NBME 16 help

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shubz123

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Hi all,

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More questions:

1) For this 52 y/r old guy that came in cause of 3 week hx of polydipsia and polyuria . . .how did we rule out the fact that, its not diabetes insipidus? is it cause of his hx with HTN and hyperlipidemia that we are leaning more towards diabetes?

2) There was a question about a lady who took antibiotics for 5 days, and then had a 3 day rash, fever, and it showed lab values( more blood than proteins . .. eosinophils were also shown). How can you tell the difference between a drug induced glomerulonephritis? vs. Interstitial nephritis?

3) This question: 44 year man c/o of 2 month hx of abdominal pain and diarrhea, which is received after eating.

I got around to thinking it was a duodenal ulcer and I thought it was associated with H.pylori.

However, now that I look at the right answer, its pointing more towards Zollinger Ellison . . .. .

So the question is, when you are given a question regarding someone having a duodenal ulcer . . .how do you know whether to treat H.pylori or, resect?
 
More questions:

1) For this 52 y/r old guy that came in cause of 3 week hx of polydipsia and polyuria . . .how did we rule out the fact that, its not diabetes insipidus? is it cause of his hx with HTN and hyperlipidemia that we are leaning more towards diabetes?
I am not recalling this question atm but barring any further details indicating insipidus (increased serum osmolarity, any CNS trauma, etc) and given HTN, hyperlipidemia, and I believe blood glucose (correct?) you can lean towards DMII as most likely in your differential.

2) There was a question about a lady who took antibiotics for 5 days, and then had a 3 day rash, fever, and it showed lab values( more blood than proteins . .. eosinophils were also shown). How can you tell the difference between a drug induced glomerulonephritis? vs. Interstitial nephritis?
The eosinophils are pretty characteristic of interstitial nephritis. When you see a renal question and it mentions any note of eosinophils, you can almost certainly think of interstitial nephritis (haven't come across any exceptions yet!)

3) This question: 44 year man c/o of 2 month hx of abdominal pain and diarrhea, which is received after eating.

I got around to thinking it was a duodenal ulcer and I thought it was associated with H.pylori.
However, now that I look at the right answer, its pointing more towards Zollinger Ellison . . .. .

So the question is, when you are given a question regarding someone having a duodenal ulcer . . .how do you know whether to treat H.pylori or, resect?
Did the question say anything about gastrin levels? W/o further details of the question, it's tough to tell as again I do not remember further details of this question. But with duodenal ulcers, ≥ 90% are caused by H pylori so for purposes of Step, you can safely assume that bacteria as the cause and start triple therapy (clarithromycin, PPI, amoxicillin [or metronidazole if penicillin allergy]).
 
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A 2-year-old boy is brought to the physician because of developmental delay. There is a history of hearing loss in his mother and delayed speech in his older sister. His maternal uncle had stroke-like episodes at the age of 25 years. Physical examination shows ophthalmoplegia and hypotonia. His serum lactic acid concentration is increased. Which of the following best explains the findings in this family?

A) Autosomal dominant inheritance
B) Decreased penetrance
C) Heteroplasmy
D) Imprinting
E) X-linked recessive inheritance

What is the correct answer?

What is the diagnosis? So many diseases in the relatives... i have no idea :(
C--Heteroplasmy is the Correct answer
 
A 2-year-old boy is brought to the physician because of developmental delay. There is a history of hearing loss in his mother and delayed speech in his older sister. His maternal uncle had stroke-like episodes at the age of 25 years. Physical examination shows ophthalmoplegia and hypotonia. His serum lactic acid concentration is increased. Which of the following best explains the findings in this family?

A) Autosomal dominant inheritance
B) Decreased penetrance
C) Heteroplasmy
D) Imprinting
E) X-linked recessive inheritance

What is the correct answer?

What is the diagnosis? So many diseases in the relatives... i have no idea :(
16 yo girl with CF, alert, oriented, vital signs normal. Not compliant to her medication regimen x6 months. She has generalized weakness, numbness and tingling of arms and legs, difficulty walking, loss of DTR, ataxic gait.

Which is deficient:
A. folic acid
B. vit A
C. vit B6
D. vit D
E. vit E
E---is correct
 
Hey I think I put that and that was wrong. I know mucus and cillia both go down and after much reading of medical articles on this , macrophages are also down. Can someone whom 100% got this right PLZ share your thoughts

I did it right and the answer is:
- Mucus secretion is Increased
- Cilia is impaired --> down
- Alveolar Macrophage activity is impaired --> Down
ANswer: C)

Rationale: think in CHronic bronchitis. It is associated with a V/Q defect due obstruction of bronchus by mucus plugs and also because the cilia is impaired, particles are trapped and can not be cleaned in alveoli due impaired macrophaguess.
 
Looking for help on the question about FUR

Fur binds tightly to DNA a short distance from 5' end of the genes for these virulence factors...
efficiency of Fur binding goes up as concentration of iron in bacteria goes up
based on this, Fur most likely regulates which process

methylation
post transcript. modification
splicing
transcription
translation

answer is transcription, I chose translation, couldn't get good insight on previous posts as to why and can't find it clearly explained in FA

ty!
 
Looking for help on the question about FUR

Fur binds tightly to DNA a short distance from 5' end of the genes for these virulence factors...
efficiency of Fur binding goes up as concentration of iron in bacteria goes up
based on this, Fur most likely regulates which process

methylation
post transcript. modification
splicing
transcription
translation

answer is transcription, I chose translation, couldn't get good insight on previous posts as to why and can't find it clearly explained in FA

ty!


It says that Fur binds a short distance from the 5' end of the gene (not mRNA). meaning just before of the transcription initiation site. So it's probably a transcription factor.
 
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