I have a few questions from the NBME. I apologize if I have missed the explanation previously in the forum on any of them. Any explanation would really be appreciated
🙂 Thank you SO much!!
A 55 yo man comes to the physician because of two episodes of painless, blood-tinged urine for the past week. His last episode was two days ago. He has smoked 1 pack of cigs daily for 35 years. Vital signs are WNL. PE shows no abnormalities. Urinalysis shows normal findings except for microscopic blood. Which of the following is the most likely diagnosis?
a). Bladder cancer
b). Bladder diverticulum
c). Interstitial cystitis
d). Nephrolithiasis
e). UTI
-I put UTI but looking back on it that was really stupid considering there were not WBC's. But is the right answer bladder cancer? I realize that painless hematuria is bladder cancer until proven otherwise but he's only had it for a week...which really makes me lean towards something else
It's bladder cancer.
A 38 yo woman at 32 weeks gestation is brought to the physician because of a two day history of fever, nausea, vomiting, and muscle aches. She appears acutely ill. Her temp is 102.2, pulse is 120/min, and respirations are 20/min. A photomicro of a gram stain of an organism recovered from a blood culture is show. Which of the floowing is the most likely causal organism?
a). Corynebacterium urealyticum (should I have heard of this before?)
b). Gardnerella vaginalis
c). Listeria mono
d). Rhodococcus equi (haven't heard of this one either)
e). Staph aureus
I had never heard of those either. It's Listeria . I thought that this was a BS question, jmo.
A autopsy is done on a 50 yo man who died of pneumonia despite 5 days of AB therapy in the ICU. He had a 15 year history of alcoholism. A photograph of a sagittal section of the brain is shown. Base on this pathology, which of the following findings was most likely present on neuro exam of the patient prior to his death?
a). Dysdiadochokinesia
b). Dysmetria on finger-nose testing
c). essential tremor
d). gait ataxia
e). Rhomberg
This one was previously discussed and someone mentioned that he was an alcoholic so think gait ataxia. But if I didn't know this association, is there a way to answer the question? How can I rule out the other answers?
No clue. Maybe someone else has an answer. I missed this one too... of course, I couldn't even tell the cerebellum was atrophied 
.
A female newborn is delivered at 34 weeks in an advanced-care setting where special delivery systems are available. The dx of a persistent pulmonary HTN is made. Considering that the newborn can be carefully monitored for methemoglobinemia, which of the following is the most appropriate therapy?
a). Desflurane
b). Hyperbaric O2 chamber
c). Nitric oxide
d). Nitrous oxide
e). O2 diluted with He
This question was also previously discussed in the setting of the difference between nitric oxide and nitrous oxide, but why wouldn't you want to use a hyperbaric O2 chamber?
No clue as to why you wouldn't want to use hyperbaric O2 chamber. When the stem mentioned methemoglobinema, I took it as asking if I knew what can cause methemoglobinemia, and went w/ Nitric oxide, due to Nitrates and stuff.
A 50 yo man comes to the physician because of a 2 mo history of pain in his wrists, changes in skin color, and progressive fatigue. His brother had DM2 and cirrhosis. PE shows bronze-colored skin, tenderness of the MCP joints in both hands, and hepatosplenomegaly. Serum studies show:
AST=100
ALT=110
Ferritin=1200
TIBC=200 (N=250-400)
Transferrin sat=80% (N=20-50)
Analysis of a liver bx specimen shows a markedly increase Fe concentration and cirrhosis. Which of the following is the most likely cause of the findings in this patient?
a). Increased EPO action
b). Increased intestinal Fe abs
c). Increased oral Fe intake
d). Decreased EPO
e). Decreased Fe excretion (wrong)
f). Decreased serum tranferrin concentration
increased intestinal Fe abs. Pt has hemochromatosis.
A previously healthy 54 yo man comes to the clinic because of lightheadedness for 6 hours. His symptoms began after skiing at a resort at an altitude of 9000 ft. he has been taking a carbonic anhydrase inhibitor since 2 days before arriving at the resort. His BP is 110/60 which sitting and 95/50 while standing. PE shows no other abnormalities. Which of the following is the most likely cause of his orthostatic hypotension?
a). High-alt. sickness
b). Hypovolemia
c). Hypoxia
d). Impaired sympathetic nerve activity (wrong)
e). Respiratory alkalosis
-I can see why some of these would make you lightheaded, but not why any of them would cause orthostatic hypotension
hypovolemia due to acetazolamide use. Hypovolemia is a pretty common cause of orthostatic hypotension
An investigator is studying the human immune response to tumor cell antigens in malignancies. Which of the following sets of cancer types and tumor antigens is most likely to produce the highest AB titer?
a). B-cell lymphoma, CD19
b). Breast cancer, HER2/Neu
c). Cervical cancer, HPV type 16 E6 protein
d). Melanoma, tyrosinase
e). Prostate cancer, prostate acid phosphatase
-This question was discussed before and apparently the correct answer is A (I put B) but I don't have a clue as to why. Any explanation would be greatly appreciated
🙂
Answer is actually C. I don't think anyone has come up w/ a great explanation other than that it's the only one of the answer choices that involves a non-self protein
