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NBME 11 question

Discussion in 'Step I' started by Master Deep, 04.15.11.

  1. jetspeeder

    jetspeeder

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    SDN Members don't see this ad. (About Ads)
    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
  2. sincity college

    sincity college

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

    jetspeeder

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    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?).
  4. silverpaw54

    silverpaw54 Member

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    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.
  5. abmd

    abmd

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    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
  6. jetspeeder

    jetspeeder

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    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
    Last edited: 05.23.11
  7. jetspeeder

    jetspeeder

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    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
  8. WBC45

    WBC45

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    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 :(
  9. jetspeeder

    jetspeeder

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    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...
  10. quepatho

    quepatho

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    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.
  11. jetspeeder

    jetspeeder

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

    quepatho

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

    jetspeeder

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

    MsKrispyKreme The "Hot" sign is on...

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    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.
  15. sincity college

    sincity college

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    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.
    Last edited: 05.23.11
  16. SlaveOfTCMC

    SlaveOfTCMC

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    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.
  17. jetspeeder

    jetspeeder

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    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?
  18. doc95380

    doc95380

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    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!!! :)
  19. doc95380

    doc95380

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

    jetspeeder

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    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
  21. SlaveOfTCMC

    SlaveOfTCMC

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    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)
  22. NoClue

    NoClue

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    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

    Attached Files:

  23. ThereHeIs

    ThereHeIs

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    Yeah this is Kawasaki's
  24. hyrule

    hyrule

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    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]
  25. doc95380

    doc95380

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    Thanks guys!
  26. silverpaw54

    silverpaw54 Member

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    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.
  27. cetona

    cetona

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    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.
  28. WBC45

    WBC45

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    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
  29. abmd

    abmd

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    So what is the answer for Sabin vs Salk question?
  30. whitestripes

    whitestripes

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    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?
    Last edited: 05.24.11
  31. SlaveOfTCMC

    SlaveOfTCMC

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    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.
  32. WBC45

    WBC45

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    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.
  33. MsKrispyKreme

    MsKrispyKreme The "Hot" sign is on...

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

    abmd

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    Thanks, Was D right?
  35. jejun

    jejun

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    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!
  36. sincity college

    sincity college

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

    abmd

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

    ScubaStarved

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

    SlaveOfTCMC

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    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
  40. abmd

    abmd

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

    SlaveOfTCMC

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    yes, that was not marked wrong in the expanded feedback
  42. abmd

    abmd

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    Thanks!!!
  43. MsKrispyKreme

    MsKrispyKreme The "Hot" sign is on...

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    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.
  44. doc95380

    doc95380

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    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?
    Last edited: 05.25.11
  45. quepatho

    quepatho

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    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". :oops:
  46. Scean

    Scean whats a goon to a goblin?

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    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?
  47. cetona

    cetona

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    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.
  48. ArcGurren

    ArcGurren only one will survive

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    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
  49. Podie

    Podie

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    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....



  50. dkb86

    dkb86

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    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
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