NBME 17 discussion

[fatwalletuab]

Can you guys correct me on this
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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)
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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)
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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
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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.
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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!
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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
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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?!
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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
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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??
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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.
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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

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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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[mmmcdowe]

Reminder: Discussion of NBME questions is permitted but 1) Do not write out the question and answer wrote and 2) Do not photograph NBME content and upload it to the site.

 

[dr.me19]

Can someone please explain the changes in lung function in a healthy 70 y/o female ?
why does the arterial PO2 goes down and why does the A-a dif increases ???
thanks

 

[SDmedman]

I picked G. Its not in my incorrects.

I picked H and it was wrong

 

[Lord_Vader]

Can someone explain why the CBSSA <-> 3 digit score correlation is different between each exam? For example, for this form a 550 corresponds to a 239 but then for another form a 550 is 234. Which one should you use to predict your actual Step 1 score?

 

[Member1991]

Hi ,

Anyone know this one?

Previously healthy 17 YO brought to ED due to 1 day history of SOB, weakness, muscle tenderness. Completed a triathalon the previous day. She is 163 cm tall and weighs 50 kg. BMI is 19 kg/m2. RR 20/min, BP 150/90 mmHg, bilateral crackle heard on auscultation. Muscle tenderness is present, serum creatinine is 4 mg/dl. Urinalysis shows 3+ protein and 4+ hemoglobin. Cause of patient's condition

• Aldolase
• Creatinine kinase
• Hemoglobin
• Myoglobin
• Troponin I

Thanks!

 

[Lord_Vader]

Hi ,

Anyone know this one?

Previously healthy 17 YO brought to ED due to 1 day history of SOB, weakness, muscle tenderness. Completed a triathalon the previous day. She is 163 cm tall and weighs 50 kg. BMI is 19 kg/m2. RR 20/min, BP 150/90 mmHg, bilateral crackle heard on auscultation. Muscle tenderness is present, serum creatinine is 4 mg/dl. Urinalysis shows 3+ protein and 4+ hemoglobin. Cause of patient's condition

• Aldolase
• Creatinine kinase
• Hemoglobin
• Myoglobin
• Troponin I

Thanks!

It's Myoglobin. She had rhadbomyolysis due to the marathon and that causes release of myoglobin. This is what damages the kidney.

 

[Member1991]

Thanks

 

[Member1991]

For the Q about Crohn disease and prednisone MOA, does it suppress mast cell degranulation or antibody binding? Someone had asked the question, but no one answered it. I chose neutrophil fxn, and it was wrong. T-lymp. function is incorrect also.

 

[Dr.G1989]

For the Q about Crohn disease and prednisone MOA, does it suppress mast cell degranulation or antibody binding? Someone had asked the question, but no one answered it. I chose neutrophil fxn, and it was wrong. T-lymp. function is incorrect also.

Hey I don't remember the question but I'm pretty sure it was T cell function.

 

[Member1991]

Hi Dr. AG1989,

Thanks for the reply. However, (supposedly) the T cell answer was wrong according to others on the forum.

 

[Dr.G1989]

Hi Dr. AG1989,

Thanks for the reply. However, (supposedly) the T cell answer was wrong according to others on the forum.

For this question posted on the first page of this forum...

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 (Correct Answer...Not in my incorrects)

 

[Member1991]

Cool. My bad. Thanks again.

 

[cage92]

hey for the question about inpatient hospice can anyone explain why choice c is right why we break the rule here?

 

[Lord_Vader]

hey for the question about inpatient hospice can anyone explain why choice c is right why we break the rule here?

Idk why but it seemed like the right thing to do.

 

[ziva26]

pls help solve: section 2(49) Man with pulmonary interstitial fibrosis has a greater maximal expiratory flow rate than predicted. which of the following explains this?a)hypercapnic bronchodilation b)hyperinflation of lungs c)hypoxic bronchodilation d)increased radial traction e)increased surfactant production

 

[ziva26]

it is right to break the rule for the hospice patient because she has less than 6months to live and has no other family. not allowing her friend in will cause more pain n suffering which is what u are trying to prevent..thats my reasoning.

 

[Lord_Vader]

pls help solve: section 2(49) Man with pulmonary interstitial fibrosis has a greater maximal expiratory flow rate than predicted. which of the following explains this?a)hypercapnic bronchodilation b)hyperinflation of lungs c)hypoxic bronchodilation d)increased radial traction e)increased surfactant production

Increased radial traction. This was almost verbatim from a Uworld question.

 

[ziva26]

as to what causes full resolution after pneumonia,i chose metaplasia of mesenchymal cells ans got it wrong.sorry. maybe the answer is maintenace of structural integrity of the BM??

 

[ziva26]

Anyone know this one?

18. A 45-year-old man comes to the physician because of yellow skin for 4 days. He lost his job 10 days ago, and he has been drinking eight to ten 12-ounce cans of beer daily since then. Physical exam shows jaundice. The liver is tender to palpation. Serum studies show:
Total bilirubin 5.9
Alk phos 210
AST 110
ALT 69
y-Glutamyltransferase 35 (N=0-30)
Histologic examination of a liver biopsy specimen will most likely show which of the following?
A) alpha1-antitrypsin globules
B) Glycogen
C) Hemosiderin
D) Lipofuscin
E) Mallory hyaline

THE ANSWER IS E.

 

[ziva26]

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.

ITS 'E'

 

[Dr.G1989]

as to what causes full resolution after pneumonia,i chose metaplasia of mesenchymal cells ans got it wrong.sorry. maybe the answer is maintenace of structural integrity of the BM??

Yeah. It's a weird question.

 

[swagkilla]

Maybe I just don't know anything, but can someone help me out with this question?

In a nuclear transplantation experiment, mouse embryos are produced with two pronuclei, of the same parental origin. When both pronuclei are from the mom, the products of conception have poorly developed extraembryonic structures. When the two pronuclei are from the dad, then the products of conception have poorly developed embryonic tissue. What is the most compatible genetic mechanism?

A. Anticipation
B. Expansion of trinucleotides
C. Imprinting
D. Loss of Heterozygosity
E.Pleiotropy

Thanks for the help!

 

[bensmith91]

Maybe I just don't know anything, but can someone help me out with this question?

In a nuclear transplantation experiment, mouse embryos are produced with two pronuclei, of the same parental origin. When both pronuclei are from the mom, the products of conception have poorly developed extraembryonic structures. When the two pronuclei are from the dad, then the products of conception have poorly developed embryonic tissue. What is the most compatible genetic mechanism?

A. Anticipation
B. Expansion of trinucleotides
C. Imprinting
D. Loss of Heterozygosity
E.Pleiotropy

Thanks for the help!

I got this one right, it's imprinting. In the two maternal/paternal pronuclei, both copies of maternally/paternally imprinted genes are inactivated, so you have no functional copies of the genes. This leads to improper development as described.

 

[LaCroix09]

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!

carries parasympathetics

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)?

leakage of enzymes requires patency of the cell membrane

 

[scoKraz4]

as to what causes full resolution after pneumonia,i chose metaplasia of mesenchymal cells ans got it wrong.sorry. maybe the answer is maintenace of structural integrity of the BM??

Full resolution in any tissue requires intact BM. The metaplasia of mesenchymal cells was a distractor because they know people are aware that Type 2 pneumos replicate to replace Type 1 pneumos...but they aren't mesenchymal cells.

 

[Grrath]

What about the one that asks about a drug's effect on itraconazole? None of them have anything to do with CYP-450

 

[blueshockey]

What about the one that asks about a drug's effect on itraconazole? None of them have anything to do with CYP-450

It was Omeprazole. None of the other drugs have anything to do with CYP450 (neither dose omeprazole for that matter) but Omeprazole can mess with the absorption of some drugs (i.e. alters with the stomach pH)

 

[Grrath]

Dang. I didn't even know that was a thing. A lot of the questions I got wrong were pretty much in the same vein.

 

[LaCroix09]

Dang. I didn't even know that was a thing. A lot of the questions I got wrong were pretty much in the same vein.

Which vein?

 

[byaaaaaaah23]

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[Radiolucent]

--MOA of cyclosporine:

a) Blocking recognition of antigens
b) forming 6-thiouric acid and blocking metabolism of nucleic acids
c) increased production of interleukin by T cells
d) suppressing the activation and production of B cells (incorrect)
e) suppressing the early response of T cells to activation (I'm assuming this must be correct but I thought this was how sirolimus works?)

--Patient that should be on insulin but thinks it will make him sick bc of family experience. Is this contemplation?

--The skin cancer slide, can anyone explain why it's actinic keratosis? Is it because there is no invasion of the basement membrane? Why isn't it keratoacanthoma?

--Splenectomized patient is most susceptible to infection with which organism?

a) Candida
b) CMV
c) E coli
d) HSV
e) Strep pneumo

I was debating between S pneumo and E coli and went with E coli, can anyone explain why E coli is wrong?

e) suppressing the early response of T cells to activation Correct
Calcineurin inhibitors and sirolimus MOA is to decrease IL-2 production/action. IL-2 --> stimulates T-cells. No Il-2 --> no T-cell stimulatuion.

Yes, its contemplation. Contemplation - "acknowledging that there is a problem, but not yet ready or willing to make a change." From FA.

I picked actinic keratosis based on presentation and elimination: Scaly lesion= actinic keratosis or SCC most often. Didnt look like melanoma och BSC on histo. Keratoacanthoma has central keratinisation from what i remember. Google some pics and you will see the difference.

I picked Pneumococci on the last q. Splenectomy predisposes to infection by encapsulated organisms. Both E. Coli and Pneumococci are encapsulated but my reasoning was that infection by the latter is more common and therefore even more common in a person post splenectomy. Does that make sense?

 

[byaaaaaaah23]

@Radiolucent Thanks a lot, really helpful. Do you think there's a difference in how they would describe CN inhibitors vs sirolimus MOA?

For anyone else wondering about the AK vs KA question, KA tends to grow/regress rapidly and this was lacking from the history. Additionally, KA presents as a nodule and the question said it was a scaly patch/plaque.

 

[Radiolucent]

@Radiolucent Thanks a lot, really helpful. Do you think there's a difference in how they would describe CN inhibitors vs sirolimus MOA?

For anyone else wondering about the AK vs KA question, KA tends to grow/regress rapidly and this was lacking from the history. Additionally, KA presents as a nodule and the question said it was a scaly patch/plaque.

I dont know if this will help or if you already know this but here goes:

Calcineurin inhibitors generally bind to a protein (calciphilin - cyclosporin, FKBP - tacrolimus) and together they inhibit IL-2 transcription. Sirolimus also binds to FKBP but instead block the IL-2 transduction in mTOR pathway. Their side effect profile is different as well; CN inh are nephrotoxic whereas siorlimus has bone marrow supression. I think FA has all this described really well and I would recommend to study the picture associated with them for better understanding if you havent already.

 

[byaaaaaaah23]

***

 

[Radiolucent]

Unless IL-2 production by the T cell is the early response to activation that the answer choice is describing. In that case, the activation = binding of antigen by CD4 + TCR and "early" response to activation = IL-2 production? Then the "late" response to activation would be the mTOR pathway activated by IL-2 receptor in that same T cell. Does this sound more accurate?

I understand now what you mean and I think what you wrote is correct: early activation of T-cells through APCs --> IL-2 production in those T-cells --> activation of other T-Cells through binding of IL-2.

So I assumed this answer choice was thrown in there as a trick to see if you really understand the difference between CSA/tacrolimus and sirolimus.

One thing that Ive learned after doing all the NBMEs (incl 1-7) is that they dont really try to trick you like UW for example. Generally if it looks like a duck ,quacks like a duck... Dont overthink your answer and if your tied between two pick the more straight forward one would be my advice. However, be vigilant when it comes to those "knee-jerk" questions because it is here that the NBME (and probably the USMLE) can lay some traps.

 

[byaaaaaaah23]

***

 

[benzonase]

--


--Splenectomized patient is most susceptible to infection with which organism?

a) Candida
b) CMV
c) E coli
d) HSV
e) Strep pneumo

I was debating between S pneumo and E coli and went with E coli, can anyone explain why E coli is wrong?

Any time I see a question regarding spleen and bacteria I default to SHiN (ignoring the rest of the mnenomic) Has worked out majority of times.

 

[BabyDoc86]

I've been scoring in the 230-240 range on all practice tests (UWSA's and NBME's).... until I took this one today and totally tanked it even though it felt easy. Exam is on Friday and now I'm freaking out. I hope the USMLE gods are kind to me on Friday...

 

[byaaaaaaah23]

I've been scoring in the 230-240 range on all practice tests (UWSA's and NBME's).... until I took this one today and totally tanked it even though it felt easy. Exam is on Friday and now I'm freaking out. I hope the USMLE gods are kind to me on Friday...

I def thought this one was the hardest of all the NBMEs. Just make sure you review the topics you got wrong then take some time off right before your test so you're well rested and relaxed!

 

[Chargers09]

193/200 was a 269

 

[CodeRedDew]

Can someone please explain the changes in lung function in a healthy 70 y/o female ?
why does the arterial PO2 goes down and why does the A-a dif increases ???
thanks

Can't remember the exact question, but lung compliance goes up as you age. ↑ lung compliance → more air trapping and ↓ PO2 (due to ↑ PCO2). Not exactly sure why the A-a difference increases though? Anyone care to shed some light as to why?

Also, I haven't seen an answer to the question regarding the man who got lightheaded after he ran a 12 miles in a marathon. Only vitals given were tachycardia and hypotension ─ question asked what changes occurred in his ANS? If this has already been answered, forgive me, but I didn't see it within this thread.

Sympathetic efferent activity: ↑, ↓, or no change
Parasympathetic efferent activity: ↑ or ↓

I'm thinking it was ↑ sympathetic activity and ↓ parasympathetic? I think I may have overthought this one...

 

[dfib slim]

Can't remember the exact question, but lung compliance goes up as you age. ↑ lung compliance → more air trapping and ↓ PO2 (due to ↑ PCO2). Not exactly sure why the A-a difference increases though? Anyone care to shed some light as to why?

Also, I haven't seen an answer to the question regarding the man who got lightheaded after he ran a 12 miles in a marathon. Only vitals given were tachycardia and hypotension ─ question asked what changes occurred in his ANS? If this has already been answered, forgive me, but I didn't see it within this thread.

Sympathetic efferent activity: ↑, ↓, or no change
Parasympathetic efferent activity: ↑ or ↓

I'm thinking it was ↑ sympathetic activity and ↓ parasympathetic? I think I may have overthought this one...

This is correct.

 

[CodeRedDew]

This is correct.

Cool! Thanks -- one more thing, for the one about the 10-year-old girl and her mother wanting to know when her daughter hits puberty. Why was breast bud development a better answer than development of pubic hair? Question specifically stated: "first objective sign of puberty will be the following?" -- is breast bud development an objective sign, please enlighten me as I've never seen breast actually develop before lol

 

[dfib slim]

Cool! Thanks -- one more thing, for the one about the 10-year-old girl and her mother wanting to know when her daughter hits puberty. Why was breast bud development a better answer than development of pubic hair? Question specifically stated: "first objective sign of puberty will be the following?" -- is breast bud development an objective sign, please enlighten me as I've never seen breast actually develop before lol

I remembered from class that thelarche usually occurs at the beginning of puberty in females followed by pubarche. Just one of those things I happened to recall.

 

[Pateln381]

Hey guys. Quick Q.

A 43 year old woman comes the doc for a routine exam. The physician is 30 minutes late. What statement by the physician is most appropriate?

A) I apologize for being behind schedule, but this won't take long.
B) I apologize for being late. Why don't we reschedule for another time?
C) I apologize for running behind. They made my schedule really tight today.
D) I'm sorry I got delayed. I hope I haven't made you late somewhere else.
E) I'm sorry I got tied up. The emergency room always seems to call me for their most difficult cases.

I chose C, and it's wrong.

Thanks in advance!

 

[dfib slim]

Hey guys. Quick Q.

A 43 year old woman comes the doc for a routine exam. The physician is 30 minutes late. What statement by the physician is most appropriate?

A) I apologize for being behind schedule, but this won't take long.
B) I apologize for being late. Why don't we reschedule for another time?
C) I apologize for running behind. They made my schedule really tight today.
D) I'm sorry I got delayed. I hope I haven't made you late somewhere else.
E) I'm sorry I got tied up. The emergency room always seems to call me for their most difficult cases.

I chose C, and it's wrong.

Thanks in advance!

I put D and got it right. Apologize and don't make excuses.

 

[Pateln381]

I put D and got it right. Apologize and don't make excuses.

Thanks!

 

[cs24]

Hey guys. Quick Q.

A 43 year old woman comes the doc for a routine exam. The physician is 30 minutes late. What statement by the physician is most appropriate?

A) I apologize for being behind schedule, but this won't take long.
B) I apologize for being late. Why don't we reschedule for another time?
C) I apologize for running behind. They made my schedule really tight today.
D) I'm sorry I got delayed. I hope I haven't made you late somewhere else.
E) I'm sorry I got tied up. The emergency room always seems to call me for their most difficult cases.

I chose C, and it's wrong.

Thanks in advance!

To add to @dfib slim
D emphasizes empathy with what the patient is concerned about, not what is wrong with your own schedule, etc. Common theme with these questions.

 

[Pateln381]

Again a quick Q.

A 6 year old boy who recently emigrated from Russia is brought to the physician by his parents b/c of unstable gait and incoordination for 2 weeks. He has had frequent pale, bulk stools for 4 years and two episodes of bacterial pneumonia and chronic cough since the age of 1 year. He is below 3rd %ile for height and weight. Increased rhonchi are heard over both lungs. Neuro exam shows ataxia, absence of DTR, loss of propioception. Stool analysis shows increased fat concentration. Which of the following vitamin is deficient?

A) Biotin
B) Niacin
C) Vitamin C
D) Vitamin D
E) Vitamin E

Is the answer Vitamin E?

 

[byaaaaaaah23]

**