NBME 12 spoiler

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coolcatrina

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Can someone answer these please??

Q ) The one with complement c3, segmented neutrophils, IL 1 , TNF in a rheumotoid arthritis patient


Q) A 68 year old man comes to the physician because of 1 month history of fatigue and pelvic pain that is exacerbated by movement and weight bearing activities. Vitals ar normal. Physical exam shows pale conjunctivae. There is mild pain on direct palpation of the pelvis. Lab studies show normochromic normocytic anemia and increased serum calcium ang globulin concentrations. A peripheral blood smear shows evidence of rouleaux frmation. An x ray of pelvis shows osteolytic bone lesions. A bone scan shows no abnormalties. Which is the folg is most likely diagnosis?

A ) Hyperparathyroidism
B ) Metastatic bone disease
C) Multiple myeloma
D) Osteitis deformans (pagets)
E) waldenstrom macroglobulinemia.

Is this C, I answered it as B because C seemed idk straight forward ( ! this is what UW does to u). Also , I thought mutiple myeloma causes crew cut lesions on skull (only ?)

Smoker..which of the following mechanisms best explains how nicotine produces this sensation leading to addiciton in this patient?
A) activation of opiod receptors in midbrain
B) increased release of dopamine in nucleus accumbens
c) inhibition of GABA release in hypothalamus
D) inhibition of glutamate receptors in amygdala
E) potentiation of GABA receptors in cerebral cortx

I remember seeing this on UW , i narrowed this to c or d , but the offline key says B. i wanted to confirm. C

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First question screams MM to me.

Addiction is associated with increased dopamine in NAcc.
 
whoa, surprised to see full questions.

First one is classic MM. Rouleaux formation of RBCs, lytic bone lesions, fatigue, anemia, age is all characteristic of MM.

I don't know why B is right, but in general, rewarding behaviors are reinforced in the limbic system by dopamine release. Nicotine doesn't have much to do with GABA/glutamate in the brain, as far as I know.
 
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