NBME 16 help

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Exam fever said:
What would we give to enhance insulin metabolism? Can u please explain?
Click to expand...
I think Liming means B is the answer for the first one, E is the answer for the second. Increase hepatic glucose production. I have no idea what would enhance insulin metabolism, it sounds like a distractor.
 
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The answer to the second one (6) is Iron. It's hemochromatosis. Dilated cardiomyopathy, cirrhosis, skin hyperpigmentation and high blood glucose "bronze diabetes"
 
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Thank you so much. I thought about it for a second then skipped it because I thought hemochromatosis casuses a restrictive cardiomyopathy :(
 
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I got first 4 rite, last one was wrong for me
1. Iron- hemochromatosis
2.chronic pyelonephritis- blunted calyces with scarring
3.influx of macrophages producing il-6/tnf -delayed hypersensitivity
4.G alpha s- uses adenyl Cyclades as it's messenger, gtp is hydrolysed and rxn stops,but as it's mutated inc AC
4.i guess it's f- left corticospinal tract
 
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Exam fever said:
I got first 4 rite, last one was wrong for me
1. Iron- hemochromatosis
2.chronic pyelonephritis- blunted calyces with scarring
3.influx of macrophages producing il-6/tnf -delayed hypersensitivity
4.G alpha s- uses adenyl Cyclades as it's messenger, gtp is hydrolysed and rxn stops,but as it's mutated inc AC
4.i guess it's f- left corticospinal tract
Click to expand...

Thank you very much. Regarding 4, Is not GH function by JAK/STAT pathway? I dont know why they mention Gs. Maybe Tumor cells have different mechanisms than normal tissue?!! I really should not miss this!
 
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Yeah, I got the same doubt but then since they mentioned I put that option
May be it's something about pituitary adenoma somatotrophs we should concentrate than the GH ;)
 
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Exam fever said:
Yeah, I got the same doubt but then since they mentioned I put that option
May be it's something about pituitary adenoma somatotrophs we should concentrate than the GH ;)
Click to expand...

I Just read it again and you're right they are talking about the tumor cells having mutation in the Gs protein and becoming overactive when stimulated, not how they are affecting their target cells. In this case, it is the Growth Hormone releasing hormone from the hypothalamus which acts via a Gs protein. I need to sleep well before the exam.
 
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Exam fever said:
i guess it's f- left corticospinal tract
Click to expand...

Doesn't Corticospinal tract at the medulla? So if the patient has Right side paralysis it should be the right corticospinal tract that's being damaged.
I got the questions wrong so I can't confirm :p
 
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I discounted Small Cell Carcinoma since the question described round cells 2x the size of lymphocytes. So are the "small" cells actually not that small at all?
 
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Cst cross at pyramid ,and its a descending tract so I think it should be contralateral, but may be Iam wrong at guessing the site of lesion, can anyone tell us the rite answer please?
 
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thehundredthone said:
This man has aspiration pneumonia, and hence is probably going to grow H. influenza out of the given options. S. pneumoniae, S. aureus and H. influenza are the most common causes of aspiration pneumonia.
Click to expand...

Actually, I put E) normal flora and I'm fairly certain I was correct. I think the poor dental hygiene pushes it towards being more likely that he's aspirating some of the overgrown bugs that are normally camping around there.

Thanks for your help with the other questions.
 
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timtheenchanter said:
Having a tough time deciphering this one -

35 y/o man with 3 yr history of enlarging nose, coarse facies, muscle weakness, increased hand/foot size. Large fleshy nose and prognathism on exam. High IGF-1 in serum. MRI shows pituitary adenoma. Morphologic analysis of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G alpha-s subunit of the tumor G proteins lack GTPase activity.

The tumor cells most likely have an increased activity of which enzyme?

Adenylyl cyclase
Guanylyl cyclase
Janus kinase
Phospholipase C
Tyrosine kinase

It's apparent that it's a growth hormone secreting adenoma. I put E, since I thought the GTPase referred to something like Ras, and would be referring to the pathway that IGF-1 works on.

Is the answer C? IE Janus kinase is the pathway for growth hormone and the tumor is clearly secreting GH? If so, how does GTPase play into the janus kinase pathway?
Click to expand...

GH mediates its effects via JAK/STAT on peripheral tissues. GHRH uses cAMP signaling in the somatotrophs, the study is revealing the mechanism by which GH synthesis/release is upregulated.
 
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Hey guys, I took nbme 16 and my exam is right around the corner. If anyone of you remember the answers to these q's please share with me. I would really like to go over my incorrect prior to the exam. I appreciate your help. I am posting the ones that I think we not mentioned above. Thank you

1) Guy who has allergies each spring, what to treat with for SHORT term relief? I picked Nictonic choligneric antagonist which was wrong. ?? I did not pick B agonist b/c that is for severe cases like asthma not just allergies. What do u guys think?

2) An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal
male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes
is most likely to be observed? Is everything low? smoking impairs mucocilliary clearance I know that much..

Mucus Production and Secretion up/down

Alveolar Macrophage Function up/down

Activity of Airway Cilia up/down

3) Newborn has hypothyrodism, the question asked what crossed the placetal barrier from mother that caused this??
TSH, TRH, THYROGLOBULIN, IODINE, T4. Can someone plz explain this? I picked TSH b/c it will be high in mom with hypothyroid.

4) 20 year old woman comes severe dysuria and painful vulvar rash for 2 days, what is the organism ?? How do u know exactly which one it is here?? Iknow HPV causes vulvar infectinos but it is painless, was very lost here.

5) Guy has prostate CA , undergoes prostatectomy , what structure is at risk for injury during removal of prostate? I put penile urethra which was wrong.

6)A 15-year-old girl is brought to the emergency department 12 hours after she ingested an entire bottle (100 capsules) of vitamin D in a suicide attempt , now her serum Ca is 10.4 . What is the MOA by which her calcium increased? I put increased 1 hydroxylase activity in kidney. Why is that wrong anyone know??

7) Fanconics syndrome, what are the Amino Acids, HC03, Phosphate and Glucose levels ? Increased or decreased for each.

I have more questions will post later I appreciate any help on this
 
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sadaca said:
Hey guys, I took nbme 16 and my exam is right around the corner. If anyone of you remember the answers to these q's please share with me. I would really like to go over my incorrect prior to the exam. I appreciate your help. I am posting the ones that I think we not mentioned above. Thank you

1) Guy who has allergies each spring, what to treat with for SHORT term relief? I picked Nictonic choligneric antagonist which was wrong. ?? I did not pick B agonist b/c that is for severe cases like asthma not just allergies. What do u guys think?

2) An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal
male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes
is most likely to be observed? Is everything low? smoking impairs mucocilliary clearance I know that much..

Mucus Production and Secretion up/down

Alveolar Macrophage Function up/down

Activity of Airway Cilia up/down

3) Newborn has hypothyrodism, the question asked what crossed the placetal barrier from mother that caused this??
TSH, TRH, THYROGLOBULIN, IODINE, T4. Can someone plz explain this? I picked TSH b/c it will be high in mom with hypothyroid.

4) 20 year old woman comes severe dysuria and painful vulvar rash for 2 days, what is the organism ?? How do u know exactly which one it is here?? Iknow HPV causes vulvar infectinos but it is painless, was very lost here.

5) Guy has prostate CA , undergoes prostatectomy , what structure is at risk for injury during removal of prostate? I put penile urethra which was wrong.

6)A 15-year-old girl is brought to the emergency department 12 hours after she ingested an entire bottle (100 capsules) of vitamin D in a suicide attempt , now her serum Ca is 10.4 . What is the MOA by which her calcium increased? I put increased 1 hydroxylase activity in kidney. Why is that wrong anyone know??

7) Fanconics syndrome, what are the Amino Acids, HC03, Phosphate and Glucose levels ? Increased or decreased for each.

I have more questions will post later I appreciate any help on this
Click to expand...
1. A- phenyl ephrine nasal decongestant
2. ?
3.T4
4.hsv I guess I don't remember the options
5.c- pelvic parasympathetics,
6.A inc absorption of ca from gut is moa of vit D
7.all levels are decreased, loss of reabsorbing capacity of pct
 
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Thanks alot for your time
For the newborn with hypothyroid it says T4 cannot cross placenta. http://www.ncbi.nlm.nih.gov/pubmed/2623398
So it TRH then??Its weird do u remember the other q on this nbme which was the newborn whos mom had Graves and now kid had symptoms.
and for number 4) options were HSV HPV CHALMYDIA NESSIERIA CANDIDA VZV
 
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hey guys, I got this q wrong even though I know the respiratory Burst steps. I am still confused on these qs. Appreciate it,

For killing of gram positive diploccoi, which of the following enzymes is going to initiate intracellular killing?
1) NADPH OXIDASE
2) CATLASE
3)SUPEROXIDE DISMUTASE
4) COX 1


3) A 42 year old woman undergoes biopsy of suspicious calcifications seen on routine mammograms. Light microscopy shows a poorly demarcated region consisting of poorly cohesive cells growing in sheets. The nucleus to cytoplasmic ratio approaches 1.1, and prominent nucleoli are observed there is microscopic evidence of invasion into stromal tissues. She has no adenopathy ct scans show no evidence of hepatic pulmonary or bone metastases. These findings are most consistent with which of the following?
A) High grade, high stage neoplasm
B) High grade, low stage neoplasm
C) Low grade, High stage neoplasm
D) Low grade , low stage neoplasms

Plz help, Thank you very much
 
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Hey.

Anyone know what to do about the 23 year old who wanted opiates for his back pain, even though his vitals were normal. he flipped out when the doctor tells him to use over the counter meds

i was stuck between doing the serum toxicology and checking his drug history.
 
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sadaca said:
hey guys, I got this q wrong even though I know the respiratory Burst steps. I am still confused on these qs. Appreciate it,

For killing of gram positive diploccoi, which of the following enzymes is going to initiate intracellular killing?
1) NADPH OXIDASE
2) CATLASE
3)SUPEROXIDE DISMUTASE
4) COX 1
Click to expand...

Should be 1), nothing else makes sense.
3) A 42 year old woman undergoes biopsy of suspicious calcifications seen on routine mammograms. Light microscopy shows a poorly demarcated region consisting of poorly cohesive cells growing in sheets. The nucleus to cytoplasmic ratio approaches 1.1, and prominent nucleoli are observed there is microscopic evidence of invasion into stromal tissues. She has no adenopathy ct scans show no evidence of hepatic pulmonary or bone metastases. These findings are most consistent with which of the following?
A) High grade, high stage neoplasm
B) High grade, low stage neoplasm
C) Low grade, High stage neoplasm
D) Low grade , low stage neoplasms

Plz help, Thank you very much
Click to expand...

Should be B, high grade, low stage, since she has no metastasis and no lymphadenopathy.

remember the TNM; tumor size, lymph nodes and metastasis
 
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shok said:
Hey.

Anyone know what to do about the 23 year old who wanted opiates for his back pain, even though his vitals were normal. he flipped out when the doctor tells him to use over the counter meds

i was stuck between doing the serum toxicology and checking his drug history.
Click to expand...


I put send for MRI. Thought that you should trust the patients first, and do a workup rather than suspecting drug abuse immediately. Anyone know the correct answer?
 
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u cant trust patients who are addicted they'll lie to get more meds. I got this one correct as I posted above about this q
 
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medstudent987 said:
I put send for MRI. Thought that you should trust the patients first, and do a workup rather than suspecting drug abuse immediately. Anyone know the correct answer?
Click to expand...
What exactly are you going to trust? That "no medications have worked"? You need to know what medications he has been taking that have not helped, that's called getting a drug history. History -> Physical -> Investigations.
 
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41

over the course of 10 years, urine creatinine excretion and clearance increases, but the serum levels stay the same

if the patient is 75 years old now, and takes supplemental calcium and vitamin d, what causes all this?

high protein diet
over supp of vit d
polycystic kidney
renovasc disease
normal aging

whenever i see normal in any answer choice, i keep going back to it

thoughts?
 
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Spinal needle goes posteriorly between l3 and l4 for anasthesia. what ligament will be traversed to reach the canal?

ant longitudinal
costotransverse
denticulate
ligamentum flavum
post longitudinal
 
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wololololololo said:
GH mediates its effects via JAK/STAT on peripheral tissues. GHRH uses cAMP signaling in the somatotrophs, the study is revealing the mechanism by which GH synthesis/release is upregulated.
Click to expand...

35 y/o man with 3 yr history of enlarging nose, coarse facies, muscle weakness, increased hand/foot size. Large fleshy nose and prognathism on exam. High IGF-1 in serum. MRI shows pituitary adenoma. Morphologic analysis of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G alpha-s subunit of the tumor G proteins lack GTPase activity.

The tumor cells most likely have an increased activity of which enzyme?

Adenylyl cyclase
Guanylyl cyclase
Janus kinase
Phospholipase C
Tyrosine kinase


Hey guys, I am confused on this, I was reading more into online and courses say, if its a pitutary adenoma(Which this q states, then its high GH) and sometimes it can be nonpituitary due to high GHRH. Also this question states SOMATOTROPHS which are pituitary cells secreting GH.
Can someone plz help with this?
 
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2) An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal
male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes
is most likely to be observed? Is everything low? smoking impairs mucocilliary clearance I know that much..

Mucus Production and Secretion up/down

Alveolar Macrophage Function up/down

Activity of Airway Cilia up/down


numero 2. should definitely be

Mucus Production and Secretion up

in response to cigarette smoke, combustible fumes and etc mucus production always increases. Just think of the reid index in chronic bronchitis, the submucosal mucous glands increase in size in response to cigarette smoke because they are secreting more mucous in order to clear all those nasty inhaled carcinogens

Alveolar Macrophage Function up

the inhaled carcinogens from cigarette smoke damage the lining of the alveoli. in response to this alveolar macrophages aggregate to clear up the mess

Activity of Airway Cilia down

this one should be easy. carcinogens in cigarette smoke destroy cilia cells lining the airway.

Listen to Dr. Sattar's lecture starting with obstructive pulmonary diseases. he explains all this really well. hope this helped
 
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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
 
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hmm saying you think you put that down doesn't really help. just saying :) doesn't make any sense why mucous production and macrophages go down in response to cigarette smoke. whats your reasoning behind this?
 
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EazyE1907 said:
2) An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal
male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes
is most likely to be observed? Is everything low? smoking impairs mucocilliary clearance I know that much..
Click to expand...


mucus secretion goes up, macrophage activity goes up, ciliary action goes down. remember, the most important risk factor in chronic bronchitis is smoking.
 
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sadaca said:
Hey guys, I am confused on this, I was reading more into online and courses say, if its a pitutary adenoma(Which this q states, then its high GH) and sometimes it can be nonpituitary due to high GHRH. Also this question states SOMATOTROPHS which are pituitary cells secreting GH.
Can someone plz help with this?
Click to expand...

Somatotrophs normally release GH in response to GHRH. GHRH binding causes the Gs subunit (which binds GDP when inactive) to bind GTP and dissociate from the receptor complex to activate adenlyl cyclase, making cAMP. The question says there's a mutation in the GTPase, which would normally cleave GTP->GDP and inactivate it. The somatotrophs have constant signaling leading to excess GH release.
 
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