Could someone explain these questions...

[mountaindew2006]

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Hey everyone...

It's me...it feels like a long time. I feel like the prodigal son of SDN. Yah I was to take the exam earlier this week (yest) but I freaked out and decided to move it. I literally feel like the dumba$$ of SDN. I literally had a panic attack. Seeing all you guys with awesome scores is great! But then I look at my qbank score and I'm like 😱

At any rate, I've started doing NBME questions. I just did the first exam. I was wondering if some of you can answer a few of the questions I saw on it. I am paraphrase/changing the q's as to not to infringe on any copyright stuff. But its generally the same q's from that NBME first self assessment. I looked up most of the questions, but I really couldnt find answers to the following q's. hehhe I kinda feel like Miss Medicine, as to when she asked q's. 🙂 Here they are:

1. The pt was on a no milk and no egg diet and was a vegan, whats the vit deficiency? I figured vitb12?

2. a 2 yo comes into the ER after ODing on some med from his mom's purse. Sedation is seen, but the resp and BP are nl. Which rx would reverse the effect.
the choices i had difficulty discerning b/w were: flumazenil, naloxone, atropine. I figured the kid Oded on ambien so flumazenil should be the answer ..

3. Clone of Ca cells is resistent to vincristine, doxorubicin, dactinomycin but not to MTX and various alklyating agents. the Mech of Resistance is most likely to involve:
a)increased DNase
b)inability to form polyglutamates
c)enhanced RX transport out of the cell
d)altered Dna polymerase
e) absensce of Superoxide dismustase
-I chose D.

4. After a full course of vaccines that comprised of recombinant polypeptides, 10% of adults failed to produce Ab's. The non responders had an increased freq of one HLA type. Whats the prob?
a)failure of b-lymphocytes to recognize polypept
b)failirue of t- " " "
c)lack of MHC class 1 presentation of polypeptide
d) lack of MHC class 2 " " " "
- I went w/ A. I figured that b-lymphocytes are APCs and thus if they cant recognize or bing the Ag's then they cant present them and thus no response..

5. Some lady came in and had an increased TSH but decreased T4. What's the likely pathological finding?
a)regenerative noduels of lakes of excess thyroid prots
b) non caseating granuloma
c)heavy lymphocye infiltrate w/ germ center formation
d)absence of thyroglobulin
I went along w/ choice D. But given the paucity of information (knowing only that it is HYPOthryoidism fo the primary type....could I assume hashimotos thus just say choice C ?)

6. Some guy had a restrictive dz (pulm fibrosis). Which kind of breathing would minimize the work of his breathing. (i wasnt clear as to whether the answer should be the ADVICE the doc should give the guy to minimize their work OR is what the pt does inherently to minimize their work).
basically a whole bunch of arrows w/ respiration frequency and tidal vol.
I put that the resp freq should be dec and the tidal vol should be increased (I put this cuz this is the best way to increase alveolar ventilation, irrespective of dz).

7. an ACE-i would do what?
-once again there were arrows. the answer I chose was a dec in A2, a dec in aldost, an inc in bradykinin, and finally Dec in Renin (i was sure my answers were right for everything except about what happens to renin).

Thanks guys/gals for your help. I appreciate it! Hopefully when I take this thing I will do as well as some of you all!

later... 👍

 

[mountaindew2006]

anyone..... 🙂

 

[Idiopathic]

1) correct. pure vegans have b12 deficiency, which is only found in animal products.

2) correct. flumazenil is likely Rx since OD was probably Xanax (BZD)
3) i think this is C. because of what vincristine does (affects microtubule polymerization), then none of the specific actions have any effect on its activity.

4) i would pick the most straightforward answer. to me, you are more likely to have a failure of a t-cell to recognize a polypeptide, which would lead to a failure of antigen presentation to the b-cell and failure to make antibody. since this is the last step, i would go with this. it could also be D, failure of MHC-2 to present to T-cell, but this seems less likely, and potentially less prominent. b-cells are minor APC's, at best, and i dont think would be important here, as they are not the predominant player.

5) i would go with Hashimoto's (C)...absence of thyroglobulin is not really a common pathological finding, i dont think.

6) i think more breaths with less TV would best lower the work of breathing, because remember the compliance is less, so it takes greater work to inflate the lungs (?)

7) renin goes up when on an ACE-i...GFR goes down due to vasodilation of the efferent arteriole. apparently, these Px aldosterone can still rise to semi-normal levels with time, and spironolacone therapy can be begun.