NBME CBSSA Form 1

[Pox in a box]

Keep all comments on this assessment (Form 1) within this thread. Giving questions and answers out in other threads is not helpful for people taking the CBSSA later.

Here's a FAQ because I'm sure there's going to be a dozen questions about what this exam is: http://www.nbme.org/PDF/sas.pdf

Here's the menu: http://www.nbme.org/programs/sas.asp

In summary, there are two assessment exams (both are 200 questions each and each one costs $45). It assesses your strengths and weaknesses (very loosely I might add) and gives you a "predicted" score.

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[C-GAR]

To those of you that have taken the real thing, how well do you think this test correlated? (especially if you have received you score!)

 

[north2southOMFS]

To those of you that have taken the real thing, how well do you think this test correlated? (especially if you have received you score!)

If you search the step 1 results thread, you'll see that there is an awsome correlation between this grade and your real results, with almost everyone doing slightly better on the real thing than the pretests predicted. Worked for me, said i'd get a 201 both times i took the NBME, and i ended up getting a 205.

 

[Pox in a box]

If you search the step 1 results thread, you'll see that there is an awsome correlation between this grade and your real results, with almost everyone doing slightly better on the real thing than the pretests predicted. Worked for me, said i'd get a 201 both times i took the NBME, and i ended up getting a 205.

Sweet. It does give a standard deviation but it's HUGE.

 

[cocoabutter]

I took form A 3 days before my actual step 1 and ended up getting almost 20 points above my predicted score. The questions are more similar to those on the real thing than qbank and gave me an idea of my weakest points to focus on in the last days before my exam. I didn't take form B (too cheap), but I would encourage every one to take at least one of them.

 

[Pox in a box]

I took form A 3 days before my actual step 1 and ended up getting almost 20 points above my predicted score. The questions are more similar to those on the real thing than qbank and gave me an idea of my weakest points to focus on in the last days before my exam. I didn't take form B (too cheap), but I would encourage every one to take at least one of them.

That is awesome.

 

[viper]

My question is how are these questions compared to the real exam. Someone who took this and the boards please tell us.

I keep reading that board questions are in clinical vignette form (suppossedly about 80%) these days and are multi-reasoning questions. I took the first NBME exam and felt the apart from 1 or 2 questions, they were pure memorization. Also it didn't seem to be hitting BIG topics and very few (just a few) were in clinical vignette format. Any thougths out there.....

 

[pharmer]

I agree w/ the above poster. Plus Step 1 is not supposed to be heavy on the buzzwords and I felt both form A and B were loaded w/ buzzwords

 

[omarsaleh66]

There are still alot of buzzwords on step 1. These exams are just like step 1. I actually got quite a few repeats from these tests. Some were word for word, others asked the NBME q in a different way so the same diseases and concepts were being tested over and over.

 

[pharmer]

There are still alot of buzzwords on step 1. These exams are just like step 1. I actually got quite a few repeats from these tests. Some were word for word, others asked the NBME q in a different way so the same diseases and concepts were being tested over and over.

Row Jimmy just posted this on another thread I had started about buzzwords on step 1: "I had exactly 1 buzzword on my exam."

You guys must have gotten extremely different versions of the test.

 

[pharmer]

Row Jimmy just posted this on another thread I had started about buzzwords on step 1: "I had exactly 1 buzzword on my exam."

You guys must have gotten extremely different versions of the test.

Either that Row Jimmy didn't know his Shi* and didn't pick up on the buzzwords or omar really knew his shi* and found little subtle things to be buzzwords

 

[Row Jimmy]

Either that Row Jimmy didn't know his Shi* and didn't pick up on the buzzwords or omar really knew his shi* and found little subtle things to be buzzwords

Hey Now Pharmer!!! I am confident in my knowledge and I know I did OK on the exam. When I think of Buzzwords, I think of "cherry red macula", "clue cells", "blue sclera" etc... I only had one like that on my exam. Now, I suppose you could make a case that every question has buzzwords and those are the words that lead us to the correct answer so maybe it is just a definition of "buzzword" difference of opinion.

So to rephrase; I had exactly 1 "classic" buzzword on my exam and many, many descriptions of "classic" buzzwords that were quite easy to fugure out.


RJ

 

[Long Dong]

Okay I just took the sucker last night and had a dum question. What the hell doest it mean when you don't have a bar at all on a content area and only have an asterisks on the performance profile? Does that mean you did good in that area? This can't be, cause I feel like no way did I do good in that area cause i guessed on almost all the questions on that subject.

 

[cremasteric]

Okay I just took the sucker last night and had a dum question. What the hell doest it mean when you don't have a bar at all on a content area and only have an asterisks on the performance profile? Does that mean you did good in that area? This can't be, cause I feel like no way did I do good in that area cause i guessed on almost all the questions on that subject.

Here's what the form says below the performance profile "Performance bands indicate areas of relative strength and weakness. Some bands are wider than others. The width of the performance band indicates the precision of measurement...An asterisk indicates that your performance band extends beyond the displayed portion of the scale..." So if your asterisk is on the right side, then hopefully yes, it's because you guessed really well on that section...but if it's on the left, then maybe your guesses were all off.

 

[WISC-ite]

I got some questions... took it today.

-Anyone know the answer for the vertebral arterogram?

-Why would the woman sue the doctor?

-How about the young lady with treatment for gingivitus by dentist?

WISC-ite

 

[me454555]

I thought the dentist one was actinomyces israelii but its been a while since I took the test

 

[sleepyhouse]

I got some questions... took it today.

-Anyone know the answer for the vertebral arterogram? I put ataxia as I thought it was in the cerebellar region.

-Why would the woman with the breast lump sue the doctor? I thought it was lack of communication.

-How about the young lady with treatment for gingivitus by dentist, then develops a pleural effusion. What is organism? Gram -'s? If so, what is the organism?

WISC-ite

first 2 are what i put, 3rd one i put gram +, probably viridans strep or actinomyces

 

[geromine]

i agree oral infections followed by endocarditis or lung infections are almost always anaerobic infections - i think actinomycetes was the only anaerobes in the choices.

 

[allylz]

well while we're talking about form 1, i have a Q that has been driving me nuts:

that picture of the kid with the nose skin problem and then the Q asks what is more likely to have happened, special ed since kindergarten, special ed since high school, episode of major depression, that kind of thing...
oh and he had had a tonic-clonic seizure?

WHAT WAS THAT? i'm just curious, i've search the web 5 ways and asked several other people who also had no clue.

 

[omarsaleh66]

well while we're talking about form 1, i have a Q that has been driving me nuts:

that picture of the kid with the nose skin problem and then the Q asks what is more likely to have happened, special ed since kindergarten, special ed since high school, episode of major depression, that kind of thing...
oh and he had had a tonic-clonic seizure?

WHAT WAS THAT? i'm just curious, i've search the web 5 ways and asked several other people who also had no clue.

i think that stuff on his nose were sebacious adenomas and he had tuberous sclerosis- u get seizures, mental ******ations, etc... I put he had special ed since kindergarten

 

[guarana]

doh! tuberous sclerosis, one of those things in FA that i can never pin down.

(at the time, all i could think of was 'that looks like leprosy...that makes no sense....but that looks like leprosy...uuuuh)

 

[Idiopathic]

My question is how are these questions compared to the real exam. Someone who took this and the boards please tell us.

I keep reading that board questions are in clinical vignette form (suppossedly about 80%) these days and are multi-reasoning questions. I took the first NBME exam and felt the apart from 1 or 2 questions, they were pure memorization. Also it didn't seem to be hitting BIG topics and very few (just a few) were in clinical vignette format. Any thougths out there.....

You will find that the actual test is about 60% "I actually studied for this?", 30% "I'm glad I read that last week" and 10% "WTF was that?"

Your score is all about how you handled the middle part.

 

[Random SDNer]

What were the answers to these questions?

1. An asymptomatic 65 year old woman comes to the gynecologist for a routine examination. Physical examination shows a left adnexal enlargement that was not present 1 year ago. Which of the following is the most likely diagnosis?

A) Endometriosis
B) Leiomyoma
C) Ovarian tumor
D) Polycystic ovarian disease
E) Ruptured luteal cyst

2. That kid with that big tumor-like thing sticking out of his head

A) Angiogenesis
B) Cell adhesion
C) Cell migration
D) Gastrulation
E) Somitogenesis

3. That embryo picture asking about the precursor cells derived from somites?

4. The gout question asking about lack of feedback inhibition of GDP or ADP at which enzyme?

A) Adenosine deaminase
B) Dihydrofolate reductase
C) G6P dehydrogenase
D) Nucleotide phophorylase
E) Phosphoribosylpyrophosphate synthetase

5. The 4 month year old kid with DiGeorge syndrome who was diagnosed with truncus arteriosus. I put that the mediastinum was widened, in addition to normal gamma globulins and decreased peripheral lymphocytes but wasn't sure of the answer.

6. A female neonate has profound hypotonia. The only known complication of pregnancy was polyhydramnios. The mother has a lack of facial expression and weak muscles; she says she did not have any problems as an infant or child. Which of the following best explains the difference in presentations in the mother and child?

A) Anticipation
B) Delayed onset
C) Genetic heterogeneity
D) Incomplete penetrance
E) Pleiotropy

was it delayed onset? I wasn't sure.

 

[p53]

What were the answers to these questions?

1. An asymptomatic 65 year old woman comes to the gynecologist for a routine examination. Physical examination shows a left adnexal enlargement that was not present 1 year ago. Which of the following is the most likely diagnosis?

A) Endometriosis
B) Leiomyoma
C) Ovarian tumor
D) Polycystic ovarian disease
E) Ruptured luteal cyst

2. That kid with that big tumor-like thing sticking out of his head

A) Angiogenesis
B) Cell adhesion
C) Cell migration
D) Gastrulation
E) Somitogenesis

3. That embryo picture asking about the precursor cells derived from somites?

4. The gout question asking about lack of feedback inhibition of GDP or ADP at which enzyme?

A) Adenosine deaminase
B) Dihydrofolate reductase
C) G6P dehydrogenase
D) Nucleotide phophorylase
E) Phosphoribosylpyrophosphate synthetase

5. The 4 month year old kid with DiGeorge syndrome who was diagnosed with truncus arteriosus. I put that the mediastinum was widened, in addition to normal gamma globulins and decreased peripheral lymphocytes but wasn't sure of the answer.

6. A female neonate has profound hypotonia. The only known complication of pregnancy was polyhydramnios. The mother has a lack of facial expression and weak muscles; she says she did not have any problems as an infant or child. Which of the following best explains the difference in presentations in the mother and child?

A) Anticipation
B) Delayed onset
C) Genetic heterogeneity
D) Incomplete penetrance
E) Pleiotropy

was it delayed onset? I wasn't sure.

1. Ovarian tumor. AGE, location of mass, and unilaterality is the key. Goljan also told me. Haha
2. Angiogenesist. The picture was a cavernous hemangioma. As Dr. Goljan would say, don't do anything.
3. The most lateral rod on the right. The picture looks like a hot dog on the right arm. The arrow that points at the right bun is the MUSCLE somite.
4. Phosphoribosylpyrophosphate synthetase. This is a key regulatory enzyme. Know all of these including HGPRT.
5. narrow mediastinum due to lack of thymus, normal gamma globulins, and decreased t lymphocytes.
6. Anticipation. The tipoff was that the mother has a lack of facial expression and muscle weakness so you know she was has the disease. The hypotonia and facial expression is give away that the disease is myotonic dystrophy. Sorry Dr. goljan, there are more ways than shaking one's hand to find out if they have this disease. Key associations myotonic dystrophy -> triple repeat and anticipation. If you understand Goljan and can apply his lectures you will anhilate this exam. Most people when they listen to his lecture memorize what he says. The smart ones think about what he says and applies it. Example, pleural effusion vs lung consolidation. He talks about it in his audio, but you have to sit down and think about the differences due to tactile fremitus, egophony etc.

Those keeping score at home. I still have my answer key for the 770 so people can verify it when they take the test. I will post it on SDN in due time. I promise. Still debating whether someone like Hidden should have an advantage on this test because they are taking the exam after since people before him didn't have access to this. Whatever I choose, the class of 2008 will have access to my answer key to give everyone in next year's class a level playing field. Until then, if you have any other questions. I will answer NBME questions on form A and give you my rationale.

p53 is back. You Heard

 

[Random SDNer]

1. Ovarian tumor. AGE, location of mass, and unilaterality is the key. Goljan also told me. Haha
2. Angiogenesist. The picture was a cavernous hemangioma. As Dr. Goljan would say, don't do anything.
3. The most lateral rod on the right. The picture looks like a hot dog on the right arm. The arrow that points at the right bun is the MUSCLE somite.
4. Phosphoribosylpyrophosphate synthetase. This is a key regulatory enzyme. Know all of these including HGPRT.
5. narrow mediastinum due to lack of thymus, normal gamma globulins, and decreased t lymphocytes.
6. Anticipation. The tipoff was that the mother has a lack of facial expression and muscle weakness so you know she was has the disease. The hypotonia and facial expression is give away that the disease is myotonic dystrophy. Sorry Dr. goljan, there are more ways than shaking one's hand to find out if they have this disease. Key associations myotonic dystrophy -> triple repeat and anticipation. If you understand Goljan and can apply his lectures you will anhilate this exam. Most people when they listen to his lecture memorize what he says. The smart ones think about what he says and applies it. Example, pleural effusion vs lung consolidation. He talks about it in his audio, but you have to sit down and think about the differences due to tactile fremitus, egophony etc.

Those keeping score at home. I still have my answer key for the 770 so people can verify it when they take the test. I will post it on SDN in due time. I promise. Still debating whether someone like Hidden should have an advantage on this test because they are taking the exam after since people before him didn't have access to this. Whatever I choose, the class of 2008 will have access to my answer key to give everyone in next year's class a level playing field. Until then, if you have any other questions. I will answer NBME questions on form A and give you my rationale.

p53 is back. You Heard

cool, thanks p53, u gonna rock this exam. I'm gonna post a couple of more from this test

 

[ucbdancn00]

1. Ovarian tumor. AGE, location of mass, and unilaterality is the key. Goljan also told me. Haha
2. Angiogenesist. The picture was a cavernous hemangioma. As Dr. Goljan would say, don't do anything.
3. The most lateral rod on the right. The picture looks like a hot dog on the right arm. The arrow that points at the right bun is the MUSCLE somite.
4. Phosphoribosylpyrophosphate synthetase. This is a key regulatory enzyme. Know all of these including HGPRT.
5. narrow mediastinum due to lack of thymus, normal gamma globulins, and decreased t lymphocytes.
6. Anticipation. The tipoff was that the mother has a lack of facial expression and muscle weakness so you know she was has the disease. The hypotonia and facial expression is give away that the disease is myotonic dystrophy. Sorry Dr. goljan, there are more ways than shaking one's hand to find out if they have this disease. Key associations myotonic dystrophy -> triple repeat and anticipation. If you understand Goljan and can apply his lectures you will anhilate this exam. Most people when they listen to his lecture memorize what he says. The smart ones think about what he says and applies it. Example, pleural effusion vs lung consolidation. He talks about it in his audio, but you have to sit down and think about the differences due to tactile fremitus, egophony etc.

as per the DiGeorge question--> wouldn't you have a decreased gamma globulin if you couldn't isotype switch as well (dec T Lymphocytes)? does this refer to the Ig in general or the specific isotype. Sorry if this seems dumb; thanks for the help..

ucb

 

[idq1i]

as per the DiGeorge question--> wouldn't you have a decreased gamma globulin if you couldn't isotype switch as well (dec T Lymphocytes)? does this refer to the Ig in general or the specific isotype. Sorry if this seems dumb; thanks for the help..

ucb

IgG defect is variable. It really depends on the number of "viable" T cells, and on the expression of CD40L

 

[Random SDNer]

1. A series of experiments are performed to determine the mechanism by which a pharmacologic agent transverses cell membranes and accumulates within target cells. The rate of transport depends on the concentration of the drug only. When the extracellular concentration of the agent exceeds 10nM, no further increase in the rate of uptake is observed. Structurally similar compounds pass through the cell membrane, but at a lower rate. Ouabain, an inhibitor of Na+/K+ ATPase, fails to inhibit transport. Which of the following is the most likely mechanism by which this agent enters cells?

A) Antiport
B) Facilitated diffusion
C) Ion-gated coupling
D) Simple diffusion
E) Symport

I thought it was either facilitated diffusion or simple diffusion since it wasn't dependent on a cation gradient but I wasn't sure...

2) A 74 year old man has a cough. On auscultation of the right posterior chest, the patient's spoken "ee" sounds more like an "ay". Which of the following conditions on the right is most likely?

A) Bronchopleural fistula
B) Lower lobe consolidation
C) Middle lobe atelectasis
D) Pleural effusion
E) Pleural plaque
F) Pneumothorax
G) Pleural sequestration

Had no idea...please enlighten us p53

3) A 42 year old man with pneumococcal pneumonia has acute fibrinous pleuritis. Which of the following proteolytic enzymes is required to eliminate the exudate and restore normal pleural anatomy?

A) Collagenase
B) Plasmin
C) Stromeolysin
D) Thrombrin
E) Trypsin

I chose E) trypsin since it was acute inflammation. I wouldn't think it was collagenase because that would breakdown fibrin (fibrosis is chronic inflammation), but then again it said 'fibrinous' pleuritis. Stromeolysin is a matrix metalloproteinase... but I don't know if this is relevant...

4) During an experiment on the cough reflex in humans, a subject inhales air containing different amounts of particles that will impact and adhere to mucus primarily in the trachea. Blockade of which of the following afferent pathways would most likely prevent this subject's reflex to initiate a cough?

A) Glossopharyngeal
B) Laryngeal
C) Olfactory
D) Trigeminal
E) Vagal

I was between Glossopharyngeal and Vagal but I wasn't sure so I picked Vagal.

5) A 24 year old man is brought to the Emergency department after being stabbed in the left 4th intercostal space, immediately next to the sternum.
Which structure was most likely damaged?

A) Pulmonary trunk
B) Right atrium
C) Right ventricle
D) Superior vena cava
E) Thoracic aorta

I put right ventricle, but I wasn't sure.

6) A 5-year-old boy with a history of recurrent ear infections receives his preschool booster immunization against diphtheria-tetanus-pertussis. He is participating in a community-sponsored study to determine the humoral immune response to tetanus toxoid (tt). His response is well below normal for age- and sex-matched children. Peripheral B lymphocyte count and T lymphocyte count and function are within the reference range. The antibody he makes is positive in both the passive hemagglutination and complement-mediated lysis of tt-coated erythrocytes. His antibodies do not opsonize tt-coated latex particles for phagocytosis and do not directly precipitate tt efficiently. This child most likely has a defect in which of the following processes?

A) Affinity maturation of immunoglobulins
B) Immunoglobulin isotype switching
C) Recombination of heavy chain variable region genes
D) Recombination of light chain variable region genes
E) Somatic mutation of immunoglobulin genes

I chose A, but i wasn't sure

7. A 25-year-old woman, gravida 1, para 0, who is Rh-negative, delivers a full-term Rh-positive neonate. The mother is given prophylactic anti-Rho(D) immune globulin immediately post partum. During her second pregnancy 3 years later, she is screened each trimester for Rho(D) antibodies. An indirect antiglobulin test done during the third trimester indicates the presence of anti-Rho(D) antibodies in her serum. Which of the following is the most likely mechanism for the occurrence of these maternal antibodies?

A) Anamnestic production of maternal anti-Rho(D) immunoglobulin
B) Intrauterine transplacental fetal-maternal hemorrhages during the second pregnancy
C) Residual circulating prophylactic anti-Rho(D) immunoglobulin
D) Transplacental passage of fetal IgG anti-Rho(D) antibodies

I picked A) since I thought this was a secondary (amnestic) immune response. I was confused though because the woman received anti-Rho(D) immediately post partum so this should've prevented Rh antigen exposure. I was between A) and B).

8. A 25 year old woman at 32 weeks' gestation begins taking a drug to delay the onset of preterm labor. After the first dose, she notices tremulousness in her hands. Which of the following types of receptors is most likely to be involved in this effect?

A) alpha-1 adrenergic
B) Beta-2 adrenergic
C) Dopaminergic (D1)
D) Muscarinic (M1)
E) NMDA

I thought she might have been taking ritodrine or terbutaline which are both B) Beta-2 agonists, but I wasn't sure on the tremulousness of the hands.

9. The bone marrow picture with that bright red line from the top right corner to the bottom left corner. Fever, fatigue, easy bruising. Low crit, Hgb, leukocyte count, and platelets. I chose aplastic anemia, but I wasn't so sure because it could have been myelofibrosis.

10. Which of the following antimicrobial agents is most likely to be administered orally for the treatment of serious systemic infections because of it's predictable bioavailability?

A) Amphotericin B
B) Ciprofloxacin
C) Gentamicin
D) Polymyxin B
E) Vancomycin

I thought it was vanco... but I wasn't sure.

11. The cross sectional picture at T-12 to L-1. Patient was nervous had heart pounds and clammy skin and was also hypertensive. Neoplasm in? I was thinking sympathetic chain tumor or something near the aorta causing an obstruciton but I could be way off.

 

[Random SDNer]

Actually now that I think about it, that last question might have been pheochromocytoma...

 

[Random SDNer]

IgG defect is variable. It really depends on the number of "viable" T cells, and the expression of CD40L

While your statement is true, there is thymic aplasia in DiGeorge syndrome so I think it's safe to assume that there are decreased T-Cells in the periphery that's why you have defective cellular immunity but intact humoral immunity albeit it's not as functional because there is less class-isotype switching. As for the gamma globulin and isotype switching, it is dependent on CD40/CD40L interaction like IdQ1 said, but gamma globulin refers to the Ig sublcasses: IgG, IgM, IgA. So you would still have normal IgM even though you don't have class isotype switching. If you want a reference, check this out.

http://www.nlm.nih.gov/medlineplus/ency/article/003544.htm

Peace out

 

[fukdbyMIT]

While your statement is true, there is thymic aplasia in DiGeorge syndrome so I think it's safe to assume that there are decreased T-Cells in the periphery that's why you have defective cellular immunity but intact humoral immunity albeit it's not as functional because there is less class-isotype switching. As for the gamma globulin and isotype switching, it is dependent on CD40/CD40L interaction like IdQ1 said, but gamma globulin refers to the Ig sublcasses: IgG, IgM, IgA. So you would still have normal IgM even though you don't have class isotype switching. If you want a reference, check this out.

http://www.nlm.nih.gov/medlineplus/ency/article/003544.htm

Peace out

Yep, I agree with the above statement. You should be a little less confident about your responses before you post them idq1i or check them over or provide a reference because you'll confuse or lead people astray. I'm pretty sure that was not your intention but it's something to keep in mind.

 

[idq1i]

While your statement is true, there is thymic aplasia in DiGeorge syndrome so I think it's safe to assume that there are decreased T-Cells in the periphery that's why you have defective cellular immunity but intact humoral immunity albeit it's not as functional because there is less class-isotype switching. As for the gamma globulin and isotype switching, it is dependent on CD40/CD40L interaction like IdQ1 said, but gamma globulin refers to the Ig sublcasses: IgG, IgM, IgA. So you would still have normal IgM even though you don't have class isotype switching. If you want a reference, check this out.

http://www.nlm.nih.gov/medlineplus/ency/article/003544.htm

Peace out

"Gamma" refers to the gamma heavy chain. Therefore, Gamma globulins are technically IgG molecules. However, If you refer to the electrophoretic definition, then gamma globulins are indeed IgA, IgM and IgG.

Looks to me like the NBME is being too vague with the definitions

 

[idq1i]

You should be a little less confident about your response

Likewise

Variable secondary humoral defects can be present, including hypogammaglobulinemia, selective antibody deficiency, and polysaccharide antigens.
http://www.emedicine.com/ped/topic589.htm

Here is the original q: as per the DiGeorge question--> wouldn't you have a decreased gamma globulin if you couldn't isotype switch as well (dec T Lymphocytes)? does this refer to the Ig in general or the specific isotype.

Here is my original post, again: IgG defect is variable. It really depends on the number of "viable" T cells, and on the expression of CD40L

Where exactly is my error?

 

[fukdbyMIT]

Likewise

Variable secondary humoral defects can be present, including hypogammaglobulinemia, selective antibody deficiency, and polysaccharide antigens.
http://www.emedicine.com/ped/topic589.htm


Here is my original post, again: IgG defect is variable. It really depends on the number of "viable" T cells, and on the expression of CD40L

Where exactly is my error?

LOL, I didn't say your statement was wrong. I agree with your statement too. NOTHING is wrong with it, but it didn't explain the other person's confusion until you clarified it later. Apologies if I offended you in the last post. It's just etiquette to provide a reference if you feel very strongly about something that's not so totally obvious.

 

[idq1i]

LOL, I didn't say your statement was wrong. I agree with your statement too. NOTHING is wrong with it, but it didn't explain the other person's confusion until you clarified it later. Apologies if I offended you in the last post. It's just etiquette to provide a reference if you feel very strongly about something that's not so totally obvious.

Not offensive at all - no apologies necessary Sorry for missing your point - i did neglect the 1st part of his q.

I posted my take on the matter in the post above the one you quoted:

"Gamma" refers to the gamma heavy chain. Therefore, Gamma globulins are technically IgG molecules. However, If you refer to the electrophoretic definition, then gamma globulins are indeed IgA, IgM and IgG.

Looks to me like the NBME is being too vague with the definitions

 

[Random SDNer]

1. A series of experiments are performed to determine the mechanism by which a pharmacologic agent transverses cell membranes and accumulates within target cells. The rate of transport depends on the concentration of the drug only. When the extracellular concentration of the agent exceeds 10nM, no further increase in the rate of uptake is observed. Structurally similar compounds pass through the cell membrane, but at a lower rate. Ouabain, an inhibitor of Na+/K+ ATPase, fails to inhibit transport. Which of the following is the most likely mechanism by which this agent enters cells?

A) Antiport
B) Facilitated diffusion
C) Ion-gated coupling
D) Simple diffusion
E) Symport

I thought it was either facilitated diffusion or simple diffusion since it wasn't dependent on a cation gradient but I wasn't sure...

2) A 74 year old man has a cough. On auscultation of the right posterior chest, the patient's spoken "ee" sounds more like an "ay". Which of the following conditions on the right is most likely?

A) Bronchopleural fistula
B) Lower lobe consolidation
C) Middle lobe atelectasis
D) Pleural effusion
E) Pleural plaque
F) Pneumothorax
G) Pleural sequestration

Had no idea...please enlighten us p53

3) A 42 year old man with pneumococcal pneumonia has acute fibrinous pleuritis. Which of the following proteolytic enzymes is required to eliminate the exudate and restore normal pleural anatomy?

A) Collagenase
B) Plasmin
C) Stromeolysin
D) Thrombrin
E) Trypsin

I chose E) trypsin since it was acute inflammation. I wouldn't think it was collagenase because that would breakdown fibrin (fibrosis is chronic inflammation), but then again it said 'fibrinous' pleuritis. Stromeolysin is a matrix metalloproteinase... but I don't know if this is relevant...

4) During an experiment on the cough reflex in humans, a subject inhales air containing different amounts of particles that will impact and adhere to mucus primarily in the trachea. Blockade of which of the following afferent pathways would most likely prevent this subject's reflex to initiate a cough?

A) Glossopharyngeal
B) Laryngeal
C) Olfactory
D) Trigeminal
E) Vagal

I was between Glossopharyngeal and Vagal but I wasn't sure so I picked Vagal.

5) A 24 year old man is brought to the Emergency department after being stabbed in the left 4th intercostal space, immediately next to the sternum.
Which structure was most likely damaged?

A) Pulmonary trunk
B) Right atrium
C) Right ventricle
D) Superior vena cava
E) Thoracic aorta

I put right ventricle, but I wasn't sure.

6) A 5-year-old boy with a history of recurrent ear infections receives his preschool booster immunization against diphtheria-tetanus-pertussis. He is participating in a community-sponsored study to determine the humoral immune response to tetanus toxoid (tt). His response is well below normal for age- and sex-matched children. Peripheral B lymphocyte count and T lymphocyte count and function are within the reference range. The antibody he makes is positive in both the passive hemagglutination and complement-mediated lysis of tt-coated erythrocytes. His antibodies do not opsonize tt-coated latex particles for phagocytosis and do not directly precipitate tt efficiently. This child most likely has a defect in which of the following processes?

A) Affinity maturation of immunoglobulins
B) Immunoglobulin isotype switching
C) Recombination of heavy chain variable region genes
D) Recombination of light chain variable region genes
E) Somatic mutation of immunoglobulin genes

I chose A, but i wasn't sure

7. A 25-year-old woman, gravida 1, para 0, who is Rh-negative, delivers a full-term Rh-positive neonate. The mother is given prophylactic anti-Rho(D) immune globulin immediately post partum. During her second pregnancy 3 years later, she is screened each trimester for Rho(D) antibodies. An indirect antiglobulin test done during the third trimester indicates the presence of anti-Rho(D) antibodies in her serum. Which of the following is the most likely mechanism for the occurrence of these maternal antibodies?

A) Anamnestic production of maternal anti-Rho(D) immunoglobulin
B) Intrauterine transplacental fetal-maternal hemorrhages during the second pregnancy
C) Residual circulating prophylactic anti-Rho(D) immunoglobulin
D) Transplacental passage of fetal IgG anti-Rho(D) antibodies

I picked A) since I thought this was a secondary (amnestic) immune response. I was confused though because the woman received anti-Rho(D) immediately post partum so this should've prevented Rh antigen exposure. I was between A) and B).

8. A 25 year old woman at 32 weeks' gestation begins taking a drug to delay the onset of preterm labor. After the first dose, she notices tremulousness in her hands. Which of the following types of receptors is most likely to be involved in this effect?

A) alpha-1 adrenergic
B) Beta-2 adrenergic
C) Dopaminergic (D1)
D) Muscarinic (M1)
E) NMDA

I thought she might have been taking ritodrine or terbutaline which are both B) Beta-2 agonists, but I wasn't sure on the tremulousness of the hands.

9. The bone marrow picture with that bright red line from the top right corner to the bottom left corner. Fever, fatigue, easy bruising. Low crit, Hgb, leukocyte count, and platelets. I chose aplastic anemia, but I wasn't so sure because it could have been myelofibrosis.

10. Which of the following antimicrobial agents is most likely to be administered orally for the treatment of serious systemic infections because of it's predictable bioavailability?

A) Amphotericin B
B) Ciprofloxacin
C) Gentamicin
D) Polymyxin B
E) Vancomycin

I thought it was vanco... but I wasn't sure.

11. The cross sectional picture at T-12 to L-1. Patient was nervous had heart pounds and clammy skin and was also hypertensive. Neoplasm in? I was thinking sympathetic chain tumor or something near the aorta causing an obstruciton but I could be way off.


Posting again cause none of the Q's were answered.

 

[Random SDNer]

Quote:
"Gamma" refers to the gamma heavy chain. Therefore, Gamma globulins are technically IgG molecules. However, If you refer to the electrophoretic definition, then gamma globulins are indeed IgA, IgM and IgG.

Looks to me like the NBME is being too vague with the definitions

Hey iDQ1 Are you 100% positive about "gamma" referring to gamma heavy chain, as in IgG? And if so, could you lead me to a reference? I thought gamma referred to the gamma fraction on electrophoresis as you said later. At least that's what I have in my class notes... but maybe both are right... who knows?

one of those things that was always kinda confusing to me.

 

[idq1i]

Here's my take:

1 - facilitated diffusion that gets saturated above a certain [] (a n educated guess)

2 - egophony = consolidation or effusion. egophony + cough = consolidation

3 - Stromeolysin, secreted by macrophages resolves the gray hepatization (an educated guess)

4 - trachea = vagal

5 - I say rv, almost at septum

6 - type switching. IgG opsonizes beads

7 - Wow, umm... hmmm. I'd say B.. She should have no A - anti-rho should have knocked out (made anergic) the reactive B cells

8 - b2 agonist side fx is a tremor!

9 - no pic = can't answer

10 - Vanco is not PO (only for luminal purposes). ampho is quite unpredictable. polymyxin - IM/intrathecal. Gentamycin - IV/IM. I'd say cipro

11 - adrenal medulla

 

[idq1i]

Quote:
"Gamma" refers to the gamma heavy chain. Therefore, Gamma globulins are technically IgG molecules. However, If you refer to the electrophoretic definition, then gamma globulins are indeed IgA, IgM and IgG.

Looks to me like the NBME is being too vague with the definitions

Hey iDQ1 Are you 100% positive about "gamma" referring to gamma heavy chain, as in IgG? And if so, could you lead me to a reference? I thought gamma referred to the gamma fraction on electrophoresis as you said later. At least that's what I have in my class notes... but maybe both are right... who knows?

one of those things that was always kinda confusing to me.

Don't cite me on this, but I think that the electrophoretic Gamma is a relic of the past. They named the electrophoretic bands alpha, beta, gamma - just like in the greek alphabet - before they figured out that the Gamma band contains gamma, mu and alpha.

The answer to your question is: I believe that the q was referring to the electrophoretic gamma (eg. G, A, M). I suppose the NBME wanted us to realize that the IgM production is independent of T cell influence.
This constant internal argument with test q writers is going to get me in trouble on Monday

HOWEVER, gamma globulins ARE globulins with a gamma heavy chain. Let me see if I can find a good reference.

 

[fukdbyMIT]

Here's my take:

1 - facilitated diffusion that gets saturated above a certain []

2 - egophony = consolidation or effusion. egophony + cough = consolidation

3 - Stromeolysin, secreted by macrophages resolves the gray hepatization (a guess)

4 - trachea = vagal

5 - I say RV as well. Netter, p 192

6 - type switching. IgG opsonizes beads

7 - Wow, umm... hmmm. I'd say B.. She should have no A - anti-rho should have knocked out (made anergic) the reactive B cells

8 - b2 agonist side fx is a tremor!

9 - no pic = no answer

10 - Vanco is not PO. I'd say cipro - the rest are not as predictable

11 - adrenal medulla

Vanco is definitely PO. While it is usually administered through IV because it's not absorbed via the oral route it's used in the treatment of C. difficile colitis. Check up on your thoughts idq1i. Reference for PO vanco can be found in Lippincott's Pharmacology 2nd edition, page 308 under pharmacokinetics. As for the answer for this question... I don't know because I'm not sure. Maybe vanco? could be cipro. Who knows?

 

[idq1i]

Who knows?

I do

Vanco is luminal PO. It is not well-absorbed. The q said "treatment of serious systemic infections." C. dificile is not systemic.

 

[fukdbyMIT]

I do

Vanco is luminal PO. It is not well-absorbed. The q said "treatment of serious systemic infections." C. dificile is not systemic.

haha... not. It's pretty obvious that C. difficile is not systemic. I was referring to you saying that Vanco was not PO which was obviously wrong.

 

[fang]

more opinions:

3) A 42 year old man with pneumococcal pneumonia has acute fibrinous pleuritis. Which of the following proteolytic enzymes is required to eliminate the exudate and restore normal pleural anatomy?

A) Collagenase
B) Plasmin
C) Stromeolysin
D) Thrombrin
E) Trypsin

I chose B -- plasmin cleaves fibrin, which will resolve fibrinous pleuritis.


Also, here is how I thought through this one... could someone clarify or correct this??

2) A 74 year old man has a cough. On auscultation of the right posterior chest, the patient's spoken "ee" sounds more like an "ay". Which of the following conditions on the right is most likely?

Egophony will be increased by anything that places more fluid between the vocal cords and the stethesope, and will be decreased by anything that fills that space with air.

A) Bronchopleural fistula -- air in the pleural space will decrease egophony
B) Lower lobe consolidation -- the denser and incompressible material (e.g. not air) will transmit sound better and will change the pitch of the sound
C) Middle lobe atelectasis -- this also would decrease the amount of air between the source of the sound and the stethosope, but maybe not as much as (b) since the remaining lobes will inflate normally.
D) Pleural effusion -- air is still present in the lunch between the chest wall and the origin of the sound, therefore egophony will not be as pronounced. However, this would still tend to cause egophony if severe enough (?)
E) Pleural plaque -- no change
F) Pneumothorax -- LESS egophony due to increased air
G) Pleural sequestration -- no change

COPD and asthma would have LESS egophony due to more air in lungs.

also, how are egophony, tactile fremitus, and whispered pectriloqy related? Are all 3 usually increased in the same situations (consolidation and pleural effusion?)

 

[idq1i]

haha... not. It's pretty obvious that C. difficile is not systemic. I was referring to you saying that Vanco was not PO which was obviously wrong.

It wasn't PO as far as the q was concerned. I edited my post to reflect this.

 

[fukdbyMIT]

It wasn't PO as far as the q was concerned. I edited my post to reflect this.

Geeze, you're really good at making yourself look like an A$$ on this forum, I've looked at a couple of other posts by you and Ramoray. No doubt, you seem like an intelligent person since you seem to know a whole lot, I'll give you props for that. If you act like this on the wards, you're in for some serious trouble when an attending is going to PIMP you hardcore, because there's no way you'll know as much as an attending, and your attitude will get you nowhere. Hopefully you're not like this in real life and I really hope you're not representative of the typical NYMC student.

 

[idq1i]

Geeze, you're really good at making yourself look like an A$$ on this forum, I've looked at a couple of other posts by you and Ramoray. No doubt, you seem like an intelligent person since you seem to know a whole lot, I'll give you props for that. If you act like this on the wards, you're in for some serious trouble when an attending is going to PIMP you hardcore, because there's no way you'll know as much as an attending, and your attitude will get you nowhere. Hopefully you're not like this in real life and I really hope you're not representative of the typical NYMC student.

What attitude? I would like to see a quote that supposedly represents my "a55hole attitude." IIRC, I apologized for missing point of your first post.

Can't we stick to the topic at hand? Let's keep the patronizing "advice" to ourselves.

 

[HiddenTruth]

What attitude? I would like to see a quote that supposedly represents my "a55hole attitude"

Can't we stick to the topic at hand? Let's keep the patronizing "advice" to ourselves.

Wow!...nothing else need be said. Accept the advice, it won't bite ya.

 

[fukdbyMIT]

What attitude? I would like to see a quote that supposedly represents my "a55hole attitude." IIRC, I apologized for missing point of your first post.

Can't we stick to the topic at hand? Let's keep the patronizing "advice" to ourselves.

yeah yeah, 770 on the shelf comment, don't deny that you didn't post that and then edit it, I saw it with my own eyes even though I don't have proof. It's a good thing you retracted that before anyone else saw that but me. While your score is amazing, No doubt. That's incredible actually, I didn't score nearly as high. You should really seriously consider changing your attitude, I'm only saying this to benefit you.

 

[idq1i]

yeah yeah, 770 on the shelf comment, don't deny that you didn't post that and then edit it, I saw it with my own eyes even though I don't have proof. It's a good thing you retracted that before anyone else saw that but me. While your score is amazing, No doubt. That's incredible actually, I didn't score nearly as high. You should really seriously consider changing your attitude, I'm only saying this to benefit you.

I deleted it because I was not following my own advice to stick to the topic at hand. What I got on the shelf is not relevant. I apologize for getting carried away - this forum is supposed to be about helping each other

 

[fukdbyMIT]

I deleted it because I was not following my own advice to stick to the topic at hand. What I got on the shelf is not relevant. I apologize for getting carried away - this forum is supposed to be about helping each other

cool, yeah I apologize too if I offended you. Looks like you're going to kick some ass on step I. Keep up the good work with your posts, you seem to have a lot of insight.

Best