NBME 11 question

[Master Deep]

Can anyone whos done NBME 11 explain how to figure out the serum protein electrophoresis question. 12 yr old boy admitted to hospital because of lethary, hip pain and fever. hes been admitted many times becaues of pneumonia. And then it gives the diff kinds of serum protein electrophoresis.
Thanks!

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[Podie]

I think someone already answered this and the answer was C.

A doesn't make sense 'cause that is involved in MHCII pathway FA pg202 (also http://en.wikipedia.org/wiki/CD74).
B I think is also referring to MHCII where antigen is loaded onto MHC protein after endocytosis by APC cells
D I don't think means anything....
E is what happens normally.

As I understand if proteins are just hanging out not doing their job they will be degraded by proteases in the cell.

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

 

[quepatho]

I think someone already answered this and the answer was C.

A doesn't make sense 'cause that is involved in MHCII pathway FA pg202 (also http://en.wikipedia.org/wiki/CD74).
B I think is also referring to MHCII where antigen is loaded onto MHC protein after endocytosis by APC cells
D I don't think means anything....
E is what happens normally.

As I understand if proteins are just hanging out not doing their job they will be degraded by proteases in the cell.

Thank you for explaining all the answer choices. Very helpful, I was so confused about this question, too.

 

[dkb86]

Thank you for explaining all the answer choices. Very helpful, I was so confused about this question, too.

yes thanks everyone!

 

[cetona]

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....

The question mentioned numbness over the thenar eminence as one of the initial symptoms, indicating it was probably a sensory thing over motor. Additionally, the fact that the nerve is in that area means it could be damaged during the surgery - it doesn't matter that it doesn't actually go through the carpal tunnel.

 

[jetspeeder]

can someone tell me if these are the right answers, thanks!

Two programs for the treatment of patients with newly detected hypercholestrolemia were tried in a community.Program A was used in one district of the community and program B was used in another.After four yrs 45% of the 2200 patients on program A and 49% of the 1900 patients on program B had been successfully treated for hypercholestrolemia.The difference between the success rates for the two programs was stastically significant pvalue is less than .01.Health officials however decided not to change to Program B in the 1st district because the magnitude of the difference was so small.Which of the following best explains their decision ?

A)They attributed the difference in success rate to chance alone
B)They distinguished between statistical significance and practical importance of the difference in success rates.
C)They felt the p value was too small to justify a decision in favor pf program B
D)They felt the samples were too small to justify a decision in favor of Program B

I think A, I saw some B's?

Increase in serum concentration in a diabetic after exercising, which enzyme is activated first?
ans: phosphorylase kinase?

 

[abmd]

can someone tell me if these are the right answers, thanks!

Two programs for the treatment of patients with newly detected hypercholestrolemia were tried in a community.Program A was used in one district of the community and program B was used in another.After four yrs 45% of the 2200 patients on program A and 49% of the 1900 patients on program B had been successfully treated for hypercholestrolemia.The difference between the success rates for the two programs was stastically significant pvalue is less than .01.Health officials however decided not to change to Program B in the 1st district because the magnitude of the difference was so small.Which of the following best explains their decision ?

A)They attributed the difference in success rate to chance alone
B)They distinguished between statistical significance and practical importance of the difference in success rates.
C)They felt the p value was too small to justify a decision in favor pf program B
D)They felt the samples were too small to justify a decision in favor of Program B

I think A, I saw some B's?

Increase in serum concentration in a diabetic after exercising, which enzyme is activated first?
ans: phosphorylase kinase?

It is B. I put that and it didn't come up as wrong. yep phosphorylase kinase.

 

[jetspeeder]

Thx abmd, now that i re-read it A) cannot make sense bc the p value is so low

what was the one with the Turner syndrome about getting pregnant? oocyte donation, surrogate? someone earlier said surrogate and idk how that makes sense can someone explain

 

[abmd]

Thx abmd, now that i re-read it A) cannot make sense bc the p value is so low

what was the one with the Turner syndrome about getting pregnant? oocyte donation, surrogate? someone earlier said surrogate and idk how that makes sense can someone explain

it is not a surrogate. it is donation. you can give them drugs to maintain preg but they have failed ovaries so no egg.

 

[jetspeeder]

it is not a surrogate. it is donation. you can give them drugs to maintain preg but they have failed ovaries so no egg.

That's what my reasoning was too so I was really confused at what someone was saying earlier in the thread, thanks so much.

 

[Premedico]

Does anyone know the answer to this one?

A female newborn dies at the age of 12. (Picture of brain at autopsy is shown). The newborn was most likely affected by which of the following?

-hyperbilirubinemia
-AV malformation
-germinal matrix hemorrhage
-hypoxia/ischemia
-transtentorial herniation

Thanks!

 

[abmd]

Does anyone know the answer to this one?

A female newborn dies at the age of 12. (Picture of brain at autopsy is shown). The newborn was most likely affected by which of the following?

-hyperbilirubinemia
-AV malformation
-germinal matrix hemorrhage
-hypoxia/ischemia
-transtentorial herniation

Thanks!

I put germinal matrix which was wrong, the consensus is hyperbili.

 

[Premedico]

I put germinal matrix which was wrong, the consensus is hyperbili.

Thank you. I had chosen hypoxia/ischemia and of course it was wrong.

Do you know what clues/key words one could have used to figure out that it's hyperbilirubin?

 

[event horizon]

Thank you. I had chosen hypoxia/ischemia and of course it was wrong.

Do you know what clues/key words one could have used to figure out that it's hyperbilirubin?

the brain looked yellow

 

[abmd]

.

 

[Mace1370]

A 5-year-old girl is brought to a new physician by her mother for an examination prior to attending kindergarden. Her mother says, "My daughter has a murmur, but I was told that she'd grow out of it." They mention a grade 2/6 systolic murmur over the left sternal border and then they give pressure and O2 sat for various locations. They wanted to know what failed during her development.

Options were:
Closure of the ductus venosus
Closure of foramen ovale (what I put)
Development of the septum secundum
Fusion of the interventricular septum with endocardial cushions
Reabsorption of the septum primum

 

[Scean]

gotta see those sat %'s they give the answer

 

[jetspeeder]

A 5-year-old girl is brought to a new physician by her mother for an examination prior to attending kindergarden. Her mother says, "My daughter has a murmur, but I was told that she'd grow out of it." They mention a grade 2/6 systolic murmur over the left sternal border and then they give pressure and O2 sat for various locations. They wanted to know what failed during her development.

Options were:
Closure of the ductus venosus
Closure of foramen ovale (what I put)
Development of the septum secundum
Fusion of the interventricular septum with endocardial cushions
Reabsorption of the septum primum

I think it was a VSD

 

[Mace1370]

I think it was a VSD

Awesome, thanks

 

[doc95380]

Does anyone know the answer to this one?

A female newborn dies at the age of 12. (Picture of brain at autopsy is shown). The newborn was most likely affected by which of the following?

-hyperbilirubinemia
-AV malformation
-germinal matrix hemorrhage
-hypoxia/ischemia
-transtentorial herniation

Thanks!

hyperbil

 

[Mandy22]

35.
During a study of the response of renal tubular cells to ischemic injury, the blood supply to the kidneys in experimental animals is interrupted for variable lengths of time. The renal tubular cells then are examined by light and electron microscopy. The presence of which of the following features would definitively indicate irreversible injury to the renal tubular cells?

Blunting of microvilli
Cellular swelling
Disaggregation of ribosomes
Disruption of the plasma membrane
Loosening of intercellular attachments
Your answer is indicated by the filled-in circle.

Can someone help me with this please? Thanks.

 

[MsKrispyKreme]

35.
During a study of the response of renal tubular cells to ischemic injury, the blood supply to the kidneys in experimental animals is interrupted for variable lengths of time. The renal tubular cells then are examined by light and electron microscopy. The presence of which of the following features would definitively indicate irreversible injury to the renal tubular cells?

Blunting of microvilli
Cellular swelling
Disaggregation of ribosomes
Disruption of the plasma membrane
Loosening of intercellular attachments
Your answer is indicated by the filled-in circle.

Can someone help me with this please? Thanks.

Disruption of the plasma membrane should be the correct answer. It is an irreversible process.

 

[mrmandrake]

Anyone know the answer to this one?

A 32-year-old African American man comes to the physician for a routine health maintenance examination. He feels well and has no history of
serious illness. His brother received the diagnosis of anemia at the age of 20 years. The patient’s pulse is 76/mm, respirations are 16/mm, and
blood pressure is 128/68 mm Hg. Examination shows no abnormalities.

Laboratory studies show:
Hemoglobin 11 g/dL
Mean corpuscular volume 70 pm3
Red cell distribution width 13% (N=13%—15%)
Serum Ferritin 200 ng/mL
Iron 150 pg/dL

A blood smear shows hypochromic microcytic erythrocytes with occasional target cells. Which of the following is most likely to confirm the
diagnosis?

A) Hemoglobin electrophoresis
B) Measurement of serum TSH
C) Measurement of serum vitamin B12
D) Colonoscopy
E) Bone marrow biopsy


I put "E", I thought it might be sideroblastic anemia. I got it wrong though. Thanks!

 

[Mandy22]

Can someone please explain/help with these?
12.
A study is conducted to assess the accuracy of a new rapid test to detect a virulent bacterial infection. This infection has an 80% mortality rate if it is not identified early in its course; however, prompt administration of antibiotics decreases the mortality rate to less than 5%. The risks of this antibiotic therapy are minimal. A total of 10,000 participants are enrolled and undergo assessment with the new test. The graph shows the distribution of infected and noninfected participants according to the results of the test. Which of the following labeled points is most appropriate for use as the optimal diagnostic cut point for results of this test?


7.
A 57-year-old woman is brought to the emergency department because she has been unable to open her left eye since she awoke 2 hours ago. She has no history of trauma to the eye. Her vital signs are within normal limits. When the left eyelid is raised during examination, her eye is fixed in the out position. When the patient is asked to move her eye out, the eye intorts. An MRI of the brain shows an aneurysm of the left posterior communicating artery. The most likely cause of this patient's condition is compression of which of the following nerves?

Abducens nerve
Long ciliary nerve
Oculomotor nerve
Ophthalmic branch of the trigeminal nerve
Trochlear nerve


38.
A 5-year-old boy with asthma is brought to the physician because of a 3-month history of recurrent cough, intermittent wheezing, and difficulty breathing. He has been admitted to the hospital twice for pneumonia during the past 12 months. He is at the 60th percentile for height and the 50th percentile for weight. His respirations are 25/min. Wheezing and crackles are heard between only the fourth to the sixth intercostal spaces on the right side of the chest. Diminished tactile fremitus and dullness are present over the right anterior section of the chest between the 4th and 6th ribs. Results of a PPD test are negative. A lateral chest x-ray shows a wedge-shaped density extending anteriorly and inferiorly from the hilum. A CT scan of the chest is most likely to show obstruction of which of the following bronchi?

Left main-stem
Left upper lobe
Right lower lobe
Right main-stem
Right middle lobe
Your answer is indicated by the filled-in circle.


14.
A lesion of which of the following lettered structures results in loss of the pupillary light reflex in the left eye when light is shone into either eye?


49.
A 1-year-old boy is brought to the physician for a well-child examination. Physical examination shows pallor. Laboratory studies show:
Hemoglobin 8.5 g/dL
Hematocrit 26%
Erythrocyte count 2.1 million/mm3
Mean corpuscular volume 65 μm3 (N=70–86)
Reticulocyte count 0.5%
Leukocyte count 8000/mm3 with a normal differential
Platelet count 480,000/mm3

A peripheral blood smear is shown in the photomicrograph. Which of the following is the most likely diagnosis?

Acute lymphoblastic leukemia
Folic acid deficiency
Iron deficiency anemia
Sickle cell disease
Vitamin B12 (cobalamin) deficiency


1.
A 63-year-old woman with an 18-year history of type 2 diabetes mellitus has decreased visual acuity. Funduscopic examination of both eyes shows hemorrhages and "cotton wool" spots. Which of the following is the predominant underlying pathologic condition in this disease?


Atherosclerosis
Microangiopathy
Optic neuritis
Thrombosis
Vasculitis


3.
A 5-year-old girl is brought to the physician because of a 1-year history of generalized tonic-clonic seizures that occur more frequently when she has a fever. Her 3-year-old brother has had similar episodes. Neurologic examination shows no abnormalities. Genetic testing shows a mutation affecting one of the subunits of the γ-aminobutyric acidA receptor. Which of the following mechanisms is the most likely cause of seizures in this patient?

Decreased postsynaptic calcium influx
Decreased postsynaptic chloride influx
Decreased presynaptic calcium influx
Increased postsynaptic potassium influx
Increased presynaptic chloride influx
Increased presynaptic potassium influx



15.
A 50-year-old man is brought to the emergency department 45 minutes after he was found unresponsive at home. He has a 3-day history of progressive lethargy and increasingly severe headache. He hit his head in a fall 4 weeks ago; at that time, he did not seek medical attention. He appears stuporous. His pulse is 60/min, and blood pressure is 150/90 mm Hg. Neurologic examination shows right hemiparesis. A CT scan of the head without contrast is shown. The most likely cause of this patient's condition is bleeding from which of the following structures?

Arteriovenous malformation
Berry aneurysm
Bridging cortical vein
Middle meningeal artery
Superior sagittal sinus
Your answer is indicated by the filled-in circle.



18.
A 24-year old man has had a purulent urethral discharge and dysuria for the past 2 days. Microscopic examination of a Gram stain of the urethral exudate shows gram-negative intracellular diplococci. He is treated with a standard dose of ceftriaxone. The symptoms disappear in 2 days but a mucoid discharge appears 10 days after treatment. Which of the following is the most likely explanation for the reappearance of symptoms?


Ceftriaxone does not penetrate host cells
The patient was initially infected with both Neisseria gonorrhoeae and Chlamydia trachomatis
The patient was reinfected by an untreated sexual partner
The patient's strain of Neisseria gonorrhoeae developed resistance to ceftriaxone


32.
Alveolar ventilation and CO2 production double during moderate exercise in a 48-year-old man. Which of the following best describes the effect on arterial Pco2?


Divided by 4
Divided by 2
Not changed
Doubled
Quadrupled

 

[mrmandrake]

@Mandy22

Someone correct me if I'm wrong but here's what I got:

12. B is the most point that makes the most sensitive test that is a good screening test

7. Oculomotor = medial rectus is involved and eyelid too

38. Right middle lobe = not sure why I guessed right though, I just thought the middle lobe is around the 4th rib

14. Because it's either eye it's an efferent defect so probably oculomotor nerve

49. Iron deficiency anemia = MCV is low and hypochromic picture

1. Microangiopathy = main mechanism of diabetes eye pathology

3. Decreased postsynaptic chloride influx = just think of what benzodiazepines do, they increase the chloride influx so if you have decreased influx you are prone to seizures

15. Bridging cortical vein = subdural hematoma

18. He has Chlamydia too

32. Not changed

 

[MsKrispyKreme]

Anyone know the answer to this one?

A 32-year-old African American man comes to the physician for a routine health maintenance examination. He feels well and has no history of
serious illness. His brother received the diagnosis of anemia at the age of 20 years. The patient’s pulse is 76/mm, respirations are 16/mm, and
blood pressure is 128/68 mm Hg. Examination shows no abnormalities.

Laboratory studies show:
Hemoglobin 11 g/dL
Mean corpuscular volume 70 pm3
Red cell distribution width 13% (N=13%—15%)
Serum Ferritin 200 ng/mL
Iron 150 pg/dL

A blood smear shows hypochromic microcytic erythrocytes with occasional target cells. Which of the following is most likely to confirm the
diagnosis?

A) Hemoglobin electrophoresis
B) Measurement of serum TSH
C) Measurement of serum vitamin B12
D) Colonoscopy
E) Bone marrow biopsy


I put "E", I thought it might be sideroblastic anemia. I got it wrong though. Thanks!

I remember choosing A for Hb electrophoresis. My reasoning:

They mentioned ethnicity so you have to think --> possible genetic cause of anemia more common among African Americans. Then they mentioned a brother with anemia also --> definitely genetic. He has a microcytic/hypochromic anemia w/ target cells with normal [ferritin] and [Fe] so that rules out iron-deficiency anemia --> order an electrophoresis to confirm a thalassemia.

As a rule of thumb, I always go with the less invasive procedure if I'm confused by two choices, lol. Someone else can feel free to chime in if my answer choice/reasoning is incorrect.

 

[RapplixGmed]

Can anyone whos done NBME 11 explain how to figure out the serum protein electrophoresis question. 12 yr old boy admitted to hospital because of lethary, hip pain and fever. hes been admitted many times becaues of pneumonia. And then it gives the diff kinds of serum protein electrophoresis.
Thanks!

I think in regards to protein electrophoresis all they expected us to know was since Bruton's has agammaglobulinemia, we should identify it with the protein electrophoresis showing gamma-globulin flattening, versus a spike in conditions like MGUS or Multiple Myeloma. I doubt they expect us to know much more in terms of electrophoresis.

Except this is NOT Bruton's agammaglobulinemia. BTK would come out in early childhood and the question says that "His neonatal period is normal." The only thing that can explain this is Common variable immunodeficiency, which has a decreased Ig level but its not anywhere close to zero. Anybody know what the elecrophoresis would look like? I'm actually leaning towards the one where the gamma peak seems to meld into the beta2 peak.

 

[ScubaStarved]

Except this is NOT Bruton's agammaglobulinemia. BTK would come out in early childhood and the question says that "His neonatal period is normal." The only thing that can explain this is Common variable immunodeficiency, which has a decreased Ig level but its not anywhere close to zero. Anybody know what the elecrophoresis would look like? I'm actually leaning towards the one where the gamma peak seems to meld into the beta2 peak.

Neonatal period and early childhood are not the same.

The disease in question is Bruton's and the answer shows an absence of a gamma globulin peak.

 

[Scean]

yeaaaa neonates got that delicious colostrum Ig supply

 

[chieflammy]

Neonatal period and early childhood are not the same.

The disease in question is Bruton's and the answer shows an absence of a gamma globulin peak.

I agree completely. The SPEP is the one shown below (because I got it right). I print-screen all my responses so I know what I got right (especially if I guess!)

 

[wannabedocta]

What was the answer to the 76 yo women who was taking HRT (past 15 years) + Vit D + prednisone for past 2 mo for RA. She had pathologic fractures, the question asked, what was the most likely cause?

a. decreased bone formation due to decreased Ca absorption
b. decreased bone formation due to inhibtion of OB differentiation
c. increased bone resorption due to decreased Ca absorption
d. increased bone resorption due to decreased serum PTH
e. Increased bone resorption due to estrogen receptor defect?

 

[wannabedocta]

What is the answer?

Section 2 ( #50) An investigator is studying oxygen transport in experimental animals. Is it found that Po2 in the renal vein is high compared to venous PO2 in other organs. What is the explanation?

was it Ratio of oxygen consumption to blood flow << in kidneys than in other organs? Can somebody explain?

 

[SeekerOfTheTree]

What is the answer?

Section 2 ( #50) An investigator is studying oxygen transport in experimental animals. Is it found that Po2 in the renal vein is high compared to venous PO2 in other organs. What is the explanation?

was it Ratio of oxygen consumption to blood flow << in kidneys than in other organs? Can somebody explain?

I think in FA it says kidneys get the bluk of the cardiac output which is why it would have an oversupply of oxygen for the work it is doing because so much blood is flowing through it. What were the other choices. I can't remember this one too well.

 

[mrmandrake]

B

what was the answer to the 76 yo women who was taking hrt (past 15 years) + vit d + prednisone for past 2 mo for ra. She had pathologic fractures, the question asked, what was the most likely cause?

A. Decreased bone formation due to decreased ca absorption
b. Decreased bone formation due to inhibtion of ob differentiation
c. Increased bone resorption due to decreased ca absorption
d. Increased bone resorption due to decreased serum pth
e. Increased bone resorption due to estrogen receptor defect?

 

[SeekerOfTheTree]

What was the answer to the 76 yo women who was taking HRT (past 15 years) + Vit D + prednisone for past 2 mo for RA. She had pathologic fractures, the question asked, what was the most likely cause?

a. decreased bone formation due to decreased Ca absorption
b. decreased bone formation due to inhibtion of OB differentiation
c. increased bone resorption due to decreased Ca absorption
d. increased bone resorption due to decreased serum PTH
e. Increased bone resorption due to estrogen receptor defect?

B. Because osteoblast express the RANKL which activate osteoclasts so if you downregulate the RANKL because of Prednisone you kill bone resorption which is necessary for building strong bones. A is not right because she is getting Vit D. C is not right because of same reason. D is not right because PTH increase causes bone resorption. E is not right because why on this earth did she just realize she had an estrogen receptor defect...that *****.

 

[wannabedocta]

The answer choices were:
a. counter-current multiplication in the kidneys allows them to use less O2 for ion transport than other organs
b. PO2 in renal aa. is >> than PO2 in other arteries
c. The ratio of o2 consumption to blood flow << in the kidneys than in other organs
d. Renal blood flow is a smaller fraction of teh C.O. than blood flow in other organs
e. Tissue Po2 is >> in every region of the kidneys

 

[Sheldor]

The answer choices were:
a. counter-current multiplication in the kidneys allows them to use less O2 for ion transport than other organs
b. PO2 in renal aa. is >> than PO2 in other arteries
c. The ratio of o2 consumption to blood flow << in the kidneys than in other organs
d. Renal blood flow is a smaller fraction of teh C.O. than blood flow in other organs
e. Tissue Po2 is >> in every region of the kidneys

C!

A lot of the blood in the kidney is there just to be filtered not to supply oxygen to tissue

 

[wannabedocta]

C!

A lot of the blood in the kidney is there just to be filtered not to supply oxygen to tissue

Ahh. that makes sense. thank you!

 

[combat]

so i just finished form 11, and i got 420/203, and i took nbme 6 last week with same score. what the hell!!!!! i thought i would improve but i am freaking out now my exam is 4 weeks from today. My uworld qbank average is 70% i think 44 % unused. I am not shooting for 240 or 250 . I would be happy with 220 ya all think its possible

 

[bowlofmushypeas]

Anyone understand why the 17 AA y/o with recurrent N meningitidis had C' deficiency > SCDz? I figured since he was 17 already, he'd have autosplenectomy whereas C' deficiency would've shown up at a younger age.

Also, I've been staring at that lung CT one where the person comes in with exercise-induced asthma. I put wheezing on the left but that's definitely wrong.. any ideas?

Finally, the snowboarder with the lateral arm loss was axillary nerve right? I always thought of the lateral arm as being musculocutaneous but I guess your shoulder can be your lateral arm?

Thanks thanks thanks in advance!

 

[kstreet]

B. Because osteoblast express the RANKL which activate osteoclasts so if you downregulate the RANKL because of Prednisone you kill bone resorption which is necessary for building strong bones. A is not right because she is getting Vit D. C is not right because of same reason. D is not right because PTH increase causes bone resorption. E is not right because why on this earth did she just realize she had an estrogen receptor defect...that *****.

Not sure this is accurate.

You want to treat osteporosis by giving anti-resoprtive drugs, basically drugs that reduce osteoclastic activity.

Prednisone causes osteoperosis because of reduced osteoblastic activity (which is necessary to build bone)

 

[Day man]

ok i have some questions, any help would be great:

1. can some one this question, i don't understand this statement: "differing phenotypes based on paternal are most compatible with which of the following genetic mechanisms: a. anticipation b. tri nucelo repeat expansion c. imprinting d. loss of heterozygosity e. pleiotropy

2. Ok 17yo AA male with N.M. infection...evaluate for: SS or Comp. deficiency. More risk factors for SS I thought? Apparently that's wrong, and I don't really understand how we can differentiate either way.

3. Lower threshold for liability in males than females, woman has dz, which relative is at greatest risk for dz? (I'm really bad with genetics, ugh).

4. old woman with renal insuff: my thought process: kidney can't resorb Ca therefore low Ca-->stimulates PTH (elevate PTH)-->PTH wastes PO4 (low PO4)-->alpha1OHlyase isn't fx therefore low Vit. D. What went wrong here?

5. Swollen third nipple...which cell type is present? I thought neutrophils for acute inflammation...is it epi cells?

6. 52 yo woman, DM2, CRF (20%CCr), takes glipizide. Ca/PO4/PTH. apparently I'm an idiot and cannot do these basic endocrine questions. Any help?

7. Salk/Sabin: common link is production of what? CTL in circ?

8. cholinesterase-i aids memory by targeting synapses where?

9. pancreas of 6yo diabetic...atrophy + fibrosis? i can't believe i got some of these wrong

10. Alcoholic with sever hyponat, tx, then develops slurred speech + mod. weakness in all extremities w/ sensation in tact. Where is the lesion?

11. AA male with hypochrom/microcytic anemia, norm Fe, brother dx with anemia at 20yo, what do you do? I put BM biopsy...so it's an electrophoresis. How would the RDW not be high for all the variation in size with the sickled RBCs?

12. Baby with diaper rash...what is going on here?

and last but not least: pharm graph of inhibitor on drug X that varies with low + high []. Not sure what I am missing here.

Thanks for any help, much appreciated!

 

[beachblonde]

ok i have some questions, any help would be great:

1. can some one this question, i don't understand this statement: "differing phenotypes based on paternal are most compatible with which of the following genetic mechanisms: a. anticipation b. tri nucelo repeat expansion c. imprinting d. loss of heterozygosity e. pleiotropy
C. imprinting (I think)

3. Lower threshold for liability in males than females, woman has dz, which relative is at greatest risk for dz? (I'm really bad with genetics, ugh).
look at the rest of the thread, people are saying it's a female baby, higher risk in her brother (1st born males have highest occurrence)

5. Swollen third nipple...which cell type is present? I thought neutrophils for acute inflammation...is it epi cells?
epithelial

7. Salk/Sabin: common link is production of what? CTL in circ?
Ab in circ...the difference that is important here is that the PO vaccine induces production of IgA, but both have circulating Ab

8. cholinesterase-i aids memory by targeting synapses where?
I don't remember the specific answer but it was the only one going to the cerebral cortex


10. Alcoholic with sever hyponat, tx, then develops slurred speech + mod. weakness in all extremities w/ sensation in tact. Where is the lesion?
Brainstem-I believe they were hinting at central pontine myelinolysis

11. AA male with hypochrom/microcytic anemia, norm Fe, brother dx with anemia at 20yo, what do you do? I put BM biopsy...so it's an electrophoresis. How would the RDW not be high for all the variation in size with the sickled RBCs?
That's because it's not sickle cell, it's thalassemia (if I am remembering this correctly)

12. Baby with diaper rash...what is going on here?
Kawasaki disease...so the one with vasculitis & coronary artery aneurysm

Thanks for any help, much appreciated!

Seeing as I just took this, I will help you where I can. I don't remember all of the questions/answers, clearly.

I think you also might be missing out on the concept of secondary hyperparathyroidism in renal failure with high PTH, low Ca, and high PO. There were two questions on that, I believe.

 

[beachblonde]

Anyone understand why the 17 AA y/o with recurrent N meningitidis had C' deficiency > SCDz? I figured since he was 17 already, he'd have autosplenectomy whereas C' deficiency would've shown up at a younger age.

Also, I've been staring at that lung CT one where the person comes in with exercise-induced asthma. I put wheezing on the left but that's definitely wrong.. any ideas?

Finally, the snowboarder with the lateral arm loss was axillary nerve right? I always thought of the lateral arm as being musculocutaneous but I guess your shoulder can be your lateral arm?

Thanks thanks thanks in advance!

I've now seen a bunch of questions regarding teenagers who have C5-C9 deficiency and recurrent infections with Neisseria meningitidis. Seems to be the standard way to ask the concept. It might be because teenagers spend more time in close contact. I would just keep your eyes peeled for that.

The asthma one was not actually an exacerbation of asthma, I'm 99% sure it was a pneumothorax. On the x-ray there was an area where it was super dark where the lung should have been (the terminology is failing me here). So "absent breath sounds" was the right answer.

Can't help you with the snowboarder one, turns out I kinda suck at innervation of the UE so I really need to spend some time on that.

 

[Day man]

Holy crap...i missed Kawasaki dz. Really? Haha. Thanks for the replies! Managed to out think the ones I knew And guess correctly on the ones I didn't...anyone take 12? Thoughts if it's as good as this one (I thought this was tough but pretty fair)?

 

[dude1344]

I have to WTF on the Q about the girl with the santa claus rash. I put the "can you tell me how often you go out blah blah blah." Can someone tell me the right answer and WHY it would be better than this one?

 

[Day man]

I have to WTF on the Q about the girl with the santa claus rash. I put the "can you tell me how often you go out blah blah blah." Can someone tell me the right answer and WHY it would be better than this one?

I definitely laughed when i read that questions...gotta love BRS ethics stuff. I put the empathetic one, "must be difficult having problems with skin on your face", and didn't get it back in my incorrects. I'm guessing that jumping to the inference that it's sun exposure related and just asking diagnostic questions was too mechanical/robot-esque...because the nbme people want us to be feeling. i could be wrong though, kaplan has a "20 rules" for those questions and use empathy is one, but also asking questions is usually never bad. I guess here it wasn't as 'open-ended' as they stress. This explanation probably wasn't very helpful, but at least I told you the right answer haha.

 

[dude1344]

.

 

[DrBB]

Anybody know the answer to this one:

35 year old woman with leiomyomata uteri undergoes an experimental treatment that involves instillation of an embolizing agent directly to the vessels that feed the leiomyomata. During this procedure, in order to reach the involved vessels, which of the following is the most direct course of the catheter after entering the femoral artery?

A) Aorta-->gonadal artery-->uterine artery
B) External iliac artery-->internal iliac artery-->uterine artery
C)External iliac artery-->superior gluteal artery-->uterine artery
D)Internal iliac artery-->inferior vesical artery-->uterine artery
E)Internal iliac artery-->superior vesical artery-->uterine artery

 

[kstreet]

Anybody know the answer to this one:

35 year old woman with leiomyomata uteri undergoes an experimental treatment that involves instillation of an embolizing agent directly to the vessels that feed the leiomyomata. During this procedure, in order to reach the involved vessels, which of the following is the most direct course of the catheter after entering the femoral artery?

A) Aorta-->gonadal artery-->uterine artery
B) External iliac artery-->internal iliac artery-->uterine artery
C)External iliac artery-->superior gluteal artery-->uterine artery
D)Internal iliac artery-->inferior vesical artery-->uterine artery
E)Internal iliac artery-->superior vesical artery-->uterine artery

prett sure its b if they are asking how to get to the uterine directly

 

[wannabedocta]

Yep, I agree. Femoral drains into the external illiac, then at the bifurcation, the catheter can go into internal illiac aa. The internal illiac gives rise to pudendal/gluteal/bladder arteries + uterine artery in females.