NBME 17 discussion

[fatwalletuab]

Can you guys correct me on this
----------------------------------------------------------------------
8.old woman with DVT. Platelet dropped significantly after a week of tx. Drug of action?
a. activate tissue plasminogen -----action of tPA
b. Interferes with carboxylation of coag factors ----action of warfarin
c. irreversibly inactivate COX -----Aspirin
d. Potentiates the action of antithrombin iii (correct answer, action of Heparin, and this is Heparin induced Thrombocytopenia HIT)
e. selectively inhibits factor Xa (Heparin does thrombin factor 2 and factor Xa)
---------------------------------------------------------------
14.ER doctor successfully delivered a baby, womanis now having severe bleeding. Pelvic exam shows an ope cervix and heavy vaginal bleeding. Ligation of a branch of which of the following arteries is most appropriate?
a. external iliac (gives femoral and inferior epigastric artery)
b. internal iliac ( Correct answer I think, bcz Uterine artery is a branch of internal iliac artery)
c. internal pudendal (supplies the external structure, but also a branch of internal iliac)
d. median sacral (supply coccyx)
e. Obturator (gives blood supply to the leg obturator muscles)
----------------------------------------------------------------------------
16. A patient cries ad says it's a bad news, isn't it?! when a doc is about to tell him the progression of carcinoma to the terminal phase. Most appropriate response?
a. How have you been since the last time I saw you?
b. lets talk about hte positive aspect first
c. look on the bright side of things
d. tell me how you are feeling
e. there are other people who have it alot worse than you
f. Yes it is
g. you've had several years better off than many others with this disease.

I was debating on A or D. I picked D and it's wrong....is that bcz it didn't end with a question mark? wth
------------------------------------------------------------------------------------------
32. A guy with chrons disease. You give antibiotics and prednisone, he got better in 3 weeks, in addition to resolving the infection, the most likely MOA of this pharmacotherapy is which of the following?
a. antibody binding
b. complement activity
c. mast cell degranulation
e. neutrophil function
f. T-lymphocyte function

I marked e. but it's wrong....so I'm guessing T-lymphocyte fumction F? as to decrease T and B cell couns. However, neutrophil count is increased.
----------------------------------------------------------------------------------
10. 45 year old lady diagnosed with invasive ductal cell CA breast . she was started on tamoxifen and serum analysis showed decreased conc. of enoxifen the active metabolite of prodrug tamoxifen. Genetic analysis showed homozygous presence of CYP450 2D6*4 alleles. WHich of following best represents the likelihood that this patient sister has same alleles?
1.0% 2. 25% 3. 50% 4. 75% 5 100%
Can anyone solve for this one??? thanks!
--------------------------------------------
49. Old man with 2 year history of decrased force of his urinary stream and increase frequency. BUN is 55 and Creatinine is 5. Ultrasound of Urinary tract shows bilateral hydronephrosis and dilated ureters. What is the mechanism of this patient's renal failure?
a. Decreased hydrostatic pressure in the glomerular capillary
b. decreased renal plasma flow
c. Increased hydrostatic pressure in Bowman space
d. Precipitation of protein in the renal tubules
e. Precipitation of uric acid in the renal tubules
---------------------------------------------------------------------
4. A 27 yo woman with fever, malaise, abdominal pain, vaginal discharge for 4 days. Pregnancy test is negative, Leukocyte count is up. Bilateral lower quadrant tenderness with rebound and guarding. Pelvic exam shows cervical bilateral adnexal tenderness. Most likely diagnosis?
a. appendicitis
b. bacterial vaginosis
c. Chancroid
d. Diverticulitis
e. Gonorrhea
f. Herpies genitalis
g. Trichomonias

Gonorrhea...I picked chancroid on the exam...because I thought chancroid can have those bubonic thing bilaterally....i guess the answer is gonorrhea?!
-------------------------------------------
6. A study is designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in pts with CHF. 60 pts with CHF are recruited for the study. Each subject is assigned by coin toss to one of two groups (standard care or standard care plus coenzyme). Which of the following best describe this study design?
a. case-control
b. case-series
c. Crossover
d. Cross-sectional
e. Historical cohort
f. Randomized clinical-trials

I'm guessing F. is the correct answer bcz by giving q10, you're giving a treatment (intervention) to the study. And the coin toss gives the randomness.

a. Case-control: have 2 groups, one health as the control and one diseased. Trying to evaluate the risk factor. So the example will be: 60 pt with CHF drink more and smoke more. Healthy individuals smoke and drink less. Risk factors are smoking and drinking alcohols.
d. Cross-sectional: snap shot, trying to find out in a population who have CHF. You know the prevalence but not incidence.
e. I don't think it is either retrospective or prospective
----------------------------------------------------------------------
A guy completed amoxillin develop watery-brown stools in the past 24 hours. Clostridium difficile toxin is positive. Pathological finding is most likely to be present?
a. Bacterial Overgrwoth of the colonic surface
b.Flask-shaped ulcers in the colon
c. Giardia trophozoites linning the duodenal mucosa
d. Necrotizing granulomatous inflammation
e. PEsudomembranes of fibrin and inflammatory debris

They want us to pick e. But I have seen many qbank and wiki sources say a). Can someone tell me why not AAAAAAAAAAAAAAA??
---------------------------------------------------------
A 1 week old girl screening sho a possible defectin fatty acid oxidation, physical exam shows no abnormality. Which of the following is the most appropriate next step in diagnosis?
a. arterial blood gas analysis
b. measurement of serum acylcarnitine conc.
c. measurement of serum amino acid conc.
d. measurement of serum electrolyte conc.
e. measurement of serum lactic acid conc.
--------------------------------------------------------------
34. 40 yo woman has a mole on her back that has increased in size during the past 4 mo. PE shows Raise irregular lesion with variegated black-tan pigmentation and ill-defined margins. Examination of tissue from the tissue shows pleomorphic, hyperchromatic cells within clear islands that tend to coalesce and are present at all levels of the epidermis, with extension into the paipillar dermis. What is it?
a. basal cell carcinoma
b. blue nevus
c. cafe au lait spot
d. intradermal nevus
e. lentigo simplex
f. melanoma
g. seborrheic keratosis

I think it is f melanoma

-------------------------
7. A 42 year farmer has a 7mm red scaly plaque on helical rim of left ear . A photomicrograph of tissue obtained on biopsy of plaque is shown. whats the diagnosis ( Picture was shown)
a. Actinic keratosis b. Basal cell CA c. Keratocanthoma d. Malignant melanoma e. Merkel cell CA

I think it's a. actinic keratosis

---

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[adakrista]

Can you guys correct me on this
----------------------------------------------------------------------
8.old woman with DVT. Platelet dropped significantly after a week of tx. Drug of action?
a. activate tissue plasminogen -----action of tPA
b. Interferes with carboxylation of coag factors ----action of warfarin
c. irreversibly inactivate COX -----Aspirin
d. Potentiates the action of antithrombin iii (correct answer, action of Heparin, and this is Heparin induced Thrombocytopenia HIT)
e. selectively inhibits factor Xa (Heparin does thrombin factor 2 and factor Xa)
---------------------------------------------------------------
14.ER doctor successfully delivered a baby, womanis now having severe bleeding. Pelvic exam shows an ope cervix and heavy vaginal bleeding. Ligation of a branch of which of the following arteries is most appropriate?
a. external iliac (gives femoral and inferior epigastric artery)
b. internal iliac ( Correct answer I think, bcz Uterine artery is a branch of internal iliac artery)
c. internal pudendal (supplies the external structure, but also a branch of internal iliac)
d. median sacral (supply coccyx)
e. Obturator (gives blood supply to the leg obturator muscles)
----------------------------------------------------------------------------
16. A patient cries ad says it's a bad news, isn't it?! when a doc is about to tell him the progression of carcinoma to the terminal phase. Most appropriate response?
a. How have you been since the last time I saw you? maybe
b. lets talk about hte positive aspect first I chose this, but it was wrong
c. look on the bright side of things Obviously no
d. tell me how you are feeling Your answer
e. there are other people who have it alot worse than you Obviously no
f. Yes it is ---- I think this is the right answer ---- Just be blunt and honest when the patient asks you that kind of question, don't beat around the bush.
g. you've had several years better off than many others with this disease. Obviously no

I was debating on A or D. I picked D and it's wrong....is that bcz it didn't end with a question mark? wth
------------------------------------------------------------------------------------------
32. A guy with chrons disease. You give antibiotics and prednisone, he got better in 3 weeks, in addition to resolving the infection, the most likely MOA of this pharmacotherapy is which of the following?
a. antibody binding
b. complement activity
c. mast cell degranulation
e. neutrophil function
f. T-lymphocyte function - Crohn's has Th1 mediated lymphoid aggregates and non caseating granuloma formation

I marked e. but it's wrong....so I'm guessing T-lymphocyte fumction F? as to decrease T and B cell couns. However, neutrophil count is increased.
----------------------------------------------------------------------------------
10. 45 year old lady diagnosed with invasive ductal cell CA breast . she was started on tamoxifen and serum analysis showed decreased conc. of enoxifen the active metabolite of prodrug tamoxifen. Genetic analysis showed homozygous presence of CYP450 2D6*4 alleles. WHich of following best represents the likelihood that this patient sister has same alleles?
1.0% 2. 25% 3. 50% 4. 75% 5 100%
Homozygous presence is talking about recessive alleles. Every child of the same parents has a 1/4 chance of being homozygous recessive for the CYP4502D6*4 alleles. Dominant she would only need 1 allele, and if she is heterozygous, she wont have the same alleles as her sister.
Can anyone solve for this one??? thanks!
--------------------------------------------
49. Old man with 2 year history of decrased force of his urinary stream and increase frequency. BUN is 55 and Creatinine is 5. Ultrasound of Urinary tract shows bilateral hydronephrosis and dilated ureters. What is the mechanism of this patient's renal failure?
a. Decreased hydrostatic pressure in the glomerular capillary
b. decreased renal plasma flow
c. Increased hydrostatic pressure in Bowman space - I got this right: increased hydrostatic pressure is due to back up of fluid all the way from the bladder to bowman space. Hence the hydronephrosis and dilation of ureters.
d. Precipitation of protein in the renal tubules
e. Precipitation of uric acid in the renal tubules
---------------------------------------------------------------------
4. A 27 yo woman with fever, malaise, abdominal pain, vaginal discharge for 4 days. Pregnancy test is negative, Leukocyte count is up. Bilateral lower quadrant tenderness with rebound and guarding. Pelvic exam shows cervical bilateral adnexal tenderness. Most likely diagnosis?
a. appendicitis
b. bacterial vaginosis
c. Chancroid
d. Diverticulitis
e. Gonorrhea - PID
f. Herpies genitalis
g. Trichomonias

Gonorrhea...I picked chancroid on the exam...because I thought chancroid can have those bubonic thing bilaterally....i guess the answer is gonorrhea?!
-------------------------------------------
6. A study is designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in pts with CHF. 60 pts with CHF are recruited for the study. Each subject is assigned by coin toss to one of two groups (standard care or standard care plus coenzyme). Which of the following best describe this study design?
a. case-control
b. case-series
c. Crossover
d. Cross-sectional
e. Historical cohort
f. Randomized clinical-trials - yep you are right.

I'm guessing F. is the correct answer bcz by giving q10, you're giving a treatment (intervention) to the study. And the coin toss gives the randomness.

a. Case-control: have 2 groups, one health as the control and one diseased. Trying to evaluate the risk factor. So the example will be: 60 pt with CHF drink more and smoke more. Healthy individuals smoke and drink less. Risk factors are smoking and drinking alcohols.
d. Cross-sectional: snap shot, trying to find out in a population who have CHF. You know the prevalence but not incidence.
e. I don't think it is either retrospective or prospective
----------------------------------------------------------------------
A guy completed amoxillin develop watery-brown stools in the past 24 hours. Clostridium difficile toxin is positive. Pathological finding is most likely to be present?
a. Bacterial Overgrwoth of the colonic surface - I know that having other bacteria covering the colonic surface helps prevent Cdiff... but iI haven't seen what you saw int he Q banks.
b.Flask-shaped ulcers in the colon
c. Giardia trophozoites linning the duodenal mucosa
d. Necrotizing granulomatous inflammation
e. PEsudomembranes of fibrin and inflammatory debris - Pseudomembranes are key.

They want us to pick e. But I have seen many qbank and wiki sources say a). Can someone tell me why not AAAAAAAAAAAAAAA??
---------------------------------------------------------
A 1 week old girl screening sho a possible defectin fatty acid oxidation, physical exam shows no abnormality. Which of the following is the most appropriate next step in diagnosis?
a. arterial blood gas analysis
b. measurement of serum acylcarnitine conc. - fatty acid oxidation uses the acyl carnitine shuttle
c. measurement of serum amino acid conc.
d. measurement of serum electrolyte conc.
e. measurement of serum lactic acid conc.
--------------------------------------------------------------
34. 40 yo woman has a mole on her back that has increased in size during the past 4 mo. PE shows Raise irregular lesion with variegated black-tan pigmentation and ill-defined margins. Examination of tissue from the tissue shows pleomorphic, hyperchromatic cells within clear islands that tend to coalesce and are present at all levels of the epidermis, with extension into the paipillar dermis. What is it?
a. basal cell carcinoma
b. blue nevus
c. cafe au lait spot
d. intradermal nevus
e. lentigo simplex
f. melanoma - ABCDE Asymmetry, Border irregularity, Color variation, Diamter>6mm, and Evolution over time.
g. seborrheic keratosis

I think it is f melanoma

-------------------------
7. A 42 year farmer has a 7mm red scaly plaque on helical rim of left ear . A photomicrograph of tissue obtained on biopsy of plaque is shown. whats the diagnosis ( Picture was shown)
a. Actinic keratosis b. Basal cell CA c. Keratocanthoma d. Malignant melanoma e. Merkel cell CA

I think it's a. actinic keratosis

 

[IceCastle]

A 50 yr-old man who has smoked 2 packs of cigarettes a day for 34 yrs has experiencesd increasing SOB on exertion, chronic cough productive of thick sputum, and frequent episodes of wheezing. The anteroposterior diameter of his chest is increased. Which of the following lab abnormalities is expected?
A-decreased blood PCO2
B-Increased blood HCO3 COPD -> respiratory acidosis -> compensatory metabolic alkalosis
C-Increased blood pH
D-Increased urinary excretion of HCO3
E-Increased urinary pH

An 8 yr old boy is brought to the physician by his parents because of disruptive behavior. They say, “He is easily distracted, constantly interrupts us while we are talking, and seems to be always moving. His teacher says he is always talking “ Physical examination shows no abnormalities. If drug therapy is indicated, administration of a drug with which of the following mechanisms of action is most appropriate.
A-antagonism at B-adrenergic receptors
B-Blockade of voltage-gated Na channels
C-Enhanced action of GABA at GABAa receptors
D-Increased release of dopamine and NE (?) mechanism of Adderall
E-Selective inhibition of uptake of serotonin at nerve terminals

A 45 yr old man comes to the physician because of intermittent bloody diarrhea and abdominal pain during the past month. Sigmoidoscopy and rectal biopsy specimens show inflammatory bowel disease. A trial of a monoclonal antibody preparation is begun. The antibody in the preparation is most likely to be directed against which of the following components?
A-Bradykinin
B-C3a
C-Class I MHC antigens
D-Fibrin
E-PGE2
F-Tumor necrosis factor (infliximab, I suppose :/) yes

A 60 yr old woman is brought to the physician 3 hrs after the sudden onset of pain of her rt ankle. She has a 4 yr hx of gradually increasing serum Cr concentrations. She began furosemide therapy 1 month ago for pedal edema. Current meds also include glipizide for type 2 DM. Her pulse is 120/min, resp 25/min, and BP 150/100mmhg. Physical exam shows exquisite tenderness to palpation of the rt ankle joint. Analysis of joint fluid aspirate shows negatively birefringent crystals. Sensation to pinprick is decreased in the feet. The patient is at increased risk for which of the following complications of the underlying process causing the joint findings?
A-Cholelithiasis
B-Nephrolithiasis uric acid in the kidney
C-Osteoarthritis
D-Osteoporosis
E-Pathologic fx

Any help with these questions would be appreciated!

 

[harleyquin]

A 42 yr old woman w/ a 3 yr hx of an intermittent facial rash, including the forehead, eyelids, nose and cheeks. She says that the rash seems to be getting worse since she moved from NY to Florida last year. She notes that she has always blushed easily. Spicy foods also precipitate a flushing reaction that seems to exacerbate the rash. Occasionally, her face burns and stings, and her skin feels dry. Physical exam shows erythema over the nose and cheeks, w/ scattered telangiectasias and a few papules. dx?
A-Acne vulgaris
B-Carcinoid syndrome (would expect to see some combo of Bronchospasm, Flushing, Diarrhea, Right heart valve disease "B-FDR")
C-Pityriasis rosea
D-Rosacea Not mentioned in FA, but spicy foods can exacerbate Rosacea, "papules" and location on nose are some key associations. Rosacea is associated with Rhinophyma.
E-Seborrheic dermatitis

 

[Hamsterlope]

I think I figured it out. I think it's because the feet are affected. See page 61 (slide 81) of this book: http://www.slideshare.net/kittymoore/highyield-neuroanatomy-4th
Maybe not the best question, but I think that's what they're getting at.

 

[Celtikman]

Has anyone figured out an explanation to the precentral/postcentral gyrus thing? It's driving me nuts, it's such a weird question:

Here's the question: 69 yo woman comes to the physician because she has had weakness of her left leg since awakening that morning. Physical exam shows weakness of the extremity. A Babinski sign is present on the left. SEnseory testing shows decreased somatic sensation in the left foot, agraphesthesia on the plantar surfaces of the toes and decreased position sense in the toes. An MRI of the brain shows an edematous are in the cerebral cortex of the right hemisphere. The most likely cause of this condition is a lesion located at which of the following labeled areas in the photographs of normal brains shown?

There's both sensory and motor/UMN abnormalities. My only guess would be that maybe A is a little too inferior to be affected lower extremities? But that's not horribly clear either.

I picked G. Its not in my incorrects.

 

[sammyade]

1. A 79 year old man brought to ED by his wife 30 minutes after he lost consciousness for 30 seconds. On arrival, he is alert, but he says he is dizzy. There is no urinary or fecal incontinence. His pulse is 40/min and regular, and blood pressure is 92/56 mmHg. Physical exam shows no evidence of tongue biting. The lungs are clear to auscultation. Cardiac examination shows a variable intensity S1. He is oriented to person, place and time. An ECG shows a third degree AV block. Which of the following is most appropriate next step in management?
A) Transesophageal echocardiography (wrong)
B) Transthoracic echo
C) Insertion of pulmonary artery catheter
D) Insertion of transvenous pacemaker
E) Cardiac catheterization with angioplasty
F) Cardiac cath with stent placement

2. 38 year old woman 2 year history of pain and heavy flow with menses. stays home from work 1 day every 2 months because of symptoms. Ibuprofen does not help with pain. She has one child, a 6yo daughter. Not been able to conceive another child, but says no longer a priority. There is family history of infertility. Physical examination shows a mildly enlarged left ovary and retroflexed uterus. Ultrasound shows evidence of ovarian cysts and one peritoneal cyst. A biopsy of one of the cysts is most likely to show which of the following?
A) Mucinous adenocarcinoma
B) Ovarian germ-cell tumor
C) Ovarian stromal tumor
D) Polycystic ovaries
E) Proliferative endometrial tissue (does this mean endometriosis? that would make sense..)

3. 50 year old man comes to physician because of persistent cough for past 2 months. Has 5kg (11lb) weight loss during this period. He is a farmer and started itraconazole 4 weeks ago for histoplasmosis after contact with chicken coops. Current medications also include hydrochlorothiazide, enalapril, atenolol, omeprazole, metoclopramide for hypertension and GERD. He appears thin. Physical exam shows no other abnormal. An interaction between itraconazole and which of the following drugs most likely accounts for lack of effect of itraconazole?
A) Atenolol
B) Enalapril
C) Hydrochlorothiazide (wrong.. no idea, was looking for p450 inducer, so thought maybe he could pee it out?)
D) Metoclopramide
E) Omeprazole (another p450 inhibitor wouldnt make the other p450 inhibitor in effective would it?)


4. 65 year old man who recently emigrated from Brazil has 8 month history of shortness of breath and fatigue. Physical examination shows edema of the lower extremities. A chest x-ray shows cardiomegaly. An endomyocardial biopsy specimen shows individual myofiber necrosis with a mixed inflammatory infiltrate of neutrophils, T lymphocytes, macrophages and eosinophils. Which of the following is the most likely causal organism?
A) Leishmania major
B) Leishmania tropica
C) Toxocara canis
D) Trichinella spiralis
E) Trypanosoma brucei
F) Trypanosoma cruzi (I forgot about the dilated cardiomyopathy.. this it?)
G) Wuchereria bancrofti

5. A female newborn delivered 38 weeks Apgar scores 8 and 8 at 1 and 5 minutes. Physical exam shows bulging, fluid filled mass approx. 5 cm in diamtere in the midline over the lumbosacral region. There are no spontaneous movements of the lower extremities. This abnormality most likely occured because of abnormal embryonic development during which of the following periods postconception (in days)?
A) 1 to 10
B) 15 to 40
C) 60 to 75
D) 100 to 120 (wrong.. complete guess)
E) 150 to 180

6. Polymorphic marker with 3 alleles (1, 2, 3) tightly linked to the gene for polycystic kidney disease. A pedigree is shown. If III, 1 is unaffected by this disease this patient most likely a carrier of which of the following markers?
View attachment 191873
A) 1,1
B) 1,2 (wrong.. i think i solved the pedigree for if the ? was diseased)
C) 1,3
D) 2,2
E) 2,3 (is this it?)

 

[Celtikman]

For #5 newborn with bulging fluid filled midline mass over lumbosacral region. No spontaneous movements... spina bifida?! I am very annoyed with myself I kept picturing something intraperitoneal and was completely confused.

 

[cage92]

guyss i need help i have a problem in ethics question i have 7 falsess in my nbme 17( i have a total of 12 mistake) my old nbme were 11 241 12 260 13 and 15 245 nbme 17 262 my weakness is ethics iam an img ive tried cornad fisher and khans and brs reallyyy those question in nbme they are different i didnt face any DNR cases or report an abuse.... .... they have ethics rules not found in books i need advice it compromise my score in every nbme in my last nbme 17 i have 7 mistake in behav

 

[AnilaMed]

-60 year old man comes to the physician because of 1 month history of progressive shortness of breath with exertion. Examination of chest shows:
Right Lung Base Left Lung Base
Breath Sounds Decreased Normal
Percussion Note Dullness Normal
Tactile Fremitus Decreased Normal
Adventitious Sounds None Crackles

Most likely diagnosis? Asthmatic bronchitis, bronchiectasis, bullous emphysema, chronic bronchitis, lobar pneumonia, pleural effusion, pneumothorax, pulmonary
embolism

- 60 year old man has acute abdominal pain and tenderness, nausea, vomiting and bloody diarrhea 2 hrs ago. Hx of cirrhosis and hepatocellular carcinoma. bp 99/50, abdominal wall becomes rigid with loss of bowel sounds. during surgical intervention half of small intestine has dark purple-red hemorrhagic appearance. Cause?

bacterial enteritis, mesenteric venous thrombosis, necrotizing enterocolitis, pseudomembranous colitis, ulcerative colitis, whipple disease?

thanks

 

[ShawnW59]

3. 50 year old man comes to physician because of persistent cough for past 2 months. Has 5kg (11lb) weight loss during this period. He is a farmer and started itraconazole 4 weeks ago for histoplasmosis after contact with chicken coops. Current medications also include hydrochlorothiazide, enalapril, atenolol, omeprazole, metoclopramide for hypertension and GERD. He appears thin. Physical exam shows no other abnormal. An interaction between itraconazole and which of the following drugs most likely accounts for lack of effect of itraconazole?
A) Atenolol
B) Enalapril
C) Hydrochlorothiazide (wrong.. no idea, was looking for p450 inducer, so thought maybe he could pee it out?)
D) Metoclopramide
E) Omeprazole (another p450 inhibitor wouldnt make the other p450 inhibitor in effective would it?)

omeprazole: i think b/c -azoles are weak acids, a PPI would promote A -> A+ making the drug less absorbable


4. 65 year old man who recently emigrated from Brazil has 8 month history of shortness of breath and fatigue. Physical examination shows edema of the lower extremities. A chest x-ray shows cardiomegaly. An endomyocardial biopsy specimen shows individual myofiber necrosis with a mixed inflammatory infiltrate of neutrophils, T lymphocytes, macrophages and eosinophils. Which of the following is the most likely causal organism?
A) Leishmania major
B) Leishmania tropica
C) Toxocara canis
D) Trichinella spiralis
E) Trypanosoma brucei
F) Trypanosoma cruzi (I forgot about the dilated cardiomyopathy.. this it?)
G) Wuchereria bancrofti

T. cruzi: yep, also with the travel to s. america and eosinophils within the lymphocytic infiltrate

5. A female newborn delivered 38 weeks Apgar scores 8 and 8 at 1 and 5 minutes. Physical exam shows bulging, fluid filled mass approx. 5 cm in diamtere in the midline over the lumbosacral region. There are no spontaneous movements of the lower extremities. This abnormality most likely occured because of abnormal embryonic development during which of the following periods postconception (in days)?
A) 1 to 10
B) 15 to 40
C) 60 to 75
D) 100 to 120 (wrong.. complete guess)
E) 150 to 180

neural tube forms in wk 3 and closes by wk 4

 

[ShawnW59]

6. Polymorphic marker with 3 alleles (1, 2, 3) tightly linked to the gene for polycystic kidney disease. A pedigree is shown. If III, 1 is unaffected by this disease this patient most likely a carrier of which of the following markers?
View attachment 191873
A) 1,1
B) 1,2 (wrong.. i think i solved the pedigree for if the ? was diseased)
C) 1,3
D) 2,2
E) 2,3 (is this it?)

the pedigree is showing a AD inheritance, even if you don't see that i think drawing out those 2x2 boxes would be helpful.

the only way the disease was passed on was if one of the '1' from the first gen 1,1 was the diseased by AD inheritance

if it was AR, 1,1 would = aa, but mixing with first gen 1,3, even if the '1' from 1,3 is a carrier, you just wouldn't have a diseased second gen 1,3 person, vice versa

2,2 in a 2x2 sq is just not possible haha

 

[ShawnW59]

-60 year old man comes to the physician because of 1 month history of progressive shortness of breath with exertion. Examination of chest shows:
Right Lung Base Left Lung Base
Breath Sounds Decreased Normal
Percussion Note Dullness Normal
Tactile Fremitus Decreased Normal
Adventitious Sounds None Crackles

Most likely diagnosis? Asthmatic bronchitis, bronchiectasis, bullous emphysema, chronic bronchitis, lobar pneumonia, pleural effusion, pneumothorax, pulmonary
embolism

↓TF rules out pneumonia / dullness to percussion rules out pneumothorax / ↓breath sounds = pleural effusion (i think)


- 60 year old man has acute abdominal pain and tenderness, nausea, vomiting and bloody diarrhea 2 hrs ago. Hx of cirrhosis and hepatocellular carcinoma. bp 99/50, abdominal wall becomes rigid with loss of bowel sounds. during surgical intervention half of small intestine has dark purple-red hemorrhagic appearance. Cause?

bacterial enteritis, mesenteric venous thrombosis, necrotizing enterocolitis, pseudomembranous colitis, ulcerative colitis, whipple disease?

acute onset, HCC associated with pylephlebitis etc, and hemorrhagic infarct for small intestines

thanks

 

[llhorc]

A 67-year-old man has urinary urgency after placement of a urinary bladder catheter during transurethral resection of the prostate for carcinoma. The most appropriate therapy is a drug with which of the following actions?

a Activation of adenosine receptors
b Activation of muscarinic receptors
c Activation of nicotinic receptors
d Inhibition of adenosine receptors
e Inhibition of muscarinic receptors
f Inhibition of nicotinic receptors

e?
thanks

 

[gr123]

e. inhibition of muscarinic receptors

I have a couple of questions too, I would really appreciate your help.

1.Guy with ankylosing spondylitis symptoms and signs- what's most likely to confirm diagnosis? I got confused and went for serum antinuclear antibody assay. I think x-ray is the only one that makes sense, but on the other hand it is supposed to show signs at late stages of disease...

2.After recanalization of occluded coronal artery, CK-MB and troponin I are increased- what's the mechanism? Cell shrinkage, apoptotic body formation, liquefactive necrosis of the myocardium, membrane lipid peroxidation (I think this one but I am not sure), protease inactivation by cytoplasmic free calcium ions.

Last, I need your opinion.

I am an IMG, and I need to get 230 at least.

I took #11(3 weeks ago)-215, #12(1.5 week ago)-226 and #17(yesterday)- 217 (really broke my spirit). I have my test day in early June. Do I stand a chance to reach my goal, or I should postpone it?

Thanks in advance, guys... And best of luck to all of you

 

[Celtikman]

e. inhibition of muscarinic receptors

I have a couple of questions too, I would really appreciate your help.

1.Guy with ankylosing spondylitis symptoms and signs- what's most likely to confirm diagnosis? I got confused and went for serum antinuclear antibody assay. I think x-ray is the only one that makes sense, but on the other hand it is supposed to show signs at late stages of disease...

2.After recanalization of occluded coronal artery, CK-MB and troponin I are increased- what's the mechanism? Cell shrinkage, apoptotic body formation, liquefactive necrosis of the myocardium, membrane lipid peroxidation (I think this one but I am not sure), protease inactivation by cytoplasmic free calcium ions.

Last, I need your opinion.

I am an IMG, and I need to get 230 at least.

I took #11(3 weeks ago)-215, #12(1.5 week ago)-226 and #17(yesterday)- 217 (really broke my spirit). I have my test day in early June. Do I stand a chance to reach my goal, or I should postpone it?

Thanks in advance, guys... And best of luck to all of you

Ankylosing spondylitis. Next step is X ray look for "bamboo spine"

Recanalization -> reperfusion injury via ROS -> membrane lipid peroxidation --> spill **** out of cell


Dude forget about NBME 17. My score dropped like 14 points I was hitting above 250 consistently. I am just counting this one as a fluke.. you should too! It is makes me feel MUCH better

 

[mrbazoun]

A 44-year-old woman comes to the physician for a follow-up examination after two separate Pap smears showed atypical squamous cells of undetermined significance. Results of a molecular diagnostic test show the presence of the viral E6 protein of human papillomavirus. This protein is known to promote cell growth and malignancy by causing cellular p53 protein degradation. This degradation most likely begins when the p53 protein is targeted to which of the following types of cellular enzymes?
A
Lysine acetyltransferase
B
Lysosomal protease
C
Serine protease
D
Tyrosine kinase
E
Ubiquitin ligase


Got this one wrong...any ideas? Thanks.

 

[mrbazoun]

20. A 28-year-old man is brought to the emergency department 30 minutes after the sudden onset of shortness of breath. He has a 3-year history of cocaine abuse. His temperature is 38.1°C (100.6°F), pulse is 100/min, and blood pressure is150/45 mm Hg. Physical examination shows diminished pulses in the left upper extremity. Crackles are heard over all lung fields. A grade 2/6 diastolic murmur is heard best at the left sternal border. A chest x-ray shows a widened aortic arch. Which of the following is the most likely diagnosis?
A
) Atherosclerotic aneurysm
B
) Dissecting aneurysm
C
) Mycotic aneurysm
D
) Pseudoaneurysm
E
) Saccular aneurysm

 

[llhorc]

E Ubiquitin ligase protein degradation

B) Dissecting aneurysm, ..A chest x-ray shows a widened aortic arch

 

[Celtikman]

More questions. would appreciate your help.
View attachment 191711
View attachment 191712
View attachment 191713
View attachment 191714
View attachment 191715

21 -- A cholesterol synthesis
28 -- A neither. Confidence Interval includes 1.0 therefore not significant. in other words if RR 1.07 CI .75 to 1.15 that means RR could be between reduced risk (0.75) to increased risk (1.15)
30 -- C Heme synthesis. Cutaneous Uroporphobilogenoephofdof .. look up heme synthesis
45 -- 21 hydroxylase deficiency = hypotension, virilization female, inc 17-OHprogesterone
47 -- proliferative endometrial tissue ---> endometriosis

 

[Celtikman]

View attachment 191776
I would really appreciate any help with these

40 = Most people find it difficult. How did you do? -- no assumptions, legitimize the difficulty

 

[Celtikman]

View attachment 191771
View attachment 191772
View attachment 191773
View attachment 191774
View attachment 191775

38. B-- --HIB PRP polyribosyl-ribose carbohydrate capsule is conjugated to diptheriae toxoid (protein) to increase its immunogenicity -- allows for T-dependent

26. A.. Niether is superior. CI includes 1.0

29. Free T4. since she is prego estrogen increases TBG ---> more T4 bound to more TBG = increase TOTAL T4, however bound T4 is not active, Free T4 is the active component therefore check her free T4 to see if she really has hyperthyroid. (If there was a nodule then you would FNA it to see whats cooking, but there is no mention of thyroid gland so not the best choice)

8. HCG alpha subunit is the same as LH, FSH, TSH and when HCG is crazy high it can act like LH (high dose HCG can be used to simulate LH surge for infertility treatments). Therefore HCG acts like LH at testicle to increase estradiol

34. C. Let these two lovers, BFFs, hang out with each other.. visiting rules are meant to be broken.

 

[Celtikman]

20. A 28-year-old man is brought to the emergency department 30 minutes after the sudden onset of shortness of breath. He has a 3-year history of cocaine abuse. His temperature is 38.1°C (100.6°F), pulse is 100/min, and blood pressure is150/45 mm Hg. Physical examination shows diminished pulses in the left upper extremity. Crackles are heard over all lung fields. A grade 2/6 diastolic murmur is heard best at the left sternal border. A chest x-ray shows a widened aortic arch. Which of the following is the most likely diagnosis?
A
) Atherosclerotic aneurysm
B
) Dissecting aneurysm
C
) Mycotic aneurysm
D
) Pseudoaneurysm
E
) Saccular aneurysm

BBB = Widened Aortic arch + diminished left upper extremity pulse (blocked left subclavian artery) = dissection.

 

[Celtikman]

A 44-year-old woman comes to the physician for a follow-up examination after two separate Pap smears showed atypical squamous cells of undetermined significance. Results of a molecular diagnostic test show the presence of the viral E6 protein of human papillomavirus. This protein is known to promote cell growth and malignancy by causing cellular p53 protein degradation. This degradation most likely begins when the p53 protein is targeted to which of the following types of cellular enzymes?
A
Lysine acetyltransferase
B
Lysosomal protease
C
Serine protease
D
Tyrosine kinase
E
Ubiquitin ligase


Got this one wrong...any ideas? Thanks.

agreed
E. Ubiquitin ligase = ubiquitinylation of protein for degradation by proteosome

 

[amaranth]

Some tough ones I haven't been able to figure out.

70 year old man is admitted to the hospital for recent loss of mental function. He has low sodium and Chloride, anemia.
A) adrenal carcinoma
B) chronic interstitial nephritis
C) diabetes (NOPE)
D) pneumococal meningitis
E) pulmonary neoplasm

40 year old man with skin blisters due to increased synthesis of compounds in the skin that are subject to excitation by visible light.
A) bile acid synthesis
B) bilirubin degradation
C) heme synthesis
D) melanin (NOPE)
E) riboflavin metabolism

56 year old man with proximal appendicular muscle flailing on the left.
A) L caudate
B) L dentate
C) left subthalamin (NOPE)
D) R caudate
E) Right dentate
F) right subthalamic

42 year old woman with 1 month history of abdominal pain after eating fatty meals. jaundice, RUQ tenderness. Which liver functions will increase?

A) cholesterol synthesis
B) conjugation of bili
C) deamination of AA (NOPE)
D) glycogen synth
E) secretion of angiotensinogen

16 year old boy with no sign of puberty. What do you measure to determin whether decreased serum T is due to lack of pituitary hormone stimulus?
A) ACTH
B) E
C)FSH
D)inhibin
E)LH

also can anyone explain the genetic inheritance problem with the P450 homozygous alleles. I know the answer is 25%

 

[Doct2be]

Some tough ones I haven't been able to figure out.

70 year old man is admitted to the hospital for recent loss of mental function. He has low sodium and Chloride, anemia.
A) adrenal carcinoma
B) chronic interstitial nephritis
C) diabetes (NOPE)
D) pneumococal meningitis
E) pulmonary neoplasm (this is a classic case of small cell carcinoma, which can be of ACTH, ADH, Lambert-Eaton Syndrome, Amplification of MYC, and Cerebellar ataxia due to autoimmune attack of the cerebellum)

40 year old man with skin blisters due to increased synthesis of compounds in the skin that are subject to excitation by visible light.
A) bile acid synthesis
B) bilirubin degradation
C) heme synthesis (this is a classic case of acute intermittent porphyria)
D) melanin (NOPE)
E) riboflavin metabolism

56 year old man with proximal appendicular muscle flailing on the left.
A) L caudate
B) L dentate
C) left subthalamin (NOPE)
D) R caudate
E) Right dentate
F) right subthalamic (this condition is hemiballismus; the lesion is localized on the contralateral subthalamic nuclei)

42 year old woman with 1 month history of abdominal pain after eating fatty meals. jaundice, RUQ tenderness. Which liver functions will increase?

A) cholesterol synthesis (this is an example of a "fat, female, forty for gallbladder disease=cholelithiasis)
B) conjugation of bili
C) deamination of AA (NOPE)
D) glycogen synth
E) secretion of angiotensinogen

16 year old boy with no sign of puberty. What do you measure to determin whether decreased serum T is due to lack of pituitary hormone stimulus?
A) ACTH
B) E
C)FSH
D)inhibin
E)LH (Since you have a decreased serum testosterone, there must be a problem with his Leydig cells which are not producing testosterone due to the inability of LH to stimulate it)

also can anyone explain the genetic inheritance problem with the P450 homozygous alleles. I know the answer is 25%

All of the answers are in bold. These are 100% verified because I got them correct on my exam.

 

[gr123]

Ankylosing spondylitis. Next step is X ray look for "bamboo spine"

Recanalization -> reperfusion injury via ROS -> membrane lipid peroxidation --> spill **** out of cell


Dude forget about NBME 17. My score dropped like 14 points I was hitting above 250 consistently. I am just counting this one as a fluke.. you should too! It is makes me feel MUCH better

Thank you, Celtikman I needed the positive attitude!

 

[jayay]

Makes sense thanks!

Is anyone else willing to share the # of incorrect with their score? This is an anonymous forum

I got 53% incorrect - 390 (205 scaled score)

 

[gr123]

I got 43 wrong, 450 or 217 score.

 

[ntgc91]

80 yo man, 2 month history of severe constipation. over the counter laxatives has not relieved his symptons.
abdominal examination shows distention. colonoscopy shows no abnormalities. the patient most likely has a disfunction of:
hypogastric
inferior rectal
pelvic splanchnic
perineal
sacral sympathethic



thanks in advance!

 

[stayingalive]

Please help with this Q:

58 y.o F brought to the ED because of 2 hours of SOB and chest pain that radiates to her back b/w the shoulder blades. RR 28/min. P.E. diaphoresis. An ECG is normal. Coronary angiography shows occlusion of the marginal branch of the LAD. Cath is done and a stent is placed. After the stend, her serum concentrations of myocardial creatine kinase (CK-MB) and troponin I are increased.Which of the following mechanisms best explain these laboratory findings?

A) Cell shrinkage
B) Formation of apoptotic bodies
C) Liquefactive necrosis of the myocardium
D) Membrane lipid peroxidation
E) Protease inactiviation by cytoplasmic free calcium ions

I assumed that the rise in cardiac enzymes was due to myocyte death and apoptosis (B) but that is not correct. Is it asking about reperfusion injury (D)?

 

[AnilaMed]

Informed consent question. Surgeon gives patient info about risk and benefits, tells patient he has done 100 of these. He tells patient he needs to pay for some of the cost of hospitalization. Patient says they understand, he wants the operation, and his family is available to discuss the procedure later in the day. What combination fulfills criteria for fully informed consent?
family agreement, competence, cost
family agreement, cost, reliability
information, competence, voluntariness
information, validity, cost
validity, voluntariness, reliability

Thanks

 

[stayingalive]

Informed consent question. Surgeon gives patient info about risk and benefits, tells patient he has done 100 of these. He tells patient he needs to pay for some of the cost of hospitalization. Patient says they understand, he wants the operation, and his family is available to discuss the procedure later in the day. What combination fulfills criteria for fully informed consent?
family agreement, competence, cost
family agreement, cost, reliability
information, competence, voluntariness
information, validity, cost
validity, voluntariness, reliability

Thanks

Informed consent has nothing to do with cost. That removes three answer choices. The fact that you gave the patient the information about the procedure (indications, risks, complications, etc), the patient understands what you told him (competence), and that they are voluntarily submitting to the procedure means that you have given "informed consent". Family agreement is not relevant as long as the patient is able to make the decision for himself. Validity and reliability are important factors as to whether the procedure should be done in the first place but are not part of the informed consent process.

 

[njmupeter]

Please help with these two questions

1. A previously healthy 72 year old man is brought to the physician because of weakness and fatigue. His hemoglobin concentration is 9.2 g/dL, leukocyte count is 5400/mm3, and platelet count is 350,000/mm3. A peripheral blood smear is shown (many small RBCs with various shape andd big central palor, one WBC and its size is bigger than the RBC shown). Which of the following is the most likely cause of these findings?
A, aplastic anemia
B, chronic myelogenous leukemia
C, gastrointestinal blood loss
D, beta-thalassemia major (wrong)
E, Vit B12 deficiency

2. A previously healthy 48 year old nulligravid woman comes to the physician because of excessive uterine bleeding for 3 months. She says the bleeding occurs during her menses and at irregular intervals. Menses had occure at regular 28 to 38 day intervals. She is 165 cm tall and weighs 72 kg, BMI 27. During pelvic exam, the adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which of the following is the most likely cause of this patient's symptoms?
A, adenomyosis
B, endometrial hyperplasia
C, endometrial metaplasia (wrong)
D, endometriosis
E, endometritis

Thanks

 

[stayingalive]

Please help with these two questions

1. A previously healthy 72 year old man is brought to the physician because of weakness and fatigue. His hemoglobin concentration is 9.2 g/dL, leukocyte count is 5400/mm3, and platelet count is 350,000/mm3. A peripheral blood smear is shown (many small RBCs with various shape andd big central palor, one WBC and its size is bigger than the RBC shown). Which of the following is the most likely cause of these findings?
A, aplastic anemia
B, chronic myelogenous leukemia
C, gastrointestinal blood loss
D, beta-thalassemia major (wrong)
E, Vit B12 deficiency

2. A previously healthy 48 year old nulligravid woman comes to the physician because of excessive uterine bleeding for 3 months. She says the bleeding occurs during her menses and at irregular intervals. Menses had occure at regular 28 to 38 day intervals. She is 165 cm tall and weighs 72 kg, BMI 27. During pelvic exam, the adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which of the following is the most likely cause of this patient's symptoms?
A, adenomyosis
B, endometrial hyperplasia
C, endometrial metaplasia (wrong)
D, endometriosis
E, endometritis

Thanks

1. C, very common cause of anemia is older person is GI blood loss. Different sizes of RBCs would give a wide red cell distribution width (RDW) which implies blood loss. The other answers do not make sense with the rest of the question stem. (A) would have pancytopenia, (B) would likely have a higher WBC and smear would have leukemia-looking cells, (D) would be severe microcytic anemia and would not be presenting now at age 72, and (E) no history to correlate with B12 deficiency/ no megaloblastic cells.

2. D, endometriosis always comes to mind in a "nulligravid" middle aged woman who has heavy bleeding that occurs at menses and irregular intervals. The endometrial overgrowth (B and C) are distractors that are not related to irregular menses. Endometritis (E) is usually related to infection and there is no mention of that in the stem. Adenomyosis (A) would not show endometrial "abundant tissue" because they occur in the myometrium (although this would be on the differential of a woman with heavy menses and pain).

Hope that helps.

 

[AnilaMed]

_ a 74 year old man comes to the ED because of a 2 day history of ringing in his ears, nausea, and fatigue. His temperature is 98.6 F, pulse 100/min, respirations 24/min, and bp 140/85 mmHg. Has mild epigastric tenderness. Arterial gas pH: 7.42 pCo2 : 30 mmhg, pO2: 95 mmHg, HCO3-: 19 mEq/L. Cause of patients condition?
Intracardial shunt, obstructive sleep apnea, pulmonary embolism, salicylate poisoning, severe kyphosis

- A previously healthy 35 year old man becomes increasingly depressed, impulsive, and difficult over the past year. he grimaces intermittently and has rigid, jerking, purposeless movements of the fingers. Which of the following historical factors is most relevant?
dietary deficiency, exposure to envt toxins, family history of similar illness, pet with unexplained illness, tick bite, travel to a foreign country

-28 year old female comes to physician for advice to lose weight. She says she binges on high carb food two to three times a week and usually forces herself to vomit after a binge. She is 5ft 6in, 140 lbs, bmi 23. What additional findings is most likely?
bradycardia, decreased virbatory sense at the ankles, partoild gland enlargement, sluggish deep tendon reflexes, sparse axillary and pubic hair

 

[njmupeter]

1. C, very common cause of anemia is older person is GI blood loss. Different sizes of RBCs would give a wide red cell distribution width (RDW) which implies blood loss. The other answers do not make sense with the rest of the question stem. (A) would have pancytopenia, (B) would likely have a higher WBC and smear would have leukemia-looking cells, (D) would be severe microcytic anemia and would not be presenting now at age 72, and (E) no history to correlate with B12 deficiency/ no megaloblastic cells.

2. D, endometriosis always comes to mind in a "nulligravid" middle aged woman who has heavy bleeding that occurs at menses and irregular intervals. The endometrial overgrowth (B and C) are distractors that are not related to irregular menses. Endometritis (E) is usually related to infection and there is no mention of that in the stem. Adenomyosis (A) would not show endometrial "abundant tissue" because they occur in the myometrium (although this would be on the differential of a woman with heavy menses and pain).

Hope that helps.

Thanks! For question 2, I think the answer might be B. Endometriosis should localize outside of the endometrial cavity and with cyclic pain. She does not have pain at all.

 

[Dr.G1989]

_ a 74 year old man comes to the ED because of a 2 day history of ringing in his ears, nausea, and fatigue. His temperature is 98.6 F, pulse 100/min, respirations 24/min, and bp 140/85 mmHg. Has mild epigastric tenderness. Arterial gas pH: 7.42 pCo2 : 30 mmhg, pO2: 95 mmHg, HCO3-: 19 mEq/L. Cause of patients condition?
Intracardial shunt, obstructive sleep apnea, pulmonary embolism, salicylate poisoning, severe kyphosis

- A previously healthy 35 year old man becomes increasingly depressed, impulsive, and difficult over the past year. he grimaces intermittently and has rigid, jerking, purposeless movements of the fingers. Which of the following historical factors is most relevant?
dietary deficiency, exposure to envt toxins, family history of similar illness, pet with unexplained illness, tick bite, travel to a foreign country

-28 year old female comes to physician for advice to lose weight. She says she binges on high carb food two to three times a week and usually forces herself to vomit after a binge. She is 5ft 6in, 140 lbs, bmi 23. What additional findings is most likely?
bradycardia, decreased virbatory sense at the ankles, partoild gland enlargement, sluggish deep tendon reflexes, sparse axillary and pubic hair

 

[stayingalive]

Thanks! For question 2, I think the answer might be B. Endometriosis should localize outside of the endometrial cavity and with cyclic pain. She does not have pain at all.

You know, now that I re-read the question, I think you're correct. The answer should be B for endometrial hyperplasia. That condition is associated with irregular menses unlike what I said before. I also thought the patient is having pain, which she is not. That makes B a better answer than D. Sorry to mislead.

 

[Lord_Vader]

I just took NBME 17 and got a 239. I didn't think the exam was hard per se but I felt like the questions were very vague (sometimes being only 2-3 sentences), much more so than the Uworld questions which are usually very detailed. Anyone else feel this way?

 

[dr.me19]

hey can anyone help me with these questions please ?
thanks



1. 12y/o boy swimming and immersed upto neck in 60*F water for 20 mins. physiologic changes likely to occur

central blood volume= up/down
serum ADH= up/down
ANP = up/down



2. RCT study of 2000 patients with insomnia, conducted to evaluate the efficacy of new medicine to treat the condition. subjects in treatment group are able to fall asleep on avg of 5 mins faster than subjects in control group. difference is stat. significant p=0.001. subjects in neither group report improvement in quality of life. investigators conclude new medication is efficacious for insomnia. which type of error

a. failure to distinguish btw statistical and clinical significance
b.failure to find clinically significant result due to attrition of subjects
c.failure to reject null hypothesis when its not true
d. rejecting null hypothesis when its true



3. new compound taken up by bacterial cells. No energy is necessary for uptake and compound is not concentrated in cell. mechanism of transport

a. ATP dep active transport
b. carrier mediated diffusion
c. group translocation
d. phosphorylation linked transport
e. proton gradient mediated transport



4. 30y/0 female training for marathon, running 20 miles/d. she says as long as she takes adequate calories, she feesl well on long distance runs of 20 miles. p/e normal. serum glucose 60 mg/dl. after her glucose stores have been depleted which organ in addition to liver is likely to release newly produced glucose in this pt.

a. adrenal gland
b. kidney
c. pancreas
d. stomach
e. thyroid gland



5. its a pic question. histo white background some dark blue purple fibers here and there .
54 y/o female had sudden loss of vision 1 week ago in lt eye. most of vision returned in 1 day. 3 month h/o progressive shortness of breath with exertion. mass in lt atrium.

a. angiosarcoma
b. fibroelastoma
c. fibrosarcoma
d. lipoma
e. myxoma
f. rhabdomyoma




6. 54 y/o female h/o htn and bilateral renal a stenosis, starts using nsaids for back pain. over next week her s.creatinine increases from 1.0 to 5.0mg/dl. most likely cause is drugs ability to inhibit


a. inflammation of glomerulus cap
b. inflammation in renal interstitum
c. vasoconstricting PGs at afferent arteriole
d. vasoconstricting PGs at efferent arteriole
e. vasodilating PGs at afferent arteriole
f. vasodilating PGs at efferent arteriole



7. 62 y/o male dies suddenly playing tennis. He had no cardiac risk factors and no history of CAD. at autopsy a cardiac valve defect and concentric lt vent hypertrophy. which of the valve abnormality is associated with sudden death

a. AI
b. AS
c. MI
d. MS
e. PI
f. PS




8. 30y/o man in ER 15 mins after he was found unconscious in a park . hes comatose. dilated pupils 4mm and not reactive to light. head ct shown. likely cause of coma is bleeding from

a. bridging vein
b.internal cerebral v
c. leticulostriate a
d. middle meningeal a
e sigmoid sinus
f. transverse sinus




9. newborn female delivered at 36 wks in resp distress. apgar score is 3 and 5 at 1 and 5 min. p/e show cyanosis. endotracheal and ng tube are placed. x-ray shows ng tube in lt hemithorax, displacement of mediastinum to rt, and absence of bowel gas in abdomen. this condition is most likely due to which embryologic event

a. failure of epimere to migrate
b. failure of hypomere to migrate
c. hypoplasia of lungs
d. incomplete formation of plueroperitoneal membrane
e. malrotation of bowel




10. 17y/o healthy girl in ER due to 1 day h/o SOB, weakness and muscle tenderness. she completed triathalon the previous day. she appears restless. she is 163 cm tall and weighs 110 lbs bmi is 19 kg/m2. temp is 110.4*F, resp 20/min , BP 150/90 mmhg. bilateral crackles in lower lung lobes. P/E show muscle tenderness . s. creatinine is 4 mg/dl. urinalysis show +3 protein and +4 hb. most likely cause of pt. condition is increased release of


a. aldolase
b. creatinine kinase
c. hemoglobin
d. myoglobin
e. troponin I





and plz if some one can explain the answer as well that would be great

 

[Dr.G1989]

hey can anyone help me with these questions please ?
thanks



1. 12y/o boy swimming and immersed upto neck in 60*F water for 20 mins. physiologic changes likely to occur

central blood volume= up/down
serum ADH= up/down
ANP = up/down

Look thru the discussion you'll find the explanation to this.

2. RCT study of 2000 patients with insomnia, conducted to evaluate the efficacy of new medicine to treat the condition. subjects in treatment group are able to fall asleep on avg of 5 mins faster than subjects in control group. difference is stat. significant p=0.001. subjects in neither group report improvement in quality of life. investigators conclude new medication is efficacious for insomnia. which type of error

a. failure to distinguish btw statistical and clinical significance
b.failure to find clinically significant result due to attrition of subjects
c.failure to reject null hypothesis when its not true
d. rejecting null hypothesis when its true



3. new compound taken up by bacterial cells. No energy is necessary for uptake and compound is not concentrated in cell. mechanism of transport

a. ATP dep active transport
b. carrier mediated diffusion
c. group translocation
d. phosphorylation linked transport
e. proton gradient mediated transport

Look thru the discussion you'll find the explanation to this.

4. 30y/0 female training for marathon, running 20 miles/d. she says as long as she takes adequate calories, she feesl well on long distance runs of 20 miles. p/e normal. serum glucose 60 mg/dl. after her glucose stores have been depleted which organ in addition to liver is likely to release newly produced glucose in this pt.

a. adrenal gland
b. kidney
c. pancreas
d. stomach
e. thyroid gland

Look thru the discussion you'll find the explanation to this. Check your first aid...biochem section. Liver, Kidney, and to a small extent the small intestine are involved in gluconeogenesis.

5. its a pic question. histo white background some dark blue purple fibers here and there .
54 y/o female had sudden loss of vision 1 week ago in lt eye. most of vision returned in 1 day. 3 month h/o progressive shortness of breath with exertion. mass in lt atrium.

a. angiosarcoma
b. fibroelastoma
c. fibrosarcoma
d. lipoma
e. myxoma
f. rhabdomyoma

Post the picture...but from what I remember it was myxoma. It's the most common tumor in the heart and esp the left atrium. Nothing to suggest Tuberous Scleros



6. 54 y/o female h/o htn and bilateral renal a stenosis, starts using nsaids for back pain. over next week her s.creatinine increases from 1.0 to 5.0mg/dl. most likely cause is drugs ability to inhibit


a. inflammation of glomerulus cap
b. inflammation in renal interstitum
c. vasoconstricting PGs at afferent arteriole
d. vasoconstricting PGs at efferent arteriole
e. vasodilating PGs at afferent arteriole
f. vasodilating PGs at efferent arteriole

First Aid .... like the first pages with physio. ALSO Look thru the discussion you'll find the explanation to this.

7. 62 y/o male dies suddenly playing tennis. He had no cardiac risk factors and no history of CAD. at autopsy a cardiac valve defect and concentric lt vent hypertrophy. which of the valve abnormality is associated with sudden death

a. AI
b. AS
c. MI
d. MS
e. PI
f. PS


Look up etiology of concentric left ventricular hypertrophy. And it's sudden cardiac death...and he's 62yrs old not 20's or 30's so not hypertrophic cardiomyopathy if thats why you were confused??? Which would be MR most likely.

8. 30y/o man in ER 15 mins after he was found unconscious in a park . hes comatose. dilated pupils 4mm and not reactive to light. head ct shown. likely cause of coma is bleeding from

a. bridging vein
b.internal cerebral v
c. leticulostriate a
d. middle meningeal a
e sigmoid sinus
f. transverse sinus

Again this is from what I remember. First Aid 2014 pg. 462. Or which ever edition you have look up intracranial hemorrhage....

9. newborn female delivered at 36 wks in resp distress. apgar score is 3 and 5 at 1 and 5 min. p/e show cyanosis. endotracheal and ng tube are placed. x-ray shows ng tube in lt hemithorax, displacement of mediastinum to rt, and absence of bowel gas in abdomen. this condition is most likely due to which embryologic event

a. failure of epimere to migrate
b. failure of hypomere to migrate
c. hypoplasia of lungs
d. incomplete formation of plueroperitoneal membrane
e. malrotation of bowel

Look thru the discussion you'll find the explanation to this. And its in first aid. Look up congenital diaphragmatic hernia



10. 17y/o healthy girl in ER due to 1 day h/o SOB, weakness and muscle tenderness. she completed triathalon the previous day. she appears restless. she is 163 cm tall and weighs 110 lbs bmi is 19 kg/m2. temp is 110.4*F, resp 20/min , BP 150/90 mmhg. bilateral crackles in lower lung lobes. P/E show muscle tenderness . s. creatinine is 4 mg/dl. urinalysis show +3 protein and +4 hb. most likely cause of pt. condition is increased release of


a. aldolase
b. creatinine kinase
c. hemoglobin
d. myoglobin
e. troponin I

Rhabdomyolysis leading to renal failure.



and plz if some one can explain the answer as well that would be great

I've answered in bold above...
But for future reference...
It would be great if you please look thru the thread before posting your questions.
Because of these redundancies people stop checking the threads and replying to peoples GENUINE questions.
Thanks

 

[dr.me19]

I've answered in bold above...
But for future reference...
It would be great if you please look thru the thread before posting your questions.
Because of these redundancies people stop checking the threads and replying to peoples GENUINE questions.
Thanks

Thanks a lot.
I know i posted some questions that have already been discussed here and i did look at the forum before posting these but some of the answers in this forum are wrong and i know bcoz i just did nbme so i was trying to make sure to get second opinion and maybe get right answers from some one who is sure

anyways thanks for help
sorry for all the trouble

 

[dr.me19]

for the woman with metastatic breast tumor i think the answer should be cerbellum.
if we read it carefully it says

59y/o female comes in with gradual onset of lack of muscle control in here left arm and legs. symptoms began 1 month ago after being diagnosed with breast cancer that has metastasized. P/E shows ataxia of left upper and lower extremities. muscle strength , dtrs , proprioception, sensation , are NORMAL. pts condition is due to metastatic tumor in which of the locations on left ?
a. cerebellum
b. cerebrum
c. cervical spinal cord
d. lumbar spinal cord
e. thoracic spinal cord

 

[Lord_Vader]

can anyone please label this pic ???

A = Type I pneumocyte?
B = RBC in capillary
C = Alveolar capillary/sac basement membrane?
D = Type II pneumocyte (I got the question right and this was it).
E = Alveolar macrophage

 

[carnelian]

A = Type I pneumocyte?
B = RBC in capillary
C = Alveolar capillary/sac basement membrane?
D = Type II pneumocyte (I got the question right and this was it).
E = Alveolar macrophage

A is endothelial cell
C is type I pneumocyte

Rest are correct.

 

[carnelian]

Ok i looked again through discussion and i couldnt find any explanation for carrier mediated transport. Maybe I m blind or something can you please tell me which page is it on ??? thanks


and how did you figure out it was middle meningeal artery ??? it looked like the suture lines were crossed ???

It's a biconvex lesion, suggesting it's epidural. If it were subdural (as you implied by saying suture lines were crossed), it'd be crescent shaped.

 

[dr.me19]

A is endothelial cell
C is type I pneumocyte

Rest are correct.

Thanks a lot

 

[dr.me19]

It's a biconvex lesion, suggesting it's epidural. If it were subdural (as you implied by saying suture lines were crossed), it'd be crescent shaped.

Thank you

 

[Dr.G1989]

Ok i looked again through discussion and i couldnt find any explanation for carrier mediated transport. Maybe I m blind or something can you please tell me which page is it on ??? thanks

Sorry I was wrong about one of them....A very constructive response though...good way to ask for help. You're rude but at least you're not blind. Congratulations!

and how did you figure out it was middle meningeal artery ??? it looked like the suture lines were crossed ???

First aid has a very similar picture...Epidural Hematoma= Bleeding from middle meningeal artert

 

[dr.me19]

First aid has a very similar picture...Epidural Hematoma= Bleeding from middle meningeal artert

thanks