NBME 11 question

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I have some questions if people can help me that would be great

6 y.o girl brought to the physician bc of swollen, itchy eyes, runny nose
ans: Occupation of parents?

generalized crackles of someone who recently have GVHD; xray of the chest shows bilateral interstitial infiltrates
ans: CMV?

concentration of drug measured by specific assay, results are shown, what explains the two-phase results?
ans: rapid distribution to tissues followed by normal elimination?

female newborn delivered at term is found to have cleft palate and cleft lip bilaterally
ans: maxillary and nasal prominence?

gastric reduction operation, to encircle the stomach, the band will pass through which of the following structures?
ans: lesser omentum?

left ovarian mass is found on pelvic examination which lymph node involved?
ans: para-aortic?

is VSD failure of fusion of interventricular septum with endocardial cushions

thx, i will probably have more questions again soon

Originally Posted by jetspeeder

I have some questions if people can help me that would be great

6 y.o girl brought to the physician bc of swollen, itchy eyes, runny nose
ans: Occupation of parents?

need other choices

generalized crackles of someone who recently have GVHD; xray of the chest shows bilateral interstitial infiltrates
ans: CMV?

need other choices

concentration of drug measured by specific assay, results are shown, what explains the two-phase results?
ans: rapid distribution to tissues followed by normal elimination?

yes

female newborn delivered at term is found to have cleft palate and cleft lip bilaterally
ans: maxillary and nasal prominence?

yes

gastric reduction operation, to encircle the stomach, the band will pass through which of the following structures?
ans: lesser omentum?

yes

left ovarian mass is found on pelvic examination which lymph node involved?
ans: para-aortic?

yes

is VSD failure of fusion of interventricular septum with endocardial cushions

yes

thx, i will probably have more questions again soon

need the answer choices for first 2, don't remember

Originally Posted by sincity college

need the answer choices for first 2, don't remember

sorry about that

the grl w/ swollen itchy eyes
a. new meds
b. new pet in household
c. occupations of parents
d. recent illness in family
e. recent school performance

the one w/ the GVHD there's a photomicrograph of lung biopsy
a. adenovirus
b. CMV
c. enterovirus
d. influenza
e. measles
f. papilloma
g. parainfluenza
h. RSV
i. rhinovirus
j. VZV

Also, don't know if you remember the question on rabies; people say it's bats, I was wondering why it's not dogs (bc there's no bite mark?).

Originally Posted by jetspeeder

concentration of drug measured by specific assay, results are shown, what explains the two-phase results?
ans: rapid distribution to tissues followed by normal elimination?

Can someone explain this one? I forgot what I put but I was thinking zero order drug that got saturated. I guess that doesn't make sense.

Originally Posted by jetspeeder

sorry about that

the grl w/ swollen itchy eyes
a. new meds
b. new pet in household
c. occupations of parents
d. recent illness in family
e. recent school performance

the one w/ the GVHD there's a photomicrograph of lung biopsy
a. adenovirus
b. CMV
c. enterovirus
d. influenza
e. measles
f. papilloma
g. parainfluenza
h. RSV
i. rhinovirus
j. VZV

Also, don't know if you remember the question on rabies; people say it's bats, I was wondering why it's not dogs (bc there's no bite mark?).

new pets
CMW - there is an owl's eye in the histo pic
rabies - going caving --> bats is much more common than dogs in USA

thx abmd and sincity for answering my questions, can you explain why it's new pets? I was thinkin conjunctivitis but now i'm sure i was on the wrong track.

and for this one
increase in myocardial cell diameter compared with normal myocardium from the same heart and blebbing of the sarcolemma
was it decreased sacrolemma ATP? thanks so much again

Originally Posted by silverpaw54

Can someone explain this one? I forgot what I put but I was thinking zero order drug that got saturated. I guess that doesn't make sense.

For saturation of enzymes to occur, it should occur earlier on and the curve had a decreasing slope (the 2nd line). there was 1 bolus of infusion, not a continuous infusion.

The concentration of the drug dropped fast in the beginning and then started slowly dropping which coincides with rapid distribution (since they measured plasma conc) to tissues and then slowly getting eliminated. hope this helped

Anyone get the one with the heart valve on x ray and they asked what valve was most likely replaced. Can anyone take me through the reasoning, i picked mitral which was obviously wrong

Originally Posted by WBC45

Anyone get the one with the heart valve on x ray and they asked what valve was most likely replaced. Can anyone take me through the reasoning, i picked mitral which was obviously wrong

It's too low to be aortic or pulmonary and on the lateral xray it's more anterior and we know that the right ventricle/atrium is more anterior compared to the other two.

Did you get the question on the swollen and itchy eyes? I still dont know why it's pets...

Originally Posted by jetspeeder

Did you get the question on the swollen and itchy eyes? I still dont know why it's pets...

I took that as a...when people get swollen and itchy eyes, they're usually allergic to something...prolly pets. That's the kind of allergy my dad gets when he's around cats.

Haha, I didn't think too much about it, I guess.

*brought to you by your extremely scientific news source.

Originally Posted by quepatho

I took that as a...when people get swollen and itchy eyes, they're usually allergic to something...prolly pets. That's the kind of allergy my dad gets when he's around cats.

Haha, I didn't think too much about it, I guess.

*brought to you by your extremely scientific news source.

Thanks! this is the 2nd time i missed a question like that, the other one was the one in UW about animal dander

Originally Posted by jetspeeder

Thanks! this is the 2nd time i missed a question like that, the other one was the one in UW about animal dander

Yeah I'm sorry I didn't have better reasoning for that. Maybe someone else will have a better answer.

your reasoning is totally legit to me, i think too much and overlook simple explanations sometimes

Originally Posted by jetspeeder

sorry about that

the grl w/ swollen itchy eyes
a. new meds
b. new pet in household
c. occupations of parents
d. recent illness in family
e. recent school performance

the one w/ the GVHD there's a photomicrograph of lung biopsy
a. adenovirus
b. CMV
c. enterovirus
d. influenza
e. measles
f. papilloma
g. parainfluenza
h. RSV
i. rhinovirus
j. VZV

Also, don't know if you remember the question on rabies; people say it's bats, I was wondering why it's not dogs (bc there's no bite mark?).

I agree "new pets" (allergic reactions to animal dander are much more common than the other choices listed) and "bats". Dogs in the U.S. are not common carriers of rabies b/c of our vaccination program. For the GVHD question, I don't remember the photomicrograph so I can't help there.

Dogs are most common cause of rabies in India (and i presume other 3rd worlds, but india its #1) just if they switch up the question stem a bit from dude from rural Illinois to dude from rural India. Easy way to trick people up

Skunks are most common in US also, then bats and raccoons.

http://en.wikipedia.org/wiki/Receptor_theory

It has to do with the concept of "spare receptors."

Simply put, low doses of the noncompetitive antagonist leave enough receptor around such that saturation of those still reaches VMax.

At higher doses when more receptors are bound noncompetitively, that is when Vmax begins to fall.

can someone explain the answer to the one with the female with fatigue, nausea, generalized bone pain, renal insufficiency, serum urea nitrogen concentration is 55 mg/dl serum creatinine is 4 mg/dl x ray shows widened osteoid seams. i read the earlier posts but i dont really know what they are talking about...

so she has multiple myeloma? that's what others kept saying... or is it just renal osteodystrophy?

is the answer decreased calcium, increased phosphorus, increased PTH, decrease VitD?

1) 66 year old man with hypertension, DM type 2 brought into ER with sudden onset of left eye dropping, double vision, and mild weakness of hand and legs. BP 155/99 mg hg. Exam shows droopy left eye and in primary gaze, the left eye is exotropic and somewhat lower than the right. Also slowed finger movement on right, pronator drift, and mild hyperreflexia (all on right side).
lesion and diganosis?
a)angular gyrus (gerstman syn)
b)dorsal lateral thalmus (dejerine-roussy syn)
c)Lower meddula (wallengburg)
d)lower midbrain (weber)
e) upper spinal cord (horners)

is it e?


2) 6 year old boy with fever and sever paroxysmal barking coughs. Has not been immmunized. leuckocyte count 30,000 (75%). Neutrophil chemotaxis and oxidative metabolism are defective due to increased activity of?

a) adenyl cyclase
b) myelporoxidase
c) NADPh oxidase
d) phospholipase C
e) proteri kinase c



thanks!!!

Originally Posted by ar2388

does anyone know the asnwer tothe question were they show the 1 yr old with the 2 day hx of diaper rash, 6 day hx of temperature, swelling of hands and feet. face and lips are red and conjuctivae appear injected. bilateral cervical lymphadenopathy ad S3 gallop with no murmur. edema and erythema on hands and feet.

a- acute arteritis with aneurysms in coronary arteries
b - epidermal hyerplasia with epidermal microabscesses and parakeratosis
c- granulomas with caseous necrosis and cervical LN's
d - granulomatous arteritis in cervical and temporal arteries
e - paracortical lymphoid hyerplasia with eosinophilic intranucelar inclusions in perihilar LN's

i can tell you its not e..

I picked A, and it didnt show up wrong in the extended feedback...

Originally Posted by doc95380

1) 66 year old man with hypertension, DM type 2 brought into ER with sudden onset of left eye dropping, double vision, and mild weakness of hand and legs. BP 155/99 mg hg. Exam shows droopy left eye and in primary gaze, the left eye is exotropic and somewhat lower than the right. Also slowed finger movement on right, pronator drift, and mild hyperreflexia (all on right side).
lesion and diganosis?
a)angular gyrus (gerstman syn)
b)dorsal lateral thalmus (dejerine-roussy syn)
c)Lower meddula (wallengburg)
d)lower midbrain (weber)
e) upper spinal cord (horners)

is it e?


2) 6 year old boy with fever and sever paroxysmal barking coughs. Has not been immmunized. leuckocyte count 30,000 (75%). Neutrophil chemotaxis and oxidative metabolism are defective due to increased activity of?

a) adenyl cyclase
b) myelporoxidase
c) NADPh oxidase
d) phospholipase C
e) proteri kinase c



thanks!!!

havent done those questions yet but i would think it's adenyl cyclase for whooping cough and Weber syndrome (CN III problem, eye is esotropic, CN III palsy causes ptosis and there's contralateral hemiplegia/hemiparesis), not sure though

Originally Posted by jetspeeder

havent done those questions yet but i would think it's adenyl cyclase for whooping cough and Weber syndrome (CN III problem, eye is esotropic, CN III palsy causes ptosis and there's contralateral hemiplegia/hemiparesis), not sure though

yep. the first one was indeed Weber syndrome. (Cross CheCk FIrst Aid Neuro Chapter for more details.

And the seCond one does refer to pertussis. The lymphoCytes may throw people off and make them think of parainfluenza (barking Cough), but one simply has to know that it is the exCess cAMP that prevents neutrophil demargination. Moreover, pertussis has something Called "lymphoCytosis aCtivating faCtor" and prevents lymphoCytes from entering lymph nodes. Or something to that extent (i am giving my own limited interpretation of how it works)

I need some help with these Q's. Some graphs and pics are attached. Thank you everyone!

1. What kind of drug is it based on graph (see attached)?
-Competitive reversible agonist
-Full agonist
-inverse agonist
-noncompetitive agonist
-partial agonist

2. 25 yo man comes in with SOB and chest pain during exercise. Has asthma and major depressive disorder...tempt and bp normal, RR=30, Osat =93%. No murmurs or increased JVP (Lab: Hgb=13, pH=7.46, pCO2=26, PO2=60). A chest x-ray is shown (attached). What pul finding most likely?
-Crackles on left lung base and apex
-Crackles on the right lung base
-Decreased breath sounds on let
-Increased wheezes on the left
-Rhonchi on the right

3. Crohn's assoc with changes in integrity with which epith defect?
-Tight junc
-Adherens
-Gap
-Basement membrane
-desmosomes

4. Osteogenesis imperfecta is AD disorder charac by remarkably wide variety of manifestations that include fracture easily, blue sclerae (etc etc). Which of the following is most likely explanation for pleiotropic effects of OI gene?
-Contiguous gene deletion
-Expression of a defective gene in multiple tissues
-Loss of imprinting at multiple loci
-Somatic loss of heterozygosity in alleles
-Variable trinucleotide repeat

Originally Posted by doc95380

I picked A, and it didnt show up wrong in the extended feedback...

Yeah this is Kawasaki's

1. What kind of drug is it based on graph (see attached)?
-Competitive reversible agonist
-Full agonist
-inverse agonist
-noncompetitive agonist (someone explained this a few posts above)
-partial agonist

2. 25 yo man comes in with SOB and chest pain during exercise. Has asthma and major depressive disorder...tempt and bp normal, RR=30, Osat =93%. No murmurs or increased JVP (Lab: Hgb=13, pH=7.46, pCO2=26, PO2=60). A chest x-ray is shown (attached). What pul finding most likely?
-Crackles on left lung base and apex
-Crackles on the right lung base
-Decreased breath sounds on let (looks like a pneumothorax.. note the flattened diaphragm on 1 side and the increase in air on that side)
-Increased wheezes on the left
-Rhonchi on the right

3. Crohn's assoc with changes in integrity with which epith defect?
-Tight junc (tight junctions prevent leakage of stuff)
-Adherens
-Gap
-Basement membrane
-desmosomes

4. Osteogenesis imperfecta is AD disorder charac by remarkably wide variety of manifestations that include fracture easily, blue sclerae (etc etc). Which of the following is most likely explanation for pleiotropic effects of OI gene?
-Contiguous gene deletion
-Expression of a defective gene in multiple tissues (concept of pleitropy)
-Loss of imprinting at multiple loci
-Somatic loss of heterozygosity in alleles
-Variable trinucleotide repeat[/QUOTE]

Thanks guys!

Question about the two polio vaccines. The common features of the two vaccines, which accounts for their efficacy is their ability to induce which of the following poliovirus-specific immune responses?
D. Neutralizing Abs in the circulation
E. Neutralizing secretory IgA Abs in the gut

I came across a UWorld question that is similar to this that stated the the oral, Sabin vaccine would induce mucosal IgA Abs, whereas the killed vaccine would not. Based off of that knowledge, I would go with D, but I'm not sure how that would be protective of Polio if it's spread fecal-orally. Sorry, just confused w/ UWorld's explanation.

Originally Posted by silverpaw54

Question about the two polio vaccines. The common features of the two vaccines, which accounts for their efficacy is their ability to induce which of the following poliovirus-specific immune responses?
D. Neutralizing Abs in the circulation
E. Neutralizing secretory IgA Abs in the gut

I came across a UWorld question that is similar to this that stated the the oral, Sabin vaccine would induce mucosal IgA Abs, whereas the killed vaccine would not. Based off of that knowledge, I would go with D, but I'm not sure how that would be protective of Polio if it's spread fecal-orally. Sorry, just confused w/ UWorld's explanation.

Only the Sabin vaccine induces mucosal IgA, similar to how the nasal flu vaccine does but the injected form does not. Secretory IgA does not form from antigens injected into the blood stream, only to antigens directly exposed to mucosal surfaces. The Sabin vaccine gives an extra layer of protection because you have the extra antibodies preventing attachment in the gut, on top of protective antibodies circulating in the blood. Another interesting thing is that Sabin vaccine can actually be spread through fecal-oral methods because the viruses are attenuated. This can be helpful in developing countries, because the vaccine is spread to people who haven't actually take the pill. This is also the bad thing about it, because it can have an effect in immunocompromised people who incidentally are exposed to it. The Salk vaccine is still effective because you have protective antibodies in the blood - even though it is spread fecal-oral, it still has to disseminate through the blood after it gets through the mucosa.

anyone get the question with the pregnant woman and the image- was that acute pyleonephritis- i couldnt tell and picked somehting else but there didnt seem to be any inflammatory infiitrate

So what is the answer for Sabin vs Salk question?

Changing my post. Dont want to get in trouble for posting copyrighted material, so i'll just summarize the gist of qs

Is melanin made in melanosomes?

Dude with alzheimer's. Tx with AchE inhibitor helps memory by targeting synapses where?

Woman with recurrent Ca Oxalate stones. What is the MOA of a drug to decr urine [Ca]?

Direct course of catheter from femoral a -> leiomyomata?

Originally Posted by whitestripes

Changing my post. Dont want to get in trouble for posting copyrighted material, so i'll just summarize the gist of qs

Is melanin made in melanosomes?

Dude with alzheimer's. Tx with AchE inhibitor helps memory by targeting synapses where?

Woman with recurrent Ca Oxalate stones. What is the MOA of a drug to decr urine [Ca]?

Direct course of catheter from femoral a -> leiomyomata?

Yes melanosomes. Check wiki

Basal forebrain and cerebral hemisphere or something of that extent

Thiazides reabsorb calcium in the DCT

femoral artery --> external iliac a --> internal iliac a --> uterus area.

Originally Posted by whitestripes

Changing my post. Dont want to get in trouble for posting copyrighted material, so i'll just summarize the gist of qs

Is melanin made in melanosomes?

Dude with alzheimer's. Tx with AchE inhibitor helps memory by targeting synapses where?

Woman with recurrent Ca Oxalate stones. What is the MOA of a drug to decr urine [Ca]?

Direct course of catheter from femoral a -> leiomyomata?

I believe the dude with alzheimers was treated with Ache inhibitors and if you remember ACh is synthesized in nuceleus basalis of meynert in in the BASAL forebrain

woman with recurrent oxoalate stones use thiazide dieuretic acts on distal convulted tubule.

Originally Posted by abmd

So what is the answer for Sabin vs Salk question?

I remember putting D b/c I thought only the oral vaccine (Sabin) involved mediating immunity in the gut mucosa (and secretory IgA).

Originally Posted by MsKrispyKreme

I remember putting D b/c I thought only the oral vaccine (Sabin) involved mediating immunity in the gut mucosa (and secretory IgA).

Thanks, Was D right?

How does kawasaki explain all the symptoms in the question? It seemed like an infection to me because, but I also thought kawaski might be hitting the kidney causing the edema...

any clarification would be appreciated!

Originally Posted by jejun

How does kawasaki explain all the symptoms in the question? It seemed like an infection to me because, but I also thought kawaski might be hitting the kidney causing the edema...

any clarification would be appreciated!

Kawasaki occurs in infants, has fever, conjunctivitis, changes in oral mucosa, lymphadenopathy, and a rash.

Can anyone explain the breast one? Why is it epithelial cells, it seems to be some sort of inflammation?

Originally Posted by abmd

Can anyone explain the breast one? Why is it epithelial cells, it seems to be some sort of inflammation?

Inflammatory process.. with a nipple on top of it? Nothing about this screamed inflammation to me. (I may be thinking of a different question.)

Personally I thought it was just a supernumerary nipple, but I can't say that for certain other than the fact there were no problems and it was described as being on the milk line

oh lol, went back and read the question ... completely was reading it wrong. thanks! and what was the right answer again epithelial cells?

Originally Posted by abmd

oh lol, went back and read the question ... completely was reading it wrong. thanks! and what was the right answer again epithelial cells?

yes, that was not marked wrong in the expanded feedback

Originally Posted by SlaveOfTCMC

yes, that was not marked wrong in the expanded feedback

Thanks!!!

No, it wasn't pathological inflammation. It's just that supernumerary nipples respond to hormones just like regular breast tissue so with the menstrual cycle, you can get enlargement/tenderness and with pregnancy, you can even get some galactorrhea.

Hi,
I took nbme 7 and then nbme 11 about 10 days later. Ended up getting the same score. I thought nbme 11 was way harder than 7.
getting the same score good or bad? any thoughts?

Originally Posted by doc95380

Hi,
I took nbme 7 and then nbme 11 about 10 days after. Ended up getting the same score. I thought nbme 11 was way harder than 7.
getting the same score good or bad? any thoughts?

I got a lower score on NBME 11 after taking NBME 7 (a week earlier).

I think we're all finding out together what it all "means".

so i guess for boards purposes someone working with insulation has asbestos exposure? For some reason i though silica was in insulation.

Question had a CXR with major stuff in the L chest and the stem gave a "anaplastic, biphasic neoplasm that expresses calretinin and cytokeratin but not carcinoembryonic antigen"

Asked what else you would find...

I put silica crystals, other choices included

Ferrunginous bodies ---> probably correct indicating asbestos?
Dense core secretory granules (chromaffin cells?)
Birbeck granules (langerhans cells)
Signet ring cells (krukenberg tumor cells)

Anybody want to elaborate on the info given by the cellular descriptions?
cytokeratin --> squamous cell carcinoma
biphasic?
calretinin?
(-) CEA?

Originally Posted by Scean

so i guess for boards purposes someone working with insulation has asbestos exposure? For some reason i though silica was in insulation.

Question had a CXR with major stuff in the L chest and the stem gave a "anaplastic, biphasic neoplasm that expresses calretinin and cytokeratin but not carcinoembryonic antigen"

Asked what else you would find...

I put silica crystals, other choices included

Ferrunginous bodies ---> probably correct indicating asbestos?
Dense core secretory granules (chromaffin cells?)
Birbeck granules (langerhans cells)
Signet ring cells (krukenberg tumor cells)

Anybody want to elaborate on the info given by the cellular descriptions?
cytokeratin --> squamous cell carcinoma
biphasic?
calretinin?
(-) CEA?

I got that question wrong too, but a quick search on google seems to indicate that cytokeratin and calretinin are associated with mesothelioma. Biphasic is also a histological subtype of mesothelioma. CEA would be positive in lung adenocarcinoma, so they were probably just trying to say that it wasn't an adenocarcinoma. The mesothelioma was associated with asbestos as you mentioned, so they were looking for ferruginous bodies.

Originally Posted by Scean

so i guess for boards purposes someone working with insulation has asbestos exposure? For some reason i though silica was in insulation.

Question had a CXR with major stuff in the L chest and the stem gave a "anaplastic, biphasic neoplasm that expresses calretinin and cytokeratin but not carcinoembryonic antigen"

Asked what else you would find...

I put silica crystals, other choices included

Ferrunginous bodies ---> probably correct indicating asbestos?
Dense core secretory granules (chromaffin cells?)
Birbeck granules (langerhans cells)
Signet ring cells (krukenberg tumor cells)

Anybody want to elaborate on the info given by the cellular descriptions?
cytokeratin --> squamous cell carcinoma
biphasic?
calretinin?
(-) CEA?

Mesothelioma. The CXR had an entire section of PLEURA blocked out. That's literally all I used to answer the question. So the answer would be Ferruginous bodies

So I know this post was from a while ago and someone said the answer was C b/c the question mentioned pain and damage to motor branches wouldn't cause pain. I would have picked D b/c I'm pretty sure the palmar cutaneous branch doesn't go through the carpal tunnel....and seems to me the question is saying something in the carpal tunnel was damaged. Is it for sure D though? I guess I thought if you damaged a nerve it could cause shooting pain no matter what the function of the nerve but maybe that's wrong....

Originally Posted by ar2388

clearly i dont know my anatomy.. any idea what the answer is to this one?

6 weeks after undergoing open carpal tunnel release operation, 44 yr old woman .... an intraoperative nerve injury is suspected. which of the following nerves is likely injured in this pt?

a) dorsal sensory branch of the ulnar n
b) lateral cutaneous nerve of the forearm
c) palmar cutaneous branch of the median n
d) recurrent motor branch of the median n
e) sensory branch of the radial n

i thought d...?

Maybe someone can help with this one: US11 gene product of CMV causes translocation of nascent class 1 mhc molecules from ER to cytosol. which will occur regarding the mhc class 1 products?
a. assoc with invariant chain
b. binding of peptides from endocytic pathway (wrong)
c. degradation by proteasome (is it this?)
d. formation of class 1 mhc/class 2 mhc hybrid
e. interaction with t lympho receptor