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NBME 12 discussion

Discussion in 'Step I' started by titan25, 05.05.11.

  1. SlaveOfTCMC

    SlaveOfTCMC

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    SDN Members don't see this ad. (About Ads)
    Just take it slow... but not too slow (because people who've taken the test tell me some stems are up to 10 lines long with lots of distractors)
  2. SeekerOfTheTree

    SeekerOfTheTree

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    Thanks man. I am going to make sure I do that. I usually speed through and have 30 minutes left on a Uworld block so I should just slow down and use that time.
  3. senseigmg

    senseigmg Junior Member

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    2 month old mice vs. 2 year old mice; decreased response to Chlamydiophila pneumoniae in the older. What is the age related change that caused this decreased response?
    B cells, macrophages, neutrophils, plasma cells, t cells
  4. SeekerOfTheTree

    SeekerOfTheTree

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    I believe t cells is the right answer. I can't remember, but I believe they are the only ones that have regulatory cells that can tone down the immune response. Correct me oh Gods of SDN if I have misspoketh.
  5. SlaveOfTCMC

    SlaveOfTCMC

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    I believe it was T cells because Chlaymdia/Chalmydophila are intracellular bugs
  6. mrmandrake

    mrmandrake

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    I only remember this cause I took it yesterday online with feedback. T cells is the right answer.

    I was debating between T cells and macrophages (also involved in intracellular killing no?) but went with the "higher yield" answer.

  7. senseigmg

    senseigmg Junior Member

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    Nevermind, I just found the answer posted earlier:
    "Using trace metals as the control group, it would have been

    2.3% - 1.3% = 1.0% absolute risk reduction

    Then 1/0.01 = 100"

    Thanks. Next up is a NNT one, I had no idea how to figure out.
    4753 nulliparous women randomized into folate & trace mineral supplement groups. In both groups, 88% of women had pregnancies ending in live birth, late fetal death, still birth, or termination of pregnancy after dx of a defect.
    How many nulliparous women with confirmed pregnancies would have to be treated with folic acid to prevent one congenital anomaly

    Neural tube defects: Folic acid- 0% Trace- 0.29%
    all congenital anomalies: Folic acid- 1.3% Trace- 2.3%
    Last edited: 06.08.11
  8. Ponger

    Ponger

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    7 day old girl vomiting green liquid with distended abdomen? fever (101.8), pulse 165

    a) distention of the hepatic capsule
    b) inflammation of the gall bladder
    c) obstruction of small bowel
    d) rupture of renal cyst
    e) torsion of ovaries

    I know B is not right because that was my answer but can someone else this one to me? Thanks
  9. senseigmg

    senseigmg Junior Member

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    Bile enters the small bowel making it green.

  10. senseigmg

    senseigmg Junior Member

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    Pt. with retinitis & endophthalmitis after 3 mo of being hospitalized for a chronic illness. He's on TPN, and taking broad spectrum antibiotics. They show a gram stain of something almost black, with a tiny red filament. It looks like some of them are budding (probably should've used this clue). How does this reproduce?

    Budding, endospore formation, hyphal fragmentation, mycelia, ovoid conidia
  11. SlaveOfTCMC

    SlaveOfTCMC

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    The diagnosis itself is not very important

    But on the picture, you can clearly see narrow based budding.

    ( I suspect Cryptococcus neoformans. The retinitis and endophthalmitis is due to CMV, which he got because of AIDS, the chronic illness)
  12. Premedico

    Premedico

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    There was a question on varicose veins asking what is the primary cause.

    Incompetent valves right? I got a bit confused because earlier in Uworld I had read that weak WALLS cause distended veins which result in incompetent valves.
  13. Ponger

    Ponger

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    3 yo boy brought to ER by his mom 1 hour after having generalized tonic-clonic seizure. He has had frequent vomiting and progressive stupor during the past 24 hours. His mother says she gave him aspirin 2 days ago bec of a temp of 103.1. Phys exam shows hepatomegaly with no jaundice. Serum studies show an increased ammonia concentration and incrased AST/ALT acitivites. Dysfunc of which of the following is most likely cause of this patients disorder?
    a.) glutamate transporters
    b.) golgi complex
    c.) microtubules
    d.) mitochondria
    e. RER

    Is the answer to this d: mitochondria? I put B because I was between lysosomal storage and something else but I realized afterwards it might be Reyes.
  14. Premedico

    Premedico

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    Yes it is mitochondria.

    Age (<4) + stupor + aspirin + liver problem ("hepatoencephalopathy") = Reyes
  15. jkuk

    jkuk

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    2 questions which i don't see in this thread:

    1) 4 year old kid, bruising, petechiae, bleeding gums, blast cells in BM, he has CD 22, CD 19, CD 3 and a bunch of IgGs. from that i figured it was ALL, but then you had to answer what was the cause?

    - i narrowed it down to pre-B and pre-T cells, which one is the right answers, b.c in FA it shows both and why?

    2) Lab test with 3 batteries, healthy volunteers had 5 percent chance of falling outside normal range, what is probability healthy person will have normal results for all 3 tests?

    -thought it was 95%, other choices were 5%, 40%, and 85%

    thanks guys, much appreciated
  16. SlaveOfTCMC

    SlaveOfTCMC

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    1) the CDs around around 20 are specificlaly B cell markers. Moreover B-ALL (95%) is far more prevalent.

    2) This one is literally high school math. Sorry, I don't mean to belittle you.

    if one test ("a battery of tests") has a 95% chance of being normal, being normal in three tests is 0.95 times 0.95 times 0.95
  17. jkuk

    jkuk

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    Lol thanks for the help man, its all good maybe i should have got the high school math question! Overall i actually felt and scored better on 12 than 11!
  18. kac714

    kac714

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    took this today- thought it was much harder than 7! I had a couple questions I didn't see earlier in the thread:

    22 y/o male comes to physician after noticing painless mass in right testicle- kicked in scrotum at soccer practice 1 wk ago, normal vitals. exam shows 2 cm mass that doesn't transilluminate, increase AFP... choices are hematoma (which i picked) leydig cell, nonseminoma neoplasm (this is my second choice) sertoli cell, or spermatocele. thoughts? Thanks!
  19. wannabedocta

    wannabedocta

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    increased AFP = Non-seminomatous tumor ( either yolk sac or endodermal sinus tumor)
  20. WashMe

    WashMe

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    I think the AFP tells you it's a germ cell tumor, so I think it's a nonseminoma neoplasm

    edit: I stopped typing this post for a few minutes once I opened it and I was beat to the punch!
  21. kac714

    kac714

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    thanks!
  22. cici1

    cici1

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    Hey guys, I've got some questions too that are bugging me.

    1) Healthy 6-month-old boy brought to physician b/c of a cough for 1 week. Initially he had a low-grade fever, sneezing, congestion, and runny nose. Then he develops a dry intermittent cough. The baby chokes and gasps if startled. No immunizations. Has paroxysms of "machine gun" like coughing with a forced expiratory grunt at the end of coughing. Leukocyte count is 30,000 (70% lymph). Neturophil chemotaxis and oxidative metabolism are defective due to increased activity of which?:
    Adenylyl cyclase, Myeloperoxidase, NADPH Oxidase, Phospholipase C (wrong), Protein Kinase C

    2) 70 y.o.m. comes to dr b/c of w month hx of left flank pain and low back pain. Has smoked 1 pack of cigarettes daily for 25 years. Physical shows left flank mass and tenderness over the low back. Has normocytic, normochromic anemia with hematuria. Spinal X-ray shows lytic lesions in lumbosacral region. MRI shows 5.3 cm defect in upper pole of left kidney. Picture is shown... Dx?
    Acute leukemia, large cell lymphoma, multiple myeloma (not it), PTH carcinoma, renal cell carcinoma

    3)Nerve regeneration study using keratin in the conduit, which enhances regeneration. Mitotic activity increases in what cells after exposure to the keratin gel?
    Fibroblasts, macrophages, neurons, plasma cells, schwann cells, undiff. stem cells (not it)

    4)Where is initial glycosylation of proteins destined to be exported from a hepatocyte?
    Cytoplasm of rER, ribosomes of rER, IMM, Mitochondrial cytoplasm, OMM

    5) What classes of receptors is most likely to trigger fastest physiological response?
    G protein coupled, intracellular steroid receptors, ligand coupled ion channels, tyrosine kinase (not it)

    6) Man w/6 day hx of fever, sore throat, and swollen lymph nodes. Traveled to Haiti recently. Exam shows cervical lymphadenopathy and pharyngeal erythema w/gray-white patches that bleed when scraped. The major virulence factor is encoded where?
    Counjugative transposon, integron, intron, lysogenic phase, plasmid (not it)

    7) 60 y.o.m. w/aspiration pneumonia is tx w/ clindamycin. 5 days later, has nausea, watery diarrhea, and cramping lower abdominal pain. Has abdominal distension and tenderness. Leukocyte count is 16,000. Most effective method to dx patient?
    Blood culture (not it), carbon 13 urea breath test, serum IgM ab conc., stool assay for toxin, stool culture on sorbitol-MacConkey agar

    8) Mutation causes substitution of serine --> alanine at positon 127 of the enzyme. Mutation reduces activity of the enzyme by preventing:
    Attachment of farnesyl groups, attachment of N-linked oligosaccharides, formation of disulfide bonds, enzyme phosphorylation, targeting of enzyme to correct cell location (not it)

    9) Necrosis of renal tubular cells w/o any damage to the underlying stromal framework or glomeruli. If there was healing of the kidneys, what would be most likely?
    Diffuse renal scarring (not it), renal atrophy, renal hyperplasia, renal hypertrophy, normal renal architecture

    10) Upregulation of which of the following mediators would prevent or ameliorate lung injury due to inhaling smoke?
    IL-1, IL-10, NFK-B (not it), Toll-like receptors, TNF
  23. whoknows2012

    whoknows2012

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    1) whooping cough-adenylate cyclase (toxin turns Gi off)
    2) RCC-hematuria + mass in kidney. Also the cells in the bone metastases seemed to be forming something similar to kidney tubular cells.
    4) I believe cytoplasm of rough ER
    5) Ion channels are by far the "quickest" responses. Not nearly the highest amplitude though (second messengers with GPCRs for example)
    6) Diphtheria--toxin is attained by lysogenic phage
    7) Clindamycin induced C. diff. Stool assay for toxin
    8) Losing a serine residue means you lose a phosphorylation spot
    9) Normal renal architecture. With damage to the glomeruli there would for sure be scarring and loss of function
    10) IL-10---inhibits Th1 response
  24. icaruswalks

    icaruswalks

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    for #3 I believe it was Schwann cells...somebody correct me if I'm wrong. They're the cells that grow out first in axonal regeneration in the periphery.
  25. kac714

    kac714

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    figured it out, thanks anyway!
    Last edited: 06.11.11
  26. Ludacris

    Ludacris

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    What's the answer to the 70 year old who wants to make a donation?
  27. winkleweizen

    winkleweizen

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    AEDs
  28. Ludacris

    Ludacris

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    Ah, that makes sense now lol. Thanks.
  29. Ludacris

    Ludacris

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    1) Anyone know the answer & why it's correct to the question about the lab tests?

    The question was What's the probability that a normal person will receive normal tests for all 3. I guess the answer is 85%?


    2) Also the question about BPH and what organism is involved? I think it's Enterococci?


    3) 1 yr old boy with recurrent infections, leukocyte count is 70,000/mm (70% lymphocytes), neutrophils chemotaxis and oxidative metabolism is defective due to increase activity of

    A) Adenyl cyclase
    B) Myeloperoxidase
    C) NADPH oxidase
    D) Phospholipase C
    E) protein Kinase C

    4) 21 YO smoker who has headache, nausea and dizziness who is a smoker and lives in the basement... What's the cause of it?
    [​IMG]
    Last edited: 06.11.11
  30. SlaveOfTCMC

    SlaveOfTCMC

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    1) Yes you are right

    2) E.Coli

    3) Adenyl Cyclase (it's something B.pertussis has)

    4) IIRC, it was CO poisnoning.
  31. Ludacris

    Ludacris

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    Thanks!

    I think 2 is Enterococci (e.g. E. faecalis) b/c they say it's Gram Positive.
  32. HotLikeSauce

    HotLikeSauce

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    1) Woman comes in w/ T2DM and on metformin. They add in pioglitazone. What is most likely to happen?

    Options: improved ability to release metformin, improved cell response to insulin, increased risk for dyslipidemia.

    I said the dyslipidemia one, now thinking it must just be improved cell responsiveness. But I thought the -glitazones were notorious for bad lipid effects?

    2) Colon cancer registry implemented in half of X number of practices. Found decreased mortality rate in practices using it so it's suggested to be implemented. Which study characteristic supports this recommendation?

    Answers: accuracy, external validity, face validity, precision, reliability

    I said reliability. To be honest I don't even freaking understand what external and face validity mean :(

    Thanks for any help!
  33. Sheldor

    Sheldor

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    1. The answer is improved cell responsiveness. The glitazones activate PPAR and thereby increase responsiveness to insulin.

    2. Its been a while since I've taken it, but I'd say the answer is accuracy?
  34. abmd

    abmd

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    Is it accuracy or external validity?
  35. Sheldor

    Sheldor

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    I don't know! They both sound pretty good and I can't remember what I put. I took 12 over 4 weeks ago. Maybe somebody who took it recently can weigh in?
  36. 318038

    318038 A Fan of Medicine

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    Not accuracy, I picked that and missed it. Must be face or external validity?
  37. winkleweizen

    winkleweizen

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    Its external validity. By implementing it they are assuming its externally valid...as in they assume that the results will hold up to a larger population of people.
  38. winkleweizen

    winkleweizen

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    I had never heard of face validity but this is what wiki says.

    Face validity is a property of a test intended to measure something. It is the validity of a test at face value. In other words, a test can be said to have face validity if it "looks like" it is going to measure what it is supposed to measure.
  39. HotLikeSauce

    HotLikeSauce

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    Ahh, thanks winkle (and everyone else!) Makes a lot more sense now. Never seen that in FA or UWorld, but glad to know it since apparently the NBME thought it was important enough to put on there lol
  40. pardonme

    pardonme MS-I

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    did anybody do poorly on this exam compared to other NBMEs?

    6: 240, 7: 242, 11: 254

    12: 235?? why did my score drop so much from the last?

    also, can anybody explain the hardy weinburg equation question? i thought i knew how to do this one but i guess not.. somebody mentioned a hardy weinburg allele table??

    Thanks!
  41. beachblonde

    beachblonde

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    I thought it was kinda brutal. I was super tired when I took it and I really struggled. I didn't have a huge score drop but I wouldn't have been surprised if I had. I only managed to gain 2 points after a week of studying. :(

    But to answer your question: the homozygote frequency was given at 1/40,000. So that's q^2. Take the square root at 1/200 or .005. The question asked what the likelihood was that the wife was a carrier-or homozygote-which is 2pq. So 2 x (1-.005) x (.005) = .00995 or .01 which was the answer.

    I'm not sure what people mean by the table...I just used the equations from FA.
  42. Mandy22

    Mandy22

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    4.
    A 15-year-old boy with cavernous sinus thrombosis has deviation of the left eye toward the midline (convergent strabismus) when he is asked to look straight ahead. Which of the following nerves is most likely involved?​
    A
    )Abducens nerve B
    )Inferior division of the oculomotor nerve C
    )Ophthalmic division of the trigeminal nerve D
    )Superior division of the oculomotor nerve E
    )Trochlear nerve

    8.
    A 25-year-old woman has a 6-month history of amenorrhea. Her serum luteinizing and follicle-stimulating hormone concentrations are increased. Two years ago she gave birth to a healthy newborn. Which of the following is the most likely explanation for her menstrual disorder?​
    A
    )
    Adrenal insufficiency​
    B
    )
    Chronic illness​
    C
    )
    Major depressive disorder​
    D
    )
    Pituitary insufficiency​
    E
    )
    Primary ovarian failure​
    Your answer is indicated by the filled-in circle.


    24.
    During an experiment, a strain of knockout mouse is developed that has an isolated deficiency of carbonic anhydrase in erythrocytes. No other type of cell or tissue is deficient in this enzyme. Compared with normal mice, venous blood in the knockout mouse will most likely have a higher concentration of which of the following substances?​
    A
    )
    Ca2+
    B
    )
    Cl&#8722;
    C
    )
    HCO3&#8722;
    D
    )
    K+
    E
    )
    Mg2+
    F
    )
    Na+
    Your answer is indicated by the filled-in circle.



    36.
    A 2-year-old boy is brought to the physician because of a 2-week history of constant wet diapers and irritability. His maternal uncle and grandfather had similar symptoms. Physical examination shows dehydration. Serum sodium concentration and osmolality are increased. Urine osmolality is decreased and does not change after the administration of desmopressin. A deficiency of which of the following is the most likely cause of the findings in this patient?​
    A
    )
    ADH (vasopressin)​
    B
    )
    Aldosterone receptor​
    C
    )
    Amiloride-sensitive sodium channel​
    D
    )
    Thiazide-sensitive Na+–Cl– transporter​
    E
    )
    V2 receptor​
    Your answer is indicated by the filled-in circle.


    [​IMG] [​IMG]
    [​IMG]Solution
    2.
    The diagram shows a portion of the cell cytoplasm containing rough endoplasmic reticulum and a mitochondrion. The initial glycosylation of proteins destined to be exported from a hepatocyte occurs at which of the following labeled sites in the diagram?​
    [​IMG]

    A
    ) B
    ) C
    ) D
    ) E
    ) 2. Your answer is indicated by the filled-in circle.
  43. Tig2575

    Tig2575

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    The dexamethasone question bothered me seriously. FA 2011 clearly states on page 294 that cortisol receptors are cytosolic receptors while T3/T4 receptors are nuclear receptors. How can the NBME have an answer choice that is so blatantly incorrect?
  44. Celestine

    Celestine

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    Now I'm freaked out that I didn't take this test. My boyfriend took it today but I don't have room in my schedule because I'm behind and have one less day of prep. *sigh*
  45. MossPoh

    MossPoh Textures intrigue me

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    Don't worry. I did have one question from 12 that I know was a similar diagram, but they did change what they were asking for. So, if that friend just answered the same thing, they might've been screwed over.
  46. Celestine

    Celestine

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    That definitely made me feel a little better, now I feel like four more hours of FA instead of an NBME is justified :)
  47. ruraldr

    ruraldr

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    Not 100% positive, but my thoughts below:

    15 y/o boy: -Abducens nerve (can't abduct in the stem)
    8. Ovarian insufficiency? Decreased estrogen leading to less negative feedback?
    24. Is it sodium? Can't do bicarb/Na exchange anymore?
    36. V2 receptor-nephrogenic DI
    2. A

  48. richse

    richse

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    I agree with you except for #24. I think its Cl, because they use a Bicarb/Cl exchanger.
  49. MossPoh

    MossPoh Textures intrigue me

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    yup
  50. iA-MD2013

    iA-MD2013 Moderator Emeritus

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    1. Synovial fluid from a pt with rheumatoid arthritis would show up/down arrows: Complement, segmented neutrophils, IL1, TNF
    Can someone explain this one?
    I saw someone earlier say dec c3 and inc everything else...but I don't understand it at all.

    2. Alzheimer's pt. Impaired memory due to lesion in: hippocampus. But why not basal forebrain?

    3. 24 yo woman vomiting for the past 4 hrs. Also has a 2 day hx of fatigue and dizziness on standing. She has had severe heartburn for the past 3 mths and OTC antacids have helped. Pulse = 110, Resp = 25, BP = 95/70. Hb = 6, Hct = 18%. Which of the following is most likely decreased in the pt?
    a. Alveolar Po2 b. Arterial O2 carrying capacity c. Arterial oxyHb conc d. Arterial P50 e. Arterial PO2
    WHAT THE HELL IS GOING ON THERE?! :laugh: I feel like this is all connected to some overlying dz/story, but I cannot see it.

    4. Which drug can dec BP and increase K?
    a. Atenolol b. Furosemide c. Losrtan d. Nifedipine e. Prazosin
    Why not atenolol for this one? I feel stupid for not picking losartan because that one is obvious...but B blockers cause hyperkalemia and decrease BP, so that should work too?

    5. 51 yo woman with symmetric enlargement of thyroid gland for past 5 mths and hypothyroidism symptoms. Low T4 (1.8). Which of the following serum findings are most likely?
    a. Dec TSH b. Dec TRH c. Inc TBG d. Presence of antithyroid peroxidase antibodies e. Presence of thyroid stimulating antibodies

    6. Why would opioid overdose lead to distant breath sounds? (Someone asked this earlier in this thread but didn't get an answer :()

    THANK YOU!!!
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