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These are a few questions on NBME 16 that I have yet to find a compelling answer to on previous forums. Please help me out if you know the answer. I will paraphrase as appropriate:
1) A healthy woman participates in a study of ghrelin effects on appetite. She is given free access to food during the study. The graph below shows plasma concentration of ghrelin during the study period. Which of the points represents the consumption of a meal?
Not really sure why C is incorrect. Ghrelin mediates hunger, thus would we not expect to see in somewhere on the downslope during food consumption? Why would D be any more correct than C in this case?
2) A 3 year old boy is brought to the physician for one week of nonproductive cough, wheezing and nausea. Bilateral crackles are heard on auscultation. Physical exam shows no abnormalities. Stool culture shows 1.6 cm roundworm larvae, and chest x-ray shows bilateral infiltrates. The disease was caused by ingestion of
A) Feces-contaminated soil
B) Improperly canned brans
C) Pork products
D) Raw shrimp
E) Undercooked meat
So the operative word here is "ingestion." First thing that jumped out at regarding the lung pathology me was Strongyloides. If Strongyloides reaches the lungs, the chest may feel as if it is burning, and wheezing and coughing may result, along with pneumonia-like symptoms (Löffler's syndrome). But my impression has was always that Strongyloides was NOT ingested, and rather contracted cutaneously when the larva migrate through the soles of the feet into the bloodstream. Thus, I did not choose A.
Based on mode of infection, I assumed this was Paragonimus westermani (lung fluke), which is contracted via ingestion of raw crustaceans, as this can also present with pneumonia like symptoms. However, choice C was incorrect.
3) Woman has BP of 140/100, fasting BUN of 50 mg/dL, glucose of 90 mg/dL. Urinalysis shows multiple WBCs and WBC casts; protein excretion is 3000 mg/24 hrs. GFR is 20% of normal. Ultrasonography shows small kidneys with blunted calyces, and voiding cystourethrogram shows vesicoureteral reflux. Which of the following is the most likely diagnosis?
A) Acute glomerulonephritis
B) Bilateral hydronephrosis (incorrect)
C) Chronic pyelonephritis
D) Diabetic nephropathy
E) Renal amyloidosis
I saw "vesicoureteral reflux" and "blunted calyces" and immediately assumed B, which was a mistake. I believe the answer is C (based on WBCs and WBC casts), but any more reason to assume that over C? What causes the vesicoureteral reflux in the case of C?
1) A healthy woman participates in a study of ghrelin effects on appetite. She is given free access to food during the study. The graph below shows plasma concentration of ghrelin during the study period. Which of the points represents the consumption of a meal?
Not really sure why C is incorrect. Ghrelin mediates hunger, thus would we not expect to see in somewhere on the downslope during food consumption? Why would D be any more correct than C in this case?
2) A 3 year old boy is brought to the physician for one week of nonproductive cough, wheezing and nausea. Bilateral crackles are heard on auscultation. Physical exam shows no abnormalities. Stool culture shows 1.6 cm roundworm larvae, and chest x-ray shows bilateral infiltrates. The disease was caused by ingestion of
A) Feces-contaminated soil
B) Improperly canned brans
C) Pork products
D) Raw shrimp
E) Undercooked meat
So the operative word here is "ingestion." First thing that jumped out at regarding the lung pathology me was Strongyloides. If Strongyloides reaches the lungs, the chest may feel as if it is burning, and wheezing and coughing may result, along with pneumonia-like symptoms (Löffler's syndrome). But my impression has was always that Strongyloides was NOT ingested, and rather contracted cutaneously when the larva migrate through the soles of the feet into the bloodstream. Thus, I did not choose A.
Based on mode of infection, I assumed this was Paragonimus westermani (lung fluke), which is contracted via ingestion of raw crustaceans, as this can also present with pneumonia like symptoms. However, choice C was incorrect.
3) Woman has BP of 140/100, fasting BUN of 50 mg/dL, glucose of 90 mg/dL. Urinalysis shows multiple WBCs and WBC casts; protein excretion is 3000 mg/24 hrs. GFR is 20% of normal. Ultrasonography shows small kidneys with blunted calyces, and voiding cystourethrogram shows vesicoureteral reflux. Which of the following is the most likely diagnosis?
A) Acute glomerulonephritis
B) Bilateral hydronephrosis (incorrect)
C) Chronic pyelonephritis
D) Diabetic nephropathy
E) Renal amyloidosis
I saw "vesicoureteral reflux" and "blunted calyces" and immediately assumed B, which was a mistake. I believe the answer is C (based on WBCs and WBC casts), but any more reason to assume that over C? What causes the vesicoureteral reflux in the case of C?
