NBME 7 q's I need help with

[1dayatatime]

I would appreciate any feedback (not just the answer, but an explanation please) I can get about these, b/c I haven't been able to google/figure them out to feel comfortable

A 35-year-old man comes to the physician because of a painful perianal mass for 2 weeks. His vital signs are within normal limits. Physical examination shows a 2-cm erythematous, warm, swollen mass superior to the anal verge. Lancing of the mass releases a sanguineous exudate. The wound is irrigated and bandaged, and antibiotics are administered. Which of the following inflammatory mediators is most likely released from the aggregated platelets in this patient?
A)interleukin-1 (IL-1)
B)Nitric oxide
C)Prostacyclin (PGI2)
D)Thrombin
E)Thromboxane A2

This is not from NBME 7 but was an NBME q:

A 25-year-old woman with stable cystic fibrosis meets
inclusion criteria for a placebo-controlled industry-sponsored
research study on a new treatment. The primary care
physician is not part of the research team, but he is familiar
with the research and considers it to be scientifically sound.
The research protocol provides medication and medical care
limited to assessing medication effects and adverse effects for
6 months. The patient knows of the study and asks the
physician if she should enroll. Which of the following is the
most appropriate initial response by the primary care
physician?
(A) Advise against participation because the research
is funded by a pharmaceutical company
(B) Provide the patient with basic information
about the study, and ask if she would like
to learn more from the research team
(C) Strongly recommend to the patient that she
participate in the study because it will
benefit future generations
(D) Tell the patient that if she enrolls in the study, he
will not be able to provide any medical care
for her during this study

They said B was correct but I picked D. this is the 2nd q I've seen about "enrolling in a clincal trial" and I can't seem to find any source that discusses this (I have Kaplan and BRS behav sci and coudln't find anything giving me the rules about something like this) -- where can i find some guidlines on these types of qs?

And then here are just some random q's I haven't settled:

how can we tell INH peripheral neuropathy (numb, tingling, burning) vs ethambutol?

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[1dayatatime]

For Chloramphenicol, do you pretty much never select it for a 1st line? I just get confused when I get q's that ask how you treat Rickettsia and Neisseria meningitidis. I know you can use Chloramphenicol for those but I guess you wouldn't pick it first right? You would pick Tetracycline for Rickettsia and Ceftriaxone or Fluoroquinolone for Neisseria meningitidis? Sorry I don't think I'm that good at this subject....

For ex, would you use Ampicillin/amoxicillin or a fluoroquinolone for E.coli UTI? FA says you can use both for E coli...

 

[notbobtrustme]

I would appreciate any feedback (not just the answer, but an explanation please) I can get about these, b/c I haven't been able to google/figure them out to feel comfortable

A 35-year-old man comes to the physician because of a painful perianal mass for 2 weeks. His vital signs are within normal limits. Physical examination shows a 2-cm erythematous, warm, swollen mass superior to the anal verge. Lancing of the mass releases a sanguineous exudate. The wound is irrigated and bandaged, and antibiotics are administered. Which of the following inflammatory mediators is most likely released from the aggregated platelets in this patient?
A)interleukin-1 (IL-1)
B)Nitric oxide
C)Prostacyclin (PGI2)
D)Thrombin
E)Thromboxane A2

Thromboxane A2. Platelets only secrete a few cytokines/mediators, of which, TA2 is one of them, especially for aggregration (which the question lays out).

This is not from NBME 7 but was an NBME q:

A 25-year-old woman with stable cystic fibrosis meets
inclusion criteria for a placebo-controlled industry-sponsored
research study on a new treatment. The primary care
physician is not part of the research team, but he is familiar
with the research and considers it to be scientifically sound.
The research protocol provides medication and medical care
limited to assessing medication effects and adverse effects for
6 months. The patient knows of the study and asks the
physician if she should enroll. Which of the following is the
most appropriate initial response by the primary care
physician?
(A) Advise against participation because the research
is funded by a pharmaceutical company
(B) Provide the patient with basic information
about the study, and ask if she would like
to learn more from the research team
(C) Strongly recommend to the patient that she
participate in the study because it will
benefit future generations
(D) Tell the patient that if she enrolls in the study, he
will not be able to provide any medical care
for her during this study

They said B was correct but I picked D. this is the 2nd q I've seen about "enrolling in a clincal trial" and I can't seem to find any source that discusses this (I have Kaplan and BRS behav sci and coudln't find anything giving me the rules about something like this) -- where can i find some guidlines on these types of qs?

Always provide information and leave the decision in the patient's hands, especially if they meet the requirements for the clinical trial. D is too harsh and may not even be true depending on how the study is set up.

And then here are just some random q's I haven't settled:

how can we tell INH peripheral neuropathy (numb, tingling, burning) vs ethambutol?

INH -> depletes B6, so s/sx of B6 deficiency.

Ethambutol -> red/green color blindness and retinal neuritis.

For Chloramphenicol, do you pretty much never select it for a 1st line? I just get confused when I get q's that ask how you treat Rickettsia and Neisseria meningitidis. I know you can use Chloramphenicol for those but I guess you wouldn't pick it first right? You would pick Tetracycline for Rickettsia and Ceftriaxone or Fluoroquinolone for Neisseria meningitidis? Sorry I don't think I'm that good at this subject....
For ex, would you use Ampicillin/amoxicillin or a fluoroquinolone for E.coli UTI? FA says you can use both for E coli...

Chloramphenicol isn't even used in the US anymore, so highly doubt you would see a question on chloramphenicol use as an antibiotic. I'd be aware of the side effects and MOA instead.

Every question I've seen on UTI treatment will always include either an MoA, patient allergy, bug resistance or side effect profile. I highly doubt a question will say "Person has a UTI, which antibiotic do you prescribe". If it comes down to that, pick cipro I guess.

 

[NeuroLAX]

For Chloramphenicol, do you pretty much never select it for a 1st line? I just get confused when I get q's that ask how you treat Rickettsia and Neisseria meningitidis. I know you can use Chloramphenicol for those but I guess you wouldn't pick it first right? You would pick Tetracycline for Rickettsia and Ceftriaxone or Fluoroquinolone for Neisseria meningitidis? Sorry I don't think I'm that good at this subject....

For ex, would you use Ampicillin/amoxicillin or a fluoroquinolone for E.coli UTI? FA says you can use both for E coli...

Where it can get hairy with Rickettsia is if you have a pediatric patient (< 8 yo), in which case doxycycline would be contraindicated. In that case, chloramphenicol IV would be my next choice.

 

[1dayatatime]

Thanks Notbob and NeuroLax!

Hmm....I picked Thrombin for the first one. why is that wrong?

Also, are you saying that you can continue to see your patient even if they're in a clinicial trial? i didn't know that. I though you definitely couldn't b/c that would screw up the variables.

Sx's of B6 def DO include periph neuropathy. So does Ethambutol (besides its very notorious eye issues). That's where I'm geting hung up

 

[notbobtrustme]

Thanks Notbob and NeuroLax!

Hmm....I picked Thrombin for the first one. why is that wrong?

Thrombin is free-floating in the serum, so it wouldn't be released by platelets. Plus, it's not really an inflammatory cytokine but more like glue that holds platelet plugs together.

Also, are you saying that you can continue to see your patient even if they're in a clinicial trial? i didn't know that. I though you definitely couldn't b/c that would screw up the variables.

Sx's of B6 def DO include periph neuropathy. So does Ethambutol (besides its very notorious eye issues). That's where I'm geting hung up

Yea, depending on how the clinical trial is setup, you can still see your own doctor. D is too harsh/direct with the patient. You want the patient to make his/her mind up on the clinical trial with information you provided.

Regarding INH vs Ethambutol, they would have to give you more information, IMO, at least. (eg pt is taking pyridoxine, pt is using as prophalyxis, drug inhibits mycobacterial cell wall crosslinking, etc etc)

If in doubt, peripheral neuropathy = INH, optic = ethambutol.

 

[1dayatatime]

good advice, thanks!