NBME 11 question

[Master Deep]

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Can anyone whos done NBME 11 explain how to figure out the serum protein electrophoresis question. 12 yr old boy admitted to hospital because of lethary, hip pain and fever. hes been admitted many times becaues of pneumonia. And then it gives the diff kinds of serum protein electrophoresis.
Thanks!

 

[Boardz]

Can someone explain why ACA is the answer:

"Pt with left sided weakness in the lower 2/3 of L face. Weak upper extremity and moderate lower extremity weakness. Hyperactive reflexes in both upper and lower limb"

I thought the ACA had to do with lower limb (not face and upper limb)

thanks

haven't done this one yet but i'm stumped. Sure you got the question and answer right?

 

[dendrites]

not sure what the correct answer is but other people on this thread said it was ACA.... i have NO idea why

 

[Luliba]

Hi everyone...could someone explain the question about the 3 week old newborn with recurrent vomiting after feedin and a mobile mass in epigastrium???? pls????😕

 

[Luliba]

Yes, the defect has an easier time being expressed in males. Thus for it to be expressed in a female = very "strong genetics" for CPS, and subsequent male children will have a higher likelihood than if it had first been diagnosed in a male child.

why does it has to be "a"??? why not b???

thanks in advance 🙂

 

[Luliba]

why does it has to be "a"??? why not b???

thanks in advance 🙂

I believe it's A because pyloric stenosis has a higher incidence in 1st born males.

Yes, the defect has an easier time being expressed in males. Thus for it to be expressed in a female = very "strong genetics" for CPS, and subsequent male children will have a higher likelihood than if it had first been diagnosed in a male child.

why does it has to be a?? why can not be b???

thanks in advance 🙂

 

[medstudentASY]

2. 24 y/o man, 2day history of confusion. Temp is 38.3 C. When speaking, he enunciates clearly but his words/word like utterances make little sense. Doesn't follow any commands. what could it be
a) cerebral toxoplasmosis
b) HSV encephalitis Why?
c) HIV encephalopathy
d) meningococcal meningitis
e) subdural empyema

Thank you!

The patient in this prompt has Wernicke's aphasia. Where is Wernicke's area? Superior *TEMPORAL* gyrus. Where is the most common area for HSV encephalitis to occur? the Temporal lobe.
From Goljan's RR Path: HSVI encephalitis: MCC sporadic fatal encephalitis, Tends to localize to temporal lobe.

 

[medstudentASY]

Can someone explain why ACA is the answer:

"Pt with left sided weakness in the lower 2/3 of L face. Weak upper extremity and moderate lower extremity weakness. Hyperactive reflexes in both upper and lower limb"

I thought the ACA had to do with lower limb (not face and upper limb)

thanks

You are referring to two different questions with this post.

There was one with a photo of a cerebral angiogram with an arrow that was pointing to the ACA. It was pretty much an anatomy identification-type question. You are correct, the ACA perfuses the portion of the motor cortex that regulates lower limb motor function.

The question you posted here was a different question. "Pt with left sided weakness in the lower 2/3 of L face. Weak upper extremity and moderate lower extremity weakness. Hyperactive reflexes in both upper and lower limb"

This question then had a cerebral angiogram with multiple arrows.
The person is suffering from a pure motor stroke, most likely location of infarct is in the internal capsule. The correct answer for this is the Right middle cerebral artery. You had to select the arrow pointing to the MCA on the right side.

 

[medstudentASY]

why does it has to be a?? why can not be b???

thanks in advance 🙂

I think this question was asking you to apply the idea of "lower threshold of liability in males compared to females" and decide which relative would basically have a HIGHER RISK of having pyloric stenosis than the baby described in the prompt.
If the baby that has pyloric stenosis is male, and he had a brother with pyloric stenosis, then, well, they would have the SAME risk of having the disease, wouldn't they?

But if the baby in the prompt were female, and it was her brother with pyloric stenosis, then in this case it's the brother that would have the GREATER risk of pyloric stenosis, because now we are comparing males with females.

Long story short, this question was stupid, and I have no idea what threshold of liability is because I was never taught it during genetics. But on the real exam, just remember that Males, especially first born males, are most likely to be affected by pyloric stenosis after birth.

 

[Wildstang]

52 YO man, scoliosis, chest pain radiating to back, history of scoliosis
HT: 6ft 10 in tall
WT: 200 lbs
BMI: 21
BP: 90/60

No pulses on upper right side.

Why not coarctation of the aorta?

 

[Belleza156]

Why would it be coarctation of the aorta? If it was adult coarctation of the aorta he would have high BP in upper extremities and low BP in the lower extremities (both extremities would be affected if it were post ductal). Def not absent pulses and low BP.

They painted the picture of a guy with Marfans (scoliosis,his BMI means hes prob really tall and skinny...yea hes almost 7 feet tall!!!) who is having an aortic dissection, common in that pt population because they get cystic medial degeneration. Whenever you hear "chest pain radiating to back" it usually means aortic dissection, and in his case looks like it may have ruptured and is now in cardiac tamponade. Not sure would have to see the rest of the symptoms but high BP leads to aortic dissection so such a low BP leads me to the conclusion that it ruptured. And he has absent pulses on one side so that would mean the the rupture is in the aortic arch after the right brachiocephalic artery but before the left common carotid artery.

 

[alternatego]

Ok, 45 yo recently diagnosed with early onset Parkinson dz, being treated with fluoxetine for long history of major depressive disorder, which of these drugs is contraindicated in this patient?
A. Amantadine
B. Benztropine
C. Levodopa
D. Ropinirole
E. Selegiline

Anyone could please help me with this question? I searched this thread twice and coulnd't find an answer

 

[alternatego]

Can someone explain why ACA is the answer:

"Pt with left sided weakness in the lower 2/3 of L face. Weak upper extremity and moderate lower extremity weakness. Hyperactive reflexes in both upper and lower limb"

I thought the ACA had to do with lower limb (not face and upper limb)

thanks

haven't done this one yet but i'm stumped. Sure you got the question and answer right?

Answer is NOT Anterior Cerebral Artery (choice C in the cerebral angiogram), I chose that and got it wrong.

 

[Dallas]

Ok, 45 yo recently diagnosed with early onset Parkinson dz, being treated with fluoxetine for long history of major depressive disorder, which of these drugs is contraindicated in this patient?
A. Amantadine
B. Benztropine
C. Levodopa
D. Ropinirole
E. Selegiline

Anyone could please help me with this question? I searched this thread twice and coulnd't find an answer

Did you pick Selegiline?
Is that one wrong? Is that why u posted this q here?

Tricky q's man.

 

[Belleza156]

Why wouldnt it be selegiline?

SSRI + MAOI ----> serotonin syndrome

 

[Dallas]

Why wouldnt it be selegiline?

SSRI + MAOI ----> serotonin syndrome

Because Serotonin is broken down with MAO-A and Selegiline is an inhibitor of MAO-B.

In fact, wikipedia says: "The risk of a true serotonin syndrome with SSRIs and selegiline is quite low and the combination can be taken together without event if caution is used. - Heinonen EH, Myllylä V (July 1998). "Safety of selegiline (deprenyl) in the treatment of Parkinson's disease". Drug Saf 19 (1): 11–22. doi:10.2165/00002018-199819010-00002. PMID 9673855"

 

[Belleza156]

Because Serotonin is broken down with MAO-A and Selegiline is an inhibitor of MAO-B.

In fact, wikipedia says: "The risk of a true serotonin syndrome with SSRIs and selegiline is quite low and the combination can be taken together without event if caution is used. - Heinonen EH, Myllylä V (July 1998). "Safety of selegiline (deprenyl) in the treatment of Parkinson's disease". Drug Saf 19 (1): 11–22. doi:10.2165/00002018-199819010-00002. PMID 9673855"

Well while your reasoning is true, it doesn't fit the logic employed in NBMEs. Doesn't matter if something if "probable", they still test the concept. Maybe you haven't noticed but many of the side effects we have to memorize for drugs happen to < 1% of patients....if that isn't defined as uncommon than I don't know what is.

So is the answer selegnine? It must be. Even Linezolid (MAOI used for Vancomycin resistant enterococci infections) is contraindicated with SSRI's due to the remote possibility of Serotonin Syndrome. If I was to guess I'd say that people who take selegnine for Parkinsons and not for depression, probably have to take a larger dose so selegnine wouldn't be MAO-B selective. Not sure on that, just guessing.

 

[Boardz]

Because Serotonin is broken down with MAO-A and Selegiline is an inhibitor of MAO-B.

In fact, wikipedia says: "The risk of a true serotonin syndrome with SSRIs and selegiline is quite low and the combination can be taken together without event if caution is used. - Heinonen EH, Myllylä V (July 1998). "Safety of selegiline (deprenyl) in the treatment of Parkinson's disease". Drug Saf 19 (1): 11&#8211;22. doi:10.2165/00002018-199819010-00002. PMID 9673855"

"Selegiline is a relatively selective MAO-B inhibitor when used at 5 to 10 mg/d to treat Parkinson's disease, though it loses MAO-B selectivity when used at higher dosages to treat depression. In a study9 of 4,568 patients with Parkinson's disease who received selegiline (in dosages selective for MAO-B) plus an antidepressant:
11 (0.24%) experienced symptoms "possibly" consistent with serotonin syndrome
2 others (0.04%) experienced serious serotonin syndrome symptoms.9
Serotonin syndrome has been reported when MAO-B-selective doses of selegiline were combined with meperidine10 and nortriptyline.11 This underscores the need for caution when combining these agents, especially if transdermal selegiline&#8212; which would not be MAO-B-selective&#8212;becomes available for treating depression."

http://www.jfponline.com/Pages.asp?AID=636

 

[Belleza156]

Selegiline is a relatively selective MAO-B inhibitor when used at 5 to 10 mg/d to treat Parkinson's disease, though it loses MAO-B selectivity when used at higher dosages to treat depression. In a study9 of 4,568 patients with Parkinson's disease who received selegiline (in dosages selective for MAO-B) plus an antidepressant:
11 (0.24%) experienced symptoms "possibly" consistent with serotonin syndrome
2 others (0.04%) experienced serious serotonin syndrome symptoms.9
Serotonin syndrome has been reported when MAO-B-selective doses of selegiline were combined with meperidine10 and nortriptyline.11 This underscores the need for caution when combining these agents, especially if transdermal selegiline&#8212; which would not be MAO-B-selective&#8212;becomes available for treating depression.

http://www.jfponline.com/Pages.asp?AID=636

OK so when used for Parkinsons, selegnine is selective for MAO-B but when used for depression it loses the selectivity because it has to be given at a higher dose?

The patient is on an SSRI for depression and he would be given selegnine at a low dose to treat parkinsons, which would make it MAO-B selective. So then I don't know the answer. What is contraindicated in this patient?


Edit: nevermind I just saw that you wrote serotonin syndrome has been reported in select cases of TCAs with selegnine at MAO-B selective doses.

 

[aadi]

For #2, I had no idea... I was also wondering about the same thing

hsv effects temporal lobes . speech centres ... mystery solved

 

[gulmohr]

1. 12 mo old girl has a large family, cared for by numerous relatives. Mother says she's always being carried around. Which aspect of development is child supposed to have problems with?
I put in "Social" because I figured she'd have prolonged separation anxiety issues as she grew older. Also because people who were excessively mollycoddled during childhood tend to be socially dysfunctional from personal experience. Talk about overthinking. Guess it's "Gross Motor" dev.


2. In the embryo question about cleft lip, can anybody explain why the answer isn't failure of fusion of "Frontonasal and maxillary prominences" over "Maxillary and nasal prominences"? What's the difference between frontonasal and nasal? Poorly worded question or is my knowledge lacking severely?

 

[ZGX]

2. In the embryo question about cleft lip, can anybody explain why the answer isn't failure of fusion of "Frontonasal and maxillary prominences" over "Maxillary and nasal prominences"? What's the difference between frontonasal and nasal? Poorly worded question or is my knowledge lacking severely?

The mouth palates occur in 2 steps

the primary palate which forms the mouth - involves the fusion of maxillary and medial nasal processes - outside

and

the secondary palate which forms the inner mouth - involves the fusion of lateral palatine processes, nasal septum, median palatine process - inside

 

[alza689]

Possibly some of the questions must have been answered but the explanations were not given or was a bit shaky to grasp the concept. Kindly offer the correct chioces with explanation to the below questions. Thank you in advance.

A 6-month-old boy is brought to the physician by his mother because of a
10-week history of cold-like symptoms. The mother says that he tastes
salty whens he kisses him. and he has large. foul-smelling stools. There
is no family history of a similar condition. He is at the 10th percentile
for length and 3rd percentile forweight. Physical examination shows
reduction in subcutaneous fat. Coarse rhonchi are heard
bilaterally.Molecular analysis shows deletion of the Phe residue at
position 508 in the cysticfibrosis transmembrane conductance regulator
(CFTRJ. Which of the following most likely occurred in this patient as a
result of this gene mutation?

A.Altered CFTR folding
B.Beta-amyloid configuration of CFTR
C.Decreased surfactant protein synthesis
D.Increased CFTR conductance
E.Increased CFTR in the membrane (Wrong) Kindly explain the concept if
possible.

A 2-month-old boy is brought to the phvsician because of failure to thrive
and poorfeeding since birth He was recentlv adopted from Romania and has
been fed cow's milk. He is below the 5th percentile for length and weight.
Physical examination shows jaundice. cataracts. and hepatomegaly. Serum
studies show a decreased glucose concentration. The urine shows a positive
reaction to a copper reduction test and a negative reaction to a test
agent that contains glucose oxidase.Deficiency of which of the following
hepatic enzymes is the most likely cause of the disorder in this patient?

A.Fructokinase
B.Fructose-1.6-bisphosphate aldolase
C.Galactokinase
D.Galactose-1-phosphate uridyltransferase (Was this the correct answer,
unmarked due to lack of time)
E.Glucose-6-phosphatase
What does the copper reduction test and glucose oxidase positivity signify here??? Kindly explain.

A randomized cohort study of drug X administered to subjects after a
myocardial infarction found that overall there was no decrease in
mortality compared with administration of a placebo after a myocardial
infarction. However. on review of the data. there were statistically fewer
deaths among drug X subjects in
the subgroup with nontransmural myocardial infarction than in the placebo
group. A retrospective assessment of the database available for drug X
supported the observation. Which of the following is the most appropriate
next step?

A.Cross-sectional population study of administration of drug X vs. placebo
after nontransmural myocardial infarction
B.Prospective. randomized. controlled study of administration of drug Xvs.
placebo after nontransmural myocardial infarction
C.Treatment of all patients with drug X after myocardial infarction F
D.Treatment of only patients with nontransmural myocardial infarction with
drug X (wrong)
E.Treatment of only patients with transmural myocardial infarction with
drug X
Kindly explain the concept with the answer...!


A 32-year-old woman comes to the physician because of intermittent
abdominal cramps and diarrhea. alternating with constipation. The stools
are loose and brown: there is no blood or mucus. She has had these
symptoms for 15 years. but they have become more frequent during the past
3 months. She has not had fever orweight loss. Colonoscopy 3 years ago
showed no abnormalities. She recently was promoted to a management
position at her company. She is 160 cm (5 ft 3 in] tall and weighs 75 kg
(165 lb]: BMI is 29 kg./m2. Her temperature is 37°C (98.6°F]. pulse is
72/'min. respirations are 16/min. and blood pressure is 130/76 mm Hg.
Examination shows no abnormalities. Test of the stool for occult blood is
negative. Which of the following is the most likely diagnosis?

A.Colon cancer
B.lnflamatory bowel disease
C.lrritable bowel syndrorne
D.Pancreatic insufficiency (Wrong)
E.Peptic ulcer disease
No blood and mucus rules out choices B&E with A as no wt loss BMI 29/kg. That leaves us two choices Was not sure of irritable bowel syn therefore I left the choice considering blood and mucus may precipitate as the name suggest. kindly explain with the correct answers.


33. A 63-year-old man comes to the physician because of weakness and
fatigue for 8 months. Physical examination shows massive splenomegaly.
Laboratory studies show:

Hemoglobin 8.2 g/dl_
Hematocrit 25%
Leukocyte count 6000./mm? _
Platelet count 60.000/mm?

A peripheral blood smear shows the presence of myelocytes. metamyelocytes.
nucleated erythrocytes. and tear rop erythrocytes. A bone marrow specimen
shows markedly thickened trabeculae with replacement of the arrow by
cellularfibrous tissue with admixed row elements. Which of the following
is the most likely diagnosis?

A.Acute myelogenous leukemia (Wrong)
B.Aplastic anemia
C.Immune thrombocytopenic p
D.Megaloblastic anemia
E.Myelofibrosis
I chose this answer due to leukocyte count normal not (pancytopenia)
presence of blast cells Metamyelocyte and myelocyte. How to differentiate
or discard acute myeloid leukemia not all question would mention Auer rods
in the question stem.


A 23-year-old woman at 32 weeks‘ gestation comes to the emergencv
department because of a 1 day history of flank pain and fever. Her
temperature is 39°C (102.3°F]. pulse is 104./min. respirations are 14/min.
and blood pressure is 120/72 mm Hg. Physical examination shows prominent
tenderness overthe left costovertebral angle A photomicrograph of a renal
biopsy specimen from a similar patient is shown. Which of the following is
the most likely diagnosis?

A.Acute pyelonephritis
B.Acute renal infarction
C.Acute tubulointerstitial nephritis (Was this the answer ???)
D.Crescentic glornerulonephritis (Wrong) if possible could you explain the
figure to derive the conclusion.No clue in the question stem I deem.
E.Hemolytic uremic syndrome
How to differentiate from HUS??? Explain.


During an experiment. an investigator wishes to evaluate the serum
cholesterol concentrations of all patients overthe age of 50 years on the
day of admission to the hospital. Both the mean and the median are the
same. lt is decided to use the mean as the measure of central tendency.
Which of the following is the most appropriate measure of dispersion to
analyze the data for this experiment?

A.Coefficient of variation
B.lnterquartile range
C.Percentile
D.Range (wrong)
E.Standard deviation (Was this the right answer??? if so How to
differentiate this from Coefficient of variation? Kindly explain)


2. The graph shows the response elicited by different concentrations of
drug X in a systern containing spare receptors in the absence (solid
curve] and presence {dashed curves] of two different concentrations of
drug Y. Drug Y alone has no effect. Which of the following best describes
drug Y?

A.Competitive reversible antagonist (wrong)
B.Full agonist
C.Inverse agonist
D.Noncompetitive antagonist
E.Partial agonist
Many gave D.Noncompetitive as the correct response for spare receptor...!
But whether there are spare receptors or not they act on different recptor
than the same as for a competitive antagonist and would bring the efficacy
down. How to differentiate it from a partial agonist? To me E. this seems an
attractive choice. Kindly explain the correct choice with narration of
course...

A 43-year-old woman with systemic lupus erythematosus has nephrotic
syndrome. Examination of renal tissue obtained on biopsy shows a diffuse
proliferative glomerulonephritis with electron-dense deposits along the
glomerular basement membrane. lmmunofluorescent studies show granular
deposits of complement along the basement membrane. Which of the
following is the most likely cause of these findings?

A.Antibodies directed against glomerular basement membrane (Wrong)
B.Antibodies directed against viral antigens expressed on endothelial
cells (What does this signify?)
C.Anti-DNA/DNA immune complex deposition in glomeruli (Was this the
answer????)
D.Autoantibodies to podocyte antigens
E.CD8+ T-lymphocijte cytotoxiclityzolil‘virds-infected mesangial cells


A previously healthy 71-year-old man comes to the physician because of a
1-day history of pain and swelling of his right leg. Physical examination
shows diffuse edema of the right lower extremity and calf tenderness.
Doppler ultrasonography shows a deep venous thrombosis in the right lower
extremity. After starting heparin therapy immediately. it is most
appropriate to initiate a 6-month course of a medication with which of the
following mechanisms of action?

A.Binds to the active site on the thrombin molecule (wrong)
B.lnterferes with the carboxylation of coagulation factors ( was this the
answer???)
C.lrreversibly inactivates cyclooxygenase
D.Potentiates the action of antithrornbin III
E.Selectivelv inhibits factor Xa
Kindly explain with the correct choices.

Any help will be greatly appreciated... Thank you 😕

 

[ZGX]

Possibly some of the questions must have been answered but the explanations were not given or was a bit shaky to grasp the concept. Kindly offer the correct chioces with explanation to the below questions. Thank you in advance.

A 6-month-old boy is brought to the physician by his mother because of a
10-week history of cold-like symptoms. The mother says that he tastes
salty whens he kisses him. and he has large. foul-smelling stools. There
is no family history of a similar condition. He is at the 10th percentile
for length and 3rd percentile forweight. Physical examination shows
reduction in subcutaneous fat. Coarse rhonchi are heard
bilaterally.Molecular analysis shows deletion of the Phe residue at
position 508 in the cysticfibrosis transmembrane conductance regulator
(CFTRJ. Which of the following most likely occurred in this patient as a
result of this gene mutation?

A.Altered CFTR folding You got a mutation, therefore the translation will result in an abnormal protein (vs normal functioning one). You should also note the differences of a normal functioning CFTR in tissue VS sweat glands.
B.Beta-amyloid configuration of CFTR
C.Decreased surfactant protein synthesis
D.Increased CFTR conductance
E.Increased CFTR in the membrane (Wrong) Kindly explain the concept if
possible.

A 2-month-old boy is brought to the phvsician because of failure to thrive
and poorfeeding since birth He was recentlv adopted from Romania and has
been fed cow's milk. He is below the 5th percentile for length and weight.
Physical examination shows jaundice. cataracts. and hepatomegaly. Serum
studies show a decreased glucose concentration. The urine shows a positive
reaction to a copper reduction test and a negative reaction to a test
agent that contains glucose oxidase.Deficiency of which of the following
hepatic enzymes is the most likely cause of the disorder in this patient?

A.Fructokinase
B.Fructose-1.6-bisphosphate aldolase
C.Galactokinase
D.Galactose-1-phosphate uridyltransferase (Was this the correct answer,
unmarked due to lack of time)
E.Glucose-6-phosphatase
What does the copper reduction test and glucose oxidase positivity signify here??? Kindly explain.
Need someone to correct me here. Here's my take on it: The Failure to properly metabolize galactose results in the accumulation of toxic substances, this also causes excess free H+ . In the presence of Copper it will bind the free H+ resulting in a copper reduction.

A randomized cohort study of drug X administered to subjects after a
myocardial infarction found that overall there was no decrease in
mortality compared with administration of a placebo after a myocardial
infarction. However. on review of the data. there were statistically fewer
deaths among drug X subjects in
the subgroup with nontransmural myocardial infarction than in the placebo
group. A retrospective assessment of the database available for drug X
supported the observation. Which of the following is the most appropriate
next step?

A.Cross-sectional population study of administration of drug X vs. placebo
after nontransmural myocardial infarction
B.Prospective. randomized. controlled study of administration of drug Xvs.
placebo after nontransmural myocardial infarction
C.Treatment of all patients with drug X after myocardial infarction F
D.Treatment of only patients with nontransmural myocardial infarction with
drug X (wrong)
E.Treatment of only patients with transmural myocardial infarction with
drug X
Kindly explain the concept with the answer...!



A 32-year-old woman comes to the physician because of intermittent
abdominal cramps and diarrhea. alternating with constipation. The stools
are loose and brown: there is no blood or mucus. She has had these
symptoms for 15 years. but they have become more frequent during the past
3 months. She has not had fever orweight loss. Colonoscopy 3 years ago
showed no abnormalities. She recently was promoted to a management
position at her company. She is 160 cm (5 ft 3 in] tall and weighs 75 kg
(165 lb]: BMI is 29 kg./m2. Her temperature is 37°C (98.6°F]. pulse is
72/'min. respirations are 16/min. and blood pressure is 130/76 mm Hg.
Examination shows no abnormalities. Test of the stool for occult blood is
negative. Which of the following is the most likely diagnosis?

A.Colon cancer
B.lnflamatory bowel disease
C.lrritable bowel syndrorne When you hear diarrhea, constipation, alternating, women, and examination shows nothing wrong suspect IBS.
D.Pancreatic insufficiency (Wrong)
E.Peptic ulcer disease
No blood and mucus rules out choices B&E with A as no wt loss BMI 29/kg. That leaves us two choices Was not sure of irritable bowel syn therefore I left the choice considering blood and mucus may precipitate as the name suggest. kindly explain with the correct answers.


33. A 63-year-old man comes to the physician because of weakness and
fatigue for 8 months. Physical examination shows massive splenomegaly.
Laboratory studies show:

Hemoglobin 8.2 g/dl_
Hematocrit 25%
Leukocyte count 6000./mm? _
Platelet count 60.000/mm?

A peripheral blood smear shows the presence of myelocytes. metamyelocytes.
nucleated erythrocytes. and tear rop erythrocytes. A bone marrow specimen
shows markedly thickened trabeculae with replacement of the arrow by
cellularfibrous tissue with admixed row elements. Which of the following
is the most likely diagnosis?

A.Acute myelogenous leukemia (Wrong)
B.Aplastic anemia
C.Immune thrombocytopenic p
D.Megaloblastic anemia
E.Myelofibrosis Tear Drop cells is pathognomonic for Myelofibrosis. Think of it this way, the BM is fibrotic, when the lineage cell lines try to come out they get squeezed through these fibrotic material resulting in its tear drop shape.
I chose this answer due to leukocyte count normal not (pancytopenia)
presence of blast cells Metamyelocyte and myelocyte. How to differentiate
or discard acute myeloid leukemia not all question would mention Auer rods
in the question stem.


A 23-year-old woman at 32 weeks&#8216; gestation comes to the emergencv
department because of a 1 day history of flank pain and fever. Her
temperature is 39°C (102.3°F]. pulse is 104./min. respirations are 14/min.
and blood pressure is 120/72 mm Hg. Physical examination shows prominent
tenderness overthe left costovertebral angle A photomicrograph of a renal
biopsy specimen from a similar patient is shown. Which of the following is
the most likely diagnosis?

A.Acute pyelonephritis HUS you see in kids and elderly (usmleRX says elderly but its more so in kids). But the answer here is Acute Pyelo since this lady has CVA tenderness, the other choices are far-fetched.
B.Acute renal infarction
C.Acute tubulointerstitial nephritis (Was this the answer ???)
D.Crescentic glornerulonephritis (Wrong) if possible could you explain the
figure to derive the conclusion.No clue in the question stem I deem.
E.Hemolytic uremic syndrome
How to differentiate from HUS??? Explain.


During an experiment. an investigator wishes to evaluate the serum
cholesterol concentrations of all patients overthe age of 50 years on the
day of admission to the hospital. Both the mean and the median are the
same. lt is decided to use the mean as the measure of central tendency.
Which of the following is the most appropriate measure of dispersion to
analyze the data for this experiment?

A.Coefficient of variation
B.lnterquartile range
C.Percentile
D.Range (wrong)
E.Standard deviation (Was this the right answer??? if so How to
differentiate this from Coefficient of variation? Kindly explain)


2. The graph shows the response elicited by different concentrations of
drug X in a systern containing spare receptors in the absence (solid
curve] and presence {dashed curves] of two different concentrations of
drug Y. Drug Y alone has no effect. Which of the following best describes
drug Y?

A.Competitive reversible antagonist (wrong)
B.Full agonist
C.Inverse agonist
D.Noncompetitive antagonist
E.Partial agonist
Many gave D.Noncompetitive as the correct response for spare receptor...!
But whether there are spare receptors or not they act on different recptor
than the same as for a competitive antagonist and would bring the efficacy
down. How to differentiate it from a partial agonist? To me E. this seems an
attractive choice. Kindly explain the correct choice with narration of
course...

A 43-year-old woman with systemic lupus erythematosus has nephrotic
syndrome. Examination of renal tissue obtained on biopsy shows a diffuse
proliferative glomerulonephritis with electron-dense deposits along the
glomerular basement membrane. lmmunofluorescent studies show granular
deposits of complement along the basement membrane. Which of the
following is the most likely cause of these findings?

A.Antibodies directed against glomerular basement membrane (Wrong)
B.Antibodies directed against viral antigens expressed on endothelial
cells (What does this signify?)
C.Anti-DNA/DNA immune complex deposition in glomeruli (Was this the
answer????)
D.Autoantibodies to podocyte antigens
E.CD8+ T-lymphocijte cytotoxiclityzolil&#8216;virds-infected mesangial cells


A previously healthy 71-year-old man comes to the physician because of a
1-day history of pain and swelling of his right leg. Physical examination
shows diffuse edema of the right lower extremity and calf tenderness.
Doppler ultrasonography shows a deep venous thrombosis in the right lower
extremity. After starting heparin therapy immediately. it is most
appropriate to initiate a 6-month course of a medication with which of the
following mechanisms of action?

A.Binds to the active site on the thrombin molecule (wrong)
B.lnterferes with the carboxylation of coagulation factors ( was this the
answer???) Heparin is given IV in hospital's and when this gentleman needs to leave, he is placed on long-term therapy of Warfarin.
C.lrreversibly inactivates cyclooxygenase
D.Potentiates the action of antithrornbin III
E.Selectivelv inhibits factor Xa
Kindly explain with the correct choices.

Any help will be greatly appreciated... Thank you 😕

I answered the best I could for some.

 

[alza689]

:

I answered the best I could for some.

Oh! Thank you ZGX for your timely information. You seem to be a genius your explanation regarding teardrop cell is spledidly presented. Am indebted to you for the explanation. Hope someonne else fills the questions that are unanswered. Thank you again for all the help.

Regards,
alza689

 

[Phloston]

For this question:

A study is conducted to assess the accuracy of a new rapid test to detect a virulent bacterial infection. This infection has an 80% mortality rate if it is not identified early in its course; however, prompt administration of antibiotics decreases the mortality rate to less than 5%. The risks of this antibiotic therapy are minimal. A total of 10,000 participants are enrolled and undergo assessment with the new test. The graph shows the distribution of infected and noninfected participants according to the results of the test. Which of the following labeled points is most appropriate for use as the optimal diagnostic cut point for results of this test?

-----------------------

I actually don't think this question was easy at all. Not just that, but I notice that people will just say "the answer is B," but they won't explain it.

The trick here actually wasn't in the graph itself, it's in the wording of the question. I bolded the portion of the question above that is the key to realizing it's B, not C.

At point-C, all infected persons seem to be accounted for, so you'd think that sensitivity is optimal at that point. However, point-C is where the test said all infected persons were accounted for. That doesn't mean they actually were all accounted for. If they were all accounted for, that would be assuming that the sensitivity of the test is 100%. So assuming the sensitivity of the test is <100% (which is normal), there are bound to be false-negatives in the non-infected loop just left to point-C. This means point-B is the first point at which many of those potential false-negative cases are eliminated. Boom.

 

[wittyname]

Anybody know the answer to the question w/ the "postal worker" who encountered a spore-forming bacteria? Sorry for the lack of details. I don't remember the stem of the question at all.
The answers included crazy compounds, like glucoruno...mannan (which I selected). There was also polyglutamic acid I think. Which I think may be the answer, cause it seemed like it was related to B. anthracis??

Anyone know what question I'm talking about..? -_-

 

[wittyname]

Also was the answer to the Ehlers-Danlos question (with the picture of the hyperextensible hand):
"defect in synthesis of extracellular glycoprotein" (cause collagen is an extracellular glycoprotein?)
or "defect in synthesis of fibrillary collagen"?

 

[Phloston]

Anybody know the answer to the question w/ the "postal worker" who encountered a spore-forming bacteria? Sorry for the lack of details. I don't remember the stem of the question at all.
The answers included crazy compounds, like glucoruno...mannan (which I selected). There was also polyglutamic acid I think. Which I think may be the answer, cause it seemed like it was related to B. anthracis??

Anyone know what question I'm talking about..? -_-

Sounds like B. anthracis, which would be polyglutamic acid capsule for sure.

Also was the answer to the Ehlers-Danlos question (with the picture of the hyperextensible hand):
"defect in synthesis of extracellular glycoprotein" (cause collagen is an extracellular glycoprotein?)
or "defect in synthesis of fibrillary collagen"?

The answer was "defect in synthesis of fibrillary collagen." I had gotten this question wrong (per extended feedback online), and I recall having put "defect in synthesis of extracellular glycoprotein." My take on it was that collagen is a form of extracellular glycoprotein because it's 1) secreted (hence extracellular), 2) it's glycosylated, and 3) it's a protein. But that was wrong. Apparently this latter answer refers to fibrillin, not collagen, which would be the correct answer if we were dealing with Marfan's. If you look up fibrillin (probably on Wiki), it will tell you it's an extracellular glycoprotein.

 

[Zaina11]

We all do it. You know the question with the two bell curves that was asking about where the cut off for the test should be? I didn't realize they were bell curves and couldn't figure out why the curves doubles back on themselves. If you can find a stupider mistake than that I will be impressed.

mwahahahaha!! HAD THE SANE f****in illusion too! those boards really mess up with ur head!

 

[marele86]

Yep, the "postal worker" = anthrax.

About the woman with the weird rash on her face - the reason its wrong to ask her about sun-exposure is that by doing so, you are avoiding her statement. I almost picked that one too - but in USMLE-bioethics-land "going straight to solving her problem" is almost always a trap. (The fact that it's phrased as a question doesn't matter since you're effectively changing the subject, so you're still limiting her communication). Instead, for image-related Qs, you're supposed to emphasize, but never offer anything that could be false reassurance.

I agree with whoever mentioned that the Kaplan 20 Rules are actually a pretty useful approach to ethics scenarios.

Can anyone help me with these questions? No one has asked them yet, so I'm positive I overlooked something simple / was thinking something really, really dumb.

13. An outbreak of multidrug resistant E. coli in an intensive care unit is being investigated. The determinants of antibiotic resistance are thought to be carried on a plasmid that has been transferred among different bacterial strains. Which of the following observations from in vitro studies best supports this hypothesis?
A) Lysogeny must precede transfer
B) Transfer is susceptible to DNase
C) Transfer requires a bacteriophage
D) Transfer requires cell-to-cell contact
E) Transfer requires transformation competent recipient strains. (wrong)
I know the right answer is D, but what tells you the plasmid was transferred by conjugation, not transformation? I read the "in vitro" studies and immediately narrowed it down to E vs B. (I guess since both of those statements are true I should've figured out 'transformation' wasn't right, but I suspect I was missing a larger concept than that.)


29. A 45-year-old male has a partial colectomy for carcinoma. Which of the following scenarios indicates the highest likelihood for survival for 5 years after resection of the lesion?
A) Moderately differentiated carcinoma invading the muscularis (wrong)
B) Mucin-producing carcinoma invasive to the serosal surface
C) Mucin-producing carcinoma metastatic to two regional lymph nodes
D) Poorly differentiated carcinoma confined to the mucosa
E) Well-differentiated carcinoma with hepatic metastasis.
So it was D, then? My rationale for choosing A was that poorly-differentiated carcinomas indicate a greater tendency towards aggressive colon cancer than moderately-differentiated, and that the muscularis invasion was irrelevant as he had the partial colectomy of the area. Guess not.

This was a weird test for me. Not too happy with missing conceptual questions this close to the real deal.

 

[Jonari]

Yep, the "postal worker" = anthrax.

About the woman with the weird rash on her face - the reason its wrong to ask her about sun-exposure is that by doing so, you are avoiding her statement. I almost picked that one too - but in USMLE-bioethics-land "going straight to solving her problem" is almost always a trap. (The fact that it's phrased as a question doesn't matter since you're effectively changing the subject, so you're still limiting her communication). Instead, for image-related Qs, you're supposed to emphasize, but never offer anything that could be false reassurance.

I agree with whoever mentioned that the Kaplan 20 Rules are actually a pretty useful approach to ethics scenarios.

Can anyone help me with these questions? No one has asked them yet, so I'm positive I overlooked something simple / was thinking something really, really dumb.

13. An outbreak of multidrug resistant E. coli in an intensive care unit is being investigated. The determinants of antibiotic resistance are thought to be carried on a plasmid that has been transferred among different bacterial strains. Which of the following observations from in vitro studies best supports this hypothesis?
A) Lysogeny must precede transfer
B) Transfer is susceptible to DNase
C) Transfer requires a bacteriophage
D) Transfer requires cell-to-cell contact
E) Transfer requires transformation competent recipient strains. (wrong)
I know the right answer is D, but what tells you the plasmid was transferred by conjugation, not transformation? I read the "in vitro" studies and immediately narrowed it down to E vs B. (I guess since both of those statements are true I should've figured out 'transformation' wasn't right, but I suspect I was missing a larger concept than that.)


29. A 45-year-old male has a partial colectomy for carcinoma. Which of the following scenarios indicates the highest likelihood for survival for 5 years after resection of the lesion?
A) Moderately differentiated carcinoma invading the muscularis (wrong)
B) Mucin-producing carcinoma invasive to the serosal surface
C) Mucin-producing carcinoma metastatic to two regional lymph nodes
D) Poorly differentiated carcinoma confined to the mucosa
E) Well-differentiated carcinoma with hepatic metastasis.
So it was D, then? My rationale for choosing A was that poorly-differentiated carcinomas indicate a greater tendency towards aggressive colon cancer than moderately-differentiated, and that the muscularis invasion was irrelevant as he had the partial colectomy of the area. Guess not.

This was a weird test for me. Not too happy with missing conceptual questions this close to the real deal.

I don't really have a good explanation as to why you're first answer is c-2-c, the kaplan micro lady does a good job explaining it, sorry. as for your 2nd question, i wrote D for the answer...basically pathoma talks about the TNM grading system...and the most important prognostic factors...basically M which stands for metastasis is the best indicator for prognosis...you want a cancer that basically hasn't metastasized/invaded...

in this case scenario...D was the best answer to go with...i got a lot of these scenario questions wrong in UWorld...went back and watched the 21 minute video that Sattar talked about and it cleared up the confusion

anybody have an idea for these 2...my rationale for the first one was she's anorexic --> will have higher levels of stress hormones in her body...and what causes stress hormones to be released - acth? im guessing the answer is b?

ok, i guess just lack of ATP no na/katpase pump working effectively?

 

[Jonari]

up

 

[Myxedema]

Q33 describes the mechanism of amenorrhea seen in anorexic patients. So the answer should be B.

Q5 describes the reversible changes seen in a cell after ischemia. Like you've said, lack of ATP is the key here, so the answer should be C.

 

[NickNaylor]

I don't really have a good explanation as to why you're first answer is c-2-c, the kaplan micro lady does a good job explaining it, sorry. as for your 2nd question, i wrote D for the answer...basically pathoma talks about the TNM grading system...and the most important prognostic factors...basically M which stands for metastasis is the best indicator for prognosis...you want a cancer that basically hasn't metastasized/invaded...

in this case scenario...D was the best answer to go with...i got a lot of these scenario questions wrong in UWorld...went back and watched the 21 minute video that Sattar talked about and it cleared up the confusion

anybody have an idea for these 2...my rationale for the first one was she's anorexic --> will have higher levels of stress hormones in her body...and what causes stress hormones to be released - acth? im guessing the answer is b?

ok, i guess just lack of ATP no na/katpase pump working effectively?

Whenever you have a patient that is nutritionally deficient for long periods of time, you can pretty much assume the GnRH axis shuts down (this is why female anorexia patients have amenorrhea).

Sent from my Nexus 7

 

[Jonari]

Whenever you have a patient that is nutritionally deficient for long periods of time, you can pretty much assume the GnRH axis shuts down (this is why female anorexia patients have amenorrhea).

Sent from my Nexus 7

Aren't you supposed to be sitting in the prometric center right about now? 😕

 

[NickNaylor]

Aren't you supposed to be sitting in the prometric center right about now? 😕

Tomorrow. 😉

Sent from my Nexus 7

 

[Jonari]

Tomorrow. 😉

Sent from my Nexus 7

What'd you think about 11? did you think it was relatively easy, medium, or hard? i'm just baffled because i did better on this nbme compared to both 5 and 6, by almost 20 points...going to take 12 next wednesday

 

[NickNaylor]

What'd you think about 11? did you think it was relatively easy, medium, or hard? i'm just baffled because i did better on this nbme compared to both 5 and 6, by almost 20 points...going to take 12 next wednesday

I thought it was pretty comparable to the others. I thought 12 was the trickiest while the others I took (11, 13, and 15) were relatively "standard."

Sent from my Nexus 7

 

[Jonari]

I thought it was pretty comparable to the others. I thought 12 was the trickiest while the others I took (11, 13, and 15) were relatively "standard."

Sent from my Nexus 7

don't you think the single digits...esp 5, 6, 7 were more tough compared to 11...

i so pray that my grades will stay consister/higher than 11...it'll be a good track record leading up to the real deal

how do you feel about tomorrow?

 

[NickNaylor]

don't you think the single digits...esp 5, 6, 7 were more tough compared to 11...

i so pray that my grades will stay consister/higher than 11...it'll be a good track record leading up to the real deal

how do you feel about tomorrow?

I never took any tests below 11 so I'm not sure how those were.

Feelin alright. Nervous obviously but I don't think I could learn this material any better than where I'm already at. It's all gonna come down to not making stupid mistakes and being fortunate with the questions I get.

Sent from my Nexus 7

 

[Jonari]

I never took any tests below 11 so I'm not sure how those were.

Feelin alright. Nervous obviously but I don't think I could learn this material any better than where I'm already at. It's all gonna come down to not making stupid mistakes and being fortunate with the questions I get.

Sent from my Nexus 7

i think this plays such a large role as well in getting a good score...if i got a test that was purely path, pharm, micro/immuno, biochem metabolism, embryo, and neuro...i'd be set

if the exam is heavy on genetics, molecular techniques (ie rflps, blots, etc etc), werid anatomy questions, weird biostats stuff, and psych i'm fuxored.

 

[Jonari]

in the meantime, here's a sick song NN...

http://www.youtube.com/watch?v=mDyOheqwTMo

not sure what the youtube embed [] is for sdn...

 

[medpack87]

I just took NBME 11 and got 530/228. I had the exact same score for NBME 13 taken a couple of weeks ago. My STEP1 is in 40 days.

I just want to thank everyone in this thread for your answers, i just read through the whole thread before going to take a look at my incorrect answer choices from the extended feedback.

I will be posting some more questions here, and gladly answer any questions from other people too. Lets keep this thread going.

 

[medpack87]

Anyone got an explanation for this one?

24 yr old man with purulent urethral discharge, gram stain shows gram neg diploccci, treated with ceftriaxone. Symptoms dissapear in 2 days, and in 10 days mucoid discharge appears, which is the following explanation:

a)ceftriaxione does not penetrate cells
b)patient was initially infected with gonorrhea and trachomatis
c)patient was reinfected by an untreated partner (I went for this one, because symptoms reappeared 10 days after initial treatment, I thought initial infection was treated, and if it had chlamydia coinfection, the mucoid discharge described above should have been there from the begining, I was wrong)
d)the patient's strain gonorrhea developes resistance

 

[Jonari]

Anyone got an explanation for this one?

24 yr old man with purulent urethral discharge, gram stain shows gram neg diploccci, treated with ceftriaxone. Symptoms dissapear in 2 days, and in 10 days mucoid discharge appears, which is the following explanation:

a)ceftriaxione does not penetrate cells
b)patient was initially infected with gonorrhea and trachomatis
c)patient was reinfected by an untreated partner (I went for this one, because symptoms reappeared 10 days after initial treatment, I thought initial infection was treated, and if it had chlamydia coinfection, the mucoid discharge described above should have been there from the begining, I was wrong)
d)the patient's strain gonorrhea developes resistance

i chose B for this...i remember that kaplan microbiology lady and also pathoma talks about how gonorrhea and trachomatis infect together...the concept is basically testing to see if you know whether or not gonorrhea/chlamydia are linked together or not...

if you have the kaplan microbio vids...go to the nesseria videos and go towards the end where she talks about the treatments...and she talks about this concept

 

[withrye]

Anyone got an explanation for this one?

24 yr old man with purulent urethral discharge, gram stain shows gram neg diploccci, treated with ceftriaxone. Symptoms dissapear in 2 days, and in 10 days mucoid discharge appears, which is the following explanation:

a)ceftriaxione does not penetrate cells
b)patient was initially infected with gonorrhea and trachomatis
c)patient was reinfected by an untreated partner (I went for this one, because symptoms reappeared 10 days after initial treatment, I thought initial infection was treated, and if it had chlamydia coinfection, the mucoid discharge described above should have been there from the begining, I was wrong)
d)the patient's strain gonorrhea developes resistance

I can't say exactly why the symptoms of C. trachomatis didn't appear until a week later, but I do know this to be a very common line of questioning with respect to medical treatment of STI. Almost every question I've gotten concerning a patient with an STI who gets monotherapy is related to the fact that they should have been co-treated for both Nisseria and Chlamydia. I think reinfection/resistance is much less likely than inadequate treatment to begin with.

 

[Jonari]

I can't say exactly why the symptoms of C. trachomatis didn't appear until a week later, but I do know this to be a very common line of questioning with respect to medical treatment of STI. Almost every question I've gotten concerning a patient with an STI who gets monotherapy is related to the fact that they should have been co-treated for both Nisseria and Chlamydia. I think reinfection/resistance is much less likely than inadequate treatment to begin with.

lol this guy explained it better...see the bolded part

 

[medpack87]

Good one. Thanks. Classical error overthinking answer choices. I did watch the microbiology Kaplan videos, with the lady that has the stuffed toy microbes.

Thanks for the help. I might be coming back for more

 

[Jonari]

Good one. Thanks. Classical error overthinking answer choices. I did watch the microbiology Kaplan videos, with the lady that has the stuffed toy microbes.

Thanks for the help. I might be coming back for more

No problem. post all your questions up at the same time...makes it easier for all of us to have a better discussion on the questions. 😀

 

[withrye]

Your first question is purely a question of what happens when you lower the threshold for a test. Yes, you can think of this as increasing the sensitivity, but that's not really necessary. Just think of it has having a lower threshold for a positive result. What happens? Suddenly, more people (specifically, everyone with a PPD between 5-10mm) are told they have TB. That means both a higher incidence and prevalence as compared to when the test only came back positive with a 10mm+ reading.

Your second question is more straightforward than you think. It's simply asking which of these factors, when it goes up, causes more tissue offloading. An increase in 2,3-BPG is the only factor listed that, when increased, supports more O2 offloading.

Your last question asks about combination therapy for HTN and Raynaud's. Raynaud's is caused by vasospasm, the most common treatment for which is a calcium channel blocker. On that list, the only CCB is nifedipine. If they had forced you to choose between verapamil (another CCB) and nefidipine, nefidipine is still the better choice because the -dipine blockers are more selective for peripheral vs. cardiac vessels (verapamil being the reverse situation).