NBME 11 question

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What about the woman that undergoes kidney and bone marrow transplant. She is not on immunosuppresants and doesn't not reject the organ. The transplanted bone marrow is producing what phenomenon?
Co stimulation
Hypersensitivity
Senescence
Surveillance
Tolerance

Originally Posted by homefree

What about the woman that undergoes kidney and bone marrow transplant. She is not on immunosuppresants and doesn't not reject the organ. The transplanted bone marrow is producing what phenomenon?
Co stimulation
Hypersensitivity
Senescence
Surveillance
Tolerance

Tolerance - just think of what each option means. Costimulation makes no sense as that's related to activation of T and B cells. Hypersensitivity also makes no sense as some hypersensitivity reactions actually mediate rejection. Surveillance means that the immune system is constantly removing malignant cells all the time (not applicable here). Senescence refers to physiologic aging, which also has nothing to do with this.

Think of it this way as well: the bone marrow is "tolerating" the body because it's not recognizing it as foreign and therefore not initiating graft vs. host.

Injury to the ureter during salpingo-oophorectomy with ligation of which of the following arteries?

A. Internal Iliac
B. Ovarian
C. Pudendal
D. Superior vesicle
E. Ureteric branches of renal artery.

Its not A. Was looking for uterine artery but it didn't have it. Picked int iliac because isn't the uterine a branch off of it?

56 YO woman with breast Ca. Xray of chest shows tumor next to the right side of the heart. What structure is most likely involved? Sorry there was a CT to go along with this.

Coronary Sinus
Greater splanchnic vein
Right phrenic N.
Right vagus N.
Thoracic duct


During an experiment the US11 gene product of CMV is expressed constitutively after stable transfection in an experimental tumor cell line. It is found that this gene product causes Translocation of nascent class I MHC molecules from the ER to the cytosol. Which of the following is most likely to occur regarding the class I MHC products?

A) Associated with invariate chain
B.) binding of peptides from the endocytic pathway
C.) Degredation by the proteasome
D.) formation of Class I MHC/classII MHC hybrid molecules
E.) Interaction with the T-lymphocyte receptor



41 YO woman brought to the ER because of pelvic pain. Heavy menstrual periods during past 3 months. Tumor in the left ovary. Oophorectomy is scheduled. During the procedure, which of the following structures immediately deep to the infundibulopelvic (suspensory) ligament must be protected while isolating and ligating the ovarian vessels in this ligament?

A) Hypogastric N.
B) lumbosacral trunk
C) Round ligament
D) Sympathetic Trunk
E) Ureter




Thanks.


Man I really don't know what to do about pelvic anatomy. I've watched the kaplan video but it didn't really seem to help or teach me much that was new. I've done all the Uworld, USMLERx, and Kaplan Qbank questions on anatomy. What else can I do?

Originally Posted by engineeredout

Injury to the ureter during salpingo-oophorectomy with ligation of which of the following arteries?

A. Internal Iliac
B. Ovarian
C. Pudendal
D. Superior vesicle
E. Ureteric branches of renal artery.

Its not A. Was looking for uterine artery but it didn't have it. Picked int iliac because isn't the uterine a branch off of it?

56 YO woman with breast Ca. Xray of chest shows tumor next to the right side of the heart. What structure is most likely involved? Sorry there was a CT to go along with this.

Coronary Sinus
Greater splanchnic vein
Right phrenic N.
Right vagus N.
Thoracic duct


During an experiment the US11 gene product of CMV is expressed constitutively after stable transfection in an experimental tumor cell line. It is found that this gene product causes Translocation of nascent class I MHC molecules from the ER to the cytosol. Which of the following is most likely to occur regarding the class I MHC products?

A) Associated with invariate chain
B.) binding of peptides from the endocytic pathway
C.) Degredation by the proteasome
D.) formation of Class I MHC/classII MHC hybrid molecules
E.) Interaction with the T-lymphocyte receptor



41 YO woman brought to the ER because of pelvic pain. Heavy menstrual periods during past 3 months. Tumor in the left ovary. Oophorectomy is scheduled. During the procedure, which of the following structures immediately deep to the infundibulopelvic (suspensory) ligament must be protected while isolating and ligating the ovarian vessels in this ligament?

A) Hypogastric N.
B) lumbosacral trunk
C) Round ligament
D) Sympathetic Trunk
E) Ureter




Thanks.


Man I really don't know what to do about pelvic anatomy. I've watched the kaplan video but it didn't really seem to help or teach me much that was new. I've done all the Uworld, USMLERx, and Kaplan Qbank questions on anatomy. What else can I do?

1. Ovarian, I think.

2. I got this wrong, so I'm not sure.

3. Degraded by proteasome I think. This is a viral defense mechanism which prevents the MHC I from getting to the surface. In the cytosol it would be quickly chopped up.

4. Ureter - runs directly posterior to the suspensory ligament in the pelvis.

For pelvic anatomy just to get a spatial understanding I would recommend looking at an atlas to get a general idea of the layout.

2 is phrenic nerve

Originally Posted by Encephalectomy

2 is phrenic nerve

Thanks. That was a really crappy radiograph

also, 1 was tricky, what they wanted you to get is that its a salpingo-oopherectomy, but they didn't take out the uterus, so didnt take the uterine artery. Pelvic anatomy is definitely tricky, I'd second what arc said and spend time looking at an atlas.

Originally Posted by engineeredout

Injury to the ureter during salpingo-oophorectomy with ligation of which of the following arteries?

A. Internal Iliac
B. Ovarian
C. Pudendal
D. Superior vesicle
E. Ureteric branches of renal artery.

Its not A. Was looking for uterine artery but it didn't have it. Picked int iliac because isn't the uterine a branch off of it?

56 YO woman with breast Ca. Xray of chest shows tumor next to the right side of the heart. What structure is most likely involved? Sorry there was a CT to go along with this.

Coronary Sinus
Greater splanchnic vein
Right phrenic N.
Right vagus N.
Thoracic duct


During an experiment the US11 gene product of CMV is expressed constitutively after stable transfection in an experimental tumor cell line. It is found that this gene product causes Translocation of nascent class I MHC molecules from the ER to the cytosol. Which of the following is most likely to occur regarding the class I MHC products?

A) Associated with invariate chain
B.) binding of peptides from the endocytic pathway
C.) Degredation by the proteasome
D.) formation of Class I MHC/classII MHC hybrid molecules
E.) Interaction with the T-lymphocyte receptor



41 YO woman brought to the ER because of pelvic pain. Heavy menstrual periods during past 3 months. Tumor in the left ovary. Oophorectomy is scheduled. During the procedure, which of the following structures immediately deep to the infundibulopelvic (suspensory) ligament must be protected while isolating and ligating the ovarian vessels in this ligament?

A) Hypogastric N.
B) lumbosacral trunk
C) Round ligament
D) Sympathetic Trunk
E) Ureter




Thanks.


Man I really don't know what to do about pelvic anatomy. I've watched the kaplan video but it didn't really seem to help or teach me much that was new. I've done all the Uworld, USMLERx, and Kaplan Qbank questions on anatomy. What else can I do?

Ovarian artery: the ureters are posterior to the ovarian arteries at that level.

Right phrenic, because that is what innervates the pericardium. (Ever wonder why people with heart attacks get left shoulder pain? referred pain to the dermatomes....)

Degradation by the proteasome.
This one you can either work up, reasoning that the tumor will now express something pro-viral infection.. or just have read that Clinical Correlate in the Kaplan Microbiology chapter discussing how CMV can downregulate MHC 1, NK receptors... but are susceptible to ADCC.

Ureter is the answer. See above

Previously healthy 20 y.o. primigravid women at 12 weeks gestation comes in with a painful swelling underneath right breast - its a 2x2 skin colored mass with a nipple in the center on the chest wall just inferior to the right breast. what would be the dominant cell type in mass biopsy?

a - epithelial
b -lymphocytes
c - macrophages
d - mast cells
e - neutrophils

Originally Posted by Merit2011

Previously healthy 20 y.o. primigravid women at 12 weeks gestation comes in with a painful swelling underneath right breast - its a 2x2 skin colored mass with a nipple in the center on the chest wall just inferior to the right breast. what would be the dominant cell type in mass biopsy?

a - epithelial
b -lymphocytes
c - macrophages
d - mast cells
e - neutrophils

I thought it was a supernumerary nipple, so I put down A

That was the right answer

thanks for the reply....would you happen to know the pathogenesis associated with this? is it directly related to the pregnancy or a spontaneous growth?

Originally Posted by Merit2011

thanks for the reply....would you happen to know the pathogenesis associated with this? is it directly related to the pregnancy or a spontaneous growth?

Again I'm not even sure what this was referring to.

All I know is that epithelial was the right answer according to expanded feedback

Thanks for the input - its been helping a lot. Had a question of my own

Drug used preop to inhibit regurgitation and pul aspiration of gastric contents. It causes decreased gastric emptying and relieves N/V.

Ondansetron
Dronabinol
Misoprostol
Metoclopramide
Scopolamine

Is it scopolamine?

Also, if you decrease cutoff to PPD test from 10 to 5 mm induration what does this do to the prevalence and incidence of the PPD test results? Does it decrease both?

Originally Posted by sincity college

Thanks for the input - its been helping a lot. Had a question of my own

Drug used preop to inhibit regurgitation and pul aspiration of gastric contents. It causes decreased gastric emptying and relieves N/V.

Ondansetron
Dronabinol
Misoprostol
Metoclopramide
Scopolamine

Is it scopolamine?

I thought it was Ondansetron -- which is the d.o.c. for post-chemo n/v. Since it's a 5HT antagonist, it also decreases gastric/intestinal motility/peristalsis. I don't have expanded feedback so I'm not sure if that's the right answer. Others can chime in.

Originally Posted by MsKrispyKreme

I thought it was Ondansetron -- which is the d.o.c. for post-chemo n/v. Since it's a 5HT antagonist, it also decreases gastric/intestinal motility/peristalsis. I don't have expanded feedback so I'm not sure if that's the right answer. Others can chime in.

i put ondansetron and i got it wrong in the feedback.....i googled all of the drugs and they are all used to treat some amount of N/V. but im now pretty sure the answer is metaclopromide -

metoclopramide used to relieve heartburn and speed healing of ulcers and sores in esophagus in GERD – also used to relieve symptoms caused by slow stomach emptying in diabetics (N/V, heartburn, loss of appetite, feeling of fullness. (class of prokinetic agents – works by speeding up movement of food through stomach and intestines)

Originally Posted by Merit2011

i put ondansetron and i got it wrong in the feedback.....i googled all of the drugs and they are all used to treat some amount of N/V. but im now pretty sure the answer is metaclopromide -

metoclopramide used to relieve heartburn and speed healing of ulcers and sores in esophagus in GERD – also used to relieve symptoms caused by slow stomach emptying in diabetics (N/V, heartburn, loss of appetite, feeling of fullness. (class of prokinetic agents – works by speeding up movement of food through stomach and intestines)

Yea you're right. Just looked it up in Pharmcards and gastric emptying is italicized.

Originally Posted by Merit2011

i put ondansetron and i got it wrong in the feedback.....i googled all of the drugs and they are all used to treat some amount of N/V. but im now pretty sure the answer is metaclopromide -

metoclopramide used to relieve heartburn and speed healing of ulcers and sores in esophagus in GERD – also used to relieve symptoms caused by slow stomach emptying in diabetics (N/V, heartburn, loss of appetite, feeling of fullness. (class of prokinetic agents – works by speeding up movement of food through stomach and intestines)

Ohhhh...thanks!

That was a tricky one...

For the euthyroid in pregnancy with a TSH of 2 and T4 of 14. What causes these findings?

Androgens
Progesterone
Estrogen
Prolactin
Corticosteroids

Is it estrogens?

Originally Posted by sincity college

For the euthyroid in pregnancy with a TSH of 2 and T4 of 14. What causes these findings?

Androgens
Progesterone
Estrogen
Prolactin
Corticosteroids

Is it estrogens?

Yep. Increased TBH, so T4 goes up.

My fellow Classmates recently took this exam. I know you're all looking for answers! Ask away!

Originally Posted by ScubaStarved

You're leaving out the pivotal points and making this impossible for us to answer: he was on the max dose for like 2 months and had blood levels <30% of lower end of normal. The max dose wouldn't be the max dose if induction of a P450 enzyme made it ineffective or there was significant tolerance (in the normal population). He's obviously got an inherited defect which is increasing the clearance.

Answer B should read: inheritance of 1 *amplified* locus and is the correct answer. (It is a gain of function mutation and thus would exhibit an autosomal dominant inheritance pattern.)

(You could imagine a variation on this question in which some drug's active metabolite does not reach therapeutic levels due to two inactivated alleles.)

I did get this Q right but I had to make the jump that inheritance of an amplified locus --> gain of function. I guess what I'm saying is: the term "amplified locus" seems pretty ambiguous. It could be CAG repeats... anything. Or does it by definition mean extra copies of the gene.

I apologize in advance for asking these questions. But these were essentially 90% of the questions I got wrong. For all of these I narrowed it down to two choices and got it wrong. IMO it had to do more with logic than knowledge, and I'd like to see your guys' thought process. Couldn't find too much help on wiki/researching. Thanks for your help!



1) Normally pretty good with endocrinology so don't know why I got TWO calcium homeostasis questions wrong!

Both questions were about renal insufficiency:
I put Ca2+ down, Phosphate down, PTH up for both questions

Can you tell me what's wrong with my logic? Lack of Vit D hydroxylation --> decreased Ca2+ AND phosphate reabsorption from gut --> low Ca2+ --> increases PTH

I'm going to go out on a limb and say that phosphate went up due to PTH's effect? But how would you know which effect dominates... Vitamin D's decrease in Ca2+ reabsorption vs. PTH's decrease in phosphate excretion?

2) 37 y.o patient comes in w/pain and swelling and stiffness of hands and wrists. Bilateral MCP and PIP involvement. What is the cause of her symptoms?

- So I'm thinking Rheumatoid arthritis and narrowed choices down to:
A) Cartilage degeneration
B) Systemic Inflammatory disease

I put cartilage degeneration. Pannus formation occurs --> cartilage destruction. I'm guessing answer was Systemic Inflammatory Disease. Wtf. I mean I know RA is systemic in nature, but cartilage degeneration seemed like the most direct answer to explain her symptoms


3) The lung biopsy histo pic. THe pt. with the bone marrow graft complicated by GVD. Cause of respiratory symptoms? nonproductive cough, bilateral crackles

- I put Influenza but was wrong.. had no idea what it was.


4) woman w/ 2nd degree burns on thigh. Explain wound contracture?
I put crosslinking.. but was the answer myofibroblasts? that's sounds like such a "muscle" term or something involved in muscle repair

5) Teenage Santa Claus face. What do you say?
I put "can you tell me how often you go out in the sun and what you use?"

Was the answer, "It's upsetting when you have a skin problem on your face"
--> If so, that sounds SOOOO damn bitchy! wtf?


6) Graph with the dual "Not infected" and "Infected" humps.
- I always get these questions wrong and never understood the point. Is there a name for these graphs and anyone have any resources to understand them??

7) ANOVA? dammit I put t-test... stupid mistake

8) Angiogram of head --> I put PCA ... could not for the life of me figure out what it was. I knew it was wrong but what else just goes straight up like that? I'm so used to seeing Circle of Willis in cross section!

9) Turner syndrome. Oocyte donation or surrogate?
Well with Turner's you have a streak gonad. So what exactly does that entail? Do you still have eggs stored in the ovary... and the ovaries don't function? That's what I thought and I picked oocyte donation --> WRONG

10) HSV.. was the answer incidence will decrease by half?
Is the logic that: fewer outbreaks of herp, fewer spreading of dz? That's on the assumption you can only spread during an outbreak... which I thought was false....

11) Glucagon Q: starving. Importance of adipocytes?
- Why not glucagon activates glycerol utilization as a source for gluconeogenesis by adipocytes. Isn't this how fat is used?

12) Restless leg syndrome. D2 agonist?
Picked Levodopa, it was wrong. Choices were Baclofen, Gabapentin, Ropinirole, Selegiline

13) Newborn died. Brain autopsy. What happened?
- Picked hypoxia-ischemia.. looked like liquefactive necrosis. No idea what the answer could be. Choices: AV malformation, Germinal matrix hemorrhage, Hyperbilirubinemia, Hypoxia-ischemia, Transtentorial herniation

14) Man this question bothered me the MOST BY FAR. I spent about 8 minutes on it.

45 yr old woman, 3 month history decreased energy and concentration. Tingling in both hands, constipation, 4lb wt gain. Appears apathetic. --> so you're thinking hypothyroidism until here

Then they say: coarse hair, doughy skin, tapping median nerves results in parasthesias. Relaxation of muscle stretch reflexes is slowed. All these sound like hypoparathyroidism signs. I put that down. Wrong!

1. Actually the secondary hyperparathyroidism should cause phosphate levels to go down (increased excretion) but remember you are dealing with chronic kidney disease which means there is impared phosphate excretion, so it builds up in the blood. I also got both questions wrong and that frustrated me a lot. So now I won't be making the same mistake but too bad I didn't get any calcium homeostasis questions on my exam.

2. Cartilage degeneration I think refers to osteoarthritis. In RA it's mainly the inflammation that causes damage.

3. I got this one right but don't remember the details. It would help if you posted the question and choices.

4. Yes, myofibroblasts. They were the only contractile cells mentioned.

5. Yeah, I think "It's upsetting when you have a skin problem on your face" is the right answer. Sometimes on these B.S. (double entendre intended) questions all you need to do is repeat what the patient says.

6. What are you talking about here? Something to do with calibrating the sensitivity/specificity of diagnostic tests?

7. Yeah, ANOVA compares >2 means. I answered chi-square but that apparently compares categorical values.

8. ACA

9. Ovaries are useless in Turner's so you need a surrogate.

10. Again I don't remember this too clearly but if you are talking about using acyclovir for HSV then you may be right: it's effective in prophylaxis against repeated outbreaks, so it would decrease incidence.

11. Adipocytes can't do gluconeogenesis. That only happens in the liver. Also, only the liver can incorporate glycerol since adipocytes lack glycerol kinase.

12. Levodopa is a dopamine precursor. Ropinirole is the only dopamine analog among the choices.

13. Germinal matrix hemorrhage/intraventricular hemorrhage.

14. Still hypothyroidism. Not sure about the paresthesias, but all the rest, including delayed reflexes, point to hypothyroidism.

There was a question concerning gastric lap band surgery, and I think the question was which ligament should the band be placed around. Does anybody know the correct answer? I don't remember the answer choices. (I don't have expanded feedback.)

Originally Posted by MsKrispyKreme

There was a question concerning gastric lap band surgery, and I think the question was which ligament should the band be placed around. Does anybody know the correct answer? I don't remember the answer choices. (I don't have expanded feedback.)

lesser omentum

11) Glucagon Q: starving. Importance of adipocytes?
- Why not glucagon activates glycerol utilization as a source for gluconeogenesis by adipocytes. Isn't this how fat is used?


11. Adipocytes can't do gluconeogenesis. That only happens in the liver. Also, only the liver can incorporate glycerol since adipocytes lack glycerol kinase.


Is the answer glucagon activates hormone sensitive lipase?

Originally Posted by sincity college

11) Glucagon Q: starving. Importance of adipocytes?
- Why not glucagon activates glycerol utilization as a source for gluconeogenesis by adipocytes. Isn't this how fat is used?


11. Adipocytes can't do gluconeogenesis. That only happens in the liver. Also, only the liver can incorporate glycerol since adipocytes lack glycerol kinase.


Is the answer glucagon activates hormone sensitive lipase?

I actually don't remember the question and choices anymore, so not sure about the answer. But it is true that glucagon activates HSL.

Originally Posted by event horizon

I actually don't remember the question and choices anymore, so not sure about the answer. But it is true that glucagon activates HSL.

Yes that was the answer (Expanded feedback)

1. A female newborn dies at 12days. Photograph with yellow stuff. I put germinal matrix hemorrhage which was wrong. is it hyperbilirubinemia?

2. 25 yo M with Type 1 DM..... Which of the following hepatic enzymes is most likely initially exercise by exercise in this patient.

3. So for lupus nephrotic ... how does DNA get out for anti-DNA/DNA complex. IS that the right answer? I put auto-AB to podocyte Ag.

4. What causes cleft lip?

5. How does Sabin and Salk protect? neutralizing Ab in the circulation?

6. The pregnant woman with 2x2 --> painful swelling?

Originally Posted by abmd

1. A female newborn dies at 12days. Photograph with yellow stuff. I put germinal matrix hemorrhage which was wrong. is it hyperbilirubinemia?

2. 25 yo M with Type 1 DM..... Which of the following hepatic enzymes is most likely initially exercise by exercise in this patient.

3. So for lupus nephrotic ... how does DNA get out for anti-DNA/DNA complex. IS that the right answer? I put auto-AB to podocyte Ag.

4. What causes cleft lip?

5. How does Sabin and Salk protect? neutralizing Ab in the circulation?

6. The pregnant woman with 2x2 --> painful swelling?

1) Yes, it's kernicterus

2) Phosphorylase kinase (think back to your college biochemistry class for this one... debranching enzyme is farther down the pathway)

3) Lupus nephritis is a Type 3 HS.. so yes Ag-Ab complex is correct

4) Fusion of medial nasal to palatine process (or something of that nature)

5) Yes

6) 2 x 2? are you referring to the euthyoid patient with high T4? Increased estrogens --> increases TBP --> increases total T4 without increasing free T4.

Originally Posted by SlaveOfTCMC

1) Yes, it's kernicterus

2) Phosphorylase kinase (think back to your college biochemistry class for this one... debranching enzyme is farther down the pathway)

3) Lupus nephritis is a Type 3 HS.. so yes Ag-Ab complex is correct

4) Fusion of medial nasal to palatine process (or something of that nature)

5) Yes

6) 2 x 2? are you referring to the euthyoid patient with high T4? Increased estrogens --> increases TBP --> increases total T4 without increasing free T4.

thanks. Sorry for 6. it's the breast one. It was for 2 days sounded like inflammation but ...?

Originally Posted by abmd

1. A female newborn dies at 12days. Photograph with yellow stuff. I put germinal matrix hemorrhage which was wrong. is it hyperbilirubinemia?

2. 25 yo M with Type 1 DM..... Which of the following hepatic enzymes is most likely initially exercise by exercise in this patient.

3. So for lupus nephrotic ... how does DNA get out for anti-DNA/DNA complex. IS that the right answer? I put auto-AB to podocyte Ag.

4. What causes cleft lip?

5. How does Sabin and Salk protect? neutralizing Ab in the circulation?

6. The pregnant woman with 2x2 --> painful swelling?

4. Maxillary and medialnasal process fusion

My friend took the real exam a couple days ago and said he got a question on baclofen and had no idea what drug that was. I asked him if he had taken NBME 11 and he said no, he opted with 6,7 and 12 instead.

Turns out baclofen was asked on 11... so take that for however you want regarding these NBMEs and how they correlate to the real thing.

Hi everyone

Here is a question I had trouble with. Unfortunately, I dont have expanded feedback so i need to paraphrase from memory.

"A woman with history of IV drug abuse and scars in the antecubital fossa with heart murmur and perihilar infiltrates. These infiltrates have foreign particles surrounded by..."

Answer choices that I remember are granulation tissue, neutrophils, macrophages... I put granulation tissue because I thought it was chronic inflammation caused by septic emboli leading to fibrosis. Could be abscesses with neutrophils. Or perhaps other things that I am not thinking of.

Originally Posted by event horizon

8. ACA

13. Germinal matrix hemorrhage/intraventricular hemorrhage.

Thanks for your help on the other answers! I still had 2 questions about these two questions... neuroanatomy not surprisingly

8. ACA.
The image was a view of the brain from behind, so how did you decide it was ACA. I can't find a similar view image on the net, so was wondering how you decided on that rather than PCA.

13. Also cluelss on how you got this one right.

Originally Posted by hyrule

Thanks for your help on the other answers! I still had 2 questions about these two questions... neuroanatomy not surprisingly

8. ACA.
The image was a view of the brain from behind, so how did you decide it was ACA. I can't find a similar view image on the net, so was wondering how you decided on that rather than PCA.

13. Also cluelss on how you got this one right.

8. You don't even need the image to answer this one. From what I recall, the stem said patient had lower leg weakness? If so, all you need to know is the homonculous (however you spell it) and know that ACA supplies medial portion of brain which on homonculus is lower extremities.

PCA would have visual problems which wasn't listed.

13. most common cause of intraventricular hemorrhage in premature infants is germinal matrix hemorrhage

Originally Posted by sincity college

8. You don't even need the image to answer this one. From what I recall, the stem said patient had lower leg weakness? If so, all you need to know is the homonculous (however you spell it) and know that ACA supplies medial portion of brain which on homonculus is lower extremities.

PCA would have visual problems which wasn't listed.

13. most common cause of intraventricular hemorrhage in premature infants is germinal matrix hemorrhage

damn, good point.. can't believe I skimmed over that.

And to the guy above ^, answer was macrophages. Don't remember anything about granulomas and IV drug use from my studying, but you don't even need to know that. But "particles surrounded by..." gave it away. You should be thinking Giant Cells, which are a collection of macrophages that wall off stuff.

Originally Posted by sincity college

My friend took the real exam a couple days ago and said he got a question on baclofen and had no idea what drug that was. I asked him if he had taken NBME 11 and he said no, he opted with 6,7 and 12 instead.

Turns out baclofen was asked on 11... so take that for however you want regarding these NBMEs and how they correlate to the real thing.

Yup Baclofen has been popping up in other NBMEs as well (as an answer choice, but it was never the correct answer). So has Bosentan, which maybe briefly mentioned in FA.

And FA now has all those new Parkinsonian drugs. Previously all I remembered was BALSA (bromcriptine, amantidine, levodopa, selegiline, anti-muscarinics.. like benztropine). Turns out we gotta know a lot more like the non-bolded ones lol

Originally Posted by hyrule

Thanks for your help on the other answers! I still had 2 questions about these two questions... neuroanatomy not surprisingly

8. ACA.
The image was a view of the brain from behind, so how did you decide it was ACA. I can't find a similar view image on the net, so was wondering how you decided on that rather than PCA.

13. Also cluelss on how you got this one right.

No prob! I think the ACA question was answered sufficiently by sincity college. About #13. I think the other guys are right, this was probably kernicterus. Can you check the picture and see if you got a yellow brain? Since I didn't see the picture I just assumed germinal matrix hemorrhage - but I think I was just remembering a UWorld question. On one of the NBMEs (I took all of them so sorry I don't remember which) I remember seeing a yellow brain and answering kernicterus.

Originally Posted by event horizon

No prob! I think the ACA question was answered sufficiently by sincity college. About #13. I think the other guys are right, this was probably kernicterus. Can you check the picture and see if you got a yellow brain? Since I didn't see the picture I just assumed germinal matrix hemorrhage - but I think I was just remembering a UWorld question. On one of the NBMEs (I took all of them so sorry I don't remember which) I remember seeing a yellow brain and answering kernicterus.

It was a yellow brain and looked kinda liquidy on the top left. I've never even heard the term Germinal Matrix hemorrhage before. I assumed with hemorrhage you'd see dark red, or black or something indicating bleeding.

Originally Posted by stimuluspackage

Hi everyone

Here is a question I had trouble with. Unfortunately, I dont have expanded feedback so i need to paraphrase from memory.

"A woman with history of IV drug abuse and scars in the antecubital fossa with heart murmur and perihilar infiltrates. These infiltrates have foreign particles surrounded by..."

Answer choices that I remember are granulation tissue, neutrophils, macrophages... I put granulation tissue because I thought it was chronic inflammation caused by septic emboli leading to fibrosis. Could be abscesses with neutrophils. Or perhaps other things that I am not thinking of.

It was the granuloma formation

Goljan's notes themselves even pointed this out.

Originally Posted by hyrule

It was a yellow brain and looked kinda liquidy on the top left. I've never even heard the term Germinal Matrix hemorrhage before. I assumed with hemorrhage you'd see dark red, or black or something indicating bleeding.

Right. And I also assumed that you would see hemorrhage into the actual ventricles with a germinal matrix hemorrhage. The site of liquefactive necrosis was in the cerebral cortex though (if I remember that question correctly). I chose hyperbilirubinemia/kernicterus for that one because I saw so much yellow stuff in the basal ganglia. Can somebody post the pic in question? And paraphrase the question stem?

Microscopic examination of urine shows atypical cells. A CT scan of the abdomen discloses a lesion of the right kidney as shown in the photograph. Which of the following compounds is i most significant predisposing risk factor for patient's condition?
a) arsenic
b) beryllium
c) 2-Napthylamine
d) nickel
e) Vinyl Chloride

Does napthylamine cause kidney cancer? I picked arsenic since it is a component of cigarette smoke...

Originally Posted by MedSchoolRox

Microscopic examination of urine shows atypical cells. A CT scan of the abdomen discloses a lesion of the right kidney as shown in the photograph. Which of the following compounds is i most significant predisposing risk factor for patient's condition?
a) arsenic
b) beryllium
c) 2-Napthylamine
d) nickel
e) Vinyl Chloride

Does napthylamine cause kidney cancer? I picked arsenic since it is a component of cigarette smoke...

Look closely, the tumor is on the renal pelvis (and thus ureters)

Napthylene is an aniline dye --> transitional cell carcinoma.


Arsenic causes angiosarcoma of the liver.

Study of hemoglobin properties. Increased H+ in blood. Results show dissociation curve shift to right.

"This effect will most likely result in which of the following processes?"

A. Binding of CO in tissue capillaries
B. Binding of oxygen in lungs
C. Decrease in RBC 2,3-BPG concentration
D. Increase in RBC 2,3-BPG concentration
E. Release of carbon dioxide in the lungs
F. Release of oxygen in tissue capillaries


So looking back I guess F is the most "direct" answer for what is going on since a right shift decreases affinity for oxygen?

Originally Posted by Scean

Study of hemoglobin properties. Increased H+ in blood. Results show dissociation curve shift to right.

"This effect will most likely result in which of the following processes?"

A. Binding of CO in tissue capillaries
B. Binding of oxygen in lungs
C. Decrease in RBC 2,3-BPG concentration
D. Increase in RBC 2,3-BPG concentration
E. Release of carbon dioxide in the lungs
F. Release of oxygen in tissue capillaries


So looking back I guess F is the most "direct" answer for what is going on since a right shift decreases affinity for oxygen?

yes it is

Originally Posted by MsKrispyKreme

Right. And I also assumed that you would see hemorrhage into the actual ventricles with a germinal matrix hemorrhage. The site of liquefactive necrosis was in the cerebral cortex though (if I remember that question correctly). I chose hyperbilirubinemia/kernicterus for that one because I saw so much yellow stuff in the basal ganglia. Can somebody post the pic in question? And paraphrase the question stem?

Germinal matrix hemorrhage is not the right answer. I picked it because I remember encountering a similar question in Robin's Qbook. It was one of the question in my expanded feedback.

I think people are getting confused here. The germinal matrix question was unrelated to the kernicterus question. They were 2 entirely differently questions and images - albeit both might have been in the answer choices.

Originally Posted by sincity college

I think people are getting confused here. The germinal matrix question was unrelated to the kernicterus question. They were 2 entirely differently questions and images - albeit both might have been in the answer choices.

I remember only one question ... The brain was yellow it was a 12 day old kid i think?