NBME 12 discussion

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

titan25

New Member
10+ Year Member
Joined
Dec 4, 2009
Messages
8
Reaction score
0
1 v max 1 enzyme is 300 and 2 nd 30 compare the Km values

km1 is 10 times km 2
km1 is 1/10 km2
we cant compare


2 upregulation of which protects from ARDS is IL 10

3 which anti hypertensive restores back potassium other k sparing

4 a 14 years old brougt to physian because mostly sleeping withdrawn and complaining of abdomen pain 3 weeks , what history will u take first...should we recretion drug history....options school history , devlopmental, family history

5 a drug given in two patients obese and normal given same doses graph ploted with conc on y axis and time on x , slope of normal person is greater
compared to normal person drug x in obese has

greater VD/ lower bioavailability / higher clearance/ shorter absorption

6 pedigree given four genrations AD 1st genration gene seq 4 5 6 changes to 156 cause...is it recombination

7 cytoplasmic enzyme mutated at 127 alanine replaced by serine why reduction of enzyme activity

Members don't see this ad.
 
Last edited:
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
 
Bile enters the small bowel making it green.

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
 
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
 
Members don't see this ad :)
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

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)
 
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.
 
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.
 
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.

Yes it is mitochondria.

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

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
 
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!
 
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!
 
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!


increased AFP = Non-seminomatous tumor ( either yolk sac or endodermal sinus tumor)
 
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!

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!
 
Members don't see this ad :)
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
 
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

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
 
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.
 
figured it out, thanks anyway!
 
Last edited:
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?
A7ENzDu4pMT7AAAAAElFTkSuQmCC
 
Last edited:
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?
A7ENzDu4pMT7AAAAAElFTkSuQmCC


1) Yes you are right

2) E.Coli

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

4) IIRC, it was CO poisnoning.
 
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!
 
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!

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?
 
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?
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.
 
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.
 
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
 
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!
 
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!

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.
 
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.


itdmedia.aspx
itdmedia.aspx

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?​
itdmedia.aspx

A
) B
) C
) D
) E
) 2. Your answer is indicated by the filled-in circle.
 
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?
 
my friend who is IMG took exam step1 today, and she got 20 questions exactly the same from nbme 12 form, which i thought is bit weird i was always under the impression that nbme are retired step questions :confused:

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*
 
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*

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.
 
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.

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

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.


itdmedia.aspx
itdmedia.aspx

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?​
itdmedia.aspx

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


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

1. not sure...i know that C3 is decreased in post strep GN so i figured it was similar - lucky guess?

2. hippocampus is involved first. discrete fact i encountered in uworld. and basal forebrain doesnt refer to the cortices.

3. vomiting means you lose acid. so you have metabolic alkalosis. respiratory compensation with hypoventilation which decreases pO2.
 
Ahhhh! Nice thanks!

For the vomiting girl, my answer was decreased arterial Po2 and that was wrong.

sadly enough i took this a wk ago and this wasnt in my wrongs. i think my brain is fried from cramming FA. anyway she is anemic so we should have decreased O2 carrying capacity...i think.
 
There was one that confused me:
60-year old man with a history of smoking and persistent hoarseness, he has a lesion on his vocal cord that is biopsied and the histology is shown. What is the dx?
(vocal cord polyp, adenocarcinoma, adenoma, squamous cell carcinoma, squamous cell papilloma)

Also, what the hell is a viscus?
It's squamous cell CA.
A viscus is any hollow abdominal organ. I think it's derived from the word viscera. When perforated, it releases air into the peritoneum that rises when the patient is standing. This causes a crescent air bubble under the diaphragm (don't confuse it with the normal gastric air bubble) in standing AXR's.

Question: 13 YO boy with pruritic rash on right foot. No fever, chills, cold. Patient's family spent weekend at a lake. (Rash is on top of foot and moving sort of linearly). Treat with a. clindamyin, b. fluconazole, c. mebendazole, d. metronidazole, or e. prednisone?

Did anyone know what this was? I thought it was a fungus but fluconazole was wrong. Parasitic maybe?
Well the answer is Mebendazole. Organism is one of those worms that penetrates the sole of bare feet, I think Ancylostoma duodonale.

1. Metaphyseal dysplasia due to single gene disorder caused my mutation in PTH receptor gene. Phenotype is "similar to that of acquired hyperparathyroidism." Mechanism?

Haploinsufficiency - wrong
Dominant Negative
Gain of function
Pleiotropy
Anticipation


2. So aripiprazole has what action compared to haloperidol on the dopamine receptors?

Reversible antagonism - wrong - didn't feel to good about it
Agonism
antagonism
inverse agonism
irreversible antagonist
partial agonism


3. Why is there reduced tactile fremitus in asthma kid?


4. Chronic peripheral neuropathy; enzyme histochemical staining shows fiber grouping. Most likely cause?

Altered trophic substance form innervating neuron - wrong
Altered muscle enzyme exprerssion due to damaged nerve fibers - correct?
Regeneration of muscle fibers
Re innervation of muscle fibers by regenerating axons
Selective loss of nerve fibers to type II muscle fibers


5. 73 year old w/ BPH, UTI +fever + chills +pain in flank + WBC + 100,000 colonies of gram + what is the causal organism?

Staphyloccus aureus - wrong
Streptococcus pyogenes
Enterococcus faecalis - would need a fistula and you'd see lots of other nasty stuff yea?


6. Lady with TIA's, cannot tolerate aspirin. Appropriate alternative?

Dipyramidal - wrong
Clopidogrel? -these were the two i narrowed
Acetaminophen
Ibuprofen
Tissue plasminogen activator


7. Lady gets to 10,000 ft ski resort. Dizzy, nausea, headache. Acetazolamide helps, how?

Stimulation of ion pumps in BBB - wrong
Direct action on resp centers, depressing ventilation
Direct action on resp centers, stimulate ventilation
Induction of metabolic acidosis, stimulate ventilation
Induction of metabolic alkalosis, depress ventilation
Stimulation of EPO

This one kid of bothered me. So her initial problem is alkalosis due to major reduction in PO2 at altitiude and subsequent increased RR blowing off CO2 = alkaline. Acetazolamide will help by creating some metabolic acidosis, but then what? Stimulating further respiration would be counter productive right? EPO would take a while. Direct action seemed a bit off to me. So i was left with ion pumps; I dunno.


8. Another carbonic anhydrase question - not my day. Didnt read this question fully though. CA deficiency in erythrocytes only; whats elevated in venous blood?

K+ wrong; i thought systemically, acidosis = H/K exchange
Ca
Cl
HCO3
Mg
Na



9. Lady with UMN issues. What helps?

Inhibit nicotinic-R in Renshaw - wrong
Activate GABA-R in muscle spindle afferents
Activate glutamate-R in gamma motoneurons
Activate serotonin-R in alpha motoneurons
Inhibit glycine-R in Golgi tendon afferents
Inhibition of (a)2-R in excitatory interneurons



10. Guy on steroids hurts his arm. Antecubital swelling and ecchymoses from antecubital fossa to mid forearm on anterior side, tender there also. Able to flex elbow actively, but unable to flex elbow or supinate against resistance. Injured muscle-tendon unit innervated by what?

Radial - wrong; i was thinking brachioradialis
Anterior interosseous
Median
Musculocutaneous
Ulnar



11. Still unclear on what would improve the lady taking a thiazide with improved BP but low K+

Atenolol - wrong
Furosemide
Losartan
Nifedipine
Prazosin


12. Septic arthritis in 18 year old kid; gram + stain picture shows what I think look like intracellular bugs

Ceftiraxone
Doxycycline - wrong
Genatmicin
Metronidazole
Vancomycin


13. Apparently autistic kid? 3 years old, 20 word vocab. Doesn't speak in sentences, points alot, no physical abnormalities. Kid is looking at reflex hammer instead of acknowledging mom's presence.

Inform her that the child will need special education - wrong
Further evaluation to determine cause of language delay
MRI
Reassure that this is normal
Advise to enroll in preschool early


14. Guy smokes 2 packs a day lives in basement apartment. Dizzie, headache, nausea for 4 hours. No physical abnormalities; what explains it?

Acidosis with heme dissociation shift right
Activation of nicotinic-R in locus caeruleus
Cerebral arteriolar constriction due to increased CO2 in blood
Competative inhibition of oxyhemeoglobin formation
Inactiation of cytochrome oxygenase by cyanide - wrong; seemed like a lot of cigs :rolleyes:

Probably competitive inhibition - CO poisoning. I skimmed over the part that said it was WINTER - and basement apartments i guess only have space heaters right? Sure.



15. What else would you give to someone w/ acute hep C already receiving (a)IFN?

IL-2 - wrong
Infliximab
Levamisole
Ribavirin
Thlidomide


16. Guy with prostate cancer; Low back pain. Most appropriate drug MoA:

Activation of GnRH receptors - probably correct if given CONTINUOUSLY
Activation of LH receptors
Blockade of estrogen receptors
Blockade of FSH receptors -wrong, convinced myself T --> DHT was FSH stimualted
Inhibition of 11-B hydroxylase



Thoughts, or some scolding to get me motivated welcome :thumbup:

1) Gain of function
2) Partial agonism
6) Clopidogrel
8) Chloride
10) Musculocutaneous
11) Ceftriaxone
12) Losartan
13) Further evaluation
15) Ribavirin
16) activation GnRH receptors (yea, if given continuously)



Question from the test

A 22 yo man who is a militar recruit is brought to the doc 15 min after fainting while waiting in line to receive vaccinations. Immediately after he fainted, his pulse was 45/min and his systolic was 50 mmHg. His pulse is now 88/min and bp is 100/70. Physical exam shows no abnormalities. What was the cause of the syncope?

A. Aortic Stenosis
B. Hypertrophic Cardiomyopathy
C. Increased Parasympathetic Tone
D. 3rd degree AV block
E. Ventricular Tachycardia
Increased PS tone- Vasovagal syncope

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
Obstruction of small bowel- She has duodenal stenosis. The obstruction is normally distal to the ampulla of vater, hence the green vomitus.


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.
Yes, incompetent valves


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?

Thanks!
I took NBME 7 two weeks ago and got a 234. Took NBME 12 today and got a 217.... friggin heartbroken!
 
...

5. i guess we assume she is taking estrogen (age 51 so postmenopause) which increases TBG and there is less free T4

Increased TBG would lead to normal free T4 and increased total serum T4, and there wouldn't be any signs of hypothyroidism.
 
These are still bugging me! Anyone know the answer or can explain them? Thanks!!!!

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. 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 (not this)

3. 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?

4. 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 (not this) b. Dec TRH c. Inc TBG d. Presence of antithyroid peroxidase antibodies e. Presence of thyroid stimulating antibodies

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