muscarinic (M1)
E) NMDA

I thought she might have been taking ritodrine or terbutaline which are both B) Beta-2 agonists, but I wasn't sure on the tremulousness of the hands.

9. The bone marrow picture with that bright red line from the top right corner to the bottom left corner. Fever, fatigue, easy bruising. Low crit, Hgb, leukocyte count, and platelets. I chose aplastic anemia, but I wasn't so sure because it could have been myelofibrosis.

10. Which of the following antimicrobial agents is most likely to be administered orally for the treatment of serious systemic infections because of it's predictable bioavailability?

A) Amphotericin B
B) Ciprofloxacin
C) Gentamicin
D) Polymyxin B
E) Vancomycin

I thought it was vanco... but I wasn't sure.

11. The cross sectional picture at T-12 to L-1. Patient was nervous had heart pounds and clammy skin and was also hypertensive. Neoplasm in? I was thinking sympathetic chain tumor or something near the aorta causing an obstruciton but I could be way off.


Posting again cause none of the Q's were answered.

Quote:
"Gamma" refers to the gamma heavy chain. Therefore, Gamma globulins are technically IgG molecules. However, If you refer to the electrophoretic definition, then gamma globulins are indeed IgA, IgM and IgG.

Looks to me like the NBME is being too vague with the definitions

Hey iDQ1 Are you 100% positive about "gamma" referring to gamma heavy chain, as in IgG? And if so, could you lead me to a reference? I thought gamma referred to the gamma fraction on electrophoresis as you said later. At least that's what I have in my class notes... but maybe both are right... who knows?

one of those things that was always kinda confusing to me.

Here's my take:

1 - facilitated diffusion that gets saturated above a certain [] (a n educated guess)

2 - egophony = consolidation or effusion. egophony + cough = consolidation

3 - Stromeolysin, secreted by macrophages resolves the gray hepatization (an educated guess)

4 - trachea = vagal

5 - I say rv, almost at septum

6 - type switching. IgG opsonizes beads

7 - Wow, umm... hmmm. I'd say B.. She should have no A - anti-rho should have knocked out (made anergic) the reactive B cells

8 - b2 agonist side fx is a tremor!

9 - no pic = can't answer

10 - Vanco is not PO (only for luminal purposes). ampho is quite unpredictable. polymyxin - IM/intrathecal. Gentamycin - IV/IM. I'd say cipro

11 - adrenal medulla

Quote:
"Gamma" refers to the gamma heavy chain. Therefore, Gamma globulins are technically IgG molecules. However, If you refer to the electrophoretic definition, then gamma globulins are indeed IgA, IgM and IgG.

Looks to me like the NBME is being too vague with the definitions

Hey iDQ1 Are you 100% positive about "gamma" referring to gamma heavy chain, as in IgG? And if so, could you lead me to a reference? I thought gamma referred to the gamma fraction on electrophoresis as you said later. At least that's what I have in my class notes... but maybe both are right... who knows?

one of those things that was always kinda confusing to me.

Don't cite me on this, but I think that the electrophoretic Gamma is a relic of the past. They named the electrophoretic bands alpha, beta, gamma - just like in the greek alphabet - before they figured out that the Gamma band contains gamma, mu and alpha.

The answer to your question is: I believe that the q was referring to the electrophoretic gamma (eg. G, A, M). I suppose the NBME wanted us to realize that the IgM production is independent of T cell influence.
This constant internal argument with test q writers is going to get me in trouble on Monday :scared:

HOWEVER, gamma globulins ARE globulins with a gamma heavy chain. Let me see if I can find a good reference.

Here's my take:

1 - facilitated diffusion that gets saturated above a certain []

2 - egophony = consolidation or effusion. egophony + cough = consolidation

3 - Stromeolysin, secreted by macrophages resolves the gray hepatization (a guess)

4 - trachea = vagal

5 - I say RV as well. Netter, p 192

6 - type switching. IgG opsonizes beads

7 - Wow, umm... hmmm. I'd say B.. She should have no A - anti-rho should have knocked out (made anergic) the reactive B cells

8 - b2 agonist side fx is a tremor!

9 - no pic = no answer

10 - Vanco is not PO. I'd say cipro - the rest are not as predictable

11 - adrenal medulla


Vanco is definitely PO. While it is usually administered through IV because it's not absorbed via the oral route it's used in the treatment of C. difficile colitis. Check up on your thoughts idq1i. Reference for PO vanco can be found in Lippincott's Pharmacology 2nd edition, page 308 under pharmacokinetics. As for the answer for this question... I don't know because I'm not sure. Maybe vanco? could be cipro. Who knows?

Who knows?

I do :laugh:

Vanco is luminal PO. It is not well-absorbed. The q said "treatment of serious systemic infections." C. dificile is not systemic.

I do :laugh:

Vanco is luminal PO. It is not well-absorbed. The q said "treatment of serious systemic infections." C. dificile is not systemic.

haha... not. It's pretty obvious that C. difficile is not systemic. I was referring to you saying that Vanco was not PO which was obviously wrong.

more opinions:

3) A 42 year old man with pneumococcal pneumonia has acute fibrinous pleuritis. Which of the following proteolytic enzymes is required to eliminate the exudate and restore normal pleural anatomy?

A) Collagenase
B) Plasmin
C) Stromeolysin
D) Thrombrin
E) Trypsin

I chose B -- plasmin cleaves fibrin, which will resolve fibrinous pleuritis.


Also, here is how I thought through this one... could someone clarify or correct this??

2) A 74 year old man has a cough. On auscultation of the right posterior chest, the patient's spoken "ee" sounds more like an "ay". Which of the following conditions on the right is most likely?

Egophony will be increased by anything that places more fluid between the vocal cords and the stethesope, and will be decreased by anything that fills that space with air.

A) Bronchopleural fistula -- air in the pleural space will decrease egophony
B) Lower lobe consolidation -- the denser and incompressible material (e.g. not air) will transmit sound better and will change the pitch of the sound
C) Middle lobe atelectasis -- this also would decrease the amount of air between the source of the sound and the stethosope, but maybe not as much as (b) since the remaining lobes will inflate normally.
D) Pleural effusion -- air is still present in the lunch between the chest wall and the origin of the sound, therefore egophony will not be as pronounced. However, this would still tend to cause egophony if severe enough (?)
E) Pleural plaque -- no change
F) Pneumothorax -- LESS egophony due to increased air
G) Pleural sequestration -- no change

COPD and asthma would have LESS egophony due to more air in lungs.

also, how are egophony, tactile fremitus, and whispered pectriloqy related? Are all 3 usually increased in the same situations (consolidation and pleural effusion?)

haha... not. It's pretty obvious that C. difficile is not systemic. I was referring to you saying that Vanco was not PO which was obviously wrong.

It wasn't PO as far as the q was concerned. I edited my post to reflect this.

It wasn't PO as far as the q was concerned. I edited my post to reflect this.

Geeze, you're really good at making yourself look like an ***** on this forum, I've looked at a couple of other posts by you and Ramoray. No doubt, you seem like an intelligent person since you seem to know a whole lot, I'll give you props for that. If you act like this on the wards, you're in for some serious trouble when an attending is going to PIMP you hardcore, because there's no way you'll know as much as an attending, and your attitude will get you nowhere. Hopefully you're not like this in real life and I really hope you're not representative of the typical NYMC student.

Geeze, you're really good at making yourself look like an ***** on this forum, I've looked at a couple of other posts by you and Ramoray. No doubt, you seem like an intelligent person since you seem to know a whole lot, I'll give you props for that. If you act like this on the wards, you're in for some serious trouble when an attending is going to PIMP you hardcore, because there's no way you'll know as much as an attending, and your attitude will get you nowhere. Hopefully you're not like this in real life and I really hope you're not representative of the typical NYMC student.

What attitude? I would like to see a quote that supposedly represents my "a55hole attitude." IIRC, I apologized for missing point of your first post.

Can't we stick to the topic at hand? Let's keep the patronizing "advice" to ourselves.

What attitude? I would like to see a quote that supposedly represents my "a55hole attitude"

Can't we stick to the topic at hand? Let's keep the patronizing "advice" to ourselves.
Wow!...nothing else need be said. Accept the advice, it won't bite ya.

What attitude? I would like to see a quote that supposedly represents my "a55hole attitude." IIRC, I apologized for missing point of your first post.

Can't we stick to the topic at hand? Let's keep the patronizing "advice" to ourselves.

yeah yeah, 770 on the shelf comment, don't deny that you didn't post that and then edit it, I saw it with my own eyes even though I don't have proof. It's a good thing you retracted that before anyone else saw that but me. While your score is amazing, No doubt. That's incredible actually, I didn't score nearly as high. You should really seriously consider changing your attitude, I'm only saying this to benefit you.

yeah yeah, 770 on the shelf comment, don't deny that you didn't post that and then edit it, I saw it with my own eyes even though I don't have proof. It's a good thing you retracted that before anyone else saw that but me. While your score is amazing, No doubt. That's incredible actually, I didn't score nearly as high. You should really seriously consider changing your attitude, I'm only saying this to benefit you.

I deleted it because I was not following my own advice to stick to the topic at hand. What I got on the shelf is not relevant. I apologize for getting carried away - this forum is supposed to be about helping each other

I deleted it because I was not following my own advice to stick to the topic at hand. What I got on the shelf is not relevant. I apologize for getting carried away - this forum is supposed to be about helping each other

cool, yeah I apologize too if I offended you. Looks like you're going to kick some ass on step I. Keep up the good work with your posts, you seem to have a lot of insight.

Best

Here's my take:

1 - facilitated diffusion that gets saturated above a certain [] (a n educated guess)

2 - egophony = consolidation or effusion. egophony + cough = consolidation

3 - Stromeolysin, secreted by macrophages resolves the gray hepatization (an educated guess)

4 - trachea = vagal

5 - I say rv, almost at septum

6 - type switching. IgG opsonizes beads

7 - Wow, umm... hmmm. I'd say B.. She should have no A - anti-rho should have knocked out (made anergic) the reactive B cells

8 - b2 agonist side fx is a tremor!

9 - no pic = can't answer

10 - Vanco is not PO (only for luminal purposes). ampho is quite unpredictable. polymyxin - IM/intrathecal. Gentamycin - IV/IM. I'd say cipro

11 - adrenal medulla

ok

For number 9, here's the picture: I hope this attachment thing works

I agree w/ your choice.

Classic BM of aplastic anemia.

Fat cells, scattered foci of lymphocytes, classical presenting sx

If it's an adrenal tumor, i think it's either B or H I wish I knew my cross sectional anatomy better...

I agree w/ your choice.

Classic BM of aplastic anemia.

Fat cells, scattered foci of lymphocytes, classical presenting sx

Cool, thanks for the netter 192 pick btw, it cleared it up for that stab question.

If it's an adrenal tumor, i think it's either B or H I wish I knew my cross sectional anatomy better...

B is the tail of the pancreas
H looks like the hepatoduodenal ligament (?)

I'd expect an adrenal tumor to be @ E

One more

A 60 year old man develops cirrhosis. He had multiple blood transfusions following severe trauma in 1985. He has no history of jaundice or hepatitis. Serologic tests and polymerase chain reactions on his blood will most likely show infection with which hepatitis virus?

A) A
B) B
C) C
D) D (delta)
E) E

I thought it was C but was confused about the no jaundice part... A and E are fecal oral, B and C are bloodborne, D superinfects needing B.

One more

A 60 year old man develops cirrhosis. He had multiple blood transfusions following severe trauma in 1985. He has no history of jaundice or hepatitis. Serologic tests and polymerase chain reactions on his blood will most likely show infection with which hepatitis virus?

A) A
B) B
C) C
D) D (delta)
E) E

I thought it was C but was confused about the no jaundice part... A and E are fecal oral, B and C are bloodborne, D superinfects needing B.

C, most likely. It's much more insidious than B. Also, screening donor blood for HCV began after 1985

hrmm... was confused

hrmm... was confused

C

I confused this w G( but this is the audio section of the brain)

C

I confused this w G( but this is the audio section of the brain)

You could be right about this. But I was thinking along the lines of Wernicke's area vs Broca's. I think G is the superior temporal gyrus of Heschl? And I thought C was the motor cortex while D was the sensory cortex. I dunno I suck at neuro though so you're probably right. I thought it was E since a lesion in Wernicke's area would obliterate comprehension of spoken language. Poor repetition, rambling speech, poor comprehension. Any other opinions?

You could be right about this. But I was thinking along the lines of Wernicke's area vs Broca's. I think G is the superior temporal gyrus of Heschl? And I thought C was the motor cortex while D was the sensory cortex. I dunno I suck at neuro though so you're probably right. I thought it was E since a lesion in Wernicke's area would obliterate comprehension of spoken language. Poor repetition, rambling speech, poor comprehension. Any other opinions?

haha my bad, that E looks like a "C". U are right. I meant E. that pic is kinda small

haha my bad, that E looks like a "C". U are right. I meant E. that pic is kinda small

yep, the pic was small, that's why i got rid of it

B is the tail of the pancreas
H looks like the hepatoduodenal ligament (?)

I'd expect an adrenal tumor to be @ E

Hey iDQ1, I thought pg 336 of netter's was helpful for this one. Show's a cross section through T12. I think it's still H but maybe it could be E. Ambiguous.

Actually H can't be the hepatoduondenal ligament because the hepatoduodenal ligament is anterior to the IVC on plate 336, so I'm thinking it's H.

more opinions:

3) A 42 year old man with pneumococcal pneumonia has acute fibrinous pleuritis. Which of the following proteolytic enzymes is required to eliminate the exudate and restore normal pleural anatomy?

A) Collagenase
B) Plasmin
C) Stromeolysin
D) Thrombrin
E) Trypsin

I chose B -- plasmin cleaves fibrin, which will resolve fibrinous pleuritis.


Also, here is how I thought through this one... could someone clarify or correct this??

2) A 74 year old man has a cough. On auscultation of the right posterior chest, the patient's spoken "ee" sounds more like an "ay". Which of the following conditions on the right is most likely?

Egophony will be increased by anything that places more fluid between the vocal cords and the stethesope, and will be decreased by anything that fills that space with air.

A) Bronchopleural fistula -- air in the pleural space will decrease egophony
B) Lower lobe consolidation -- the denser and incompressible material (e.g. not air) will transmit sound better and will change the pitch of the sound
C) Middle lobe atelectasis -- this also would decrease the amount of air between the source of the sound and the stethosope, but maybe not as much as (b) since the remaining lobes will inflate normally.
D) Pleural effusion -- air is still present in the lunch between the chest wall and the origin of the sound, therefore egophony will not be as pronounced. However, this would still tend to cause egophony if severe enough (?)
E) Pleural plaque -- no change
F) Pneumothorax -- LESS egophony due to increased air
G) Pleural sequestration -- no change

COPD and asthma would have LESS egophony due to more air in lungs.

also, how are egophony, tactile fremitus, and whispered pectriloqy related? Are all 3 usually increased in the same situations (consolidation and pleural effusion?)

Yeah, now that I think about it, I think plasmin is right. Would get rid of the fibrin in fibrinous pleuritis/carditis. Resolution vs organization

Actually H can't be the hepatoduondenal ligament because the hepatoduodenal ligament is anterior to the IVC on plate 336, so I'm thinking it's H.

Could be. I'm not sure what to make of that blip

Those keeping score at home. I still have my answer key for the 770 so people can verify it when they take the test. I will post it on SDN in due time. I promise. Still debating whether someone like Hidden should have an advantage on this test because they are taking the exam after since people before him didn't have access to this. Whatever I choose, the class of 2008 will have access to my answer key to give everyone in next year's class a level playing field. Until then, if you have any other questions. I will answer NBME questions on form A and give you my rationale.

p53 is back. You Heard

Go ahead and post it. The world is curious to find out what a 770 looks like. You don't have much of a point speaking on whether HiddenTruth gets an advantage whenever by that thought process, you're going to disadvantage ALL future NBME CBSSA takers from the Class of 2008 equally.

UH-OH.....anybody NOT do well and do ok on the real thing?? I did not do great-am I doomed to fail

Hi everyone,

Regarding the purchase of the 2 $45 exams.

1. Is it downloaded or do they send you a CD?

2. I heard it is best to do it in UNTIMED mode so you can "copy" and make note of the HY info they want you to know. What do you suggest is the best way to do this?

3. So do es that mean if you take it timed, you won't be able to go over the Qs again? I mean there are 400 questions in all. Do you recommend sitting there taking notes on all of them?

Thanks for the input.

W.Osler III

Hi everyone,

Regarding the purchase of the 2 $45 exams.

1. Is it downloaded or do they send you a CD?

It's an online subscription like Qbank. However, you can not go back once you've clicked the end button on ANY section. You have to pay $45 for each one.

2. I heard it is best to do it in UNTIMED mode so you can "copy" and make note of the HY info they want you to know. What do you suggest is the best way to do this?


Doing the timed method would be just plain stupid in my opinion. The point of this exam is to gauge how you are doing and try to gain a little bit of insight into how they ask questions. If you run out of time during your hour, oh well. You've still got 3 hours left (for each block).

3. So do es that mean if you take it timed, you won't be able to go over the Qs again? I mean there are 400 questions in all.

You won't be able to look again. That's correct.

Anyone know what was up with the question where it had the picture of the stillborn fetus with a cleft palate, and asked for the inheritance? Options were like auto dominant, auto recessive, sex-linked, mitochondrial, and multifactorial.

Anyone know what was up with the question where it had the picture of the stillborn fetus with a cleft palate, and asked for the inheritance? Options were like auto dominant, auto recessive, sex-linked, mitochondrial, and multifactorial.

Trisomy 13/patau ?

Failure of palatine shelf fusion is usually multifactorial.

Those keeping score at home. I still have my answer key for the 770 so people can verify it when they take the test. I will post it on SDN in due time. I promise. Still debating whether someone like Hidden should have an advantage on this test because they are taking the exam after since people before him didn't have access to this. Whatever I choose, the class of 2008 will have access to my answer key to give everyone in next year's class a level playing field. Until then, if you have any other questions. I will answer NBME questions on form A and give you my rationale.

p53 is back. You Heard

Haha, you're a true comedian. I am glad you care that much about me to single handedly include me in your post. The fact that you actually care whether HIDDEN gets to see the answers or not is something to ponder in an on fitself. Bro, I don't think anyone cares to see your answers, and I can definately speak for myself, nor has anyone made any request, nor do half the people on this forum believe your score. And, lastly, go back to the hole that u were in. ..Nuff said.

Oh, and...nice way to delete the post after you wrote it. Ram, toolmen list modified--p53 can finally be happy that he can be #1 in something.

Haha, you're a true comedian. I am glad you care that much about me to single handedly include me in your post. The fact that you actually care whether HIDDEN gets to see the answers or not is something to ponder in an on fitself. Bro, I don't think anyone cares to see your answers, and I can definately speak for myself, nor has anyone made any request, nor do half the people on this forum believe your score. And, lastly, go back to the hole that u were in. ..Nuff said.

Oh, and...nice way to delete the post after you wrote it. Ram, toolmen list modified--p53 can finally be happy that he can be #1 in something.

man the tool list is climbing fast! i dont get it who cares if someone is at an advantage to a practice test? or am i missing something ,i think that is the most ridiculous thing i have read on this forum in awhile... well probably not since i read man ridiculous things but none the less ridiculous.. someone want to fill me in on this 770 contraversy and why it would negatively effect hiddden and the entire class of 2008. strange

Pox,

Can you pause in between blocks or do you have to do the whole exam in 1 day?

Also can you crop and paste?

Thanks again

:luck:

Pox,

Can you pause in between blocks or do you have to do the whole exam in 1 day?

Also can you crop and paste?

Thanks again

:luck:

I guess you could do the test over as much time as you wanted. I had to restart my computer in the middle of a block, and it came back right where I left of when I reloaded it. But I'd say you should do it all at once. Yes, you can cut and paste.

1. Ovarian tumor. AGE, location of mass, and unilaterality is the key. Goljan also told me. Haha
2. Angiogenesist. The picture was a cavernous hemangioma. As Dr. Goljan would say, don't do anything.
3. The most lateral rod on the right. The picture looks like a hot dog on the right arm. The arrow that points at the right bun is the MUSCLE somite.
4. Phosphoribosylpyrophosphate synthetase. This is a key regulatory enzyme. Know all of these including HGPRT.
5. narrow mediastinum due to lack of thymus, normal gamma globulins, and decreased t lymphocytes.
6. Anticipation. The tipoff was that the mother has a lack of facial expression and muscle weakness so you know she was has the disease. The hypotonia and facial expression is give away that the disease is myotonic dystrophy. Sorry Dr. goljan, there are more ways than shaking one's hand to find out if they have this disease. Key associations myotonic dystrophy -> triple repeat and anticipation. If you understand Goljan and can apply his lectures you will anhilate this exam. Most people when they listen to his lecture memorize what he says. The smart ones think about what he says and applies it. Example, pleural effusion vs lung consolidation. He talks about it in his audio, but you have to sit down and think about the differences due to tactile fremitus, egophony etc.

Those keeping score at home. I still have my answer key for the 770 so people can verify it when they take the test. I will post it on SDN in due time. I promise. Still debating whether someone like Hidden should have an advantage on this test because they are taking the exam after since people before him didn't have access to this. Whatever I choose, the class of 2008 will have access to my answer key to give everyone in next year's class a level playing field. Until then, if you have any other questions. I will answer NBME questions on form A and give you my rationale.

p53 is back. You Heard


Hi:

Based on the post. Is it fare for me to assume that NO ANSWERS are provided by the NBOME? HOw do you know if you are REALLY correct?

So has anyone just copied and paste the questions and try to print it on paper?

HOw many Qs all 2gehter?>

Thanks buddies :idea:

hey I was wondering if anyone could help me out...some I just want to check if my answer was correct...kinda iffy on some...thanks so much.

1. the guy with cervical lymphadenopathy hx of low grade feverr, 10 lb wt loss, low Hb, Hct, MCV 80, Iron 24 microg/dL, TIBC low, what is the cause of anemia?

2. the 49 yr old man w/ hx of 1 week SOB, no fever, cough, or chills, BS decreased in L lower lobe, adn vocal and tactile fremitus are decreased, dull to percussion. What does he have?

3. Picture of the 17 yr old post-tonic clonic seizure with stuff on his face???

4. What drug decreases thyroid H in pregnancy (fetus)? B-blocker?

5. How would a pt w/ pulm fibrosis breathe easier? in regards to how would frequency and tidal vol change if at all?

Thanks so much...I didn't realize the NBME didn't give answers, it's driving me nuts...and looking up answers is taking forever...and my exam is in 4 days!

1. Ovarian tumor. AGE, location of mass, and unilaterality is the key. Goljan also told me. Haha
2. Angiogenesist. The picture was a cavernous hemangioma. As Dr. Goljan would say, don't do anything.
3. The most lateral rod on the right. The picture looks like a hot dog on the right arm. The arrow that points at the right bun is the MUSCLE somite.
4. Phosphoribosylpyrophosphate synthetase. This is a key regulatory enzyme. Know all of these including HGPRT.
5. narrow mediastinum due to lack of thymus, normal gamma globulins, and decreased t lymphocytes.
6. Anticipation. The tipoff was that the mother has a lack of facial expression and muscle weakness so you know she was has the disease. The hypotonia and facial expression is give away that the disease is myotonic dystrophy. Sorry Dr. goljan, there are more ways than shaking one's hand to find out if they have this disease. Key associations myotonic dystrophy -> triple repeat and anticipation. If you understand Goljan and can apply his lectures you will anhilate this exam. Most people when they listen to his lecture memorize what he says. The smart ones think about what he says and applies it. Example, pleural effusion vs lung consolidation. He talks about it in his audio, but you have to sit down and think about the differences due to tactile fremitus, egophony etc.

Those keeping score at home. I still have my answer key for the 770 so people can verify it when they take the test. I will post it on SDN in due time. I promise. Still debating whether someone like Hidden should have an advantage on this test because they are taking the exam after since people before him didn't have access to this. Whatever I choose, the class of 2008 will have access to my answer key to give everyone in next year's class a level playing field. Until then, if you have any other questions. I will answer NBME questions on form A and give you my rationale.

p53 is back. You Heard

This is an internet forum...I don't hear anything.

anyone have any explanation to those q's? sorry i wasnt able to cut and paste..it wouldnt let me..thanks :)

bump.

Do any of you out there remember these questions and know the correct answers?


Adult Hb is 98% saturated, but arterial O2 is decreased, most likely cause is what?
a. Anemia
b. AV shunt
c. Hemoglobinopathy
d. high-altitude hypoxia
e. Pulmonary diffusion defect

I put Anemia, what's the right answer?

Cancer cells resistant to vincristine, doxorubicin, dactinomycin, but not resistant to methotrexate and alkylating agents, why?
a. absence of superoxide dismutase
b. altered DNA polymerase
c. enhanced drug transport out of cell
d. inability to form polyglutamates
e. increased DNAse

i'm not even sure about this question, i know that it's not choice d.

Genotype of chorionic villi that comprises human placenta, what's it made from?
a. maternal and fetal
b. fetal
c. maternal
d. paternal

I didn't write down this question completely, hope it makes sense.

Thanks everyone!

surely, someone here has the questions and answers recorded to these NBME forms.

come on, folks, cough it up...

Do any of you out there remember these questions and know the correct answers?


Adult Hb is 98% saturated, but arterial O2 is decreased, most likely cause is what?
a. Anemia
b. AV shunt
c. Hemoglobinopathy
d. high-altitude hypoxia
e. Pulmonary diffusion defect

I put Anemia, what's the right answer?

Cancer cells resistant to vincristine, doxorubicin, dactinomycin, but not resistant to methotrexate and alkylating agents, why?
a. absence of superoxide dismutase
b. altered DNA polymerase
c. enhanced drug transport out of cell
d. inability to form polyglutamates
e. increased DNAse

i'm not even sure about this question, i know that it's not choice d.

Genotype of chorionic villi that comprises human placenta, what's it made from?
a. maternal and fetal
b. fetal
c. maternal
d. paternal

I didn't write down this question completely, hope it makes sense.

Thanks everyone!


Anemia will decrease the total O2 level in the blood without altering the saturation of what hemoglobin there is.

Chorionic villi are of fetal origin, which is why they are used for testing.

I went with enhanced drug transport out of cell for the middle one.

I put my thoughts in brackets (which may be wrong) below the question.

hey I was wondering if anyone could help me out...some I just want to check if my answer was correct...kinda iffy on some...thanks so much.

1. the guy with cervical lymphadenopathy hx of low grade feverr, 10 lb wt loss, low Hb, Hct, MCV 80, Iron 24 microg/dL, TIBC low, what is the cause of anemia?

[Anemia of chronic disease where the macs improperly store iron and don't release it hence the TIBC is low]

2. the 49 yr old man w/ hx of 1 week SOB, no fever, cough, or chills, BS decreased in L lower lobe, adn vocal and tactile fremitus are decreased, dull to percussion. What does he have?

[ i think pleural effusion]

3. Picture of the 17 yr old post-tonic clonic seizure with stuff on his face???

[ i think someone asked this before - perherps sebaceous adenomas on his face so tuberous scelrosis; hence he would be mentally handicapped since kindergarten]

4. What drug decreases thyroid H in pregnancy (fetus)? B-blocker?

[i put PTU, but was unsure]

5. How would a pt w/ pulm fibrosis breathe easier? in regards to how would frequency and tidal vol change if at all?

[ i think it would help them to increases respiration/rate but decresaes each tidal volume]

Thanks so much...I didn't realize the NBME didn't give answers, it's driving me nuts...and looking up answers is taking forever...and my exam is in 4 days!

Anemia will decrease the total O2 level in the blood without altering the saturation of what hemoglobin there is.

Chorionic villi are of fetal origin, which is why they are used for testing.

I went with enhanced drug transport out of cell for the middle one.


Yup, those are what I went with
I believe its called the MDR (multi-drug resistance) gene that some cancer cells have to help them pump out those particular drugs

Okay, here are my post NBME Form 1 questions - thanks to anyone who shares their thoughts

1) women in waiting room is nervous w/ clenched fists says to u "lets get this over with"
you as the doc say:
- okay , tell me what brings you in
- i can see you are upset, please tell me what is botheirng you

2) if you give a postural hypotensive pt. flucortisone, after 5 days what will their
serum K+ and renin, and urine K+ be?
I put dec K, dec renin, and inc. urine K+

3) do prions contain anything other than protein?

4) 2 yo girl ingests drugs from mom's purse. is sedated, but respirations and blood pressure are normal.
which of the following will reverse the sedation?
- acetylcysteine, apomorphoine, flumenazil, atropine, haloperidol, naloxone, amyl nitatre

5) posterolateral nephretomy - whats cut
- parietal or visceral peritoneum
- costal or diaphagmatic pleura
- transversalis fasica (which is what i went with)

6) if mom has + serum AFP; what will be have the greatest value in determining predictive value of this AFP test for her baby's neural tube defects
- sensitivity
- specificty
- prevalence

7) 61yo man with 3month history of dull aching pain on left side of chest - what do do next?
- Past Medical History, fam history, physical CV exam, ask additional details about pain

8) neonate born w/ thyroid enlargement, dec T4, Inc TSH b/c mom took what?
- PTU, T4, T3, Bblocker, GCS

Bump for the newbies

6) if mom has + serum AFP; what will be have the greatest value in determining predictive value of this AFP test for her baby's neural tube defects
- sensitivity
- specificty
- prevalence

I put prevalence. Isn't sensitivity and specificity intrinsic to a test but increasing prevalence raises the PPV of a test and decreasing prevalence raises the NPV of a test?


7) 61yo man with 3month history of dull aching pain on left side of chest - what do do next?
- Past Medical History, fam history, physical CV exam, ask additional details about pain
I put ask additional details about the pain-- aren't you supposed to do the sharp, dull, throbbing, radiating as a followup to pain questions?

3) do prions contain anything other than protein?]
I thought prions don't contain DNA nor RNA, only protein

I think you guys were correct about tuberous sclerosis! (http://www.emedicine.com/ped/images/707Adenoma_sebaceum.jpg)

But according to e-medicine.com: (http://www.emedicine.com/ped/topic2796.htm)

Approximately 50-85% of children with TSC have mental retardation. Nearly all patients with mental retardation have seizures, although the reverse is not always true. Seizures and mental retardation may be present concomitantly.

All patients with TSC with mental retardation have seizures, but not all patients with seizures have mental retardation. Intelligence may be normal, or children may have mild, moderate, or severe mental retardation.

For the question with the EM, were those gap junctions, therfore communicating? I thought they might be hemidesmosomes.

Has anyone been able to definitively answer this:

1. A 22 year old man has a 36 hour history of pain/swelling in left testis. One week ago, he had mild dysuria and urethral discharge. Gram stain from urethra shows numerous neutrophils but no organisms. Most likely cause of the patient's symptoms is infection with which of the following?-

A. Chlamydia trachomatis
B. Cytomegalovirus
C. E coli
D. Herpesvirus
E. Mumps virus
F. Neisseria gonorrhoea
G. Trichomonas Vaginalis

Cant remember any of these bugs, I havent studied this stuff since last September. I will eliminate B, C, D, and E because those are either not bacteria or they are not associated with STDs. So it could be A, F, or G. I'm guessing its A.

P.S. What was up with the man who was feeding himself with his fingers? I thought that was Alzheimers....

Has anyone been able to definitively answer this:

1. A 22 year old man has a 36 hour history of pain/swelling in left testis. One week ago, he had mild dysuria and urethral discharge. Gram stain from urethra shows numerous neutrophils but no organisms. Most likely cause of the patient's symptoms is infection with which of the following?-

A. Chlamydia trachomatis
B. Cytomegalovirus
C. E coli
D. Herpesvirus
E. Mumps virus
F. Neisseria gonorrhoea
G. Trichomonas Vaginalis

Cant remember any of these bugs, I havent studied this stuff since last September. I will eliminate B, C, D, and E because those are either not bacteria or they are not associated with STDs. So it could be A, F, or G. I'm guessing its A.
[/b]

hx leads you to neisseria or chlamydia, and chlamydia doesn't gram-stain well (bacteria are too tiny) so I vote for chlamydia

Another memory from NBME form I: For the guy with the worm/bug in his brain does anyone remember what he was bitten by? Not a mosquito, isn't that malaria? Blackfly gives river blindness, sandfly leishmania?? Does anyone know what the answer was???

Another memory from NBME form I: For the guy with the worm/bug in his brain does anyone remember what he was bitten by? Not a mosquito, isn't that malaria? Blackfly gives river blindness, sandfly leishmania?? Does anyone know what the answer was???

Cysticercosis transmitted via Taenium Soelium through ingestion by pigs; they larvae disseminate and become cysts in the brain that calcify.

hx leads you to neisseria or chlamydia, and chlamydia doesn't gram-stain well (bacteria are too tiny) so I vote for chlamydia
I thought it was chlamydia, too since chlamydia are the intracellular bugs, so they wouldn't necessarily be in discharge, but then how would you transmit it???

Ooooh, pigs, that's right! I was thinking trichinosis!

Has anyone been able to definitively answer this:

1. A 22 year old man has a 36 hour history of pain/swelling in left testis. One week ago, he had mild dysuria and urethral discharge. Gram stain from urethra shows numerous neutrophils but no organisms. Most likely cause of the patient's symptoms is infection with which of the following?-

A. Chlamydia trachomatis
B. Cytomegalovirus
C. E coli
D. Herpesvirus
E. Mumps virus
F. Neisseria gonorrhoea
G. Trichomonas Vaginalis

Cant remember any of these bugs, I havent studied this stuff since last September. I will eliminate B, C, D, and E because those are either not bacteria or they are not associated with STDs. So it could be A, F, or G. I'm guessing its A.

P.S. What was up with the man who was feeding himself with his fingers? I thought that was Alzheimers....

It was Pick's disease:

Pick's disease primarily affects frontal and temporal lobes but what is characteristic about Pick's is they show minimal dementia and lose "frontal inhibition." ----> Why he become rude, unkempt, and made wierd comments to people.

For the question with the EM, were those gap junctions, therfore communicating? I thought they might be hemidesmosomes.

Haha, I have no clue what the hell was in that Frozen Etched specimen even after looking it up!

What did you guys put for the angry patient? The lady who was really upset and just told you to get this over with?

-I thought you might bring up scheduling her another day because Ive heard a doctor do that but the way it was written on test didnt seem too nice

It was Pick's disease:

Pick's disease primarily affects frontal and temporal lobes but what is characteristic about Pick's is they show minimal dementia and lose "frontal inhibition." ----> Why he become rude, unkempt, and made wierd comments to people.
Drats! That was my second choice!!!

--------------------------------------------------------------------------------

What did you guys put for the angry patient? The lady who was really upset and just told you to get this over with?

-I thought you might bring up scheduling her another day because Ive heard a doctor do that but the way it was written on test didnt seem too nice

I thought for that one it was either the "what brings you in" or "you seem angry-- is there something bothering you?" For the first one isn't that the way you're supposed to introduce yourself? For the second one, it acknowledges the patients problem (rapport) but could be a bit judgemental???

Haha, I have no clue what the hell was in that Frozen Etched specimen even after looking it up!

http://www.visualsunlimited.com/browse/vu350/vu350783.html

is that what it looked like? I said gap jxn but im not sure if that site is the same as was on the test.

Yeah, I thought it was a gap junction, in which case the purpose would be communicating (???) but I also thought it could be a hemidesmosome, the one like the rivet???

What did you guys put for the angry patient? The lady who was really upset and just told you to get this over with?

-I thought you might bring up scheduling her another day because Ive heard a doctor do that but the way it was written on test didnt seem too nice


You gotta acknowledge their anger. Why are you upset. That's straight up from HY behav as tho Fadem wrote that Q.

http://www.visualsunlimited.com/browse/vu350/vu350783.html

is that what it looked like? I said gap jxn but im not sure if that site is the same as was on the test.


Ahhhh, thank you! That's exactly what it looked like.

I remembered some additional questions related to anatomy:

1) For the what fossa is this part of the brain in what was the right answer? I thought it was the ptergopalatine (??) fossa?

2) For the fracture of the median epicondyle and nerve deficit, it sounded like an ulnar nerve injury. I put down the pt couldn't pronate his arm, but now that I think about it maybe it was he couldn't flex his fingers (i.e. claw hand). The thing that threw me was the question said "fingers" but I thought the thumb was a finger and its flexion wouldn't be affected by an ulnar n. lesion as it is controlled by the median n (????). I really need to study anatomy-- does anyone have insight on these questions!

For the behavioral sciences question about the breast lump, I thought that the physician could be sued only if the patient was found to have cancer (i.e. suffered harm). Although a smart lawyer could probably argue that the patient suffered harm from the anxiety associated with the lump, in which case I would be wrong.

Aha, for the orchitis question, Wikipedia (http://en.wikipedia.org/wiki/Chlamydia) provides a possible answer:

In men, chlamydia may not cause any symptoms, but symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, swollen or tender testicles, or fever.

Chlamydia in men can spread to the testicles, causing epididymitis, which can cause sterility. Chlamydia causes more than 250,000 cases of epididymitis in the USA each year.

For the behavioral sciences question about the breast lump, I thought that the physician could be sued only if the patient was found to have cancer (i.e. suffered harm). Although a smart lawyer could probably argue that the patient suffered harm from the anxiety associated with the lump, in which case I would be wrong.

naw dude, #1 reason why doctors get sued is poor patient doctor communication.

I believe the brain part was behind the eye so middle fossa.

The ulnar nerve Q I said Flex fingers but I haven't studied anatomy yet so not sure about that either.

naw dude, #1 reason why doctors get sued is poor patient doctor communication.

I believe the brain part was behind the eye so middle fossa.

The ulnar nerve Q I said Flex fingers but I haven't studied anatomy yet so not sure about that either.
Whaaat??? I thought FA says: Civil suit under negligence requires:

1) Breach of duty to patient
2) Pt suffers harm
3) Breach of duty causes harm

So my reasoning was that the pt can sue only if she suffers harm (i.e. breast cancer).

Whaaat??? I thought FA says: Civil suit under negligence requires:

1) Breach of duty to patient
2) Pt suffers harm
3) Breach of duty causes harm

So my reasoning was that the pt can sue only if she suffers harm (i.e. breast cancer).

Right, but the questions was asking why DO they sue and most patients sue due to breakdown of doctor patient communication. I'm sure First Aid says it somewhere in there. The reasons you gave above are what makes the doctor liable to be sued. "Pt suffers harm" happens all the time in Hospitals/doctor's offices(eg wrong pills, giving foods with sugar to a diabetic etc), but not everyone will sue.

I had a whole day's lecture on this so I'm pretty sure that this is the right choice.

You're probably right given that I scored a 410! (I'm not worthy, I'm not worthy)

You know for that image of the esophagus with vomiting, was that a mallory weiss tear or a ruptured varicie?

You know for that image of the esophagus with vomiting, was that a mallory weiss tear or a ruptured varicie?

Ruptured Varicle, the question mentioned that he wasn't vomitting so it ruled out a tear --> hence portal htn ----> ruptured varicele.

I thought he had painless vomiting of bright red blood? I put the ruptured varicele? Hey Kashue, do you know what the answer was to that kid who took the sedative (?) from mom's purse? I thought flumazenil.

I thought he had painless vomiting of bright red blood? I put the ruptured varicele? Hey Kashue, do you know what the answer was to that kid who took the sedative (?) from mom's purse? I thought flumazenil.


I put ruptured Varicele too, no idea if that's right coz I was weak in GI which is wierd since I thought the GI Q's were easy.

Ya, it's flumazenil - straight from FA. I believe it's a GABA antagonist.

Oh boy we're back to square one with this infectious orchitis question. I'm doing QBank and one question says:

"Acute orchitis with prominent neutrophils in a sexually active male are most likely due to an infection with N. Gonorrhea or Chlamydia trachomatis. N. Gonorrhea can produce a specific pattern of acute inflammation (non-specific epidimitis and orchitis) or can be sufficiently severe to cause frank abscesses within the epididymis."

I put ruptured Varicele too, no idea if that's right coz I was weak in GI which is wierd since I thought the GI Q's were easy.

Ya, it's flumazenil - straight from FA. I believe it's a GABA antagonist.


I hate to dredge this thread back up again, but I just took #1 and am wondering of P53 ever posted his answer key.

BTW, I chose benzo antagonist (flumazenil) as well because I remembered that benzo's depress resp much less than barbs, and opiods would have depressed resp. majorily.

The medial epicondile question (I'm thinking) was adduction and abduction of the fingers (via the intrinsic interosseous muscles of the hand) which is controlled by the Ulnar N.

I but Mallory Weise for the ruptured esophagus because (rather than portal HTN) because I though they said he was vomitting. I feel lousy about that one because I think I may have answered before even seeing the varicosity answer. CRAP!!

Did anybody know what the still-born infant with the cleft lip/palate had. I missed that one pretty good.

Judd

I hate to dredge this thread back up again, but I just took #1 and am wondering of P53 ever posted his answer key.

BTW, I chose benzo antagonist (flumazenil) as well because I remembered that benzo's depress resp much less than barbs, and opiods would have depressed resp. majorily.

The medial epicondile question (I'm thinking) was adduction and abduction of the fingers (via the intrinsic interosseous muscles of the hand) which is controlled by the Ulnar N.

I but Mallory Weise for the ruptured esophagus because (rather than portal HTN) because I though they said he was vomitting. I feel lousy about that one because I think I may have answered before even seeing the varicosity answer. CRAP!!

Did anybody know what the still-born infant with the cleft lip/palate had. I missed that one pretty good.

Judd

I think they asked about inheritance right? I put multifactorial.

Can someone help me with these questions? Thanks!

1. 56-year-old man has fever and pleuritic chest pain for 1 day. He was admitted to the hospital 3 weeks ago because of an acute transmural anterior MI. He has taken a beta-adrenergic blocking agent and aspirin since being discharged. A friction rub is heard over the pericardium. What is the most likely cause of these findings?
A. Adverse drug effect
B. Aortic dissection
C. Autoimmune reaction
D. Postviral inflammation
E. Recurrent ischemia

Is the answer C (Dressler’s syndrome)?

2. A 35-year-old woman has had twelve 0.5 to 1.5 cm lesions on her neck, trunk, and limbs for 5 years. Which of the following is the most likely diagnosis?
A. Chronic hepatic disease
B. Cushing’s syndrome
C. HIV infection
D. Melatonin excess
E. Neurofibromatosis

I put neurofibromatosis, even though I thought the cafe-au-lait spots would have been there since birth.


3. A 23-year-old woman has had intermittent amenorrhea since the birth of her first child 5 years ago. She received 10 units of blood during her delivery. Her skin is thick and doughy. She has no energy and is depressed. Which of the following is the most likely cause of her symptoms?
A. Adrenocortical insufficiency
B. Chronic fatigue syndrome
C. Hemochromatosis
D. HIV infection
E. Pituitary necrosis

I thought Adrenocortical insufficiency, but what does this have to do with her skin changes and the blood transfusion?

4. Four months after a cholecystectomy for removal of gallstones, a 43-year-old woman has recurrent episodes of biliary colic. After endoscopic sphincterotomy, the episodes of colic do not recur. Which of the following defects in the sphincter of Oddi best explains this patient’s course?
A. Inability of smooth muscle to contract
B. Inability of the enteric nervous system to activate excitatory motoneurons
C. Loss of enteric inhibitory motor innervation
D. Reflux of duodenal contents into the common bile duct
E. Release of vasoactive intestinal polypeptide

5. Man with nausea, vomiting, abdominal pain, tachycardia, absent bowel sounds, involuntary guarding, rebound tenderness.
A. Cholecystitis
B. Gastritis
C. Gastroenteritis
D. Peritonitis
E. Small bowel obstruction

I picked small bowel obstruction.

6. Baby with 4 x 4 cm mass posterior to right sternocleidomastoid muscle. Mass is unilocular, filled with watery fluid, and no other abnormalities are present.
A. Branchial cyst
B. Cystic hygroma
C. Preauricular sinus
D. Thyroglossal duct cyst
E. Zenker’s diverticulum

I chose Branchial cyst, but according to the internet, those are usually anterior to the sternocleidomastoid muscle.

7 . A woman has ringing in her ears and dizziness 7 days after starting a drug. What is she on?
A. Acetaminophen
B. Aspirin
C. Auranofin
D. Methotrexate
E. Prednisone

I couldn't find those side effects listed for any of the drugs, although I did see dizziness listed for methotrexate and prednisone.

I would think E- Sheehan's syndrome. If she hemorraged during delivery she would need blood. Lack of pit hormones = hypothryoid sx (skin, fatigue, depression)
--------------------------------------------------------------------------
Can someone help me with these questions? Thanks!
3. A 23-year-old woman has had intermittent amenorrhea since the birth of her first child 5 years ago. She received 10 units of blood during her delivery. Her skin is thick and doughy. She has no energy and is depressed. Which of the following is the most likely cause of her symptoms?
A. Adrenocortical insufficiency
B. Chronic fatigue syndrome
C. Hemochromatosis
D. HIV infection
E. Pituitary necrosis
I thought Adrenocortical insufficiency, but what does this have to do with her skin changes and the blood transfusion?

I would think E- Sheehan's syndrome. If she hemorraged during delivery she would need blood. Lack of pit hormones = hypothryoid sx (skin, fatigue, depression)
--------------------------------------------------------------------------
Can someone help me with these questions? Thanks!
3. A 23-year-old woman has had intermittent amenorrhea since the birth of her first child 5 years ago. She received 10 units of blood during her delivery. Her skin is thick and doughy. She has no energy and is depressed. Which of the following is the most likely cause of her symptoms?
A. Adrenocortical insufficiency
B. Chronic fatigue syndrome
C. Hemochromatosis
D. HIV infection
E. Pituitary necrosis
I thought Adrenocortical insufficiency, but what does this have to do with her skin changes and the blood transfusion?

Classical History for SheeHan syndrome ---> Pit necrosis

Classical History for SheeHan syndrome ---> Pit necrosis

yea, the give-away is the need for blood during the delivery. Funny, I never pegged USMLE for such dirty tricks, but I think the Hemochromatosis was thrown in an attractor (Fe from all the blood).

On the others:

Post MI Friction rub - no idea

cafe Au Lait - I also put NFT

Sphincter of Oddi - This one was tough as balls. Relaxing Oddi is "pro-kinetic", but would appear to require inhibition of motor neurons (hence, the "relaxation" of the sphincter). Hence, loss of inhibitory neurons (it would seem to me) would cause excess tone of the sphincter and be the cause of the colic. BUT, Oddi tone (I thought) was actually controlled by Cholycytsikinin (which relaxes the sphincter of Oddi put contracts the gall bladder). So, not sure how that fits in.

GI problems - I am under the impression (which I'm sure is wrong) that the dDx for "rebound tenderness" is peritonitis, peritonitis and. . . peritonitis. Someone set me straight.

Cyst - I thought brachial cyst also. I always pick Brachial Cyst when I see a cyst on the neck. It's probably wrong in this case, but it should be right 80% of the time.

Ear ringing - I am under the impression that Tinnitis is caused by Aspirin

Judd

1. yes, dressler's

6. I thought it was a cystic hygroma, like in Turner's, but maybe those are bilateral

7. aspirin toxicity definitely causes tinnitus

Can someone help me with these questions? Thanks!

1. 56-year-old man has fever and pleuritic chest pain for 1 day. He was admitted to the hospital 3 weeks ago because of an acute transmural anterior MI. He has taken a beta-adrenergic blocking agent and aspirin since being discharged. A friction rub is heard over the pericardium. What is the most likely cause of these findings?
A. Adverse drug effect
B. Aortic dissection
C. Autoimmune reaction
D. Postviral inflammation
E. Recurrent ischemia

Is the answer C (Dressler’s syndrome)? I think Dressler's is correct, 6 wks after initial MI occurs

2. A 35-year-old woman has had twelve 0.5 to 1.5 cm lesions on her neck, trunk, and limbs for 5 years. Which of the following is the most likely diagnosis?
A. Chronic hepatic disease
B. Cushing’s syndrome
C. HIV infection
D. Melatonin excess
E. Neurofibromatosis

I put neurofibromatosis, even though I thought the cafe-au-lait spots would have been there since birth. NF is probably correct since the only other "condition" that's associated with cafe-au-lait spots is birthmark


3. A 23-year-old woman has had intermittent amenorrhea since the birth of her first child 5 years ago. She received 10 units of blood during her delivery. Her skin is thick and doughy. She has no energy and is depressed. Which of the following is the most likely cause of her symptoms?
A. Adrenocortical insufficiency
B. Chronic fatigue syndrome
C. Hemochromatosis
D. HIV infection
E. Pituitary necrosis

I thought Adrenocortical insufficiency, but what does this have to do with her skin changes and the blood transfusion? Sheehan's, blood loss due to pregnancy causes pituitary insufficiency

4. Four months after a cholecystectomy for removal of gallstones, a 43-year-old woman has recurrent episodes of biliary colic. After endoscopic sphincterotomy, the episodes of colic do not recur. Which of the following defects in the sphincter of Oddi best explains this patient’s course?
A. Inability of smooth muscle to contract
B. Inability of the enteric nervous system to activate excitatory motoneurons
C. Loss of enteric inhibitory motor innervation
D. Reflux of duodenal contents into the common bile duct
E. Release of vasoactive intestinal polypeptide

I went with loss of enteric inhibitory motor innervation since everything else seems to relax smooth muscles

5. Man with nausea, vomiting, abdominal pain, tachycardia, absent bowel sounds, involuntary guarding, rebound tenderness.
A. Cholecystitis
B. Gastritis
C. Gastroenteritis
D. Peritonitis
E. Small bowel obstruction

I picked small bowel obstruction. same here

6. Baby with 4 x 4 cm mass posterior to right sternocleidomastoid muscle. Mass is unilocular, filled with watery fluid, and no other abnormalities are present.
A. Branchial cyst
B. Cystic hygroma
C. Preauricular sinus
D. Thyroglossal duct cyst
E. Zenker’s diverticulum

I chose Branchial cyst, but according to the internet, those are usually anterior to the sternocleidomastoid muscle. branchial cyst sounds good to me

7 . A woman has ringing in her ears and dizziness 7 days after starting a drug. What is she on?
A. Acetaminophen
B. Aspirin
C. Auranofin
D. Methotrexate
E. Prednisone

I couldn't find those side effects listed for any of the drugs, although I did see dizziness listed for methotrexate and prednisone. side effects of aspirin include fever, tinnitus, and initial respiratory alkalosis

Just my $.02