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A new NBME 15 is out! Here is the official discussion page. How did you guys feel about this nbme?
Is the answer really MDD? That's a bull**** questionDoes anyone have a good explanation for this one:
A 54yo man has abd. pain for 2 months and weight loss. He's jaundiced, and basically has a mass in the head of the pancreas that has extended into the stomach and biliary system. He's most at risk for: major depressive disorder.
Are they saying he is at risk for major depression as a result of the cancer diagnosis? I haven't really ever come across any review material that covers this, but I vaguely remember the idea from class.
Is the answer really MDD? That's a bull**** question
I was thinking along the lines of heptaic failure -> hyperammnonianainaenamia -> encephalopathy -> memory impairment/personality change.
Same here... just took this exam today and I'm going over the answers I got wrong right nowI chose memory impairment for this question and apparently I got it wrong. Frustrating.
Guy gets salmonella enterica and his symptoms resolves to a milder form after 36 hours. If he took antibiotics, which of the following is most likely to occur?
a. anaphylaxis as a result of antibiotic hypersensitivity (Chose this one and it's wrong)
b. decreased risk of endocarditis - salmonella doesnt cause endocarditis
c. decreased risk for hemolytic uremic syndrome - HUS I think of e. coli - never heard of salmonella doing this
d. establishment of carrier state in spleen - why would antibiotics cause a carrier state? also never heard of carrier state in spleen... maybe gallbladder
e. prolonged fecal excretion of organism - why would taking antibiotics make it longer?
...I chose A because I eliminated all the other ones for the reasons listed above. What's the answer?
Same here... just took this exam today and I'm going over the answers I got wrong right now
234... no improvement from last weekIf you don't mind me asking, how did you do?
234... no improvement from last week
15 days!! Omg not even done with Uworld first pass or FA first pass yet...That's really good! How far is your test?
15 days!! Omg not even done with Uworld first pass or FA first pass yet...
15 days!! Omg not even done with Uworld first pass or FA first pass yet...
Putting my money on the inherited protease deficiecy. Air trapping, decreased FEV1, and decreased diffusion capacity due to reduced surface area make me think of COPD but since he hasn't smoked any tobacco, would expect inherited alpha 1 antitrypsin deficiency. Makes sense with the hepatomegaly too. Can do a PAS stain and look for eosinophilic inclusions
Is the answer really MDD? That's a bull**** question
I was thinking along the lines of heptaic failure -> hyperammnonianainaenamia -> encephalopathy -> memory impairment/personality change.
Alpha-1 anti-trypsin (A1AT) is a serpine protease inhibitor, more specifically in this setting, an irreversible inhibitor of elastase, a protease. Some have argued that A1AT is a protease itself, a "good protease" cancelling out a "bad protease." But A1AT's mechanism of action functions via conformational change to (1) irreversibly bind and thus inhibit elastase, forming a complex thereby (2) facilitating its degradation. The A1AT has no direct proteolytic action. Thus, an A1AT deficiency is a protease inhibitor deficiency that results in protease overabundance & hyperactivity. (Source: Carrell RW, Lomas DA. Alpha1-antitrypsin deficiency--a model for conformational diseases. N Engl J Med. 2002;346(1):45.)
Update: I sent the NBME a message about this to see if they'd consider reviewing it...They agreed very quickly. I'll post the outcome later. (Be cautious about the copyright policy you agreed to when taking the exam, especially now that this question will be under review.)
43yo man with 10yr history of alcoholism has jaundice. He takes 2 extra strength acetaminophen every 4-6hrs for the past 3 days. He has increased prothrombin time and increased AST activity. Alternation in which metabolites within hepatocytes is a/w his illness?
- I choose increased NADH due to his alcoholism apparently that's not what they we're going for. Some people thought decreased glutathione but that wasn't right either- the answer supposedly is "decreased NAD+"---does anyone understand this? I mean I know his NADH/NAD ratio should be increased but then I feel like increased NADH should be right too.
You're right about the increased NADH/NAD ratio but main reason for it has to do with not enough NAD+ being around to continue glycolysis, not that there is too much NADH. If you could somehow inject NADH into the cell, you wouldnt see the symptoms. BUT if you could selectively take away NAD+, you would.
No, but the fact they've not yet replied with a simple "it's correct," is rather promising. I think if they stay behind their original choice, they're considering A1AT a protease. Because in retrospect, after rereading my message to them and realizing much of my argument hinged on my use of "lack of proteolytic activity," not all proteases are proteolytic. Still, based on the functional and structural biology, I don't see it as a "protein processor" either, much like a similar question from another NBME test that reworded the best answer to "protein processing" to describe the end result of pol gene translation (e.g., ligases, integrases, etc). That was a tricky little bastard.any update on this? I just took 15 today and got this wrong- I was really confused by this simply because it said protease deficiency and I've always considered it to be a protease inhibitor deficiency...but I feel like I should probably aire on the side that, "they are not tricking me" I feel like that's where I miss most questions.
. . .
I'm saddened by their answer to this inquiry:No, but the fact they've not yet replied with a simple "it's correct," is rather promising. I think if they stay behind their original choice, they're considering A1AT a protease. Because in retrospect, after rereading my message to them and realizing much of my argument hinged on my use of "lack of proteolytic activity," not all proteases are proteolytic. Still, based on the functional and structural biology, I don't see it as a "protein processor" either, much like a similar question from another NBME test that reworded the best answer to "protein processing" to describe the end result of pol gene translation (e.g., ligases, integrases, etc). That was a tricky little bastard.
I'll post an update as soon as the NBME committee responds, promise.
Sent from my iPhone using SDN mobile
43yo man with 10yr history of alcoholism has jaundice. He takes 2 extra strength acetaminophen every 4-6hrs for the past 3 days. He has increased prothrombin time and increased AST activity. Alternation in which metabolites within hepatocytes is a/w his illness?
- I choose increased NADH due to his alcoholism apparently that's not what they we're going for. Some people thought decreased glutathione but that wasn't right either- the answer supposedly is "decreased NAD+"---does anyone understand this? I mean I know his NADH/NAD ratio should be increased but then I feel like increased NADH should be right too.
Just took NBME 15. 252/19 incorrect. I was hoping for 260, but I made some silly mistakes...Anyway, on to questions:
1. Whats the risk of fetus if the mom is on Cocaine? I chose Heart Defect, but it was wrong.
2. Anyone managed to do the NY/SF question? I sure crapped my pants when I saw it I have the data for it, so if anyone wants to solve it, let me know. Cant post it here, copyright problems I guess.
3. Concentration of Insulin in DM2 . This was a silly mistake, it suppose to be high, ..I wanna know if it is 40 or 80.
4. I think this one we know from the above discussion..OGP poisoing, first thing after Airway securing is Atropine, not Pralidoxime.
5.Unpasterized cheese, Gram+ cocobacilli. I chose Bacillus cerues, but wrong. I missed the point that it was recovered from Blood. Options are: Camplybacter, Clostridium, Listeria, Ecoli, Salmonella, Staph, Vibrio, Yersinia.
6.Study, for Dextromethorphan use and cough. what limited the validity? I chose "Study location limited to emergency department", but this was wrong. Other options were Limited number of participants; Marginal statistical significance; Lack of blinding between groups; Subjective nature of the study(but this is wrong, in another thread)
7.Pharmacotherapy for GERD. I chose metoclopramide over Omeprazole, but this was obviously wrong. I was thinking metoclopromide will increase the LES tone, and prevent reflux, but apparently its wrong. So the answer has to be omeprazole then. Other options were Cimetidine, sucralfate, Calcium carbonate,
8. Again, another nutcracker, and I feel like an idiot. Down, with symtoms of leukemia. What is seen on BM? I chose Megaloblastosis, since the child is less than 5 year old and is increased risk for M7, but this is wrong. Its sure Excess Lymphoblasts. I guess the distinction of the risk for Down in terms of age is a minor detail, not relavent (i.e. Less than 5 = Risk of M7 , More than 5 year old = Risk of ALL)
9. Huge heart shown. Hx of HTN. I chose Infarct, since there was a red mark under the LV ventricle. But, its wrong. I think it was hypertrophy. The size of the heart is 650g.
10. Kid at 2 month, decreasing Hb/Ht. 3 columns for his CBC at 24hours/1week/1month. I chose congenital CMV infection, wrong again!
11. This was a bummer, since I was so sure its right. Patient has hypokinesia of LV post wall on increasing activity on stress echo. Reason for this finding? I chose "Increased myocardial oxygen consumption". Crap! I think it was "Increased LV end diastolic pressure"
12. Another crapy question. Got shot in abdomen, patient requires decreasing dose of Warfarin 6 weeks later. I chose "Septic shock caused by Ecoli", but wrong!
13. Patient, cries after loss of sister, and then has a headache. I chose "abnormal grief response". I think its "normal emotional response"
14. Female Hx of fever, Lower quadrant pain, Leukocytosis, Increase hcg . Pic shows a cavity, lookling like a mole. I chose "Hydatiform mole", but I think it was Choriocarcinoma, since the entire wall was invaded. Or was it Ectopic?
15. Function of IkB in NF-KB. I know this now, its "Release NFkB after undergoing phosphorylation"
The other 4 were my silly mistakes. G+ve messed up, Teratoma is a Germ cell tumor, not Sex chord etc.
Aright, let me know what you guys answered. If you want to know an answer to some question, let me know and I'll try to remember my response.
Thanks.
Regarding this, how can you differentiate between Diaphragm and Spleen? Aren't they describing the Kehr sign perfectly?please help with this one
A 45 year old pt with ulcer in anterior superior fondus of stomach has acute pain in left upper quadrant and left shoulder x4 hours. PE shows rigid abdomen. Perforation of stomach wall by ulcer is suspected. Irritation of which of the following by gastric contents explains the left shoulder pain?
Diaphram
Duodenum
Gallbladder
Liver
Pancreas (I chose this and was marked wrong)
Spleen
43yo man with 10yr history of alcoholism has jaundice. He takes 2 extra strength acetaminophen every 4-6hrs for the past 3 days. He has increased prothrombin time and increased AST activity. Alternation in which metabolites within hepatocytes is a/w his illness?
- I choose increased NADH due to his alcoholism apparently that's not what they we're going for. Some people thought decreased glutathione but that wasn't right either- the answer supposedly is "decreased NAD+"---does anyone understand this? I mean I know his NADH/NAD ratio should be increased but then I feel like increased NADH should be right too.