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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[02115]

It was Pick's disease:

Pick's disease primarily affects frontal and temporal lobes but what is characteristic about Pick's is they show minimal dementia and lose "frontal inhibition." ----> Why he become rude, unkempt, and made wierd comments to people.

Drats! That was my second choice!!!

 

[02115]

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What did you guys put for the angry patient? The lady who was really upset and just told you to get this over with?

-I thought you might bring up scheduling her another day because Ive heard a doctor do that but the way it was written on test didnt seem too nice

I thought for that one it was either the "what brings you in" or "you seem angry-- is there something bothering you?" For the first one isn't that the way you're supposed to introduce yourself? For the second one, it acknowledges the patients problem (rapport) but could be a bit judgemental???

 

[maswe12]

Haha, I have no clue what the hell was in that Frozen Etched specimen even after looking it up!

http://www.visualsunlimited.com/browse/vu350/vu350783.html

is that what it looked like? I said gap jxn but im not sure if that site is the same as was on the test.

 

[02115]

Yeah, I thought it was a gap junction, in which case the purpose would be communicating (???) but I also thought it could be a hemidesmosome, the one like the rivet???

 

[Kashue]

What did you guys put for the angry patient? The lady who was really upset and just told you to get this over with?

-I thought you might bring up scheduling her another day because Ive heard a doctor do that but the way it was written on test didnt seem too nice

You gotta acknowledge their anger. Why are you upset. That's straight up from HY behav as tho Fadem wrote that Q.

 

[Kashue]

http://www.visualsunlimited.com/browse/vu350/vu350783.html

is that what it looked like? I said gap jxn but im not sure if that site is the same as was on the test.

Ahhhh, thank you! That's exactly what it looked like.

 

[02115]

I remembered some additional questions related to anatomy:

1) For the what fossa is this part of the brain in what was the right answer? I thought it was the ptergopalatine (??) fossa?

2) For the fracture of the median epicondyle and nerve deficit, it sounded like an ulnar nerve injury. I put down the pt couldn't pronate his arm, but now that I think about it maybe it was he couldn't flex his fingers (i.e. claw hand). The thing that threw me was the question said "fingers" but I thought the thumb was a finger and its flexion wouldn't be affected by an ulnar n. lesion as it is controlled by the median n (????). I really need to study anatomy-- does anyone have insight on these questions!

 

[02115]

For the behavioral sciences question about the breast lump, I thought that the physician could be sued only if the patient was found to have cancer (i.e. suffered harm). Although a smart lawyer could probably argue that the patient suffered harm from the anxiety associated with the lump, in which case I would be wrong.

 

[02115]

Aha, for the orchitis question, Wikipediahttp://en.wikipedia.org/wiki/Chlamydia provides a possible answer:

In men, chlamydia may not cause any symptoms, but symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, swollen or tender testicles, or fever.

Chlamydia in men can spread to the testicles, causing epididymitis, which can cause sterility. Chlamydia causes more than 250,000 cases of epididymitis in the USA each year.

 

[Kashue]

For the behavioral sciences question about the breast lump, I thought that the physician could be sued only if the patient was found to have cancer (i.e. suffered harm). Although a smart lawyer could probably argue that the patient suffered harm from the anxiety associated with the lump, in which case I would be wrong.

naw dude, #1 reason why doctors get sued is poor patient doctor communication.

I believe the brain part was behind the eye so middle fossa.

The ulnar nerve Q I said Flex fingers but I haven't studied anatomy yet so not sure about that either.

 

[02115]

naw dude, #1 reason why doctors get sued is poor patient doctor communication.

I believe the brain part was behind the eye so middle fossa.

The ulnar nerve Q I said Flex fingers but I haven't studied anatomy yet so not sure about that either.

Whaaat??? I thought FA says: Civil suit under negligence requires:

1) Breach of duty to patient
2) Pt suffers harm
3) Breach of duty causes harm

So my reasoning was that the pt can sue only if she suffers harm (i.e. breast cancer).

 

[Kashue]

Whaaat??? I thought FA says: Civil suit under negligence requires:

1) Breach of duty to patient
2) Pt suffers harm
3) Breach of duty causes harm

So my reasoning was that the pt can sue only if she suffers harm (i.e. breast cancer).

Right, but the questions was asking why DO they sue and most patients sue due to breakdown of doctor patient communication. I'm sure First Aid says it somewhere in there. The reasons you gave above are what makes the doctor liable to be sued. "Pt suffers harm" happens all the time in Hospitals/doctor's offices(eg wrong pills, giving foods with sugar to a diabetic etc), but not everyone will sue.

I had a whole day's lecture on this so I'm pretty sure that this is the right choice.

 

[02115]

You're probably right given that I scored a 410! (I'm not worthy, I'm not worthy)

 

[02115]

You know for that image of the esophagus with vomiting, was that a mallory weiss tear or a ruptured varicie?

 

[Kashue]

You know for that image of the esophagus with vomiting, was that a mallory weiss tear or a ruptured varicie?

Ruptured Varicle, the question mentioned that he wasn't vomitting so it ruled out a tear --> hence portal htn ----> ruptured varicele.

 

[02115]

I thought he had painless vomiting of bright red blood? I put the ruptured varicele? Hey Kashue, do you know what the answer was to that kid who took the sedative (?) from mom's purse? I thought flumazenil.

 

[Kashue]

I thought he had painless vomiting of bright red blood? I put the ruptured varicele? Hey Kashue, do you know what the answer was to that kid who took the sedative (?) from mom's purse? I thought flumazenil.

I put ruptured Varicele too, no idea if that's right coz I was weak in GI which is wierd since I thought the GI Q's were easy.

Ya, it's flumazenil - straight from FA. I believe it's a GABA antagonist.

 

[02115]

Oh boy we're back to square one with this infectious orchitis question. I'm doing QBank and one question says:

"Acute orchitis with prominent neutrophils in a sexually active male are most likely due to an infection with N. Gonorrhea or Chlamydia trachomatis. N. Gonorrhea can produce a specific pattern of acute inflammation (non-specific epidimitis and orchitis) or can be sufficiently severe to cause frank abscesses within the epididymis."

 

[juddson]

I put ruptured Varicele too, no idea if that's right coz I was weak in GI which is wierd since I thought the GI Q's were easy.

Ya, it's flumazenil - straight from FA. I believe it's a GABA antagonist.

I hate to dredge this thread back up again, but I just took #1 and am wondering of P53 ever posted his answer key.

BTW, I chose benzo antagonist (flumazenil) as well because I remembered that benzo's depress resp much less than barbs, and opiods would have depressed resp. majorily.

The medial epicondile question (I'm thinking) was adduction and abduction of the fingers (via the intrinsic interosseous muscles of the hand) which is controlled by the Ulnar N.

I but Mallory Weise for the ruptured esophagus because (rather than portal HTN) because I though they said he was vomitting. I feel lousy about that one because I think I may have answered before even seeing the varicosity answer. CRAP!!

Did anybody know what the still-born infant with the cleft lip/palate had. I missed that one pretty good.

Judd

 

[Kashue]

I hate to dredge this thread back up again, but I just took #1 and am wondering of P53 ever posted his answer key.

BTW, I chose benzo antagonist (flumazenil) as well because I remembered that benzo's depress resp much less than barbs, and opiods would have depressed resp. majorily.

The medial epicondile question (I'm thinking) was adduction and abduction of the fingers (via the intrinsic interosseous muscles of the hand) which is controlled by the Ulnar N.

I but Mallory Weise for the ruptured esophagus because (rather than portal HTN) because I though they said he was vomitting. I feel lousy about that one because I think I may have answered before even seeing the varicosity answer. CRAP!!

Did anybody know what the still-born infant with the cleft lip/palate had. I missed that one pretty good.

Judd

I think they asked about inheritance right? I put multifactorial.

 

[DoctorWannaBe]

Can someone help me with these questions? Thanks!

1. 56-year-old man has fever and pleuritic chest pain for 1 day. He was admitted to the hospital 3 weeks ago because of an acute transmural anterior MI. He has taken a beta-adrenergic blocking agent and aspirin since being discharged. A friction rub is heard over the pericardium. What is the most likely cause of these findings?
A. Adverse drug effect
B. Aortic dissection
C. Autoimmune reaction
D. Postviral inflammation
E. Recurrent ischemia

Is the answer C (Dressler’s syndrome)?

2. A 35-year-old woman has had twelve 0.5 to 1.5 cm lesions on her neck, trunk, and limbs for 5 years. Which of the following is the most likely diagnosis?
A. Chronic hepatic disease
B. Cushing’s syndrome
C. HIV infection
D. Melatonin excess
E. Neurofibromatosis

I put neurofibromatosis, even though I thought the cafe-au-lait spots would have been there since birth.


3. A 23-year-old woman has had intermittent amenorrhea since the birth of her first child 5 years ago. She received 10 units of blood during her delivery. Her skin is thick and doughy. She has no energy and is depressed. Which of the following is the most likely cause of her symptoms?
A. Adrenocortical insufficiency
B. Chronic fatigue syndrome
C. Hemochromatosis
D. HIV infection
E. Pituitary necrosis

I thought Adrenocortical insufficiency, but what does this have to do with her skin changes and the blood transfusion?

4. Four months after a cholecystectomy for removal of gallstones, a 43-year-old woman has recurrent episodes of biliary colic. After endoscopic sphincterotomy, the episodes of colic do not recur. Which of the following defects in the sphincter of Oddi best explains this patient’s course?
A. Inability of smooth muscle to contract
B. Inability of the enteric nervous system to activate excitatory motoneurons
C. Loss of enteric inhibitory motor innervation
D. Reflux of duodenal contents into the common bile duct
E. Release of vasoactive intestinal polypeptide

5. Man with nausea, vomiting, abdominal pain, tachycardia, absent bowel sounds, involuntary guarding, rebound tenderness.
A. Cholecystitis
B. Gastritis
C. Gastroenteritis
D. Peritonitis
E. Small bowel obstruction

I picked small bowel obstruction.

6. Baby with 4 x 4 cm mass posterior to right sternocleidomastoid muscle. Mass is unilocular, filled with watery fluid, and no other abnormalities are present.
A. Branchial cyst
B. Cystic hygroma
C. Preauricular sinus
D. Thyroglossal duct cyst
E. Zenker’s diverticulum

I chose Branchial cyst, but according to the internet, those are usually anterior to the sternocleidomastoid muscle.

7 . A woman has ringing in her ears and dizziness 7 days after starting a drug. What is she on?
A. Acetaminophen
B. Aspirin
C. Auranofin
D. Methotrexate
E. Prednisone

I couldn't find those side effects listed for any of the drugs, although I did see dizziness listed for methotrexate and prednisone.

 

[OldLady]

I would think E- Sheehan's syndrome. If she hemorraged during delivery she would need blood. Lack of pit hormones = hypothryoid sx (skin, fatigue, depression)
--------------------------------------------------------------------------
Can someone help me with these questions? Thanks!
3. A 23-year-old woman has had intermittent amenorrhea since the birth of her first child 5 years ago. She received 10 units of blood during her delivery. Her skin is thick and doughy. She has no energy and is depressed. Which of the following is the most likely cause of her symptoms?
A. Adrenocortical insufficiency
B. Chronic fatigue syndrome
C. Hemochromatosis
D. HIV infection
E. Pituitary necrosis
I thought Adrenocortical insufficiency, but what does this have to do with her skin changes and the blood transfusion?

 

[Kashue]

I would think E- Sheehan's syndrome. If she hemorraged during delivery she would need blood. Lack of pit hormones = hypothryoid sx (skin, fatigue, depression)
--------------------------------------------------------------------------
Can someone help me with these questions? Thanks!
3. A 23-year-old woman has had intermittent amenorrhea since the birth of her first child 5 years ago. She received 10 units of blood during her delivery. Her skin is thick and doughy. She has no energy and is depressed. Which of the following is the most likely cause of her symptoms?
A. Adrenocortical insufficiency
B. Chronic fatigue syndrome
C. Hemochromatosis
D. HIV infection
E. Pituitary necrosis
I thought Adrenocortical insufficiency, but what does this have to do with her skin changes and the blood transfusion?

Classical History for SheeHan syndrome ---> Pit necrosis

 

[juddson]

Classical History for SheeHan syndrome ---> Pit necrosis

yea, the give-away is the need for blood during the delivery. Funny, I never pegged USMLE for such dirty tricks, but I think the Hemochromatosis was thrown in an attractor (Fe from all the blood).

On the others:

Post MI Friction rub - no idea

cafe Au Lait - I also put NFT

Sphincter of Oddi - This one was tough as balls. Relaxing Oddi is "pro-kinetic", but would appear to require inhibition of motor neurons (hence, the "relaxation" of the sphincter). Hence, loss of inhibitory neurons (it would seem to me) would cause excess tone of the sphincter and be the cause of the colic. BUT, Oddi tone (I thought) was actually controlled by Cholycytsikinin (which relaxes the sphincter of Oddi put contracts the gall bladder). So, not sure how that fits in.

GI problems - I am under the impression (which I'm sure is wrong) that the dDx for "rebound tenderness" is peritonitis, peritonitis and. . . peritonitis. Someone set me straight.

Cyst - I thought brachial cyst also. I always pick Brachial Cyst when I see a cyst on the neck. It's probably wrong in this case, but it should be right 80% of the time.

Ear ringing - I am under the impression that Tinnitis is caused by Aspirin

Judd

 

[hale-bopp]

1. yes, dressler's

6. I thought it was a cystic hygroma, like in Turner's, but maybe those are bilateral

7. aspirin toxicity definitely causes tinnitus

 

[surgwannabe]

Can someone help me with these questions? Thanks!

1. 56-year-old man has fever and pleuritic chest pain for 1 day. He was admitted to the hospital 3 weeks ago because of an acute transmural anterior MI. He has taken a beta-adrenergic blocking agent and aspirin since being discharged. A friction rub is heard over the pericardium. What is the most likely cause of these findings?
A. Adverse drug effect
B. Aortic dissection
C. Autoimmune reaction
D. Postviral inflammation
E. Recurrent ischemia

Is the answer C (Dressler’s syndrome)? I think Dressler's is correct, 6 wks after initial MI occurs

2. A 35-year-old woman has had twelve 0.5 to 1.5 cm lesions on her neck, trunk, and limbs for 5 years. Which of the following is the most likely diagnosis?
A. Chronic hepatic disease
B. Cushing’s syndrome
C. HIV infection
D. Melatonin excess
E. Neurofibromatosis

I put neurofibromatosis, even though I thought the cafe-au-lait spots would have been there since birth. NF is probably correct since the only other "condition" that's associated with cafe-au-lait spots is birthmark


3. A 23-year-old woman has had intermittent amenorrhea since the birth of her first child 5 years ago. She received 10 units of blood during her delivery. Her skin is thick and doughy. She has no energy and is depressed. Which of the following is the most likely cause of her symptoms?
A. Adrenocortical insufficiency
B. Chronic fatigue syndrome
C. Hemochromatosis
D. HIV infection
E. Pituitary necrosis

I thought Adrenocortical insufficiency, but what does this have to do with her skin changes and the blood transfusion? Sheehan's, blood loss due to pregnancy causes pituitary insufficiency

4. Four months after a cholecystectomy for removal of gallstones, a 43-year-old woman has recurrent episodes of biliary colic. After endoscopic sphincterotomy, the episodes of colic do not recur. Which of the following defects in the sphincter of Oddi best explains this patient’s course?
A. Inability of smooth muscle to contract
B. Inability of the enteric nervous system to activate excitatory motoneurons
C. Loss of enteric inhibitory motor innervation
D. Reflux of duodenal contents into the common bile duct
E. Release of vasoactive intestinal polypeptide

I went with loss of enteric inhibitory motor innervation since everything else seems to relax smooth muscles

5. Man with nausea, vomiting, abdominal pain, tachycardia, absent bowel sounds, involuntary guarding, rebound tenderness.
A. Cholecystitis
B. Gastritis
C. Gastroenteritis
D. Peritonitis
E. Small bowel obstruction

I picked small bowel obstruction. same here

6. Baby with 4 x 4 cm mass posterior to right sternocleidomastoid muscle. Mass is unilocular, filled with watery fluid, and no other abnormalities are present.
A. Branchial cyst
B. Cystic hygroma
C. Preauricular sinus
D. Thyroglossal duct cyst
E. Zenker’s diverticulum

I chose Branchial cyst, but according to the internet, those are usually anterior to the sternocleidomastoid muscle. branchial cyst sounds good to me

7 . A woman has ringing in her ears and dizziness 7 days after starting a drug. What is she on?
A. Acetaminophen
B. Aspirin
C. Auranofin
D. Methotrexate
E. Prednisone

I couldn't find those side effects listed for any of the drugs, although I did see dizziness listed for methotrexate and prednisone. side effects of aspirin include fever, tinnitus, and initial respiratory alkalosis

Just my $.02

 

[Dynamite972]

If someone print screens as they do their exam, and then looking up answers after its completed...

I'm wondering if anyone knows how to correlate a raw score (out of 50) with the 3 digit score...