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- Mar 7, 2012
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A new NBME 15 is out! Here is the official discussion page. How did you guys feel about this nbme?
Couple questions for you guys!
1. The old woman with the Ca around 8 and really really high PTH-muscle pain exacrbated by activity-any idea. I put primary hyperPTH but that was wrong.
2. Vignette of a albino (white skin, hair, blue eyes) child-asks what the number of melanocytes and melanin would be, I assume its decreased melanocytes and normal melanin?
3. Right wrist injury, not a fracture in 15 y/o. Point tenderness to palpation of radial aspect between abductor pollicis longus and extensor brevis tendons-asks for sequelae. Put subluxation of trapezium, wrong. Could it be damage to median N.?
4. 18 y/o trys suicide w/ 100 ASA tablets-two days later you find blood in stool, her Hb conc is 12, what else would you expect to find abnormal?
I put platelet count, but that was incorrect.
5. newborn with esophagela atresia, what germ layer is the origin of the cells filling the lumen? Endoderm? I suck at embryo
Thanks guys
Regarding the patient who had cardiac failure, it would be prrenal azotemia, but what should his urine show? would it be the dirty brown casts?
Hi guys, was wondering if I could get some help on some of the questions. A brief EXPLANATION would be great too if you have one.
Before I post though, I briefly read some of the above posts and thought I'd contribute:
- I got the Down Syndrome with ALL wrong too. I put MEGALOBLASTOSIS because of pathoma. But note that Megaloblastosis DOES NOT refer to Megakaryoblastic Leukemia, it refers to large RBC's (MCV>100). So I guess pathoma isn't wrong in this case.
- saw someone post that the anal lesion with a picture was SCC of the anus, but its actually external hemorrhoids (painful and doesn't bleed). Maybe someone already corrected this.
My questions:
Lymphocyte neoplasm DOES NOT express: CD4, CD8, surface igM, surface IgG, cytoplasmic IgM and mu-heavy chains, cytoplasmic IgG, and gamma-heavy chains. It DOES express class I MHC and show rearrangement of the T-lymphocyte receptor beta-chain gene D and J segments. Which is the normal counterpart?
a. Activated cytolytic effector T lymphocytes in circulation
b. Mature IgM-secreting B lympchotes in LN
c. Mature Immunoglovulin secreting plasma cells in LN
d. Pre-B lymphocyte progenitor of mature B lymphobytes in the BM
e. T-lymphocyte thyocytes localized to the thymic cortex
Kid presents with congestive heart failure due to a VSD. After fixing the VSD, what changes will be seen in the following:
- Left Ventricular P
- Right Ventricular P
- Left Atrial P
I though the Right ventricular P would obviously go down since the Left -> Right shunt will be closed off. What happens to LV and LA pressure and Why?? This one drove me nuts! (I put increased LA pressure because the Right ventricle wont be as overloaded from the shunt, and will be able to pump blood out more effectively, but that was wrong)
4. Woman has history of altered consciousness. She stops talking in mid-sentence, turns her head to the right, and extends and stiffens her right upper extremity. She has a blank look and does not respond to any questions. She then has some repetitive lip smacking and picking movement of the hands. Episodes lasts 30secs. She slowly returns to he normal state during the next 4-5min. What type of seizure is it?
- Absence
- Complex partial
- Generalized tonic clonic
- Simple partial motor
- Simple partial sensory
Put Tonic clonic just cause I saw the stiffness, followed by a repetitive movement. Is this wrong because its not the entire body/extremities? Is the answer Complex partial? Didn't know it would switch from stiffness to clonus like that.
67 year old man comes to the physician because of a 2 month history of pain in his feet. It is more severe at night and is relieved by taking a hot bath. He has DM2. Strength is normal and symmetric in the distal and proximal upper and lower extremities. Achilles deep tendon reflexes are decreased and quadricept deep tendon reflexes are normal. Sensation to pinprick and vibration is decreased from just above the ankles distally. This patients pain is most likely described as?
- Aching, Burning, Colicky, Cramping, Sharp, Squeezing
Put sharp thinking it was neuropathy induced pain, but I'm guessing its Cramping due to peripheral vascular disease?? Does DM neuropathy not present with sharp pain (Probably made that up during the exam haha)?
Thanks in advance guys! Again, explanations would be greatly appreciated!
In the question about the defect in renal ammoniagenesis, what is the source of ammonia production?
Hey, guys, what was answer to that question about cocaine effect on fetus?
Most often cocaine exposure causes IUGR... so small baby. Dont remember what the answer was worded exactly, but something to the effect of growth restriction.
Hi, I just took the form 15 online and bought the expanded pack. How can you know which questions you got wrong or right? It only tells me how many questions I got wrong in each discipline. Thanks a lot!
Regarding the VSD, can someone explain what happens to the left atrium and left ventricle after correction? I see the RVH being corrected so the right ventricle has less pressure, not really understanding the correct answer for that one.
Thanks so much
there was a q that talked about someone taking a loop diuretic and what disturbance it what cause?
i knew it would be hypokalemia so I thought cells in body will try and push out potassium to compensate for the loss of K+ and then take up Hydrogen. Then the alkalosis will happen. but the second part asks for volume contraction?
can someone explain the way to think behind this one? thanks so much guys
For the girl who has somatization disorder (I think) do you not try and confront them about this issue or do you just keep running tests, etc. Seems very against the whole idea of decreasing costs in medicine.
Alright that's it. I would appreciate it if someone could clarify any of these. Thanks.
Cocaine doesn't cause IUGRMost often cocaine exposure causes IUGR... so small baby. Dont remember what the answer was worded exactly, but something to the effect of growth restriction.
- sexually active 26 y/o w/ lump on rectal area...severe pain, no bleeding, inconsistently uses condoms (anal carcinoma, anal fissure, external hemorrhoid, HPV, skin tag)
This one I missed too .
The correct one is HPV which causes the SCC of the anus ( ectoderm Ca , this is the reason for pain ) .
The general rule in this type of question where you see also pictures should be HPV .
The picture was not the best one and confusing ... .
-why deoxygenated blood can carry more CO2 than oxygenated blood.
This is Halden effect . Correct answer is buffering better .. .
External hemorroids! Not just that I had that answer right, I also have themthis one isn't HPV because I said that and got it wrong, I read on another board that it was external hemorrhoids
1. If the patient has high PTH and low Ca then it cannot be primary hyperparathyroidism. It has to be secondary to something. I do not remember the question to tell what was the cause.
2. In albinos there are normal melanocytes and decreased production of melanin. As opposed to vitiligo where there is destruction of melanocytes.
3. Cannot remember, but I think it was median nerve dmg.
4. cannot remember the other answer choices.
5. Yes, endoderm is the right answer.
experimental question about H pylori stains which shows. Which of the following mechanisms best explains this genetic change?
Original isolate:
... ACC CCC CCC ACT CAA ATT GAA CCT AGC ....
... Thr Pro Pro Thr Gln lle Glu Pro Ser .....
Subsequent isolates:
... ACC CCC CCC CAC TCA AAT TGA ACC TAG ...
... Thr Pro Pro His Ser Asn STOP
C) Slipped-strand mispairing
E) Transposon insertion (chose this and I got it wrong)
Anyone have a clue on this one?
I just went through the whole thead but I am still unsure about these ones I missed:
72 year old man w COPD - slow the rate of decline in this pt's pulmonary function?
I put corticosteriord therapy -- is the answer smoking cessation? ( I thought smoking cessation would IMPROVE his pulmonary function)
22 year old college student who is anxious and drinks 2 cups of coffee every morning?
I put substance-induced anxiety disorder --- is the answer general anxiety disorder?
Find the Km -- I took the Vmax (2) and divided it by 2 = 1 but answer choices were
<.06
.2-.5
.5-1
1-2
8-20
If half of Vmax is 1 --how do you decided between .5-1 and 1-2?
Pt w a teratoma (cystic lesion w hair, oily substance) what is the source of the neoplasm?
germ cells
granulosa cells
sex cord cells
stromal cells
surface epithelial cells (I put this because the neoplastic part usually comes from skin)
Thanks a ton. I take the exam in 6 days.
Caffeine does't really cause anxiety and if it did it would be only right around when the person drank coffee. GAD is more likely but need to see the stem.I just went through the whole thead but I am still unsure about these ones I missed:
72 year old man w COPD - slow the rate of decline in this pt's pulmonary function?
I put corticosteriord therapy -- is the answer smoking cessation? ( I thought smoking cessation would IMPROVE his pulmonary function)
22 year old college student who is anxious and drinks 2 cups of coffee every morning?
I put substance-induced anxiety disorder --- is the answer general anxiety disorder?
Find the Km -- I took the Vmax (2) and divided it by 2 = 1 but answer choices were
<.06
.2-.5
.5-1
1-2
8-20
If half of Vmax is 1 --how do you decided between .5-1 and 1-2?
Pt w a teratoma (cystic lesion w hair, oily substance) what is the source of the neoplasm?
germ cells
granulosa cells
sex cord cells
stromal cells
surface epithelial cells (I put this because the neoplastic part usually comes from skin)
Thanks a ton. I take the exam in 6 days.
.5 is included in 2 answer choices
The answer is .2 - .5. 1/2Vmax, so what's the maximum Vmax? 2. What is half of that, that equals 1. Go up to 1 and now go to the left, it's found between .2-.5.
Essentially getting at precocious puberty (dont give a cause) just want you to know that initially the height will be above normal (75th percentile) and there growth plates will fuse earlier leading to a shorter person than normal (25th percentile) as an adult.
Couple questions for you guys!
1. The old woman with the Ca around 8 and really really high PTH-muscle pain exacrbated by activity-any idea. I put primary hyperPTH but that was wrong.
2. Vignette of a albino (white skin, hair, blue eyes) child-asks what the number of melanocytes and melanin would be, I assume its decreased melanocytes and normal melanin?
3. Right wrist injury, not a fracture in 15 y/o. Point tenderness to palpation of radial aspect between abductor pollicis longus and extensor brevis tendons-asks for sequelae. Put subluxation of trapezium, wrong. Could it be damage to median N.?
4. 18 y/o trys suicide w/ 100 ASA tablets-two days later you find blood in stool, her Hb conc is 12, what else would you expect to find abnormal?
I put platelet count, but that was incorrect.
5. newborn with esophagela atresia, what germ layer is the origin of the cells filling the lumen? Endoderm? I suck at embryo
Thanks guys
Hey guys did anyone get the question of influenza A virus SF and NY ?!!!!
any help please i've been trying but don't know if i'm trying right or imagining stuff,,,
Hey guys, just finished going over this exam. Overall I thought it was relatively difficult and a lot of WTF questions. The stems seemed pretty long and I basically had 5 minutes or less left in each block. I've been hearing that the real exam has super long stems so hopefully I'll have enough time on test day. Ended up getting a 252 (19 missed) which I was a little upset with considering the fact that I got a 252 on 13 and 12 (taken 1 and 3 weeks ago respectively). Hopefully I can go up a couple more points by test day, have little less than a week left.
I was able to find answers to all of the questions I missed but still had a couple questions on some that I don't quite understand if someone could explain. Thanks
How does smoking decrease the recurrence of a duodenal ulcer and why would decreasing caffeine and fatty foods not decrease the recurrence of either H. pylori or the ulcer.
Question about the kid who has down syndrome and now has pancytopenia, lethargy, bruising, fever, etc. Answer was ALL so he would have increased lymphoblasts but why could it not be aplastic crisis caused by parvovirus?
Question about organophosphate poisoning I understand that atropine is important and the problems it causes can be really bad but why wouldn't you want to give pralidoximine right away considering the fact that it only works prior to aging and that's a time sensitive thing?
How is H. pylori associated with esophageal adenocarcinoma? I didn't see any mention of that in First Aid, Pathoma, or Uptodate.
For the girl who has somatization disorder (I think) do you not try and confront them about this issue or do you just keep running tests, etc. Seems very against the whole idea of decreasing costs in medicine.
Alright that's it. I would appreciate it if someone could clarify any of these. Thanks.
During an experiment of muscle contraction, intracellular contraction is decreased after a substance is administered to a muscle preparation obtained from an experimental animal. which of the following explains why contraction is inhibited in this case?
1)ach release is increased
2) depolarization along t tubules is enhanced
3) myosin binding sites on on actin remain covered by troponin c(correct)
4) sodium influx is increased
5) tropomyosin is detached from actin (wrong)
option 5) is wrong because tropomyosin detachment from actin would expose the myosin binding site on actin and would thus help in promoting contraction, not inhibiting it. Options 1), 2) & 4) would also help to enhance contraction.
option 5) is wrong because tropomyosin detachment from actin would expose the myosin binding site on actin and would thus help in promoting contraction, not inhibiting it. Options 1), 2) & 4) would also help to enhance contraction.
That's exactly what i thought while i was picking 3) but i still went with it anyway coz the others seemed to do the opposite of what they r asking.. i got it right.. hope this link helps.. http://www.pansportmedical.ro/english/sports_medicine/articles/attach/muscle_fiber_bi_3.gifthe only reason why i was unsure about 3 was because i thought calcium binds tropininc c...which then removes tropomyosin...not tropnin c from the binding sites