NBME 11 question

[Master Deep]

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!

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[kstreet]

An 80 yo woman is brought to the ER after she was found wandering the street confused. She has no medical conditions and medications. She states she wants to go home. Oriented to person, not time and place. Only able to provide home address.

A. Try to contact family
B. Arrange for transport to her home
C. Arrange for transfer to nursing facility
D. Administer sedative
E. Admit pt to psych center



Wasn't sure about this one...

 

[wannabedocta]

I marked A. I think contacting her family would be the most effective way to solving her problem. She could be living alone or with her family and just be experiencing acute episode of delirium.

A. Try to contact family - probably most effective solution for long term resolution.
B. Arrange for transport to her home - She could be living alone. She could just walk out and be found on streets again the next day.
C. Arrange for transfer to nursing facility- don't know if she's physically incompetent to provide basic needs, she may be physically ok and able to feed, bathe, and take care of herself. Not enough info.
D. Administer sedative - that's probably illegal
E. Admit pt to psych center - she has no medical conditions, no signs of any psychotic problems.

 

[DrBB]

Does anyone remember the answer to this question:

A 56 year old woman has recently diagnosed carcinoma of the breast. X-ray shows a tumor next to the right side of the heart. An enhanced CT scan with the tumor invading the pericardium is shown. Which of the following structures is most likely involved?

A) Coronary sinus
B) Greater splanchnic vein
C) Right phrenic nerve
D) Right vagus nerve
E) Thoracic duct

The CT just shows a tumor on the right side of the heart...

 

[dude1344]

.

 

[SlaveOfTCMC]

An 80 yo woman is brought to the ER after she was found wandering the street confused. She has no medical conditions and medications. She states she wants to go home. Oriented to person, not time and place. Only able to provide home address.

A. Try to contact family
B. Arrange for transport to her home
C. Arrange for transfer to nursing facility
D. Administer sedative
E. Admit pt to psych center



Wasn't sure about this one...

Remember determining one's competency is up to a judge. THe doctor cannot make the decision herself/himself. THerefore, anything that robs the patient of autonomy at this point is unethical.

B) is wrong because this is abandoning the patient.
C) is wrong because it robs autonomy
D) is wrong because it may be construed as maleficence
E) is wrong because it robs autonomy

 

[winkleweizen]

Does anyone know the answer to the question about which heart valve was replaced and then they showed two pictures of it.

I put aortic, but am not sure cause i forgot to buy extended feedback.

 

[kstreet]

Does anyone know the answer to the question about which heart valve was replaced and then they showed two pictures of it.

I put aortic, but am not sure cause i forgot to buy extended feedback.

That picture def sucked, but i think it was the tricuspid valve.

edit: reason being was that the direction of the valve was from the right atrium to right ventricle.

 

[winkleweizen]

That picture def sucked, but i think it was the tricuspid valve.

edit: reason being was that the direction of the valve was from the right atrium to right ventricle.

thanks much..gotta brush up on anatomy!

 

[Cookie Queen]

Anybody know the answer to this one:

35 year old woman with leiomyomata uteri undergoes an experimental treatment that involves instillation of an embolizing agent directly to the vessels that feed the leiomyomata. During this procedure, in order to reach the involved vessels, which of the following is the most direct course of the catheter after entering the femoral artery?

A) Aorta-->gonadal artery-->uterine artery
B) External iliac artery-->internal iliac artery-->uterine artery
C)External iliac artery-->superior gluteal artery-->uterine artery
D)Internal iliac artery-->inferior vesical artery-->uterine artery
E)Internal iliac artery-->superior vesical artery-->uterine artery

Yes, it's B. I just did some re-tracing through the good ol' anatomy pictures after I got it wrong myself.

 

[Cookie Queen]

That picture def sucked, but i think it was the tricuspid valve.

edit: reason being was that the direction of the valve was from the right atrium to right ventricle.

It was the tricuspid - that's what I put and it didn't show up in my incorrect questions.

 

[ATrim7]

Checked the thread for this question, but its getting long now...so here's my questions.

Dude moves to California. He has fever, cough, chest pain, and malaise for 14 days. A picture of his lungs taken with gamma rays shows bronchopneumonia in scattered areas. A culture shows a mold and he has some eosinophilia on CBC.

There is a micro picture of something that looks like Nocardia to me - but that wasn't the answer.

Other options:
Actinomyces
Histo
Coccidio
Legionella
Staph
S. Pneum

Help?

 

[abmd]

California = Coccoid. always

 

[ATrim7]

California = Coccoid. always

Had a feeling that was the case - but the stem actually said central California - not southern or desert or Arizona.

Thanks - I'll keep the California = always in mind.

 

[abmd]

Had a feeling that was the case - but the stem actually said central California - not southern or desert or Arizona.

Thanks - I'll keep the California = always in mind.

ya the pic was confusing because it wasn't what you expected remember it's dimorphic. I think also north mexico is coccoid but don't quote me on that

 

[SlaveOfTCMC]

Goljan said that it is the earthquakes in California that send the Cocciodiodes spore flying


Moreover, that picture was the MOLD FORM

The stem mentioned they cultured the organism. Culture would imply outside of the body at 25C.

MOreover, the spherule form within the tissue would be seen if the surrounding looked like it was from within an organism (cellular background, as opposed to an empty background)

(Google up cocciodiodes spherule yeast form and then take a look at the background... it looks very cellular)

 

[dude1344]

.

 

[iA-MD2013]

An 88 yo loses consciousness when his neck is palapated. He has a 40 yr history of hypertension and he takes thiazides for it as well as anti-inflammatory drugs for his osteoarthritis. What caused his syncope?
complete heart block, laryngospasm, peripheral arteriole constriction, peripheral arteriole dilation (not this!), sinus bradyarrythmia, ventricular tachyarrythmia

 

[iA-MD2013]

I can't put up the xray, but if anyone remembers the one with the prosthetic valve and an arrow pointing towards one of them, what was the answer? And where was the second prosthetic valve placed?

 

[iA-MD2013]

Last one:
A previously healthy 6 mo boy develops fever and paroxysmal nocturnal cough. He has not had any immunizations. His leukocyte count is 30,000 (70% lymphocytes). Neutrophil chemotaxis and oxidative metabolism are defective due to decreased activity of which of the following enzymes:
adenylyl cyclase, myeloperoxidase, NADPH oxidase, phospholipase C, or protein kinase C

 

[Celestine]

An 88 yo loses consciousness when his neck is palapated. He has a 40 yr history of hypertension and he takes thiazides for it as well as anti-inflammatory drugs for his osteoarthritis. What caused his syncope?
complete heart block, laryngospasm, peripheral arteriole constriction, peripheral arteriole dilation (not this!), sinus bradyarrythmia, ventricular tachyarrythmia

It's sinus bradyarrhythmia. If you have an unusually sensitive carotid baroreceptor, palpation can overstimulate these receptors, simulating high blood pressure and causing reflex bradycardia.

 

[iA-MD2013]

It's sinus bradyarrhythmia. If you have an unusually sensitive carotid baroreceptor, palpation can overstimulate these receptors, simulating high blood pressure and causing reflex bradycardia.

But wouldn't it also cause vasodilation...I always thought that the syncope was directly caused by the vasodilation: peripheral vasodilation = decreased blood flow to the brain = syncope.

 

[Celestine]

But wouldn't it also cause vasodilation...I always thought that the syncope was directly caused by the vasodilation: peripheral vasodilation = decreased blood flow to the brain = syncope.

I feel like stimulation of those baroreceptors decreases sympathetic output, but doesn't necessarily cause direct vasodilation of arterioles, just less vasoconstriction. And I doubt you would see that effect immediately. Correct me if I'm wrong, it's always a possibility I've learned, haha

 

[kstreet]

But wouldn't it also cause vasodilation...I always thought that the syncope was directly caused by the vasodilation: peripheral vasodilation = decreased blood flow to the brain = syncope.

Stimulation of the baroreceptors causes overall Parasympathetic upregulation and Sympathetic downregulation which means the heart slows down. This is why they do carotid stimulation as a way to rx PVST. Valsalva would do the same by increasing intrathoracic pressure pressing on those baroreceptors.

 

[Celestine]

Stimulation of the baroreceptors causes overall Parasympathetic upregulation and Sympathetic downregulation which means the heart slows down. This is why they do carotid stimulation as a way to rx PVST. Valsalva would do the same by increasing intrathoracic pressure pressing on those baroreceptors.

Oops yeah, the direct effect on heart rate comes from parasympathetic upregulation as well. Thanks

 

[iA-MD2013]

Oops yeah, the direct effect on heart rate comes from parasympathetic upregulation as well. Thanks

That makes sense...thanks for the help!!!

 

[iA-MD2013]

Last one:
A previously healthy 6 mo boy develops fever and paroxysmal nocturnal cough. He has not had any immunizations. His leukocyte count is 30,000 (70% lymphocytes). Neutrophil chemotaxis and oxidative metabolism are defective due to increased activity of which of the following enzymes:
adenylyl cyclase, myeloperoxidase, NADPH oxidase, phospholipase C, or protein kinase C

^ I still have no idea what the answer to this is...if anyone has an idea, I'd appreciate any thoughts

 

[kstreet]

^ I still have no idea what the answer to this is...if anyone has an idea, I'd appreciate any thoughts

Kid has Bordella Pertussis. One of the toxins is an adenylate cyclase toxin that increases cAMP and prevents neutrophil chemotaxis.

 

[iA-MD2013]

Kid has Bordella Pertussis. One of the toxins is an adenylate cyclase toxin that increases cAMP and prevents neutrophil chemotaxis.

Thanks!!! How did you realize it was pertussis anyway? Why can't this be some random viral or bacterial infection?

 

[kstreet]

Thanks!!! How did you realize it was pertussis anyway? Why can't this be some random viral or bacterial infection?

Pertussis has a catarrahal stage where the symptoms are cold like and a paroxysmal stage with coughing. All kids should get a DTP immunization, and this pt did not have any.

So i guess the two trigger words were paroxysmal coughing and no immunizations.

 

[iA-MD2013]

Pertussis has a catarrahal stage where the symptoms are cold like and a paroxysmal stage with coughing. All kids should get a DTP immunization, and this pt did not have any.

So i guess the two trigger words were paroxysmal coughing and no immunizations.

Awesome...thanks again!

 

[HotLikeSauce]

1) Pt with decreased energy, falls asleep early, decreased libido/erection problems. Has mild gynecomastia and decreased muscle mass. Which drug to give?

Ans: testosterone, right? (I said sildenafil bc of the erection problems)

2) Pt with Crohn's has higher amount of radiolabeled lactulose in urine than regular person. What part of epithelium is disrupted in inflammation?

Ans: adherens junctions, basement membrane, desmosomes, gap junctions, tight junctions

I have no freaking idea about #2. If anyone can even explain why some of the answer choices are wrong, I'd be super grateful!

 

[iA-MD2013]

1) Pt with decreased energy, falls asleep early, decreased libido/erection problems. Has mild gynecomastia and decreased muscle mass. Which drug to give?

Ans: testosterone, right? (I said sildenafil bc of the erection problems)

2) Pt with Crohn's has higher amount of radiolabeled lactulose in urine than regular person. What part of epithelium is disrupted in inflammation?

Ans: adherens junctions, basement membrane, desmosomes, gap junctions, tight junctions

I have no freaking idea about #2. If anyone can even explain why some of the answer choices are wrong, I'd be super grateful!

1. Testosterone.
2. Tight Junctions.

I don't actually have a good explanation. My reasoning for it was that it could either be TJs, adherenes, or desmosomes because they block paracellular flow. Since tight junctions are the...well, tightest, they're the most important. So, losing TJs would allow for lactulose to enter between cells.

 

[HotLikeSauce]

1. Testosterone.
2. Tight Junctions.

I don't actually have a good explanation. My reasoning for it was that it could either be TJs, adherenes, or desmosomes because they block paracellular flow. Since tight junctions are the...well, tightest, they're the most important. So, losing TJs would allow for lactulose to enter between cells.

DURRRR! Gah, you're right. Seems so obvious now haha. Thanks! Even says explicitly in FA, "TJ: prevents diffusion across paracellular space." *facepalm*

 

[skk3]

24 year old man with erectile dysfunction and lower back pain and hemorrhoids. Why is there ED?

Compromised blood flow from pampiniform plexus
damaged blood and nerve to erectile tissue
lumbosacral strain
obturator nerve compression
pressure of hemorrhoids on erectile tissue


I was sure it was lumbosacral strain (S2,3,4 keeps the penis off the floor). Why is this wrong and why is the correct answer correct? Is the answer "damaged blood and nerve to erectile tissue"? That would be my second choice.

I'm thinking now... does strain not equivalent to herniation? Did I make an incorrect assumption?

 

[kac714]

24 year old man with erectile dysfunction and lower back pain and hemorrhoids. Why is there ED?

Compromised blood flow from pampiniform plexus
damaged blood and nerve to erectile tissue
lumbosacral strain
obturator nerve compression
pressure of hemorrhoids on erectile tissue


I was sure it was lumbosacral strain (S2,3,4 keeps the penis off the floor). Why is this wrong and why is the correct answer correct? Is the answer "damaged blood and nerve to erectile tissue"? That would be my second choice.

I'm thinking now... does strain not equivalent to herniation? Did I make an incorrect assumption?

I said B, because he was a biker. I did extended feedback and got this one right

 

[Poiu86]

OK what about this one...

Dude is making a drug to block HIV entry into the cell... what is the most appropriate target?

CD8
Chemokine receptor
Protease Inhibitor
Fc receptor
Integrase
IL-2 Receptor
Reverse transcriptase
Tat


I put protease inhibitor, thinking that by blocking Gp160--> Gp120 & Gp41, there would be less binding (120) and fusion/entry (41). Apparently the folks at NBME disagree. Thoughts?

 

[iA-MD2013]

Chemokine receptor

 

[Poiu86]

aaahhhh thanks. I forgot about CXC and CCR.



and go hawks

 

[the_samrat]

few more q's...

12 y/o girl w/ rash on left buttock for last 2 days. family returned from a 2-week vacation in Maine. Vitals normal. likely cause of this patient's infection is taxonomically and morphologically similar to...

a) Bacillary angiomatosis
b) Chanchroid
c) Leptospirosis
d) Lymphogranuloma venereum
e) Q fever


A rapidly degenerative neurologic disease in a population in a Pacific island. EM --> spherica to conical particles, RNA-dependent-DNA polymerase activity. This virus is most closely related to

a) Coxsackie
b) HSV
c) HIV
d) Papilloma
e) West Nile virus

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
c) HIV encephalopathy
d) meningococcal meningitis
e) subdural empyema


24 y/o woman, unresponsive. despondent for 2 weeks b/c of ending long-term relationship. recently seen a physician seeking help. Unresponsive to pain stimuli. Temp: 35.7C, pulse is 52, resp is 5/min, shallow and BP 85/55. Pinpoint pupils reactive to light. toxicity of what?

a) CO
b) Ethylene glycol
c) Methanol
d) Opioids
e) SSRI
f) TCAs

38 y/o man w/ hemorrhoids, esp. when defecating. had a similar episode 1 yr back.
a) anal fistula
b) colorectal carcinoma
c) hemorrhoids
d) perianal abscess

 

[iA-MD2013]

few more q's...

12 y/o girl w/ rash on left buttock for last 2 days. family returned from a 2-week vacation in Maine. Vitals normal. likely cause of this patient's infection is taxonomically and morphologically similar to...

a) Bacillary angiomatosis
b) Chanchroid
c) Leptospirosis
d) Lymphogranuloma venereum
e) Q fever


A rapidly degenerative neurologic disease in a population in a Pacific island. EM --> spherica to conical particles, RNA-dependent-DNA polymerase activity. This virus is most closely related to

a) Coxsackie
b) HSV
c)HIV
d) Papilloma
e) West Nile virus

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
c) HIV encephalopathy
d) meningococcal meningitis
e) subdural empyema


24 y/o woman, unresponsive. despondent for 2 weeks b/c of ending long-term relationship. recently seen a physician seeking help. Unresponsive to pain stimuli. Temp: 35.7C, pulse is 52, resp is 5/min, shallow and BP 85/55. Pinpoint pupils reactive to light. toxicity of what?

a) CO
b) Ethylene glycol
c) Methanol
d) Opoids
e) SSRI
f) TCAs

38 y/o man w/ hemorrhoids, esp. when defecating. had a similar episode 1 yr back.
a) anal fistula
b) colorectal carcinoma
c) hemorrhoids
d) perianal abscess

That first one annoyed me...what is borrelia toxonomically and mophologically more similar to leptospira than treponema? EDIT: nevermind! Just noticed the answer choice is chancroid not chancre...

 

[azof02]

so i just finished form 11, and i got 420/203, and i took nbme 6 last week with same score. what the hell!!!!! i thought i would improve but i am freaking out now my exam is 4 weeks from today. My uworld qbank average is 70% i think 44 % unused. I am not shooting for 240 or 250 . I would be happy with 220 ya all think its possible

Definitely; I was panicking because I got similar scores and only had 2 weeks left....just took 11 yesterday and jumped 33 points in a week, so you'll be fine. Just keep studying!

 

[the_samrat]

That first one annoyed me...what is borrelia toxonomically and mophologically more similar to leptospira than treponema? EDIT: nevermind! Just noticed the answer choice is chancroid not chancre...

thank you!

 

[ih8mcat]

Can anyone explain the breast one? Why is it epithelial cells, it seems to be some sort of inflammation?

To confirm it was a supernumary nipple - and they tend to grow during pregnancy - especially late pregnancy - just like the breast and normal nipples. With this growth they often cause pain - I found this on some surgical handbook off of google.

 

[jdmd1student]

16y/o boy who frequently goes fishing; the kid has superficially invasive melanoma w/ features of regression. What causes the regression?
a-) Ab-dependent cellular rxn.
b-)Ab mediated cellular dysfunction
c-)Arthus rxn.
d-)Complement and Fc recept. mediated response
e-)T lymphocyte mediated cytotoxicity.

Thx in advance.

 

[ih8mcat]

16y/o boy who frequently goes fishing; the kid has superficially invasive melanoma w/ features of regression. What causes the regression?
a-) Ab-dependent cellular rxn.
b-)Ab mediated cellular dysfunction
c-)Arthus rxn.
d-)Complement and Fc recept. mediated response
e-)T lymphocyte mediated cytotoxicity.

Thx in advance.

I think I got this one right. I believe I selected e. I was thinking aberrant MHC 1 expression - I think that MHC displays signs of distress from cancer along with viral markers. I ruled out a and b because I though ab = foriegn. And this is something internal to the boys immune system.

 

[ih8mcat]

I can't quite figure out what didn't add up in the addison's question. A slide is shown of the different layers of the adrenals. And the question asks for what layer is responsable for ELECTROLYTE abnormalities. I chose the outher most layer which was option A.

Maybe A was some sort of adrenal capsule - serosal like tissue. But I figured it was the zona glomerulosa make her mineralocorticoids.

Any thoughts guys?

 

[jdmd1student]

I think I got this one right. I believe I selected e. I was thinking aberrant MHC 1 expression - I think that MHC displays signs of distress from cancer along with viral markers. I ruled out a and b because I though ab = foriegn. And this is something internal to the boys immune system.

Thank you

 

[Poiu86]

I can't quite figure out what didn't add up in the addison's question. A slide is shown of the different layers of the adrenals. And the question asks for what layer is responsable for ELECTROLYTE abnormalities. I chose the outher most layer which was option A.

Maybe A was some sort of adrenal capsule - serosal like tissue. But I figured it was the zona glomerulosa make her mineralocorticoids.

Any thoughts guys?

You thought right. I'm pretty sure "a" was the capsule. B was the glomerulosa. I usually orient myself by ID'ing the fasciculata first. It has a more longitudinal appearance (looks like it is perpindicular to the capsule)

 

[the_samrat]

yea, i think the answer was B) the layer below the cortical capsule.

 

[richse]

i got this one wrong too

The answer is that it is a noncompetitive antagonist in the setting of excess receptor. Since there is excess receptor, the non-competitive antagonist knocking out receptors actually has no effect on the efficacy(vmax), but does decrease the chance of the drug binding the receptor--> decreasing potency. At higher doses it brings the amount of receptor down past excess levels and begins to effect efficacy (vmax).

Can someone explain to me why the noncompetitive antagonist is changing Km in this question? I thought it was supposed to be only Vmax that is altered with non-competitive inhibition.